臺灣博碩士論文加值系統

背景與目的：許多被診斷為動作協調障礙兒童 (Developmental Coordination Disorder，DCD) 常合併有注意力、學習及心理社會調適的問題。過去有許多探討DCD兒童的相關問題，但這些研究在選取研究個案時，通常只使用單一評估工具或非標準化測驗（老師或醫生轉介）來診斷DCD，無法篩選出不同亞型的DCD兒童。然而，先前使用超過二種評估工具來診斷DCD之研究多侷限於臨床樣本。因此，本研究的目的是以兩步驟選取法，探討社區樣本中DCD和疑似DCD兒童的注意力、學習問題及心理社會調適問題，以及不同動作障礙程度兒童在上述的表現。
方法：第一步驟以發展協調障礙問卷-中文版 (Developmental Coordination Disorder Questionnaire-Chinese version, DCDQ-C) 篩選出因動作問題而致日常生活功能受影響之兒童，第二步驟使用兩個標準化動作測驗，分別是兒童動作評量組 (Movement Assessment Battery for Children, MABC) 與布朗尼動作能力測驗 (Bruininks-Oseretsky Test of Motor Proficiency, BOTMP) 鑑定DCD組、疑似DCD組以及正常組。由家長填寫兒童活動量表及兒童行為檢核表，並給予兒童施測基本讀寫字綜合測驗。
結果：結果顯示三組在兒童活動量表和兒童行為檢核表之注意力向度上有顯著差異。在學習方面，看字讀音與看字造詞上，三組有顯著差異；在看注音寫國字與聽寫上，三組均無顯著差異；在心理社會調適問題上，DCD與疑似DCD兒童均比正常組顯示更多的問題，除了身體上的抱怨這一項；但DCD組與疑似DCD組之間並無差異。
結論：本研究結果顯示這一群未被轉介到臨床的社區兒童，透過兩步驟的方法鑑定為DCD的兒童，與臨床個案一樣，在注意力、學習發展與心理社會調適上均有問題；而被我們鑑定為疑似DCD的兒童與臨床個案一樣，在注意力與心理社會調適上均有問題，而在基本閱讀及書寫技巧上是沒有困難的；在不同動作障礙的DCD中，在注意力、學習與心理社會調適問題上都有相同的影響。因此，針對社區兒童進行動作協調障礙的篩檢，以早期發現、早期介入，對於後續學習問題的預防是相當重要的。此外，本研究結果提醒臨床工作者或父母需注意這一群未被轉介的DCD兒童，不僅在學習上要留意，更要注意其行為與心理社會調適問題。

Background and Purpose: Many children diagnosed with developmental coordination disorder (DCD) show problems with attention, learning and psychosocial adjustment. Much literature investigated the attention, learning and psychosocial adjustment issues of children with DCD, but most of them identified children with DCD through either one motor test or doctors’/teachers’ referral and one motor test. Although few studies used more than two tests for identification, they might use the clinical samples rather than community samples. Thus, the purpose was to use two-step procedure to identify children in the community and investigate the problems in attention, learning and psychosocial adjustment of the children with different degrees of DCD.
Methods: The first step was to screen children with motor impairments by the Developmental Coordination Disorder Questionnaire-Chinese version (DCDQ-C). The second step used two standardized movement tests, i.e., Movement Assessment Battery for Children (MABC) and Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) to identify the children with motor impairments. The parents of these children completed the Child behavior checklist- Chinese version (CBCL-C) and the Activity Level Rating Scale (ALRS). The children of the three groups received assessment of the Basic Reading and Writing Test Battery (BRWTB) by the examiner.
Results: Results revealed significant group differences on the Attention Problems subscale of the CBCL-C and the ALRS. Results revealed marginal and significant group effects on two subtests of the BRWTB, but no significant group effects on another subtests of the BRWTB. Children with motor impairments had more difficulties in psychosocial adjustment problems except the Somatic Complaints than the control group, but no significant differences existed on psychosocial adjustment problems between children with different severity of motor impairment.
