注意力缺陷過動症兒童在中文書寫語文能力與視覺動作能力之相關研究

A Study of Relationship between Chinese Written Ability and Visual Motor Ability for ADHD Children

張力尤(Li-Yu Chang)

指導教授 ： 葉重新

亞洲大學/人文社會學院/心理學系/碩士(2008年)

摘要

注意力缺陷過動症（attention deficit-hyperactivity deficit, ADHD）普遍為國小學童常見的疾患，常造成教師、同學的困擾。而寫字困難是一種ADHD兒童所缺陷的基本學業技巧之一（Barkley, 1998），拼字錯誤也常見於這些孩子（Kroese, Hynd, Knight, Heimenz, & Hall, 2000; Mayes, Calhoun, & Crowell, 2000）。雖然這兩個情形被認為有共同的遺傳病因（Stevenson, Pennington, Gilger, Defries, & Gillis, 1993），具書寫障礙之ADHD兒童在基本機制及導致此缺陷的神經心理歷程鮮為人知。本研究即在探討ADHD兒童的書寫語文能力，以及在視覺動作上的能力。

本研究流程分為「轉介階段」、「確認階段」、「篩選階段」及「研究階段」。在轉介階段，由兒童青少年精神科醫師依「DSM-IV診斷標準」轉介門診ADHD兒童後，家長填寫「干擾行為評量表」，以確認轉介之ADHD兒童的干擾行為達ADHD兒童常模之臨床顯著指標。再對參與之ADHD兒童個別施測「國小兒童書寫語文能力診斷測驗」，篩選出具有書寫障礙及不具書寫障礙之ADHD兒童，最後，所有參與本研究之ADHD兒童皆個別施測「拜瑞－布坦尼卡視覺動作統整發展測驗」。

研究結果顯示，7位ADHD兒童和8位一般兒童中，ADHD組兒童較一般組兒童有較差的造句商數(t =－2.77, p＜.05）。進一步以語法(用字、錯字、標點符號)、錯誤類型(添加、省略、替代、字序)和組別（一般組、ADHD組）之三因子混和設計變異數分析，探討造句商數中的錯誤表徵。結果顯示，語法(F =20.08, p＜.01)與錯誤類型(F =16.62, p＜.01)的主要效果皆有顯著差異，表示語法和錯誤類型對ADHD兒童和一般兒童有差異，且語法(F =9.18, p＜.01)和錯誤類型(F =11.07, p＜.01)皆與組別有交互作用存在。其中事後比較語法的三個水準發現，用字顯著較標點符號、錯字多，標點符號顯著較錯字多。此外，事後比較錯誤類型的四個水準發現，添加顯著較字序多，省略亦顯著較字序多，而替代則顯著較省略和字序多。

另外，在視覺動作發展能力方面，ADHD兒童比一般兒童在知覺動作統整量尺(t =－9.43, p＜.01）、視知覺量尺(t =－8.95, p＜.01）、動作協調分量尺(t=－7.02, p＜.01）皆較差。此外，在書寫語文障礙能力和視覺動作發展能力間，作文產品與視覺動作統整和動作協調有顯著相關（ρ=.78, .86 ; p＜.01）。

由本研究結果推論，ADHD兒童能力出的書寫障礙，可能與ADHD兒童視覺動作統整和動作協調發展較差有很高的關連性。是故，未來臨床上可嘗試針對具有書寫障礙之ADHD兒童，增進其視覺動作統整和動作協調，可能有助於改善ADHD兒童之書寫障礙能力。

關鍵字

注意力缺陷過動症兒童(ADHD兒童) ； 書寫障礙 ； 視覺動作統整 ； 視知覺 ； 動作協調

並列摘要

Children with Attention deficit-hyperactivity disorder (ADHD) were commonly seen in elementary school, and always disturbed teachers and classmates. Dysgraphia was one of the basic academic skills ADHD children deficits, and spelling errors were seen on these children either. Although two of these conditions considered as an etiology with the shared heredity, the basic mechanism and the causing neuropsychological process for ADHD children with dysgraphia were rarely understood. This study was to research Chinese written ability and visual motor ability for ADHD children.

The administration was separated into referral stage, confirming stage, screening stage, and studying stage. At referral stage, ADHD children were referred from psychiatric physician according to DSM-IV diagnosis criteria. Parent filled out Disruptive Behavior Disorders Rating Scale- Parent Form (DBDRS-PF) to confirm that participants’ reached clinical index of ADHD children, and that was confirming stage. Into screening stage, psychiatric physician administrated The Wechsler Intelligence Scale for children-Third Edition (WISC-Ⅲ, Chinese Version) to ensure participants with normal intelligence. Finally at researching stage, participants individually administrated Written Language Ability Diagnostic Test for Children and The Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI).

Results indicated that among 7 ADHD children and 8 normal children, ADHD children had worse productivity than normal children (t =－2.77, p＜.05). On visual motor ability, ADHD children had worse visual motor integration (t =－9.43, p＜.01), visual perception (t =－8.95, p＜.01), and motor coordination (t=－7.02, p＜.01). ADHD children had highly positive correlation between Productivity and visual perception and motor coordination (ρ=.78, .86 ; p＜.01).

This study concluded that ADHD with dysgraphia had highly positive correlation with visual motor integration and motor coordination. Therefore, ADHD children with dysgraphia could clinically train visual motor integration and motor coordination to improve the dysgraphic performance.

並列關鍵字

children with Attention Deficit-Hyperactivity Disorder (ADHD children) ； dysgraphia ； visual motor integration ； visual perception ； motor coordination

參考文獻

Tseng, M. H. (1993a). Factorial validity of the Tseng handwriting problem checklist. Journal of Occupational Therapy Association ROC, 11, 13-27.

Tseng, M. H. (1993b). Concurrent validity of the Tseng handwriting problem checklist. Journal of Occupational Therapy Association ROC, 11, 29-41.

Mao, H. F. (1995). Performance of chinese children in Taiwan on Berry's VMI Test. Journal of Occupational Therapy Association ROC, 13, 13-24.

李瑩玓（2004）。寫字困難學生寫字特徵之分析。師大學報：教育類，49，43-64。

林寶貴、錡寶香(2000)。國小兒童語言能力評量工具之發展。中華聽語雜誌，15，46-59。