臺灣博碩士論文加值系統

研究目的：
注意力不足過動症是一種神經發展障礙疾患，神經回饋訓練是針對注意力不足過動症兒童的腦波特徵所發展的非藥物治療方法；而超過一半的注意力不足過動兒童，特別是男孩，會在七歲後共病對立反抗症，其對立反抗症共病的出現與父母教養有高度的關聯性，父母管教訓練是針對對立反抗症常見的治療。本研究目的在於以個案研究方式探討神經回饋訓練與父母管教訓練對於ADHD共病ODD兒童的治療效果，並完整介紹治療設計與歷程。
研究方法：
本研究對象為一名6歲ADHD共病ODD學齡男孩及其母親，兒童接受四十次神經回饋訓練，母親也同時接受四十次的父母管教訓練。本研究主要參考Tompson等人(1998)的概念設計神經回饋訓練，並參考奧勒岡模式父母管教訓練(Parent Management Training-Oregon Model, PMTO, Patterson, 1982)設計父母管教訓練。評量工具包括SNAP、CPT、GDS評估個案的ADHD症狀與注意力；而父母與老師填寫的SNAP、CBCL、TRF、簡式情緒量表評估個案的ODD症狀、問題行為與情緒調控能力。針對父母管教訓練的療效評估則是採用父母後設情緒理念量表與親子互動關係量表。研究分別在治療前、治療結束與治療後六個月追蹤進行評估。
研究結果：
經過治療後，個案的ADHD症狀在父母與老師評量有明顯的改善；在CPT表現中，個案的反應時間與遺漏值變得正常；在GDS的警覺測驗與分心測驗呈現明顯的進步，特別是在警覺測驗中從臨床異常下降至正常範圍。ODD症狀在老師的評估有明顯改善，而個案在家與在校的問題行為明顯減少，生氣情緒調控能力提升。
在半年後的追蹤療效中，母親認為個案的ADHD症狀持續改善，而老師則是認為個案的ADHD症狀有輕微上升的趨勢；在CPT的反應時間持續減少；GDS的延遲測驗、警覺測驗與分心測驗都有明顯的進步。個案在家與在校的ODD症狀獲得改善，問題行為也持續減少，老師認為個案的生氣情緒調控能力持續增進。父母管教訓練治療結果顯示母親在治療後與追蹤時的教養技巧增加，親子互動關係提升。
結論與討論：
綜合研究結果來說，個案的ADHD症狀與ODD症狀獲得改善，注意力提升，問題行為減少，生氣情緒調節能力增加，而母親的教養能力提升，親子關係更加緊密親近。治療效果不只在治療結束時出現，甚至在治療結束後的半年仍持續進步。整體來說，本研究以神經回饋訓練改善個案的注意力不足與過動衝動症狀，並以父母管教訓練降低兒童的對立反抗症狀，這樣的治療組合對於本研究的ADHD共病ODD男童是一有效的治療方式，能夠作為後續研究者與臨床工作者在進行ADHD共病ODD兒童治療時的參考。

Objective
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder, and neurofeedback training is a promising non-pharmacological treatment which is based on the specific brainwave patterns of ADHD children. Half or more of all children with ADHD- mostly boys-meet criteria for Oppositional defiant disorder (ODD) by age 7 or later. The comorbidity of ODD is highly correlated with parenting, and parent management training is a common treatment for ODD.The goal of the case study is to explore the treatment effects of neurofeedback training and parent management training in children with ADHD comorbid ODD and to completely demonstrate the treatment practices and processes.
Method
A 6-year-old boy with ADHD comorbid ODD and his mother participated in the study. The client received 40 sessions of neurofeedback training, while his mother received 40 sessions of parent management training. In this study, the neurofeedback training treatment was adapted from Thompson and Thompson’s study(1998),and the parent management training was adapted from Parent Management Training-Oregon Model (PMTO, Patterson, 1982). ADHD symptoms and attention were measured by SNAP-IV, Conners’ continuous performance test (CPT) and Gordon Diagnostic System (GDS).ODD symptoms, disruptive behaviors and emotional ability were measured by SNAP-IV, Child Behavior Checklist (CBCL),Teacher Report Form(TRF) and the emotion questionnaire by parent and teacher. The treatment outcomes of parent management training were assessed by Parental Meta-Emotion Philosophy Questionnaire and the Sale of Prents-child Interaction.The assessments were adminustred in Pre-training, post-training assessment and six month follow-up assessment.
Results
In post-training assessment, there were significant reductions of parent-rated and teacher-rated ADHD symptoms. CPT demonstrated a normalization of the reaction time and ommission.The client’s performances on the GDS vigilance and distractibility tasks were apparently improved,and especially the scores of vigilance tasks declined from abnormal to normal level.There was a significant reduction of teacher-rated ODDsymptoms,while the client’s disruptive behaviors in school or at home were declined dramatically,and his anger emotion regulation was improved.Parental Meta-Emotion Philosophy Questionnaire rated by client’s mother indicated the improvement that her emotion philosophy from emotion dysfunction bacame emotion-coaching.The authority of Parent-child relationshipdeclined.
In follow-up assessment, there was a reduction of parent-rated ADHD symptoms and a slight increasing tendency for teacher-rated ADHD symptoms.With the reaction time of CPT still improving, the client’s performances on the GDS delay, vigilance and distractibility tasks were all remarkable.Parent-rating and teacher-rating of ODD symptoms showed improving,and the client’s disruptive behaviors decreased.The client’s anger emotion regulation kept consistently progressing.Client’s mother still kept emotion-coaching and the parent-child interaction improved.
Conclusions and discuss
According to the results,the client’s ADHD symptoms, ODD symptoms declined,attemtion performance improved,disruptive behaviors decreased and anger emotion regulation made progressing.The parenting of his mother enhanced, and the parent-child interaction got closer.The treatment effects not only showed in post-training assessment but also in follow-up assessment. In summary, the neurofeedback training improved the client’s innattention and hyperactive-impulsive symptoms, and parent management training improved the client’s ODD symptoms.The combination of the two treatments is an effective therapy for the client with ADHD comorbid ODD which could be referenced by future researchers and clinical practitioners in treatment of children with ADHD comorbid ODD.

摘要
第一章 、緒論 1
第二章 、文獻回顧 3
第一節、注意力不足/過動症共病對立反抗症兒童的特徵 3
第二節、注意力不足/過動症共病對立反抗症的兒童治療 12
第三節、ADHD的神經回饋訓練 17
第四節、ODD的父母管教訓練 30
第五節、研究目的 42
第三章 研究方法 43
第一節、研究對象 43
第二節、研究工具 49
第三節、研究步驟與程序 55
第四章 治療作法與研究結果 57
第一節、治療計劃 57
第二節、治療作法與歷程探討 60
第三節、治療結果 70
第四節、家長的回饋 82
第五章 討論 85
第一節、治療效果探討 85
第二節、治療師的反思實踐 91
第三節、研究貢獻與限制 96
參考文獻 96

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