Conclusion: In summary, the results of the study indicated that the non-referred children who were identified by standardized motor tests as DCD were like referred children who were reported to be often associated with problems in attention, learning and psychosocial adjustment. The results also indicated that non-referred children who were identified as suspect for DCD were at risk for problems in attention and psychosocial adjustment, but had no difficulties in basic reading and writing skills. Furthermore, the findings of the present study indicated that DCD had similar impacts on attention, learning and psychosocial adjustment of children with different severity of motor impairments. Thus, it is suggested that parents and teachers be aware of the behavior and psychosocial problems of their non-referred children with DCD, in addition to learning problems.

Abstract .......................................................................................I
中文摘要 ....................................................................................III
Table of Contents ........................................................................V
List of Tables ...............................................................................VIII
List of Figure................................................................................IX
Introduction .................................................................................1
Introduction to the children with DCD .........................................1
Terminology ................................................................................1
The diagnosis criteria of DCD ......................................................2
The prevalence of DCD ................................................................3
The associated problems of children with DCD ............................3
Problems in attention and hyperactivity .........................................3
Problems in learning.......................................................................4
Problems in psychosocial adjustments...............................................5
The limitations of previous studies on the associated problems in children with DCD......................................................................................8
The merits of a two-step procedure........................................................9
The purpose of the study.....................................................................10
Methods ..........................................................................................11
Participants .......................................................................................11
Instruments .......................................................................................11
Procedures ......................................................................................18
Data analyses ...................................................................................20
Results ........................................................................................21
Group differences on age, gender, and SES .....................................21
Attention problems and activity level................................................21
Learning problems ...........................................................................23
Psychosocial adjustment problems ...................................................24
Discussion ........................................................................................27
Attention problems and activity level................................................27
Learning problems ............................................................................28
Psychosocial adjustment problems ....................................................30
Clinical implications .........................................................................32
Limitations and the Recommendations for further research ...............33
Conclusions ................................................................................34
References ..................................................................................35
Tables ..........................................................................................43
Figure .........................................................................................47
Appendices ...................48
Appendix 1 Developmental Coordination Disorder Questionnaire-Chinese version .............................................................................48
Appendix 2 Activity Level Rating Scale ..........................................................51
Appendix 3 Child Behavior Checklist- Chinese version ..................................54

List of Tables
Table 1 Group differences on the mean scores of the BRWTB………43
Table 2 Group differences on the mean scores of the CBCL-C………44
Table 3 The percentage of children scored in the clinical range of the CBCL-C………………………………………………45
Table 4 Group differences in the proportion of children scored in the clinical range of the CBCL-C between groups the cutoff on the ALRS between groups……………………………………46

List of Figure
Figure 1 Two-step procedure in sampling………………………47

Achenbach, T. M. (1991). Manual for the child behavior checklist4-18 and 1991 profile. Burlington, VT: University of Vermont.
American Psychiatric Association. (1994). Motor skill disorder 315.40 Developmental coordination disorder., Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Bruininks, R. H. (1978). Bruininks-Oseretsky Test of Motor Proficiency: Examiner''s Manual. Circle Pines, Minnesota: American Guidance Service.
Cantell, M. H., Smyth, M. M., & Ahonen, T. P. (1994). Clumsiness in adolescence: Educational, motor and social outcomes of motor delay detected at 5 years. Adapted Physical Activity Quarterly, 11, 115-129.
Chen, W. J., Faraone, S. V., Biederman, J., & Tsuang, M. T. (1994). Diagnostic accuracy of the Child Behavior Checklist scales for attention-deficit hyperactivity disorder: a receiver-operating characteristic analysis. Journal of Consult Clinical Psychology, 62, 1017-1025.
Chow, S. M., & Henderson, S. E. (2003). Inter-rater and test-retest reliability of the Movement Assessment Battery for Chinese preschool children. American Journal of Occupational Therapy, 57, 574-577.
Dewey, D., Kaplan, B. J., Crawford, S. G., & Wilson, B. N. (2002). Developmental coordination disorder: Associated problems in attention, learning, and psychosocial adjustment. Human Movement Science, 21, 905-918.
Dewey, D., & Wilson, B. N. (2001). Developmental coordination disorder: What is it? Physical & Occupational Therapy in Pediatrics, 20, 5-27.
Dewey, D., Wilson, B. N., Crawford, S. G., & Kaplan, B. J. (2000). Comorbidity of developmental coordination disorder with ADHD and reading disability. Journal of the International Neuropsychological Society, 6, 152.
