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研究生:林美亨
研究生(外文):Mei Heng Lin
論文名稱:探討外在回饋對注意力缺損/過動症兒童抑制能力、錯誤處理能力之效應
論文名稱(外文):The Effect of External Feedback on Inhibition and Error Processing in Children with Attention-Deficit Hyperactivity Disorder
指導教授:沈宜璇沈宜璇引用關係
指導教授(外文):I. H. Shen
學位類別:碩士
校院名稱:長庚大學
系所名稱:職能治療學系
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
論文頁數:143
中文關鍵詞:注意力缺損/過動症抑制能力錯誤處理能力外在回饋
外文關鍵詞:ADHDInhibitionError processingExternal feedback
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文獻中指出注意力缺損/過動症兒童不僅在抑制上有所缺失,在犯錯後亦無法準確調整行為並修正表現,影響其與環境互動的效率。目前有關注意力缺損/過動症兒童在抑制能力與錯誤處理能力的討論仍有不一致處,而且少有研究探討如何提升注意力缺損/過動症兒童此兩種能力的方式。本研究目的為探討注意力缺損/過動症兒童抑制能力、與錯誤處理能力,並進一步探討給予外在回饋的行為治療方式對注意力缺損/過動症兒童抑制能力、錯誤處理能力之效應。
本研究共招募31位9~12歲、智力正常之注意力缺損/過動症兒童、與30位年齡、智力與注意力缺損/過動症兒童組匹配之典型發展孩童,經排案後將24位注意力缺損/過動症男童隨機分至有回饋組(n=12)、無回饋組(n=12),另24位典型發展孩童也分為有、無回饋兩組。四組受試者須執行反應/不反應史楚普任務(Go/no-go Stroop task),其中兩組回饋組受試者在不反應任務後,會依據其行為表現(有抑制住反應/未抑制住反應)提供正/負回饋(金幣/炸彈);而另兩組無回饋組受試者則無。本研究以行為資料與事件相關電位比較四組受試者之抑制能力、錯誤處理能力。
在行為表現上,四組受試者錯誤試驗反應時間均比正確試驗快,且兩組注意力缺損/過動症受試者抑制失敗率、反應時間變異性皆較兩組控制組高。四組受試者之錯誤後速度減緩皆不顯著。在回饋的效應上,注意力缺損/過動症有回饋組較注意力缺損/過動症無回饋組抑制失敗率低、錯誤後試驗反應時間較長、錯誤後試驗準確性較高。在事件相關電位上,四組受試者在不反應試驗上之N2、ERN振幅均無顯著差異,而注意力缺損/過動症兒童有回饋組之P3b潛伏期較無回饋組長、Pe振幅較無回饋組大。
本研究顯示注意力缺損/過動症兒童在抑制能力、錯誤處理能力上有所缺失,然而,當給予注意力缺損/過動症兒童外在回饋後,對於部分抑制能力、以及錯誤後行為策略調整有正向效應。
Previous studies indicated that impaired inhibition control and error processing were shown in Attention deficit/hyperactivity disorder (ADHD). Although substantial studies provided the evidence of inhibition and error processing deficits in ADHD, some controversy still exists. Moreover, there is lack of empirical intervention research related to these two issues. Hence, the aims of this study are two folded: by use of the behavioral and ERP indices (1) to investigate the inhibition and error processing abilities in ADHD (2) to verify the effect of external feedback on inhibition and error processing abilities in ADHD.
Twenty-four boys with ADHD aged between 9~12 and IQ above 85 were randomly assigned into two groups: tasks with feedback (AF) and without feedback (AN). Twenty-four IQ and age matched controls were also recruited, divided into two groups (CF and CN). All participants completed modified go/no-go Stroop task. Both group AF and CF received external feedback (coin or bomb) according to their performance after each no-go trial.
Compared to both control groups, both ADHD groups made more errors and were more variable in react\ion time. The RTs are faster on error trials than correct trials across four groups. No post-error slowing (PES) effect was shown in all groups. However, less errors, more percentage of accuracy, and longer reaction time of trials followed by errors were found in the two feedback groups compared to the other non-feedback groups. No group difference was shown in N2, ERN amplitude. However, Pe amplitude was larger, and P3b latency is longer in group AF, compared with group AN.
Results showed that deficits in inhibition and error processing in children with ADHD. External feedback can motivate ADHD to enhance their inhibitory control and adjust performance after committing errors, as observed in higher successful inhibition rate and better post-error behavioral adjustments in group AF than in AN.
