臺灣博碩士論文加值系統

注意力缺陷過動症（ADHD）是盛行率最高的兒童精神疾患之一，主要症狀為不專注與過動衝動症狀，ADHD症狀影響著兒童的行為與認知方面的表現，DSM-IV與ICD-10中首次將症狀需跨情境出現納入ADHD診斷準則中，因此在診斷ADHD過程中需取得不同情境裡不同資料提供者之訊息，然而，不同資料提供者的報告間並不一致，本研究的目的為探討ADHD兒童在不同情境中多元資料提供者評量ADHD症狀之同意度情形。
本研究的對象為39名初次臨床診斷為ADHD的兒童及其母親、父親與教師。本研究所採用的工具包括：干擾行為評量表家長版、干擾行為評量教師版、兒童行為檢核表、教師報告表與Conners持續性表現測驗（CPT-II），ADHD兒童之母親、父親與教師分別填答干擾行為評量表家長版、干擾行為評量表教師版、兒童行為檢核表及教師報告表，兒童則接受CPT-II的評估。研究結果發現，母親、父親與教師三者在ADHD症狀嚴重度的報告上無顯著差異，母親、父親與教師對ADHD症狀評量的一致性與相互預測力亦比預期低，其中，母親與父親的報告有顯著中度相關，母親與教師的報告有顯著低至中度相關，父親與教師的報告只有低度相關且未達顯著。另外，母親、父親、教師的評量結果與兒童的CPT-II結果無顯著相關，三者的評量結果與醫師診斷則達到中度的同意度。
研究結果顯示，診斷ADHD時不能僅依據單一情境或單一資料提供者的訊息，在臨床衡鑑過程中，臨床工作者須同時取得不同情境中多元資料提供者的報告，以及謹慎考量如何整合與解釋不一致的衡鑑結果。未來研究可進一步探討影響不同資料提供者間同意度之因素。

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent mental disorders in children. It is characterized by three primary symptoms: inattention, hyperactivity, and impulsivity, which often affect cognitive and behavioral performance of ADHD children. In their revised diagnostic criteria for ADHD, the DSM-IV and ICD-10 added the perva- siveness of ADHD symptoms as a necessary condition for making such a diagnosis; therefore, clinicians require information from multiple sources in the process of diagnosis and assessment. Nevertheless, previous re- search often reported discordance among multiple sources. The aim of this study is to examine the degree of agreement among multiple infor- mants in terms of their ratings of ADHD symptoms in different situations.
A sample of 39 ADHD children and their parents and teachers par- ticipated in this study. Instruments used in this study included: the Disrup- tive Behavior Rating Scale-Parent Form (DBRS-PF) and Teacher Form (DBRS-TF), Child Behavior Checklist (CBCL), Teacher Report Form (TRF), and Conners’ Continuous Performance Test (CPT-II). Parents completed the DBRS-PF and CBCL; teachers completed the DBRS-TF and TRF; and the CPT-II was administered to the children. The results indicated there is no significant discrepancy among mother, father, and teacher ratings. The degree of concordance and predictability among three informants were lower than expected. There were significant moderate correlations between maternal and parental rating and significant low to moderate correlations between mother and teacher rating, but the corre- lations between father and teacher rating was low and not significant. In addition, correlations between reports of mother, father, and teacher and CPT-II results were minimal and not significant. Degree of agreement be- tween reports from three informants and clinical diagnosis were in the moderate range.
The results suggest that the diagnosis of ADHD should not merely based on information from single informant or single setting. In the pro- cess of assessment, it is suggested that practitioners try to collect infor- mation from multiple sources and integrate and interpret the information with cautions. Further investigation of factors that might affect the degree of agreement between different informants is warranted.

長庚大學碩士學位論文 指導教授推薦書 i
長庚大學碩士學位論文 口試委員會審定書 ii
博碩士論文授權書 iii
博碩士論文電子檔案上網授權書 iv
長庚大學博碩士紙本論文著作授權書 v
誌 謝 vi
摘 要 viii
目 錄 xii
第一章 緒論 1
1.1研究背景 1
1.2文獻回顧 5
1.2.1注意力缺陷過動症 5
1.2.1.1主要症狀 6
1.2.1.2診斷相關議題與現況 8
1.2.1.3盛行率 11
1.2.1.4病因 12
1.2.2 ADHD的心理衡鑑 16
1.2.2.1 臨床晤談 16
1.2.2.2 評量表 18
1.2.2.3 其他心理測驗 19
1.2.3 兒童衡鑑之多元資料提供者相關議題 23
1.2.3.1兒童心理病理與兒童衡鑑 23
1.2.3.2兒童之重要他人在衡鑑過程中之重要性 24
1.2.3.3不同資料提供者間同意度情形之實徵研究 26
1.3研究目的與假設 32
1.3.1研究目的 32
1.3.2研究假設 33
第二章 研究方法 34
2.1 研究參與者 34
2.2 研究工具 35
2.2.1基本資料問卷 36
2.2.2兒童行為評估工具—他人評量 37
2.2.3兒童行為評估工具—直接評量 42
2.3 研究步驟 45
2.4 同意度指標 46
2.5 資料分析方法 49
第三章 研究結果 51
3.1 ADHD兒童樣本及其母親、父親和教師之基本資料 51
3.2 ADHD症狀量表之信效度 57
3.2.1 信效度樣本之基本資料 57
3.2.2 信度考驗 57
3.2.3 效度考驗 58
3.3 母親、父親與教師在ADHD症狀之同意度分析 60
3.3.1母親、父親與教師報告ADHD症狀之差異性分析 61
3.3.2母親、父親與教師報告ADHD症狀之一致性分析 65
3.3.3母親、父親與教師報告ADHD症狀之預測性分析 70
3.4 他人報告ADHD症狀結果與臨床評估結果之相關分析 75
3.4.1 ADHD症狀與CPT-II測量指標之相關 75
3.4.2 母親、父親、教師報告與醫師診斷之同意度百分比 83
第四章 討論 86
4.1 研究樣本之代表性 86
4.2 研究工具之適當性 88
4.2.1 ADHD症狀分量表之信效度考驗 88
4.2.2 CPT-II的內部相關考驗 90
4.3 母親、父親與教師報告兒童ADHD症狀之同意度情形 91
4.3.1 差異性議題 91
4.3.2 一致性議題 92
4.3.3 預測性議題 94
4.3.4 小結 97
4.4 母親、父親、教師報告結果與臨床情境評估結果之比較 97
4.4.1 CPT-II指標與ADHD症狀向度之相關 98
4.4.2 CPT-II指標與18項ADHD核心症狀之相關 99
4.4.3不同資料提供者報告與醫師診斷結果間之同意度情形 100
4.4.4 小結 101
第五章 結論與建議 103
5.1 研究結論 103
5.2 研究貢獻與臨床應用 105
5.3 研究限制 107
5.3.1 研究樣本 107
5.3.2 研究工具 107
5.3.3 研究步驟 108
5.4 未來研究方向 108
參考文獻 111
附錄一、受試者同意書 126
附錄二、兒童心智科初診表格 127
附錄三、教師基本資料 129
附錄四、父母社經地位計算說明 130

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