臺灣博碩士論文加值系統

背景與目的：注意力缺陷過動（Attention-deficit Hyperactive Disorder，簡稱ADHD）孩童在動作表現上較一般人差，而相關的動作表現量測大多以粗動作、精細動作等功能性活動為主，較少文獻去探討ADHD孩童的動作流暢性與彈性（Motor Fluency & Flexibility）表現，並觀察其執行動作測驗時的運動學變數變化。另外，根據美國「診斷及統計手冊」第四版（DSM-IV）的診斷準則中所描述，認為ADHD的動作協調不好可能與孩童在執行動作活動時缺乏注意力和易分心有關，且在ADHD孩童的動作表現研究中，也發現ADHD孩童與發展性運動協調障礙（Developmental Coordination Disorder，簡稱DCD）有高共病性的情況。因此本研究的目的主要是量測ADHD孩童其精細動作流暢性與彈性的表現是否有缺陷，並量測其執行動作流暢性與彈性測驗時的運動學上變數。此外，也將探討ADHD孩童的注意力與衝動控制缺損情況是否會影響其精細動作流暢性和彈性表現與運動學上的變數，並比較當ADHD孩童合併有DCD診斷時，其在精細動作流暢性與彈性和運動學上的變數是否與單純的ADHD孩童有所不同。研究方法：分別各有23和38位6~12歲的ADHD與正常孩童，所有的孩童參與者其詞彙理解能力與視知覺正常，研究工具使用了家長填寫的兒童行為量表與柯能氏兒童行為檢核表-家長版、IVA+Plus CPT（Integrated Visual and Auditory Continuous Performance Test）、動作流暢性與彈性測驗、觸控式螢幕等。研究結果：ADHD孩童在精細動作流暢性與彈性表現上可能有缺陷，但是其動作過程中顯示ADHD孩童比一般正常人所執行的速度較快、加速度較大，且較不平順。另外，ADHD孩童的注意力缺失與衝動控制等核心症狀的嚴重程度亦會影響孩童的精細動作流暢性與彈性表現，並影響動作過程中的平順度，核心症狀越嚴重的孩童其精細動作流暢與彈性越差，動作的過程表現越不平順。此外，本研究亦發現當ADHD孩童合併有動作缺陷時，其精細動作的流暢性與彈性表現會越差，且動作過程中越不平順。結論：ADHD孩童在動作上的表現有缺陷，且其核心症狀會影響到孩童的表現，當ADHD孩童合併有DCD時，其在動作的表現上更容易顯現出問題，因此臨床上除了期望著重訓練孩童的注意力與衝動控制能力來改善ADHD孩童的動作表現外，仍須針對本身有動作問題的ADHD孩童進行動作發展復健，來改善孩童本身的動作缺陷問題。此外，ADHD孩童在動作的品質上也有缺陷，其動作過程中較正常孩童不平順，且越高階層的認知處理與速度越快的活動，越容易顯示出問題。

Background & Purposes：Recent researches have suggested that the children with attention-deficit hyperactive disorder (ADHD) have motor problems. The motor tasks which have been suggested to assess the children are main in fine and gross motor. The researches about motor fluency and flexibility in children with ADHD remains few. In addition, according to the DSM-IV, the poor motor coordination associated with ADHD may be linked to the children’s lack of attention or respone control when they are doing the motor tasks. However, some researches suggested that motor problems are typically unaffected in children with ADHD, only when children with ADHD and coexisting with development coordination disorder (DCD) would shown had motor problems. For these reasons, the purposes in the study are to use the Tracking & Pursuit Tasks to exam the performance of fine motor fluency and flexibility in children with ADHD and meausure the kinematic variables during the motor tasks when children doing. Moreover, explore the relationship of motor performance in children with ADHD and their ability of attention or respone control, and examine the impact on fine motor fluency and flexibility ability of children with ADHD when co-existing with DCD. Methods：Twenty-three children with ADHD and 38 healthy children were enrolled in the present study. All children in the study are normal development in visual perception and following instructions. The children doing the tracking & pursuit tasks involving fine motor fluency and flexibility. Results：children with ADHD may have deficit in fine motor fluency and flexibility, but the kinematic variables show that the children with ADHD used high speed, acceleration and not smoothness to do the motor tasks. Moreover, fine the motor fluency, flexibility and smoothness would influence by the symptom severity or co-existing with DCD in children with ADHD.Conclusions：The main findings are interrupted as evidence for a specific deficit in high-level controlled processing and close-loop movements in children with ADHD. The motor problem not only influence by their core symptoms, but also they have a motor deficit. Thus, the occupational therapy would not only intervene in improving attention or response control, the rehabilitation of motor programs are also need in children with ADHD.

中文摘要 II
Abstract IV
致謝 VI
目錄 VII
圖目錄 X
表目錄 XI
附錄目錄 XIII
第一章 緒論 1
第一節 研究目的 1
第二節 研究源由及重要性 1
第四節 研究假說 3
第五節 操作型定義與名詞解釋 3
第二章 文獻回顧 6
第一節 注意力缺失╱過動疾患（ADHD）的簡介 6
第二節 ADHD的職能治療介入 9
第三節 ADHD孩童的衝動與注意力問題 12
第四節 ADHD孩童的粗動作、精細動作與動作協調性表現 17
第五節 ADHD孩童的動作流暢性與彈性表現 24
第六節 動作流暢性與彈性之量測工具探討與比較 26
第七節 ADHD與DCD的共病性 28
第三章 研究方法 30
第一節 研究對象 30
第二節 研究工具 31
第三節 研究流程 37
第四節 統計方法 38
第四章 研究結果 39
第一節 人口基本資料 39
第二節 動作協調評估 40
第三節 ADHD孩童的核心症狀與動作協調評估相關性 41
第四節 動作流暢性與彈性測驗分析 41
第五節 ADHD孩童的核心症狀和精細動作流暢性與彈性之相關性
分析 42
第六節 動作流暢性與彈性測驗之運動學分析 43
第七節 ADHD孩童的核心症狀與動作流暢性與彈性測驗之運動學
相關性分析 45
第八節 DCD的共病性對精細動作流暢性、彈性與過程之分析 46
第五章 討論 52
第一節 人口基本資料 52
第二節 動作協調評估與ADHD孩童之核心症狀相關性 53
第三節 精細動作流暢性與彈性 54
第四節 ADHD孩童的核心症狀和精細動作流暢性與彈性之
相關性 55
第五節 動作流暢性與彈性測驗之運動學 56
第六節 ADHD孩童的核心症狀與動作流暢性測驗之運動學分析 59
第七節 DCD的共病性對精細動作流暢性、彈性與過程之影響 60
第八節 臨床應用 61
第九節 研究限制 62
第十節 未來建議 63
英文參考文獻 66
中文參考文獻 76

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