認識抽動症學生－衡鑑與處遇考量

The Psychological Assessment, Social and Psychologial Treatment and Educational Placement of Tics Disorder

洪慧涓(Hui-Chuan Hung)

《教育科學期刊》 5卷1期 (2005/06) Pp. 1-14

https://doi.org/10.6388/JES.200506.0001

摘要

本文旨在介紹抽動症的臨床表現、疾病影響、衡鑑考量與治療考量等相關議題。抽動症是一種神經精神障礙，由遺傳、神經生化代謝以及環境因素等因素交互作用的結果，症狀主要可分為三類：聲語型、動作型與心因性等三種形式。由於症狀的種類與發作次數有變異很容易為父母忽略。加上症狀初期會以主要表現的器官為求診的科別也容易造成周遊各科(doctor shopping)，不易及早診斷而延誤治療。
目前抽動症藥物治療的預後不錯，但多種動作與聲語型的抽動症預後較差。未來研究可就有問題的基因、決定基因的順序與排列、媒介基因細胞轉印的因素與應用分子生物學的研究來預防及治療這些疾病；但其衍生教育、情緒、行為、家庭、與藥物副作用等問題亟待心理與教育工作者的參與以使其能獲得全面而周延的照護。
由於此疾患常合併注意力／過動、強迫、憂鬱、或行為的問題，例如攻擊、自我傷害、以及學習問題，因此此疾患對兒童心理與教育產生的問題值得重視。處遇前先運用訪談與心理衡鑑工具進行衡鑑，目標在評量個體全部的適應功能，以確認損傷和影響的範圍，並評估個人及家庭的長處與短處，也要收集家庭神經精神疾病史、發展史、疾病史、與家人及同儕關係或工作表現及重要的生活事件史。
依據衡鑑的結果，以便提供藥物為主，社會、心理與教育為輔的相關處遇的協助，社會治療以幫助家庭面對疾病引起的社會壓力為主、心理治療以處理個體的適應與情緒問題，並以行為治療學習衝動的控制，並依據其學習的問題給予特殊教育的安置。

關鍵字

抽動症 ； 心理衡鑑 ； 處遇

並列摘要

The purpose of this article is to introduce the clinical expressions, the impacts of illness, assessment and treatments evaluation are also discussed. In the early stage, patients often see different doctors according to the expressions of their symptoms. The symptoms of the illness primarily have three patterns: vocal, motor, and psychological types. Tics can be easily neglected by parents due to its variations, wax and wane of symptoms. This doctor-shopping behavior makes early diagnosis difficult and treatments delayed.
Medical treatments for tics are effective. However, prognosis for multiple motor and vocal tics is poor at present time. In future studies, researcher may focus on the defective genes, genetic linkage and arrangements, and gene transfer factors. Molecular biological techniques may help prevent and treat the disorder.
Tics is commonly combined with attention deficit hyperactivity, compulsion, depression, and behavior disorders such as attack, self-damage and learning disorder. The psychological and educational needs caused by the disease must be addressed. Interview and psychological assessment before intervention are required. Interviews and assessments are employed to understand the patient's holistic adjustment, range of damage and impacts, interrelationship with family and peers, accomplishments and important life events. Moreover, the assessment can evaluate the strengths and weaknesses of the patient and his/her family, and collect data of the patient's family history of neuro-psychiatric diseases and development.
Based on assessment results, we can provide primary treatment (drugs) and supplemental intervenion (social, psychological treatment and education). Social treatment can help the family deal with social stresses of the disease. Psychological treatment helps the patient with adaptation and emotional problems. Behavioral treatment is helpful for the patient to control urges. Displacement of special education can be assigned according to the patient's specific learning problems.

並列關鍵字

Tics Disorder ； Psychological Assessment ； Intervention

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