臺灣博碩士論文加值系統

本研究旨在了解ADHD社會認知功能的發展歷程。社會認知功能是人際互動過程中，用以理解他人的關鍵能力。特別是我們經常藉由凝視方向傳遞社會性的訊息，而能夠了解他人的意圖。過去的研究發現他人凝視方向會引發如同邊緣線索般的注意力轉移作用，即短SOA有促進的線索效應，長SOA有抑制的IOR。同時，他人凝視方向和臉孔情緒的結合還會引發連結性注意力，例如我們對被他人開心看著的物品的喜好程度會高於被嫌惡看著的物品。因此，本研究採用他人凝視方向，測試ADHD的注意力轉移作用（作業一）與連結性注意力（作業二）等兩項社會認知功能，再加上臉孔情緒辨識作業（作業三），以了解社會認知能力。由於ADHD是發展性的疾患，而社會認知也有發展的趨勢，所以本研究計畫收取三個年齡層的參與者，分別為6-8歲、9-12歲和13-16歲等三個年齡層，加以檢視ADHD與一般人，對他人凝視方向所引發的社會認知功能是否有發展上的不同。研究結果有三個主要的發現。首先，ADHD隨著年齡增長，社會認知功能的表現越差，尤其到了13-16歲的青少年階段，當一般青少年的能力已經與成人相同時，ADHD青少年卻有顯著的缺損。其次，在兒童早期，ADHD與一般參與者的表現沒有顯著差異，表示ADHD的社會認知功能很可能是疾病本身和環境的交互作用之下，逐步惡化的結果。最後，臉孔情緒會影響ADHD的線索效應，使連結性注意力消失。最後本研究提出相關的教學建議以及可能的內在機制。

Abstract

The aim of the study explored the developmental processes of social attention in ADHD. Within the interpersonal interaction, we needed the social attention to catch the others’ intention, especially the gaze cue. In fact, gaze could induce the automatic attentional shift like the peripheral cue：the validity in the short SOA, and the IOR in the longer SOA. Moreover, the combination of gaze and emotional face could produce the joint attention to affect the social judgment, such as the object was looked by an happy face was more attractive than it was looked by a disgust face. Thus, the study adopted gaze to test the attentional shift and joint attention of ADHD, and added the emotional faces to test their ability to recognize the emotions in face. Besides, we decided to understand the developmental trends in ADHD, thus used three groups to be participants, including 6-8 years、9-12 years and 13-16 years. The results had three main findings. First, within ADHD group, their social attention was worse in older age, especially in 13-16-year group. Second, the ability of social attention in ADHD was as similar as the controls in early age. Maybe it showed that the social attention deficits in ADHD were from the interaction under their disorders and environments. Third, the emotional faces could affect the cueing effects in ADHD, and caused the validity of gaze to disappear. According to the findings, we had some suggestions for teaching sites and the possible inner mechanism of social attention deficits in ADHD.

第一章 緒論 4
第一節 研究動機 4
第二節 研究目的和問題 9
第三節 名詞釋義 9
第二章 文獻探討 12
第一節ADHD的診斷 12
一、臨床DSM手冊對ADHD診斷的改變 14
二、ADHD是「發展性」的神經心理功能失調 15
（一）ADHD與其他兒童精神疾患的區辨性 15
（二）亞型的診斷會隨著發展而改變 16
（三）增加成人ADHD的診斷 17
三、ADHD的社會適應困難 19
第二節 ADHD可能之肇因 20
一、ADHD的空間注意力缺損 20
二、注意力的警醒狀態（arousal）和激發作用（vigilance） 24
三、ADHD之執行功能缺損 26
（一）Barkley的抑制控制理論 26
（二）支持ADHD有抑制能力缺損的研究 29
（三）不支持ADHD有抑制能力缺損的研究 31
四、大腦的動機路徑與ADHD 32
（一）Sonuga-Barke的雙重路徑模式：認知路徑與動機路徑的交互作用32
（二）獎賞回饋迴路中的情緒調節系統對ADHD的影響 34
第三節 ADHD與社會認知 35
一、社會認知能力 36
二、他人的凝視方向是一個重要的社會性注意力線索 38
（一）他人的凝視方向會引發穩定的線索效應 40
（二）他人的凝視方向引發的迴向抑制和邊緣線索不同 41
（三）他人的凝視方向所引發的注意力轉移作用有個別差異 43
（四）處理他人凝視方向的神經傳導路徑涉及社會訊息處理的區域 44
三、連結性注意力：他人的凝視方向引發情感性判斷 45
（一）他人的凝視方向可影響情感性判斷 46
（二）連結性注意力的神經傳導路徑和動機路徑重疊 49
四、ADHD可能有偵測他人凝視方向相關的社會認知功能損傷 50
五、ADHD辨識臉孔情緒的能力 51
第四節 ADHD隨發展的變化 53
一、ADHD患者顯現腦部發展遲緩的現象 53
二、ADHD的過動/衝動行為症狀隨年齡增長而減緩 55
三、社會認知功能和注意力的發展 56
四、一般發展性研究的年齡區分方式 57
第三章 研究方法 60
一、研究對象 60
二、研究設備與材料 61
三、作業一 凝視線索作業 61
（一）研究目的 61
（二）作業的刺激材料 62
（三）作業設計 63
（四）作業程序 63
（五）計分方式 64
四、作業二 連結性注意力作業 64
（一）研究目的 64
（二）作業的刺激材料 64
（三）作業設計 65
（四）作業程序 66
（五）計分方式 67
五、作業三 辨識臉孔情緒作業 67
（一）研究目的 67
（二）作業的刺激材料 67
（三）作業設計 68
（四）作業程序 69
（五）計分方式 69
第四章 研究結果 70
第一節 他人凝視方向所引發的注意力轉移作用 70
一、凝視線索作業的線索效應與IOR……………………………………………71
二、凝視線索作業的反應正確率 77
第二節 連結性注意力 78
一、連結性注意力影響情感判斷 78
二、連結性注意力的線索效應 80
三、連結性注意力影響情感判斷的反應正確率 82
四、作業二的結果整理 82
第三節 線索效應大小的組間差異考驗 83
第四節 臉孔情緒的辨識能力 83
一、辨識臉孔情緒的反應正確率 84
二、辨識臉孔情緒的反應時間 85
第五節 反應時間變異範圍分析 86
第六節 相關考驗 87
第五章 討論與結論 90
第一節 ADHD的社會認知能力與發展 90
第二節 ADHD與ASD的社會認知能力 94
第三節 ADHD的臉孔情緒辨識能力 95
第五節 ADHD社會認知發展的可能內在機制 97
第六節 對臨床診斷和教學現場的意義 97
第七節 研究限制與未來的建議 98
第八節 結論 99
參考文獻 100

