- 學位論文
探究六至八歲感覺處理困難孩童之書寫表現
Handwriting in Children Aged 6–8 Years with Sensory Processing Difficulties
摘要
前言背景：書寫是孩子們至關重要的職能活動，書寫困難會深遠地影響一個人的學業表現，甚至是全人的發展。根據以往的研究，兒童的書寫困難可能來自於許多不同方面的要素技能，例如精細動作控制、雙側動作協調和視覺運動整合、持續注意力、動作計畫和感覺覺知等。根據上述研究，多種書寫模型已經被建構及應用討論，例如從書寫的神經心理過程的角度、以及書寫動作過程和產出的角度來著手研究書寫困難。若仔細探究書寫模型的關鍵組成，不難發現感覺處理功能是根基。有感覺處理相關問題的兒童，例如自閉症類群障礙、或注意力缺失過動症診斷的兒童，也曾被過去文獻指出其書寫困難可能與他們的感覺處理困難（SPD）有關。然而目前尚未有研究著重於單純為感覺處理困難(即無合併其他醫學診斷的)之兒童的書寫表現。 目的：本研究的主要目的是通過基本讀寫字綜合測驗（BCBL）來深入探討具有不同程度感覺處理困難的兒童的書寫表現； 並以感覺處理障礙的不同向度探討孩童書寫表現的決定性預測因子，以及透過五個關鍵的感覺系統探討其與書寫表現的相關性。 方法：本研究招募了 53 名六到八歲不具有、或具有不同程度的感覺處理困難的兒童。 每位參與者都被要求完成基本讀寫字綜合測驗 (BCBL) 和拜瑞－布坦尼卡視覺－動作統整發展測驗 (Beery VMI) 和補充任務。斯皮爾曼相關性檢驗(Spearman’s rho)用於分析 SPD 指標軸與 BCBL 書寫表現的關係。透過線性前進選擇法迴歸分析探討書寫的預測因子。根據家長訪談和兒童感覺統合功能量表（SIF）的結果，將兒童分為兩組（非 SPD 組和 SPD 組）。 採用獨立樣本t檢驗分析比較兩組人在BCBL中的書寫表現。 結果：讀字組合分數 (RTCS) (ρ = -0.406) 和寫字組合分數 (WTCS) (ρ = -0.310) 均與整體SPD情形呈顯著負相關。且讀字組合分數與聽覺、前庭覺及口腔感覺系統有顯著相關，而寫字組合分數則與聽覺、視覺及前庭覺系統有顯著相關。針對RTCS，SPD指標軸之一的「情緒及行為反應」是顯著的預測因子，它與另一個預測因子（智能）解釋力為26.3 %；針對WTCS，「注意力與活動量」與智能一起作為顯著的預測因子，解釋力為30.0 %。 結論：6-8歲兒童之筆寫表現與SPD之間存在顯著相關性。SPD中的「情緒及行為反應」指標軸可作為RTCS的預測因子；而對 WTCS來說，則可由「注意力與活動量」作為預測。對於上述兩個書寫表現面向，研究結果顯示其重要的感覺系統為前庭系統、聽覺、視覺和口腔感覺系統。且最後此研究指出，針對6-8歲兒童其可能因不同程度的SPD而在其書寫表現上產生負面影響。
並列摘要
Backgrounds: Handwriting is an essential occupation for children, and difficulties in it can greatly influence one’s academic performance or even holistic personal development. According to previous research, handwriting difficulties can arise from many aspects of children’s component skills, such as fine motor control, bilateral and visual-motor integration, sustained attention, motor planning, and sensory awareness. In line with those studies, several models of handwriting have been applied to investigate handwriting difficulties from the perspective of the neuropsychological processes of handwriting, as well as handwriting process and product. Close examination of the components of models of handwriting suggests that sensory processing function lies at the foundation. It has been reported that, in children with sensory processing conditions, such as some children with ASD or ADHD, handwriting difficulties might be related to their sensory processing difficulties (SPD). However, no research has focused mainly on children with pure sensory processing difficulties. Purposes: The major purpose of this study was to investigate handwriting performance in children without and with varying degrees of sensory processing difficulties by the Battery of Chinese Basic Literacy (BCBL); then to examine the determinant predictors of handwriting from dimensions of SPD. Also to investigate the relationship between handwriting and five crucial sensory systems. Methods: Fifty-three children aged 6–8 years with varying degrees of SPD or without SPD were recruited in this study. Each participant was asked to complete the Battery of Chinese Basic Literacy (BCBL) and the Berry Visual-Motor Integration Task (Beery VMI) and the supplemental tasks. Spearman’s rho correlation test was used to analysis relationships of dimensions of SPD to performance on the BCBL. Linear forward selection regression analyses were conducted to examine the predicting factors of handwriting performance. Based on the parent interview and the results of the Sensory Integration functional checklist for children (SIF), the children were divided into two groups (Non-SPD group and SPD group). Independent-sample t test was used to analyze and compare the handwriting performances on the BCBL of the two groups. Results: Both the Reading Tests Composite Score (RTCS) (ρ = -0.406) and the Writing Tests Composite Score (WTCS) (ρ = -0.310) were significantly negatively correlated with overall SPD. The relationship between RTCS, auditory, vestibular and oral sensory systems was found, and as well the relationship between WTCS, auditory, visual and vestibular systems. The significant predictor from the 4 dimensions of SPD was Behavior and Emotion, which with another predictor (intelligence) accounted for 26.3 % of the variance of the RTCS; Attention and Activity Level with another predictor (intelligence) explained 30.0 % of the variance of the WTCS. Conclusion: The results indicated a significant relationship between handwriting and SPD. The significant factor from the 4 dimensions of SPD for the RTCS was Behavior and Emotion, and for the WTCS, it was Attention and Activity Level. And findings indicated that the significant relationship between handwriting, vestibular, auditory, visual and oral sensory systems. Finally, varied degrees of SPD in children aged 6–8 years could have negative influences on handwriting.