探討噪音對注意力不足過動症病患之抑制功能的影響

Noise Effect to Inhibition Function in Patients with Attention-Deficit / Hyperactivity Disorder.

吳信維(Hsin-Wei Wu)

指導教授 ： 田意民

中山醫學大學/醫學科技學院/心理學系暨臨床心理學碩士班/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00151

摘要

研究問題：檢驗在不同背景噪音水準對注意力不足過動症病患(Attention-Deficit / Hyperactivity Disorder, ADHD)兒童青少年的抑制功能表現，並比較不同亞型及一般孩童間的差異。

研究方法及資料：本研究使用停止訊號作業(stop signal task)來測量參與者的停止訊號反應時間(Stop signal reaction time, SSRT)，作為抑制功能的指標。所有參與者皆被要求分別在3種背景噪音強度(0dB、35dB、55dB)下進行進行視覺判斷作業，當聽見停止訊號時則須中止按鍵反應。研究對象為6-16歲經身心科專科醫生確診為ADHD的兒童青少年，分心組的有效樣本數35名，混合/過動-衝動組為67名，控制組為同年齡層16名兒童。蒐集重要參數包括正確率、反應時間、停止訊號反應時間等，以二因子混合設計變異數分析作資料處理。

研究結果：發現在一般情境下，分心組與混合/過動-衝動組的確在停止訊號反應時間(SSRT)上高於控制組，分心組與混合/過動-衝動組的SSRT也有分開的趨勢，在一般情境下混合/過動-衝動組的SSRT最長。本研究發現35分貝的噪音即可顯著改善混合/過動-衝動亞型的抑制功能。然而，噪音對所有受試者都付出判斷作業上的代價，混合/過動-衝動組的判斷作業正確率隨著噪音水準增加而下降，分心組的判斷反應時間則隨之增加。

結論與建議：ADHD的抑制功能仍較一般孩童有顯著缺損，但不同亞型的缺損程度不同，混合/衝動-過動亞型有較嚴重的抑制缺損。在噪音的效果上，選擇性地對混合/過動-衝動組有顯著的獲益，顯示短暫噪音的確對不同亞型的效果不同。而SSRT變短的同時，判斷作業的正確率也隨著噪音強度增加而下降，顯示短暫噪音的存在也會對個體造成干擾。綜合上述，此結果可作為後續相關議題的基礎。在臨床心理治療的應用上，建議空間環境應更嚴謹考量環境噪音型態的影響，尤其是環境與個案心智特性的配合，結合藥物、臨床心理治療與治療環境的各種有利因素，期能找出對ADHD病患協助的最佳方案。

關鍵字: 注意力不足過動症、亞型、背景噪音、停止訊號作業

關鍵字

注意力不足過動症 ； 亞型 ； 背景噪音 ； 停止訊號作業

並列摘要

Research Questions: This study aimed to addressed the issue of the facilitation / interference effect of background noise on patients with attention-deficit / hyperactivity disorder (ADHD) by adopting stop-signal task. And try to clarify that if there is any different inhibition deficit on ADHD subtypes and non-ADHD children.

Method: All participants were tested by stop signal task in 3 different background noise (0dB、35dB、55dB). Participants were asked to respond to the visual stimuli, and to withhold their response when the stop signal was presented. Stop signal reaction time(SSRT) was obtained to be the index of inhibition function. Participants included adolescent and children, aged 6 to 16 years old, who refer from psychiatric clinic hospital and were diagnosed with ADHD. 35 children were inattentive subtype(ADD), 67 children with combine/ hyperactivity-impulsive subtypes(ADHD/HD) and 16 non-ADHD children(Control).

Result: The result revealed the SSRT of ADD and ADHD/HD groups were significantly higher than Control group. SSRT of ADHD/HD were significantly longer than ADD and Control. The SSRT of ADHD/HD group was longer than other groups and was different with ADD group. Facilitative effect only happen on ADHD/HD in noise level 35 dB. But noise caused disadvantage to all participants. The accuracy of ADHD/HD group was decreased by increased noise level, and the reaction time of ADD group was increased by increased noise level.

Conclusion: ADHD children has significant inhibition deficit than non-ADHD children, but different subtypes have different level of inhibition impairment, combine / hyperactivity-impulsive subtype have more severe impairment. Noise effect only has benefit to Combine / hyperactivity-impulsive subtype, the result suggested that short-term noise has different effect to different subtypes. When the SSRT of Combine / hyperactivity-impulsive subtype was decreased, the accuracy of judgment task was decreased, and it suggested that short-term noise has interference effect too. In conclusion, our results can be the references to the further issues. In clinical intervention application, Considered the effect of environment noise is also an important factor.

Keyword: ADHD, subtype, Background noise, stop signal task

並列關鍵字

ADHD ； subtype ； Background noise ； stop signal task

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