「重度身心障礙者診斷性評估工具第二版(DASH-II)」應用在台灣重度智能障礙者之信效度研究

The Reliability and Validity of the Diagnostic Assessment for the Severely Handicapped Revised (DASH-II) with Adults with severe Intellectual Disabilities in Taiwan

鄭曉儀(Hsiao-Yi Cheng)

指導教授 ： 譚偉象

中原大學/理學院/心理學研究所/碩士(2011年)

https://doi.org/10.6840/CYCU.2011.00209

摘要

在過去的十幾年，西方國家開始逐漸注意到智能障礙者可能有精神健康的需求，他們一致的認為智能障礙者也有可能表現與一般人有相似情緒上的困擾，甚至智能障礙者比一般智力正常的人更脆弱的發展成精神疾病。然而，由於重度及極重度之智能障礙者因有限的語言表達能力，無法將個人的情感、想法和信念表達出來以方便醫療專業人員診斷。有鑑於此，國外學者發展許多用於篩選不同障礙程度之智能障礙可能有精神疾病問題的評估量表，用以協助相關專業人員提供進一步精神醫療服務之用。反觀，台灣目前服務智能障礙者的機構都開始面臨智能障礙者合併精神疾病的狀況，亟需一個評估工具協助篩選智能障礙是否合併精神疾病的可能性，再加上重度及極重度智能障礙者比較困難被發現有合併精神疾病的狀況，因此特別從國外眾多評量工具中挑選重度身心障礙者診斷性評估工具第二版（DASH-II）進行中文版的心理計量研究，期望未來可以在台灣使用，協助所有服務重度及極重度之智能障礙者的專業人員提供醫療服務之依據。
本研究採橫斷式（cross-section）研究，以非隨機取樣法中的立意取樣台灣苗栗以北的啟智教養機構之重度或極重度智能障礙者（N=100），晤談其主要照顧者進行DASH-II中譯本和成人發展性障礙精神症狀檢核表（PAS-ADD Checklist Revised），以內在一致性信度檢驗、皮爾森相關法及羅吉斯迴歸進行統計分析。
研究結果顯示DASH-II中譯本各分量表的內在一致性與原英文版本相似，α介於.473~.823之間，三個向度的評分者間信度幾乎完全吻合，Kappa值分別為.982(頻率)、.952（持續時間）及.983（嚴重程度）。而DASH-II中譯本具有良好的效標關聯效度，與同為用於篩選智能障礙者有無精神疾病問題的成人發展性障礙精神症狀檢核表各分量表間達顯著相關；另外，以羅吉斯迴歸分析DASH-II中譯本13個分量表，初步分析結果顯示13個分量表具有解釋和預測效果，以Hosmer-Lemeshow檢定分析，其整體迴歸模式適配性尚可，顯示DASH-II中譯本尚具建構效度。
整體而言，DASH-II中譯本的信效度尚可，可用於台灣的重度及極重度智能障礙者篩選有無潛在的精神疾病問題。不過，除了廣泛性發展障礙/自閉症分量表外，DASH-II中譯本其餘分量表仍缺乏單獨的效度檢驗，因此臨床工作者需要依據至少兩個分量表上的分數超過切截分數，才可以篩選其具有潛在的精神疾病。

關鍵字

效度 ； 信度 ； 成人發展性障礙精神症狀檢核表 ； 精神疾病 ； 對嚴重身心障礙的診斷性評估工具第二版 ； 極重度智能障礙 ； 重度智能障礙

並列摘要

In the last ten years, Western countries gradually noticed that people with intellectual disabilities have the needs of mental health. They were thought to have the same emotional disturbance of normal individuals. People with intellectual disabilities seem to be more vulnerable for developing psychiatric disorders. Since people with severe and profound intellectual disabilities have limited verbal communication, they cannot express their personal emotions, thoughts, and beliefs for clinicians to diagnose. Several assessment tools in foreign countries have been developed for screening possible psychiatric disorders in individuals with different levels of intellectual disabilities, and clinicians can use assessment tools to help those who are experiencing psychiatric disorders receive mental health services. However, in Taiwan, clinicians working with people with intellectual disabilities face the situation that those individuals may have comorbid psychiatric disorders. The clinicians need an assessment tool to assess psychopathology in people with intellectual disabilities. In addition, diagnosing mental illness in people with severe and profound intellectual disabilities can be difficult. Among the numerous assessment tools in foreign countries, this study selected the Diagnostic Assessment for the Severely Handicapped Revised (DASH-II) and evaluated its psychometric properties in Taiwan. We hope DASH-II can provide useful information to assist people with intellectual disabilities in receiving mental health services.
This was a cross-sectional study. The participants (N=100) were recruited purposefully by interviewing the caregivers of individuals with severe and profound intellectual disabilities in institutions located north of Miaoli. They were administered the Diagnostic Assessment for the Severely Handicapped Revised (DASH-II) and Psychiatric Assessment Schedule for Adults with Developmental Disabilities Checklist Revised (PAS-ADD Checklist Revised). The statistical methods of Cronbach’s alpha coefficient, Pearson correlation, and logistic regression were applied in this study.
The internal consistency of the DASH-II Chinese version subscales was similar to the original English version. Cronbach’s alphas ranged from .473 to .823. The interrater reliability of the three dimensions was almost perfect. The Kappa coefficients of the interrater reliability were .982 for frequency, .952 for duration, and .983 for severity rating. The DASH-II Chinese version had good criterion validity. Every subscale of the DASH-II Chinese version correlated moderately with each of the subscales of the PAS-ADD Checklist Revised Chinese version. Furthermore, the DASH-II Chinese version had good construct validity. The results of the Hosmer-Lemeshow test confirmed the regression model fit of the logical regression, which supported the explanatory and predictive abilities of the DASH-II Chinese version.
The results of this study showed that the DASH-II Chinese version appeared to have adequate reliability and validity. It can be used in Taiwan to screen people with severe and profound intellectual disabilities for latent psychiatric disorders. Except for the pervasive developmental disorders/autism subscale, the other subscales of the DASH-II Chinese version still lack specific validation. So clinicians using the DASH-II Chinese version to screen for latent psychiatric disorders in people with severe and profound intellectual disabilities were recommended to rely on having at least two subscales with scores above the cutoff scores.

並列關鍵字

profound intellectual disabilities ； psychiatric disorders ； DASH-II ； PAS-ADD Checklist Revised ； reliability ； validity. ； severe intellectual disabilities

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