ADHD兒童症狀嚴重度、睡眠困擾及其照顧者親職壓力、焦慮與憂鬱關係探討

The Relationship between Severity of Symptoms, Sleep Disturbances in Children with ADHD, and Parenting Stress, Anxiety, and Depression of Caregivers

翁承澤(CHENG-ZE WONG)

指導教授 ： 詹雅雯

中原大學/理學院/心理學系/碩士(2022年)

https://doi.org/10.6840/cycu202201129

摘要

研究背景與目的：注意力不足過動症（Attention Deficit Hyperactivity Disorder, ADHD）是兒童常見的精神疾病之一，其核心症狀主要為注意力缺陷及衝動／過動，上述症狀往往會給照顧者帶來較高的親職壓力，並影響照顧者的情緒狀況。除白天症狀外，兒童夜間的睡眠困擾亦會影響照顧者親職壓力、焦慮與憂鬱的重要因素，ADHD兒童中有近7成左右會經歷不同程度的睡眠困擾，可能因此更加劇了照顧者的親職壓力及情緒困擾。然，ADHD兒童症狀嚴重程度及睡眠困擾的關係是複雜的，因此本研究擬以ADHD兒童症狀嚴重程度及睡眠困擾探討其與照顧者親職壓力及情緒狀況間所扮演的角色。研究方法：本研究利用社群網路進行參與者招募，招收155位6～12歲學齡期ADHD兒童照顧者，以郵寄的方式將量表寄送至參與者家中，共回收85份資料，刪除無效資料及極端資料後，共76筆有效資料納入分析。評估使用問問卷包含親職壓力量表（Parenting Stress Index, Fourth Edition , PSI-4）、兒童睡眠習慣問卷（Children’s Sleep Habits Questionnaire, CSHQ）、兒童行為檢核表（Achenbach System of Empirically Based Assessment : Child Behavior Checklist For Ages 6-18, CBCL／6-18）、注意力缺陷過動症量表（Swanson, Nolan, and Pelham Rating Scale, SNAP-IV）、貝克焦慮量表（Beck Anxiety Inventory, BAI）及貝克憂鬱量表（Beck Depression Inventory-II, BDI-II）。研究結果：研究結果顯示，78.9%的ADHD兒童有顯著的睡眠困擾，ADHD兒童症狀嚴重程度能顯著預測ADHD兒童睡眠困擾及照顧者親職壓力，而ADHD兒童睡眠困擾亦可顯著預測ADHD兒童症狀嚴重程度與照顧者親職壓力，但ADHD兒童睡眠困擾與照顧者情緒狀況（BAI、BDI）無顯著關係。此外，在ADHD兒童症狀嚴重程度、睡眠困擾與照顧者親職壓力的關係中，ADHD兒童症狀嚴重程度能中介ADHD兒童睡眠困擾與照顧者親職壓力間的關係；但ADHD兒童症狀嚴重程度及ADHD兒童睡眠困擾皆對親職壓力無調節作用。討論：根據研究結果，ADHD兒童的症狀嚴重程度與睡眠困擾皆能預測照顧者親職壓力，且ADHD兒童的睡眠困擾會透過ADHD兒童症狀嚴重程度影響照顧者的親職壓力，過去亦有研究結果指出改善ADHD兒童的入睡困難對照顧者的親職壓力有顯著的幫助。此外，親職壓力與照顧者的親職功能是有所關聯的，因此改善ADHD兒童的睡眠困擾可能會對ADHD兒童的症狀嚴重程度與照顧者親職壓力是有益處的。綜上所述，在進行ADHD兒童的評估與介入時，將睡眠面向納入是重要的。
關鍵字：注意力不足過動症（ADHD）、學齡兒童、睡眠困擾、親職壓力

關鍵字

注意力不足過動症（ADHD） ； 學齡兒童 ； 睡眠困擾 ； 親職壓力

並列摘要

Background and purpose: Attention-deficit/hyperactivity disorder (ADHD) is a common mental disorder in children. The core symptoms, including attention deficits and impulsivity/hyperactivity, might cause high parenting stress and poor emotion of caregivers. In addition, children's sleep disturbances also lay caregivers at risk for higher parenting stress and poor emotion. However, up to 70% of children with ADHD suffer from problems with their sleep, which might amplify caregiver burden, anxiety and depression symptoms. However, the relationship between the severity of symptoms and sleep disturbances is complex. Therefore, the aim of this study intends to explore the relationship between the severity of symptoms, sleep disturbances, parenting stress, and mental health of caregivers in ADHD. Methods: A sample of 155 caregivers of 6-12 school-aged children with ADHD were recruited by social networks. The questionnaires were mailed to participants, and the remaining 85 completed the survey and mailed back in the end. After excluding invalid data and extreme data, 76 cases were included for final analysis. Participants were asked to complete following questionnaires: Parenting Stress Index, Child Behavior Checklist (CBCL), Swanson, Nolan, and Pelham Rating Scale(SNAP), Beck Anxiety Inventory, and Beck Depression Inventory-II. Results: There were 78.9% of children with ADHD suffered from sleep problems. Simple linear regression analyses showed the severity of ADHD symptoms could predict sleep problems in ADHD and parenting stress of ADHD caregivers. Also, sleep problems in ADHD could predict the severity of ADHD symptoms and parenting stress of ADHD caregivers. Furthermore, the severity of ADHD symptoms had mediated effects between sleep problems in ADHD and parenting stress of ADHD caregivers, but neither the severity of ADHD nor sleep problems in ADHD has moderated effect on parenting stress. Discussion: The results showed that the severity of ADHD symptoms and sleep problems in ADHD could predict parenting stress of caregivers in ADHD, and the sleep problems in ADHD could affect parenting stress of caregivers in ADHD through the severity of ADHD symptoms. Previous studies had demonstrated that improving sleep latency of ADHD has beneficial effects to reduce parenting stress of caregivers. Otherwise, parenting stress is related to parenting efficacy. According to this study, improving problems in ADHD might be beneficial in reducing the severity of ADHD symptoms and parenting stress of caregivers. As stated above, it is recommendations for the assessment and management of sleep disorders in ADHD.

Key Words: Attention-deficit/hyperactivity disorder(ADHD), school-age children, sleep disturbance, parenting stress.

並列關鍵字

Attention-deficit/hyperactivity disorder(ADHD) ； school-age children ； sleep disturbance ； parenting stress

參考文獻

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中文部分

車先蕙、盧孟良、陳錫中、張尚文、李宇宙（2006）。中文版貝克焦慮量表之信效度。台灣醫學，10(4)，447-454。https://doi.org/10.6320/FJM.2006.10(4).05

翁毓秀（2019）。親職壓力量表（第四版中文版）。心理出版社。

陳怡群、黃惠玲、趙家琛（2009）。阿肯巴克實證衡鑑系統。心理出版社。