臺灣博碩士論文加值系統

目的：工作記憶缺損為注意力缺陷/過動 （Attention-Deficit/Hyperactivity Disorder，ADHD）患者之認知與行為問題的核心原因之一，其中複合亞型在工作記憶成分呈現廣泛且穩定的缺損。近年來工作記憶訓練已顯示對工作記憶缺損族群有良好療效，但受限於國外工具有外語的限制，且缺乏應用於ADHD之訓練研究，本研究運用郭乃文、鄭中平於2005年所發展之廣泛性記憶力訓練系統（Comprehensive Memory Training System，CMTS），透過電腦化模組對學齡期ADHD複合型兒童進行訓練，並評估介入成效。

方法：三十六名自願加入訓練之7-12歲ADHD複合型兒童隨機分派至兩組，實驗組接受CMTS訓練每次1小時，每週兩次，以完成所有訓練項目為結訓標準，平均約16.95小時；控制組接受閱讀理解訓練，平均約15.07小時。CMTS為一神經心理訓練工具，將學習歷程與提取歷程分開訓練，透過主動連結經驗的方式，促進記憶與學習策略的提取與應用。訓練前後以廣泛性非語文注意力測驗組、記憶廣度測驗、曾氏語文工作記憶量表、日常生活之工具性語文工作記憶量表、廣泛性非語文記憶力測驗組、閱讀理解困難篩選測驗、注意力評估問卷、中文版注意力缺陷過動症量表（Swanson, Nolan, and Pelham, Version IV，SNAP-IV）為工具，探討介入之認知功能轉移效果。

結果：實驗組在注意力、語文工作記憶、非語文工作記憶、執行錯誤、教師觀察參與者之注意力症狀有顯著進步。且兩組織閱讀理解能力皆有顯著提升。

討論：研究結果顯示針對中央執行系統介入，強調自主學習與執行控制的CMTS可提升ADHD複合型兒童之注意力表現、工作記憶、閱讀理解能力，以及日常生活注意力表現。未來宜追蹤其廣泛與長遠療效，亦可推廣應用於其他以工作記憶缺損為主要問題之患者，如創傷性腦損傷或中風等案例。

Objective: Working memory deficit is the core cause behind the cognitive and behavior problems in Attention-Deficit/Hyperactivity Disorder (ADHD), among which, combined type present extensive and stable deficit in the working memory components. In recent years, working memory training has shown to have therapeutic effect on those with working memory deficit. However, tools abroad are limited by its foreign language, and studies on its application to ADHD is lacking. This study used a pervasive memory training system (the Comprehensive Memory Training System, CMTS) developed by Nai-Wen Guo and Chung-Ping Cheng (2005), using this computerized program, school-age ADHD combined type children were trained, and the effect of training were evaluated.

Methods: Thirty-six 7-12 year old children diagnosed as ADHD combined type were randomly assigned to two groups, the experimental group received an hour of CMTS training twice a week to complete all training items, which took an average of 16.95 hours; The control group received reading comprehensive training, which took an average of 15.07 hours. The CMTS is a neuropsychological training tool, which separately trains learning process and retrieval process through the method of actively connecting experiences to promote the retrieval and application of memory and learning strategies. The Comprehensive Nonverbal Attention Task Battery, Digit Span, verbal working memory, Comprehensive Nonverbal Memory Test Battery, reading comprehension task, and behavior interventory were assessed before and after training to investigate the effectiveness of the intervention on cognitive function and daily life performances.

Results: The CMTS training group showed siginificant improvent in attention, verbal working memory, nonverbal working memory, executive function, and attention syndromes in daily life. Otherwise, reading comprehensive ability was significant improved in each group.

Discussion: This study found the CMTS, which targeted on the intervention of the central executive system, and emphasized self-learning and executive control, can elevate the attention performance, working memory, executive error and reading comprehension ability of ADHD combined type children. Future studies should follow-up on its pervasive and long-term effect, and generalize its application to other patients with core deficit in working memory, such as traumatic brain injury or stroke cases.

第壹章 緒論 1
第一節 研究背景與目的 1
第貳章 文獻探討 6
第一節 工作記憶之理論與探討 6
一、 工作記憶理論 6
二、 工作記憶的臨床神經心理學研究 11
第二節 注意力缺失過動疾患之探討 14
一、 注意力缺失過動疾患的本質與診斷 14
二、 注意力缺失過動疾患之神經心理學病理 17
第三節 工作記憶與注意力缺失過動疾患之探討 21
一、 注意力缺失過動疾患工作記憶損傷的理論與實徵研究 21
二、 注意力缺失過動疾患亞型之工作記憶表現型態分析 26
第四節 工作記憶訓練實徵研究 29
一、 工作記憶訓練之類別與實徵研究 29
二、 廣泛性記憶力訓練系統（CMTS）之理論基礎與訓練內容 39
第參章 研究方法 45
第一節 研究設計與流程 45
第二節 研究對象 47
第三節 研究工具 47
一、 評估工具 48
二、 訓練程序 55
第四節 統計分析 57
第肆章 研究結果 58
第一節 受試者人口學資料統計 58
第二節 神經心理測驗與閱讀理解測驗結果 59
第三節 行為量表資料統計 69
第伍章 研究討論 73
第一節 訓練結果分析 73
第二節 CMTS為何有效 76
第三節 工作記憶與注意力 78
第四節 工作記憶與閱讀理解能力 80
第五節 研究限制與建議 81
第六節 研究貢獻與未來展望 82
參考文獻 84
附錄 99

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