目錄
論文指導教授推薦書 -i-
論文口試委員審定書 -ii-
國家圖書館授權書 -iii-
長庚大學授權書 -iv-
誌謝 -v-
中文摘要 -vii-
英文摘要 -ix-
目錄 -xi-
第一章、緒論 -1-
第一節、研究背景與重要性 -1-
第二節、研究動機與目的 -1-
第三節、待答問題 -3-
第四節、名詞釋義 -3-
壹、注意力缺損過動症 -3-
貳、事件相關電位 -4-
參、外在回饋 -4-
第二章、文獻回顧 -5-
第一節、ADHD執行功能缺陷 -5-
第二節、ADHD抑制能力探究 -6-
壹、抑制能力 -6-
一 、反應不反應任務及參數介紹 -8-
二 、ADHD執行反應不反應任務之行為表現 -9-
貳、反應不反應任務事件相關電位研究 -10-
一、N2波 -10-
二、P3波 -12-
三、ADHD執行反應不反應任務相關之ERP研究 -14-
第三節、ADHD錯誤處理能力探究 -15-
壹、錯誤處理機制 -15-
一、錯誤處理相關參數介紹 -17-
二、ADHD之錯誤處理行為表現 -18-
貳、錯誤處理相關ERP -19-
一、ERN波 -19-
二、Pe波 -20-
三、ADHD錯誤處理相關ERP研究 -22-
第四節、外在回饋對ADHD行為表現的效應 -23-
壹、外在回饋的功能 -23-
一、反映結果的資訊 -24-
二、提升動機 -24-
貳、外在回饋與ADHD之相關研究 -26-
參、ADHD外在回饋之事件相關電位研究 -26-
一、回饋相關負波 -26-
第五節、總結 -27-
第六節、研究提問與研究假設 -28-
壹、研究提問 -28-
貳、研究假設 -28-
第三章、研究方法 -30-
第一節、研究設計 -30-
壹、研究法 -30-
貳、研究架構 -30-
參、變項定義 -31-
肆、實驗設計 -31-
第二節、研究對象 -34-
壹、選取標準 -34-
貳、排除標準 -34-
參、樣本來源 -35-
肆、樣本數量及檢定 -35-
第三節、研究工具 -35-
壹、控制變項研究工具 -35-
貳、自變項研究工具 -36-
一、診斷 -36-
二、試驗情境 -36-
參、依變項研究工具 -36-
一、行為資料 -36-
二、腦電生理訊號記錄 -37-
第四節、研究過程 -38-
壹、研究程序 -38-
貳、研究設備 -39-
第五節、資料分析 -39-
壹、控制變項 -39-
貳、自變項 -40-
參、依變項 -40-
一、行為資料 -40-
二、事件相關電位分析 -42-
第四章、研究結果 -43-
第一節、基本資料 -43-
第二節、行為資料 -45-
壹、反應/不反應任務(Go/No Go task)相關行為參數 -45-
一、抑制失敗率 -46-
二、反應試驗遺漏率 -47-
三、試驗反應時間 -48-
四、正確反應時間變異性 -49-
貳、錯誤處理層面 -50-
一、錯誤覺察率 -50-
二、錯誤後速度減緩 -51-
三、錯誤後試驗準確率 -52-
第三節、腦波資料 -53-
壹、抑制能力層面 -53-
一、N2 -53-
二、P3a -57-
三、P3b -60-
貳、錯誤處理層面 -64-
一、無回饋組中與覺察相關之腦波結果 -65-
二、四組受試者正確試驗、錯誤試驗之腦波結果比較 -73-
三、四組受試者錯誤試驗ERP、Pe比較 -75-
參、回饋層面 -83-
一、回饋相關負波 -83-
肆、結果小結 -86-
第五章、討論 -88-
第一節、基本資料 -88-
第二節、行為資料 -88-
壹、反應/不反應任務(Go/No Go task)相關行為參數 -89-
¬貳、錯誤處理能力 -91-
第三節、腦波資料 -95-
壹、抑制能力層面 -95-
一、N2 -95-
二、P3 -97-
¬貳、錯誤處理層面 -98-
一、錯誤察覺 -99-
二、外在回饋對於錯誤處理之效應 -100-
參、行為表現與ERP綜論 -104-
第六章、結論 -107-
第一節、臨床應用 -107-
第二節、研究限制 -108-
附錄一 -109-
參考文獻 -112-

表目錄
表2-1 ERP波形總整理 -28-
表3-1 各變項定義 -31-
表3-2 行為參數表 -41-
表3-3 ERP分析表 -42-
表4-1 四組受試者基本資料與問卷得分結果 -44-
表4-2 四組受試者整體表現行為資料表 -45-
表4-3 抑制失敗率變異數分析摘要表 -46-
表4-4 反應試驗遺漏率變異數分析摘要表 -47-
表4-5 反應時間變異數分析摘要表 -48-
表4-6 正確反應時間變異性變異數分析摘要表 -49-
