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  • 學位論文

停止訊號作業在ADHD臨床診斷上之運用-以台灣學齡前兒童為例

To apply the Stop Signal Task in clinical assessment of AD/HD: Preschool children in Taiwan

指導教授 : 李宏鎰
本文將於2025/12/31開放下載。若您希望在開放下載時收到通知,可將文章加入收藏

摘要


研究背景與目的:雙重路徑模式(The dual pathway model)已說明造成ADHD兒童的主要神經心理機制是認知缺陷(抑制缺陷)與動機不足(延宕厭惡)(Sonuga-Barke, 2002)。目前台灣並沒有基於雙重路徑模式所設計的ADHD兒童標準化測驗,加上學齡前兒童本因發展因素而本性好動,較難判斷是否為ADHD兒童。為了發展能有效區辨學齡前ADHD兒童與一般兒童,本研究使用雙重路徑的兩個作業,以便了解這些作業作為評估工具的適用性,以及發展適合台灣兒童的臨床心理神經工具。 研究方法:本研究使用停止訊息作業(Stop signal task)及時間折扣作業(Temporal discounting task)兩個可代表雙重路徑模式的作業。在研究一中比較30名ADHD學齡前兒童與31名一般兒童的行為表現;研究二中收集台灣中、南兩區域5到12歲兒童的行為表現,共收集到中部125與南部146位5到12歲的一般兒童資料。 研究結果:研究一結果顯示,ADHD學齡前兒童在停止訊息作業中的漏按比一般兒童表現差、反應時間比一般兒童快、反應時間變異較小,但代表抑制能力的SSRT指標未達顯著差異;在時間折扣作業中兩組也未達顯著差異。研究二地區性的行為表現資料顯示,中區兒童在停止訊息作業中的漏按次數、左右按錯次數、SSRT達顯著差異,表示隨年齡上升表現越好;在時間折扣作業中則未達顯著差異。南區兒童在停止訊息作業中的漏按次數、按錯次數、SSRT及反應率達顯著差異,表示隨年齡上升表現越好。上述的指標中,兩區兒童在部分年齡層也有顯著差異。 討論:本研究認為研究一學齡前兒童的動作抑制能力還在發展中,尚不穩定,因此在停止訊號作業中的SSRT指標未顯著。漏按次數達顯著差異代表注意力在兩組兒童間不同;而一般兒童可能因因為較謹慎導致有較大的反應時間。研究二的中部與南部地區都在漏按次數、左右按錯次數與SSRT有年齡效果,表示這三個指標較穩定。但指標在部分年齡層兩區有顯著差異,代表該年齡層要分區建立常模。時間折扣作業在兩研究中都未達顯著差異,本研究認為此作業不適合用來評量兒童的延宕能力。

並列摘要


Purpose: The dual pathway model of attention deficit/ hyperactivity disorder (ADHD) has indicated that the neuropsychology dysfunction of ADHD is mainly caused by inhibitory deficit and delay aversion. However, there is no standard test for ADHD based on the dual pathway model in Taiwan. In addition, preschool children are hardly diagnosed as ADHD due to their nature. Activity level is higher in this age. In order to distinguish preschool children with ADHD, this study examined the validity of stop signal task and temporal discounting task, which are the representative tasks of the dual pathway model, as well as to develop proper clinical neuropsychological tests for children with ADHD in Taiwan. Method: In the first study we compared the performance between preschool normal children and children with ADHD, 31 preschool normal children and 30 children with ADHD participated. In the second study we compared the performance of children from 5 to 12 in two regions in Taiwan, 125 in Middle region and 146 in South region, to understand the age effect of tasks in Taiwan. Results: In the first study, the data in the stop signal task showed that children with ADHD made more omission errors than that of normal children; they also had faster reaction time and smaller standard deviation of reaction time. However, the SSRT showed no difference between two groups. Also, there was no difference between two groups in the index scores of the temporal discounting task. In the second study, we found that data of children in Middle region of Taiwan showed significant differences in the numbers of omission errors, the numbers of pressing wrong button and SSRT among groups with different ages. Data of children in South region of Taiwan showed significant differences in the numbers of omission errors, the numbers of pressing wrong button, SSRT and the reaction rate among groups with different ages. In these indices, there were also differences between ages in two regions. The temporal discounting task also showed no difference in ages in the Middle region. Discussion: The motor inhibition ability of preschool age children might still being developing, it’s not stable as the school age children, so there was no difference in SSRT. Observing the number of omission errors between two groups might be promising: it showed the different ability in attention. The normal children had longer reaction time because they were more causious duing the task. The number of omission errors, the number of pressing the wrong button and SSRT were different between ages, indicated those indices were more stable. However, there were some differences between two regions in some ages of these indices, representing that the norm must be established separately. The temporal discounting task showed no difference in two studies, so it might not be suitable for assessing the delay ability of children in Taiwan.

參考文獻


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