兒童職能治療動態認知評量於注意力缺陷過動症兒童之心理計量研究

目的：兒童動態職能治療認知評量(DOTCA-Ch)為應用於6-12歲兒童、以動態評量為導向的認知評估工具，此測驗共有22題、涵括五大認知領域：定向感、空間知覺、動作運用、視覺動作建構、和思考運轉。本研究目的為檢驗中文版DOTCA-Ch應用於注意力缺陷過動症 (ADHD) 兒童之心理計量特質。並探討ADHD兒童在DOTCA-Ch測驗之表現。方法：本研究對象為30位ADHD（平均年齡：106.9 ± 18.8個月）與45位正常發展兒童 (TD)（平均年齡：108.0 ± 21.4個月）。兩組在前測時均接受DOTCA-Ch測驗，ADHD組於前測時亦接受中文版學校日常生活功能量表 (SFA) 及注意力缺陷過動症中文版量表 (SNAP-IV) 評估。ADHD組會在前測兩週後接受DOTCA-Ch後測。本研究驗證ADHD兒童在DOTCA-Ch測驗之信度（內部一致性、再測信度、反應性與最小可偵測之變異量）及效度（同時效度、已知族群效度、聚斂效度與區辨效度）。同時也藉由ADHD兒童在DOTCA-Ch之表現探討其認知缺損。結果：（一）兩組差異：相較於正常發展組，ADHD在DOTCA-Ch測驗之「定向感」與「空間知覺」領域分數較低，顯示在此兩項領域有認知缺損。（二）信度：DOTCA-Ch具有尚可之內部一致性 (α = .63)。再測信度部分，除了「思考運轉」領域 (ICC = .19) 外，其它領域均有良好再測信度 (ICC: .56 - .88)。在反應性部分，ADHD兒童在DOTCA-Ch各領域之測量標準誤 (SEMs) 介於.51 – 1.17。DOTCA-Ch各領域最小可偵測之變異量 (MDD) 介於1.41至3.23。（三）效度：在同時效度方面，ADHD兒童僅在DOTCA-Ch「空間知覺」與「動作運用」領域分數與SFA「認知卅行為」向度分數相關 (r = .25, .07)。DOTCA-Ch測驗之「空間知覺」、「視覺動作建構」與「思考運轉」領域與SNAP-IV呈現中度相關，同時效度尚佳。DOTCA-Ch具有良好已知族群效度（區辨率：76.7%, p = .00），可被用來區辨ADHD與正常發展兒童。在聚斂效度方面，「定向感」與「動作運用」、「定向感」與「視覺動作建構」、「定向感」與「思考運轉」、及「動作運用」與「視覺動作建構」領域間呈中度相關 (r = .38 - .56)，具有中等以上之聚斂效度。結論：本研究結果顯示，DOTCA-Ch應用於ADHD時之心理計量特質尚可，以再測信度、同時效度、已知族群效度與聚斂效度較佳。部份反應性結果數值（例如：MDD）可用於解釋臨床介入之成效。

關鍵字

注意力缺陷過動症；兒童動態職能治療認知評量；認知；心理計量特質；動態評量

並列摘要

Purpose: Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA-Ch) provides a measure of cognitive assessment and learning potential for children ages 6-12 with special needs. It consists of 22 sub-tests in 5 cognitive areas: Orientation, Spatial Perception, Praxis, Visuomotor Construction and Thinking Operations. The purpose of the study was to examine the psychometric properties of DOTCA-Ch-Chinese Version in ADHD. This study investigated the cognitive profiles of children with ADHD by utilizing the DOTCA-Ch as well. Methods: Thirty children with ADHD (age = 106.9 ± 18.8 mo), and forty-five age-matched typical developing (TD) participants (age = 108.0 ± 21.4 mo) were recruited in this study. At pretest, both groups were assessed by DOTCA-Ch, and the ADHD group was also administered with both School Function Assessment (SFA) and Chinese Version of the Swanson, Nolan, and Pelham, Version IV Scale (SNAP-IV). The ADHD group was re-tested by DOTCA-Ch with a 2-week interval after the pre-test (post-test). The study examined the reliabilities (internal consistency, test-retest reliability, responsiveness and minimum detectable difference) and validities (concurrent validity, known-groups validity, convergent validity and discriminant validity) of DOTCA-Ch in ADHD children. We also discussed the possible cognitive deficits in ADHD by analyzing their performances on DOTCA-Ch. Results: (1) Between group differences: Comparing to the TD group, ADHD group had lower scores on the Orientation and Spatial Perception areas of the DOTCA-Ch. The results suggested their possible deficits in these two areas. (2) Reliabilities: The DOTCA-Ch has below-fair internal consistency (α = .63). All the five DOTCA-Ch areas have good test-retest reliabilities (ICC: .56 - .88) except for the Thinking Operation area (ICC = .19). For the responsiveness indices, the values of the standard error of measurement (SEMs) of the DOTCA-Ch areas range from .51 to 1.17. The minimal detectable difference (MDD) values of the areas range from 1.41 to 3.23. (3) Validities: Low correlations (r = .25, .07) were obtained between the scores of DOTCA-Ch Spatial Perception, Praxis areas and Cognitive/Behavioral Function of SFA respectively. The SNAP-IV moderately correlated with the Spatial Perception, Visuomotor Construction and Thinking Operation areas of DOTCA-Ch, and the results demonstrate moderate concurrent validities of the three DOTCA-Ch areas. The DOTCA-Ch could be used to discriminate ADHD and TD children due to its sound known-groups validity (discriminant rate = 76.7%, p = .00). Moderate correlations (r = .38 - .56) were obtained between the scores of Orientation and Praxis areas, Orientation and Visuomotor Construction areas, Orientation and Thinking Operation areas, Praxis and Visuomotor Construction areas of DOTCA-Ch. The correlations among DOTCA-Ch areas show moderate convergent validities. Conclusion: In conclusion, the DOTCA-Ch has moderate psychometric properties in ADHD children. The test has good test-retest reliability, concurrent validity, known-groups validity and convergent validity. Some responsiveness indices (e.g., MDD) could be used to interpret the real intervention effects.