過動兒父母訓練團體之成效研究：執行功能之分析

注意力缺失過動疾患 (Attention-Deficit / Hyperactivity Disorder，簡稱ADHD)是一種高發生率的兒童疾患，在臨床上也十分常見。目前有關ADHD的相關研究很多，較著名的有Barkley所提出的父母管教訓練 (Parent Management Training) 方案及執行功能混和模式 (A Hybrid Model of Executive Function) ，此外，在治療的模式方面，還有Rapport, Chung, Shore, & Isaacs (2001) 所提出的ADHD概念模式 (A Conceptual Model of ADHD)。本研究將以此三個概念為主，進行治療成效的評估。本研究目的為：(1) 持續探討學齡前ADHD父母管教訓練方案的成效(2) 結合Barkley所提出「父母管教訓練方案」及「執行功能混和模式」之概念，來探討治療效果之內涵及意義。研究對象為18位學齡前ADHD兒童，由其父母親參與團體，再於家中進行相關的執行功能技巧能力訓練，團體共有十一次課程，每週進行一次；並利用干擾性行為量表家長版/教師版、兒童注意力問題量表、家庭情境問卷/學校情境問卷來監控團體介入期間的治療效果。研究發現，在透過父母管教訓練方案對執行功能技巧能力進行訓練之後，的確可以降低學齡前ADHD兒童的症狀行為，改善注意力問題、過動衝動問題，以及對立反抗行為，此外，也能夠降低因症狀行為所衍生的相關問題，如：照顧者的困擾程度等等；另一方面，本研究同時發現其具有「成效性」及「情境性」，即：技巧能力訓練必須不斷的進行，才能獲得顯著的治療效果；而針對家庭情境進行處理時，治療效果僅能展現於家庭情境下的不適應行為，若想要向外延伸到學校情境，除了需要針對該情境進行相關能力訓練之外，仍然需要家長針對家庭情境所需的能力持續進行訓練，才能夠將家中的良好行為延伸至學校情境之中。

關鍵字

父母管教訓練；執行功能；過動兒

並列摘要

Attention Deficit / Hyperactivity Disorder (ADHD) is a commonly found children’s metal disorder. There are a number of current studies on ADHD, some of the more famous were from Barkley (1997), who addressed the Parent Management Training (PMT) program and the Hybrid Model of Executive Function. In addition, Rapport, Chung, Shore, and Isaacs (2001) developed A Conceptual Model of ADHD which was relevant. This study is based on these three models and evaluates the results when used in a clinical environment. The methods used for this study were: 1) The PMT program was used on preschoolers with ADHD and evaluated the results. 2) Barkley’s PMT program and the Hybrid Model of Executive Function were combined to further evaluate the results. There were a total of 18 participants of pre-school age with ADHD along with their parents who participated in group therapy. While at home, the parents would continue to use the Executive Skills with their children. There were 11 group sessions held once a week. The following tools were used to track the participants’ progress and results: DBDRS-PF / TF, CAP and HSQ / SSQ. The study found that by using both the PMT program and the Hybrid Model of Executive Function the ADHD problem behavior of pre-school age children was reduced, attention span was improved and hyperactive and argumentative behavior was reduced. In addition, there were improvements in problems related to ADHD, including care-giver well being. This study showed that the combination of the methods was very effective and situational dependence, but the Hybrid Model of Executive Function should be continually applied to produce the best benefit. The study findings further indicate that although this method is very effective in a family environment when applied constantly, for other situations like in school, the method must be altered to fit those other situations and be performed continually in that environment in order to achieve the same results.