臺灣博碩士論文加值系統

本研究從認知神經心理學出發，探究在復健心理學之領域，如何建立注意力衡鑑模式。注意力功能不足是臨床上最常見之認知受損後遺症，一套配合受損病理與認知訓練的衡鑑系統亟為所需。本研究從注意力的認知神經理論模式、生理與神經系統、臨床上常見注意力受損功能、以及注意力發展等四方面著手，探討注意力衡鑑之重要面相。根據這些理論基礎，回應傳統測驗理論之要求，研究者認為注意力衡鑑應具備下述四點效度驗證歷程，其一，回應建構理論；其二，具有發展實質；其三，具有臨床實質；其四，具效標效度。本研究以三個子研究分別探討之。
研究者以Cohen(1993,1998)之理論為主軸，選定感官選擇、反應之選擇與控制、影響注意力資源、以及注意力持續等四部件為衡鑑重點，並參考其他研究者之建議，發展了廣泛性非語文注意力測驗組（Comprehensive Non-verbal Attention Test Battery, 以下簡稱CNAT），包含六個層次作業，共建立了三十三個指標、二十七項指標間的假設考驗。
子研究一以六百名正常兒童與青少年檢驗 CNAT 各項建構假設和發展趨勢。以ANOVA考驗組間變項效果（年齡變項）和組內變項效果(注意力各指標假設)。子研究二以 CNAT 衡鑑六十六名創傷性腦傷患者，檢驗各指標能否呈現患者之受損；討論中重度受損腦傷患者在 CNAT 各指標上受損之比例，並嘗試由患者受傷時的神經生理檢查指標來預估患者注意力之預後。子研究三分別以一百六十六名和六十名兩組正常青少年為受試者，以傳統單項性注意力衡鑑工具(Knox''s木塊測驗、數字廣度測驗、注意力和速度測驗)、具層次特質之神經心理注意力測驗（自編修正Stroop作業）以及魏氏兒童智力測驗(第三版)為效標，探討 CNAT 之區辨效度。
子研究一結果發現，所建立來檢驗 CNAT 建構效度的二十七項假設全部與原假設符合，年齡組變項也全部顯著。不過，當中有十九項達顯著的互動效果，事後比較的結果發現，主要來由十六歲組到十九歲組的發展方向不如預期，以及其中三個指標的發展在年齡層中出現非線性變化所致。研究中發現各年齡層受試者都沒有使用精確/速度互換策略。此外，以能完成分配注意力作業為認知組高低之分類，發現以因素分析討論建構效度，高低認知組的結構略有不同。其中，在動作選擇與控制和知覺選擇兩方面的指標較為穩定地各在一個因子內。而原假設的注意力資源與持續指標，可能含有注意力資源的「結構因素」和「執行策略」兩因子，和注意力持續的「警覺程度」和「時間上持續」兩因子，與Cohen的理論也具相互呼應之功。唯反應時間平均數和標準差兩類指標，尚無法區辨。
子研究二結果發現，與七歲組、十一歲組以及十九歲組比較，中重度創傷性腦傷患者在各層次作業上都有相當比例的無法完成作業、反應時間緩慢以及高錯誤率的患者，在四種注意力部件指標上也都有相當的受損比例。以人口學變項和神經學檢查變項來預測患者在 CNAT 各指標的受損程度，結果唯有視覺昏迷指數達到顯著。此外，因為中重度患者在反應時間平均數和標準差指標上的受損模式不盡相同，回應子研究一之建構討論，此二類指標應該各具不同注意力意涵。
子研究三結果發現，CNAT 各指標與效標測驗都只達到低到中等的相關，經過以逐步複回歸、因素分析、典型相關分析等，發現 CNAT 指標和這些測驗部份重疊但典型相關係數不高，顯示臨床上應用 CNAT 自有其貢獻。此外，再次發現反應時間平均數和標準差指標與效標中的相關模式並不類似。
最後，討論 CNAT 的評價和回應Cohen的理論，並說明未來研究的方向。

目錄
第一章 研究背景 1
一、認知神經心理學對注意力功能之定義與解說 1
1.1 注意力功能之定義與相對生理基礎 2
1.1.1 由生理與神經系統衍生的觀念 2
1.1.2 由忽略現象衍生的注意力理論 3
1.1.3 認知神經心理學的統整性理論 7
1.1.4 認知神經心理學研究中的注意力監控與動作反應 18
1.2 神經系統受損患者之注意力功能缺損 20
1.2.1 局部性受損患者 21
1.2.2 全面性受損患者 22
1.2.3 發展性受損患者 24
1.2.4 共病與其他臨床上常見注意力不足之疾患 26
1.3 注意力功能之發展實質性與神經系統實質性 27
1.3.1 注意力功能之發展與神經系統成熟之關係 27
1.3.2 認知功能衡鑑與神經系統運作之關聯性 31
二、注意力衡鑑於神經心理復健之必要性與衡鑑工具探討 33
2.1 神經心理復健模式：神經心理衡鑑與認知復健時機 33
2.1.1 神經心理學衡鑑為認知復健之基礎 34
2.1.2 注意力衡鑑為認知神經功能衡鑑之基礎 35
2.2 傳統臨床神經心理衡鑑常用之注意力衡鑑工具之定位與分析 36
2.3 臨床衡鑑注意力功能的困境與新的方向 41
2.3.1 定義與理論層面的問題與討論 41
2.3.2 衡鑑方法與實際臨床狀態的問題與討論 44
2.3.3 注意力衡鑑的新主張（多向度、多層次、發展性） 46
第二章 研究目的與研究內容 49
一、子研究一：統整性、多層次注意力功能的衡鑑與假設檢驗 51
1.1 研究目的 51
1.2 研究方法 52
1.2.1 廣泛性注意力測驗組之作業設計理念與評量重點 52
1.2.2 受試者 61
1.2.3 假設檢驗 65
1.3 結果分析 65
1.3.1 檢驗各作業部件間指標的關係假設 65
1.3.2 檢驗各作業部件間指標分數之相對內涵 66
1.3.3 檢驗各作業部件間指標分數之因素結構 71
1.3.4 檢驗各作業部件間指標分數之發展趨勢 77
1.4 討論 84
1.4.1 討論各作業部件間指標的關係假設 84
1.4.2 討論各作業部件間指標的發展趨勢 89
二、子研究二：多層次注意力衡鑑在TBI患者上之應用研究 93
2.1 研究目的 89
2.2 研究方法 90
2.2.1 研究工具 90
2.2.2 受試者 94
2.2.3 施測 98
2.2.4 假設檢驗 98
2.3 結果分析 99
2.3.1 檢驗TBI患者在CNAT各作業部件間指標的表現 99
2.3.2 檢驗中重度TBI患者在CNAT各作業部件間指標上的表現差異
105
2.4 討論 111
三、子研究三：以多層次注意力衡鑑與其他注意力測驗之效度研究
3.1 研究目的 114
3.2 研究方法: 114
3.2.1研究工具 114
3.2.2 受試者 115
3.2.3 假設檢驗 116
3.3 結果分析 117
3.3.1. 檢驗CNAT之各類注意力指標與其他傳統單項性注意力測驗和多層次神經心理測驗指標間的相關研究 117
3.3.2 . 檢驗CNAT之各類注意力指標與魏氏智力測驗測驗的關連 124
3.4 討論 127
第三章 再探注意力的定義、衡鑑以及應用 128
參考資料 134
附錄 142

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