目的:注意力缺失過動障礙(ADHD)和高功能泛自閉症障礙(HFA),在診斷準則上雖有明顯差異,但在日常生活、學習、人際互動上都會出現困擾。臨床工作中,發現HFA孩童也會有注意力問題,所以在初期先被診斷為ADHD,經過評估和治療後發現較符合HFA特質的情形時有所見。有些學者針對HFA和ADHD提出一些注意力特質上的差異,也在認知類型分數上發現分享一些的相似性和差異性,本研究的目的即為探討ADHD組、HFA組和共病組孩童在認知類型分數表現的差異,期待能提供鑑別診斷及早期介入之依據。方法:本研究以病歷回顧方式將6-8歲接受魏氏兒童智力量表第四版(WISC-IV)評估之孩童,分成三組ADHD組、HFA組和共病組,每組40位,針對全量表和四個指數分數,以及十個分測驗分數進行變異數分析和事後比較,了解三組認知表現上的差異,同時針對有差異的分測驗進行區辨分析看是否有鑑別診斷的效能。結果:ANOVA顯示三組孩童在WISC-IV的知覺推理指數分數(Perceptual Reasoning Index)、圖形設計(Block Design)和理解(Comprehension)分測驗達顯著差異,事後比較發現HFA組在知覺推理指數分數及圖形設計分測驗明顯高於其他兩組, 但在理解分測驗HFA組明顯低於其他兩組;依據達顯著差異的兩個分測驗共同進行區辨分析,強勢的圖形設計和弱勢的理解分測驗能正確區辨HFA孩童的百分比為67.5%;以強勢的圖形設計和理解分測驗能正確區分ADHD孩童的百分比為72.5%。而共病組孩童在認知表現大部分都介於其他兩組,僅處理速度指數分數稍優於其他兩組。結論:本研究初步證實WISC-IV的圖形設計和理解分測驗可以區辨HFA和ADHD孩童,共病組孩童認知表現因為重疊症狀之故較無特殊性表現。期待在未來研究能夠將正常孩童組加入,將疾病孩童與正常孩童進行比較,才能提出證據支持疾病組的所有的指標分數是否真的都有異常和特定性,並將年齡擴展到12歲,可以看到不同年齡或年級在疾病組的表現有無差異。
Objective: Although there are distinct sets of diagnostic criteria for ADHD and HFA, children of both groups share difficulties in learning and social interaction. Clinically, it is not uncommon that attention problems of some children with HFA manifest first and therefore the diagnosis of ADHD precedes. The diagnosis of HFA then follows after further evaluation and/or treatment were done. Some researchers have found differences between ADHD and HFA children on their attention performance. However,they also share similarities on index scores in IQ tests. The objective of this study is to investigate the differences among the WISC-IV scores of children with ADHD, HFA and comorbidity group. The results of this study may contribute to early dif-ferential diagnosis and intervention. Method: The FSIQ, 4 index and 10 subtest scores of 120 children aged 6-8 who were diagnosed as ADHD, HFA or comorbidity (n=40 in each group) were retrieved through chart review. ANOVA and post hoc analysis were performed to investigate group differences of the FSIQ, each index scores and subtest score. For the scores that showed significant differences, Discriminant analysis was further performed to see if any of them can successfully differentiate groups. Results: ANOVA found significant group differences on Perceptual Reasoning Index (PRI), block design subtest and comprehension subtest scores. Post hoc analysis found that the HFA group scored higher than the other two groups in PRI and in block design subtest. Both ADHD and dual diagnoses groups scored higher than the HFA group in comprehension subtest. Discriminant analysis showed that superior block design and inferior comprehension scores together could successfully detect 67.5% of HFA group while superior comprehension and block design scores together could correctly detect 72.5% of ADHD group. No single or combined scores could tease out the comorbidity group. Conclusion: This study found preliminary evidence that the scores on block design and comprehension subtests of WISC IV could help to differentiate ADHD and HFA children .Suggestion for future studies include recruiting typical children as control group to confirm the specificity on cognitive performance of ADHD and HFA children. The age range of participants should also extend to 12 years to explore the stability of this score pattern.
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