表目次

表2-1-1 ADHD的不良行為症狀………………………………………………… 10
表2-2-1 ADHD之空間性注意力研究摘要表…………………………………… 18
表2-2-2 以停止訊號作業測試ADHD之抑制能力結果摘要表………………… 27
表2-3-1 ADHD臉孔情緒辨識能力之相關研究………………………………… 49
表2-4-1 社會認知能力發展研究的年紀區分表………………………………… 56
表3-1 研究對象基本資料摘要表……………………………………………… 57
表4-1-1 各組別和各年齡層研究參與者之線索效應組內反應時間刪除標準（毫秒）與刪除率（%）………………………………………………………………68
表4-1-2 研究參與者之平均反應時間（毫秒）、正確率（%）和ANOVA考驗結果……………………………………………………………………………………69
表4-2-1 各組別和各年齡層研究參與者之喜好程度組內反應時間刪除標準（毫秒）與刪除率（%）………………………………………………………………77
表4-2-2 研究參與者之偏好作用反應時間的平均值（毫秒）和正確率（%）78
表4-2-3 各組別和各年齡層在凝視線索作業之線索效應、正確率和喜好程度 79
表4-3-1 各組別和各年齡層對臉部情緒辨識作業的反應正確率（%）…… 82
表4-5-1 相關分析的人數和各項測驗的平均數和標準差……………………… 84
表4-5-2 ADHD臨床測驗分數和作業分數達顯著之皮爾遜相關分析摘要表… 85
表4-5-3 ADHD臨床鑑定測驗分數與作業一、作業二和作業三表現之皮爾遜相關考驗摘要表……………………………………………………………………………86
表5-1 本研究所有參與者在凝視線索作業（作業一）與連結性注意力作業的表現（作業二）………………………………………………………………………… 87
表5-2 所有參與者的線索效應效果量摘要表………………………………… 91
表5-3 由資料選用臉孔情緒的常模標準摘要表……………………………… 93

圖目次

圖2-2-1 簡單偵測作業…………………………………………………………… 10
圖2-2-2 控制性注意力轉移作業………………………………………………… 20
圖2-2-3 強迫選擇性作業………………………………………………………… 20
圖2-2-4 Barkley的抑制控制…………………………………………………… 24
圖2-2-5 Sounga-Barke的雙重路徑模式……………………………………… 30
圖2-3-1 Baron-Cohen的心智理論…………………………………………… 35
圖2-3-2 Friesen與Kingstone（1998）的凝視方向作業示意圖………… 38
圖2-3-3 Frischen等人（2004）的凝視方向作業示意圖…………………… 39
圖3-3-4 連結性注意力（joint attention）……………………………… 43
圖2-3-5 Bayliss等人（2006）的分類作業示意圖………………………… 44
圖2-3-6 Bayliss等人（2007）的分類作業示意圖………………………… 45
圖3-1 作業程序示意圖………………………………………………………… 59
圖3-2 作業程序示意圖………………………………………………………… 62
圖3-3 實驗材料示意圖………………………………………………………… 65
圖3-4 實驗材料示意圖………………………………………………………… 65
圖4-1-1 6-8歲對他人凝視方向之線索效應與標準誤………………………… 70
圖4-1-2 9-12歲對他人凝視方向之線索效應與標準誤………………………… 71
圖4-1-3 13-16歲對他人凝視方向之線索效應與標準誤……………………… 72
圖4-1-4 一般組和ADHD三個年齡層在凝視線索作業的線索效應與95%信賴區間……………………………………………………………………………………… 73
圖4-2-1 9-12歲對他人凝視方向產生之喜好程度與標準誤…………………… 76
圖4-2-2 13-16歲對他人凝視方向產生之喜好程度與標準誤………………… 76
圖4-4-1 一般組和ADHD對凝視線索作業的反應效率………………………… 83

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