表4-7 四組受試者錯誤處理層面行為資料表 -50-
表4-8 錯誤後速度減緩變異數分析摘要表 -51-
表4-9 錯誤後試驗準確性變異數分析摘要表 -52-
表4-10 四組受試者於Fcz之N2尖峰潛伏期與平均振幅 -55-
表4-11 Fcz區N2波尖峰潛伏期變異數分析摘要表 -55-
表4-12 Fcz區N2波平均振幅變異數分析摘要表 -56-
表4-13 Fz區P3a波尖峰潛伏期與平均振幅 -58-
表4-14 Fz區P3a波尖峰潛伏期變異數分析摘要表 -58-
表4-15 Fz區P3a波平均振幅變異數分析摘要表 -59-
表4-16 Pz區P3b波尖峰潛伏期與平均振幅 -61-
表4-17 Pz區P3b波尖峰潛伏期變異數分析摘要表 -62-
表4-18 Pz區P3b波平均振幅變異數分析摘要表 -64-
表4-19 ERN於各電極區之尖峰潛伏期與平均振幅表 -66-
表4-20 ERN尖峰潛伏期變異數分析摘要表 -67-
表4-21 ERN平均振幅變異數分析摘要表 -68-
表4-22 Pe於各電極區之尖峰潛伏期與平均振幅表 -69-
表4-23 Pe尖峰潛伏期變異數分析摘要表 -69-
表4-24 Pe平均振幅波變異數分析摘要表 -71-
表4-25 ERN各電極區之尖峰潛伏期與平均振幅表 -76-
表4-26錯誤試驗之ERN平均潛伏期變異數分析摘要表 -76-
表4-27錯誤試驗下ERN平均振幅變異數分析摘要表 -77-
表4-28 Pe各電極區之尖峰潛伏期與平均振幅表 -78-
表4-29錯誤試驗下錯誤正波平均潛伏期變異數分析摘要 -78-
表4-30 錯誤試驗下Pe平均振幅變異數分析摘要 -80-
表4-31 錯誤試驗下Pe尖峰振幅變異數分析摘要表 -81-
表4-32 各電極區之FRN尖峰潛伏期與平均振幅表 -84-
表4-33 FRN尖峰潛伏期變異數分析摘要表 -84-
表4-34 FRN平均振幅變異數分析摘要表 -85-
表4-35行為資料統整表 -86-
表4-36 ERP結果統整表 -87-

圖目錄
圖2-1 圖解錯誤處理機制 -16-
圖2-2 結合錯誤察覺任務與反應不反應任務之實驗示意圖 -18-
圖2-3 社會性與非社會性回饋增強實驗設計示意圖 -25-
圖3-1 研究架構圖 -30-
圖3-2 實驗刺激程序示意圖 -33-
圖3-3 研究程序 -38-
圖3-4 NuAmps放大器 -39-
圖3-5實驗配置圖 -39-
圖4-1 ADHD組受試者資料選取過程 -43-
圖4-2 四組受試者之抑制失敗率 -46-
圖4-3 四組受試者之反應試驗遺漏率 -47-
圖4-4 四組受試者試驗反應時間 -49-
圖4-5 四組受試者正確反應時間變異性 -50-
圖4-6 兩組受試者之錯誤覺察率 -51-
圖4-7 四組受試者之錯誤後試驗準確率 -52-
圖4-8 反應與不反應試驗下四組受試者之ERP -54-
圖4-9有無外在回饋下四組受試者之ERP -54-
圖4-10 四組受試者在Fcz區之N2波平均振幅 -56-
圖4-11 兩種試驗下四組受試者之ERP -57-
圖4-12 兩種回饋情境下四組受試者之ERP -57-
圖4-13 四組受試者在Fz區之P3a波尖峰潛伏期 -59-
圖4-14 四組受試者在Fz之P3a波平均振幅 -60-
圖4-15 兩種試驗類型下,四組受試者之ERP -61-
圖4-16 四組受試者在Pz之P3b波尖峰潛伏期 -63-
圖4-17 兩組受試者察覺錯誤試驗、未察覺之錯誤試驗ERP -66-
圖4-18 兩組受試者ERN尖峰潛伏期 -67-
圖4-19 兩組受試者不同試驗下之Pe尖峰潛伏期 -70-
圖4-20 兩組受試者不同試驗下之Pe平均振幅 -72-
圖4-21 四組受試者在正確試驗、錯誤試驗下之ERN、Pe波形 -73-
圖4-22 四組受試者在錯誤試驗下,有無外在回饋之ERN、Pe波 -75-
圖4-23 四組受試者錯誤試驗之ERN平均振幅 -77-
圖4-24 四組受試者錯誤試驗之Pe尖峰潛伏期 -79-
圖4-25 四組受試者錯誤試驗之Pe平均振幅 -81-
圖4-26 四組受試者錯誤試驗Pe尖峰振幅 -82-
圖4-27 兩組受試者FRN波形 -83-
圖4-28兩組受試者Fz, Fcz電極區正負向回饋之FRN尖峰潛伏期 -86-
圖5-1 四組受試者之錯誤後試驗反應時間 -93-
圖5-2 四組受試者在不同試驗下之反應時間 -94-
中文文獻
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