生態取向遊戲治療對學齡前疑似注意力不足過動症兒童之職能治療方案發展與成效探究

The Occupational Therapy Project Development and Effectiveness Investigation of the Ecosystemic Play Therapy for Suspected Attention-Deficit/Hyperactivity Disorder Preschool Children

詹雅淳(Ya-Chun Chan) ； 許育光(Yu-Kuang Hsu)

《特殊教育學報》 53期 (2021/06) Pp. 61-97

https://doi.org/10.3966/207455832021060053003

摘要

本研究針對學齡前疑似注意力不足過動症兒童設計生態取向遊戲治療方案，並進行方案評鑑與探究治療成效及歷程。研究之方案發展以前導研究進行方案評估初探，再修正為正式方案進行正式研究。12對4到6歲疑似注意力不足過動症兒童與其家長參與本研究：實驗組接受6週的生態取向遊戲治療；控制組待排治療。以「注意力缺陷／過動障礙測驗」及「克氏注意力持續度表現測驗第二版」進行前後測及3週後的追蹤。並以生態瞬間評估法讓家長填寫「兒童活動量表」。結果平均出席率為99%。雖然介入前實驗組兒童注意力症狀較控制組兒童稍為嚴重，但組內比較發現實驗組兒童症狀與行為問題進步程度均達顯著（p＜.05）；控制組兒童只有在「遺漏錯誤」、「違規錯誤」、「持續動作」及「反應時間」進步程度達顯著。組間比較發現實驗組兒童之立即介入成效以專注力及日常生活行為問題進步程度顯著優於控制組兒童；保留效果在過動及衝動症狀和日常生活行為問題進步程度達顯著。生態評估法的結果發現實驗組兒童的行為在前三週改善效果最為顯著，並持續進步至追蹤期。研究結論支持生態取向遊戲治療方案對疑似注意力不足過動症兒童之症狀與行為有正向影響。研究依據結果進行討論，並對實務與未來研究提出相關建議。

關鍵字

生態取向遊戲治療（EPT） ； 注意力不足過動症（ADHD） ； 生態瞬間評估法（EMA）

並列摘要

The goal of this study is to develop and examine the effectiveness of an Ecosystemic Play Therapy (EPT) Program for suspected attention-deficit/hyperactivity disorder (ADHD) preschool children. The program was developed from a pilot experiment and then a randomized controlled trial was conducted to examine its effectiveness. 12 parent-child dyads were randomly assigned to the experimental group and the waitlist control group. The experimental group received the EPT Program for 6 weeks. Outcomes were measured with the Attention- Deficit/Hyperactivity Disorder Test and the Conners' Kiddie Continuous Performance Test II at baseline, after treatment, and at follow-up. For each child participant, a parent would complete the Ecological momentary assessment (EMA) protocol with the Activity Level Rating Scales for Parents. The percentage of attendance was 99%. Although the experimental group showed a little more severe inattention symptoms before the treatment, they showed significant improvement in ADHD symptoms and behavior problems, while the control group showed significant improvement in partial symptoms, ＂Omissions＂, ＂Commissions＂, ＂Perseverations＂ and ＂Hit Reaction Time＂. Comparing the differences between the two groups, the experimental group showed significant improvement in attention and behavior after the treatment, and again significant improvement in hyperactive/impulsive symptoms and behavior when reevaluated at the follow-up appointment. EMA results showed the behavior problems of the experimental group improved significantly in the first 3 weeks and continued to the follow-up. In conclusion, the EPT Program has positive effects on suspected ADHD preschool children. Research based on the results to discuss and make recommendations for practice and further studies.

並列關鍵字

ecosystemic play therapy (EPT) ； attention-deficit/hyperactivity disorder (ADHD) ； ecological momentary assessment (EMA)

參考文獻

凃怡安、徐如維、黃凱琳、劉慕恩、陳牧宏(2017)。注意力不足過動症：診斷與治療之現今概況。臨床醫學月刊，79(3)，154－157。https://doi.org/10.66- 66/ClinMed.2017.79.3.028

Akutagava-Martins, G. C., Rohde, L. A., & Hutz, M. H. (2016). Genetics of attention-deficit/hyperactivity disorder: An update. Expert Review of Neurotherapeutics, 16(2), 145-156. https://doi.org/ 10.1586/14737175.2016.1130626

Belanger, S. A., Andrews, D., Gray, C., & Korczak, D. (2018). ADHD in children and youth: Part 1-etiology, d-iagnosis, and comorbidity. Paediatr Child Health, 23(7), 447-453. https://doi.org/10.1093/pch/pxy109

Brikell, I., Kuja-Halkola, R., Larsson, J. O., Lahey, B. B., Kuntsi, J., Lichte-nstein, P., Rydelius, P. A., & Larss-on, H. (2016). Relative immaturity in childhood and attention-deficit/hyperactivity disorder symptoms from childhood to early adulthood: Exploring genetic and environmental overlap across development. Journal of the American Academy of Child and Adolescent Psychiatry, 55(10), 886-895. https://doi.org/10.1016/j.jaac.2016.06.014

Charach, A., Carson, P., Fox, S., Ali, M. U., Beckett, J., & Lim, C. G. (2013). Inter ventions for preschool children at high risk for ADHD: A comparative effectiveness review. Pediatrics, 131(5), e1584-e1604. https://doi.org/10.1542/peds.2012-0974