Elliott, S. N., Busse, R. T. (1992). Review of the Child Behavior Checklist (Vol. 11). Lincoln: NE: Buros Institute of Mental Measurement.
Geuze, R. H., & Borger, H. (1993). Children who are clumsy: Five years later. Adapted Physical Activity Quarterly, 10-21.
Gillberg, C. (1998). Hyperactivity, inattention and motor control problems: Prevalence, comorbidity and background factors. Folia Phoniatrica et Logopedica, 50, 107-117.
Gillberg, C. (2003). Deficits in attention, motor control, and perception: A brief review. Archives of Disease in Childhood, 88, 904-910.
Gillberg, I. C. (1985). Children with minor neurodevelopmental disorders: Nerological and neurodevelopmental problem at age 10. Developmental Medicine & Child Neurology, 27, 3-16.
Gillberg, I. C., & Gillberg, C. (1989). Children with preschool minor neurodevelopmental disorders. IV: Behavior and school achievement at age 13. Developmental Medicine and Child Neurology, 31, 3-13.
Gillberg, I. C., Gillberg, C., & Gorth, J. (1988). Children with preschool minor neurodevelopmental disorders: Neurodevelopmental profiles at age 13. Developmental Medicine & Child Neurology, 31, 14-24.
Gubbay, S. S. (1975). Clumsy children in normal schools. Medical Journal of Australi., 1, 233-236.
Hellgren, L., Gillberg, I. C., Bagenholm, A., & Gillberg, C. (1994). Children with deficits in attention, motor control and perception (DAMP) almost grown up: Psychiatric and personality disorders at age 16 years. Journal of Child Psychology and Psychiatry, 35, 1255-1271.
Hellgren, L., Gillberg, C., Gillberg, I. C., & Enerskog, I. (1993). Children with deficits in attention, motor control and perception (DAMP) almost grown up: Genaral health at 16 years. Developmental Medicine and Child Neurology, 35, 881-892.
Henderson, S. E., & Barnettt, A. L. (1998). The classification of specific motor coordination disorders in children: Some problems to be solved. Human Movement Science, 17, 449-469.
Hollingshead, A. B. (1957). Two Factor Index of Social Position. New Haven: Hollingshead AB.
Huang, H. L., Chuang, S. F., & Wang, Y. C. (1994). Developing the multiaxial behavioral assessment of children in Taiwan. Psychology Press, Taipei, Taiwan: C. A. Associaltion.
Jensen, P. S., Wantanabe, H. K., Richters, J. E., Roper, M. (1996). Scales, diagnosis, and child psychopathology: Comparing the CBCL and the DISC against external validators. Journal of Abnormal Child Psychology, 24, 151-168.
Jongmans, M. J., Smits-Engelsman, B. C., & Schoemaker, M. M. (2003). Consequences of comorbidity of developmental coordination disorders and learning disabilities for severity and pattern of perceptual-motor dysfunction. Journal of Learning Disabilities, 36, 528-537.
Kadesjo, B., & Gillberg, C. (1998). Attention deficits and clumsiness in Swedish 7- year-old children. Developmental Nedicine Child Neurology, 40, 796-804.
Kadesjo, B., & Gillberg, C. (1999). Developmental coordination disorder in Swedish 7-year-old children. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 820-828.
Kaplan, B. J., Dewey, D. M., Crawford, S. G., & Wilson, B. N. (2001). The term comorbidity is of questionable value in reference to developmental disorders: Data and theory. Journal of Learning Disabilities, 34, 555-565.
Kaplan, B. J., Wilson, B. N., Dewey, D., & Crawford, S. G. (1998). DCD may not be a discrete disorder. Human Movement Science, 17, 471-490.
Kuo, P. H., Yang, H. J., Soong, W. T., & Chen, W. J. (2002). Substance use among adolescents in Taiwan: Associated personality traits, incompetence, and behavioral/emotional problems. Drug and Alcohol Dependence, 67, 27-39.
Lee, D. A., Portnoy, S., Hill, P., Gillberg, C., & Patton, M. A. (2005). Psychological profile of children with Noonan syndrome. Developmental Medicine & Child Neurology, 47, 35-38.
Levine, M. D., Busch, B., & Aufseeser, C. (1982). The dimension of inattention among children with school problems. Pediatrics, 3, 387-395.
Losse, A., Henderson, S. E., Elliman, D., Hall, D., Knight, E., & Jongmans, M. (1991). Clumsiness in children: Do they grow out of it? A 10-year follow-up study. Developmental Medicine & Child Neurology, 33, 55-68.
Macmann, G. M., Barnett, D. W., Burd, S. A., Jones, T. (1992). Construct validity of the Child Behavior Checklist: Effects of item overlap on second-order factor structure. Psychological Assessment, 4, 113-116.
Missiuna, C., & Pollock, N. (1995). Beyond the norms: Need for multiple sources of data in the assessment of children. Physical and Occupational Therapy in Pediatrics, 15, 57-71.
Mooney, K. C. (1984). Review of the Child Behavior Checklist. (Vol. 1). Kansas City: MO: Westport Publications.
Piek, J. P., Pitcher, T. M., & Hay, D. A. (1999). Motor coordination and kinaesthesis in boys with attention deficit-hyperactivity disorder. Developmental Medicine & Child Neurology, 41, 159-165.
Portman, P. A. (1995). Who is having fun in physical education classes? Experiences of sixth-grade students in elementary and middle schools. Journal of teaching in Physical Education, 14, 445-453.
Rarick, G. L., & McKee, R. (1949). A study of twenty third-grade children exhibiting extreme levels of achievement on tests of motor proficiency. Research Quarterly, 20, 142-152.
Rosblad B, a. G. L. (1998). The assessment of children with developmental coordination disorders in Sweden: A preliminary investigation of the suitability of the movement ABC. Human Movement Science, 17, 711-719.
Rose, B., Larkin, D., & Berger, B. (1997). Coordination and gender influences on the perceived competence of children. Adapted Physical Activity Quarterly, 14, 210-221.
Rutter, M. (1989). Pathways from childhood to adult life. Journal of Child Psychology and Psychiatry, 30, 23-51.
Schoemaker, M., & Kalverboer, A. F. (1994). Social and affective problems of children who are clumsy: how early do they begin? Adapted Physical Activity Quarterly, 11, 130-140.
Cermak, S. A., Larkin, D. (2002). Developmental coordination disorder. Albany, NY: Delmar Thomson Learning.
Spielberger, C. D. (1973). The state-trait anxiety inventory for children. In (pp. 1-11). Palo Alto, CA: Consulting Psychologists Press.
Tseng, M. H., & Fu, C. P. (2006). Chinese version of the Developmental Coordination Disorder Questionnaire: A reliability and validity study. (in manuscript).
Van Dellen, T., Vaessen, W., & Schoemaker, M. M. (1990). Clumsiness: definition and selection of subjects. In I. A. F. Kalverboer (Ed.), Developmental biopsychology: Experimental and observational studies in children at risk (pp. 135-152): Ann Arbor: University of Michigan Press.
Visser, J. (2003). Developmental coordination disorder: A review of research on subtypes and comorbidities. Human Movement Science, 22, 479-493.
Weingarten, G. (1980). The contribution of athletic and physical variables to social status in Israeli boys. International Journal of Physical Education, 17, 23-26.
Werry, J. (1968). Developmental hyperactivity. Pediatric Clinics of North America, 15, 581-599.
Wilson, B. N., Kaplan, B. J., Crawford, S. G., Campbell, A., & Dewey, D. (2000). Reliability and validity of a parent questionnaire on childhood motor skills. American Journal of Occupational Therapy, 54, 484-493.
Wilson, P. H., Maruff, P., Ives, S., & Currie, J. (2001). Abnormalities of motor and praxis imagery in children with DCD. Human Movement Science, 20, 135-159.
Wright, H. C., & Sugden, D. A. (1996). A two-step procedure for the identification of children with developmental coordination disorder in Singapore. Developmental Medicine & Child Neurology, 38, 1099-1105.
Yang, H. J., Soong, W. T., Chiang, C. N., & Chen, W. J. (2000). Competence and Behavioral/Emotional problems among Taiwanese adolescents as reported by parents and teachers. Journal of American Academic Child Adolescent Psychiatry, 39, 232-239.
The Ministry of the Interior (n.d.). Investigation of the birth rates in the past years in Taiwan. Retrieved July 7, 2006, from http://www.moi.gov.tw/home/home.asp