臺灣博碩士論文加值系統

學習障礙是一個異質性高的群體，其中包含許多不同的亞型。本研究選取臨床上最常見的讀寫障礙與單純寫字障礙這兩亞型，從語言系統角度切入，探討「讀寫障礙組」、「單純寫字障礙組」及「典型發展組」三組學童在音韻處理、唸名速度及 P300 表現之差異。
本研究共有 45 位國小二年級到六年級的三組受試學童。學障組學童依據醫師的臨床診斷予以歸類，分為讀寫障礙、單純寫字障礙兩組，及經由學校老師推薦讀寫正常發展學童的典型發展組。每組皆為 15 位受試者，並依照性別、智力及年級進行配對。每位學童皆接受音韻處理能力評估（分別為：音韻覺識、音韻操弄、非詞複述），快速唸名提取能力評估（分別為：數字唸名、顏色唸名、圖片唸名及部件唸名）以及長程誘發電位 P300 神經生理學檢查（包含：聽知覺、視知覺），比較三組學童在上述能力之差異。
研究結果發現（一）讀寫障礙組學童在音韻處理、快速唸名及 P300 聽、視知覺能力在三組學童中皆為最弱的。（二）單純寫字障礙學童僅在唸名速度、P300 視知覺顯著落後於典型發展學童。（三）音韻處理中又以音韻操弄最能預測 P300 聽知覺之表現。（四）快速唸名測驗中又以數字唸名最能預測 P300 視知覺之表現。
本研究結果確認使用音韻處理測驗、快速唸名測驗及臨床 P300 誘發神經檢查，可以提供臨床工作人員作為協助臨床學習障礙亞型鑑別診斷的輔助工具。

Objective: This study investigated the differences in phonological processing, rapid naming speed, and P300-long-latency evoked potential among children with dyslexia, children with dysgraphia and typically developed children.

Methods: Forty-five primary school children were recruited in this study; thirty children with learning disabilities were allocated into two groups, dyslexia group and dysgraphia group, based on the clinical diagnosis of experienced pediatric neurologist; fifteen typically developed children were recommended by primary school teacher. These children were paired according to their gender, non-verbal intelligence quotient and school’s grade. The performances of phonological processing (phonological discrimination, phonological
manipulation and non-word repetition), rapid naming (number, color, picture and Chinese radical naming), and P300 (auditory and visual evoked potential) were compared among children with dyslexia, children with dysgraphia, and typically developed children.

Results: a) The performances of children with dyslexia on phonological processing, rapid naming speed and P300 significantly fall behind, compared with the performances of children from the other two groups; b) Both the rapid naming speed and P300 visual evoked potential latency of children with dysgraphia are significantly slower than the performances of typically developed children; c) Phonological manipulation subtest is the most sensitive test to predict P300 auditory evoked latency; d) Rapid number naming is the most sensitive test to
predict P300 visual evoked latency.

Discussion: This study confirmed that the examinations on phonological processing and rapid naming along with P300 evoked auditory and visual potentials could be utilized in the clinical differential diagnosis on the subtypes of learning disabilities.

目 次
誌謝.............................................................................................. I
中文摘要........................................................................................... II
英文摘要........................................................................................... III
目 次 .......................................................................................... IV
圖 次 .......................................................................................... VI
表 次 .......................................................................................... VII
第一章 緒論 ........................................................................................ 1
第二章 文獻探討 ..................................................................................... 5
第一節 學習障礙 ..................................................................................... 5
第二節 學習障礙的成因 ................................................................................ 18
第三節 P300 ....................................................................................... 34
第四節 研究目的與研究問題 ............................................................................. 45
第三章 研究方法 ..................................................................................... 46
第一節 研究對象 ..................................................................................... 46
第二節 研究工具 ..................................................................................... 48
第三節 研究程序 ..................................................................................... 56
第四節 資料統計與分析 ................................................................................ 57
第四章 研究結果 ..................................................................................... 58
第一節 學習障礙學童在音韻處理、唸名速度的表現 ............................................................. 59
第二節 學習障礙學童在 P300 的表現 ...................................................................... 71
第三節 學習障礙學童音韻處理、唸名速度與 P300 的相關性分析 .................................................. 75
第五章 討論與建議 .................................................................................... 78
第一節 音韻處理的差異 ................................................................................. 78
第二節 唸名速度的差異 ................................................................................. 83
第三節 P300 聽、視知覺的差異 .......................................................................... 85
第四節 音韻處理、唸名速度與 P300 的相關性分析 ............................................................ 87
第五節 結論 ......................................................................................... 89
第六節 研究限制與建議 ................................................................................. 90
參考文獻 ............................................................................................ 93
附錄 ............................................................................................... 109
附錄一 受試學童及家長同意書 ............................................................................ 109
附錄二 音韻操弄測驗（phonemic manipulation task） ..................................................... 114
附錄三 音韻覺識測驗（phonemic awareness task） ........................................................ 116
附錄四 非詞複述測驗 .................................................................................. 117
附錄五 常用部件快速唸名測驗 ............................................................................ 119
附錄六 專家效度檢核表 ................................................................................. 120
附錄七 分別為三組小學二年級男生的 P300 聽知覺結果 ......................................................... 121
附錄八 分別為三組小學二年級男生的 P300 視知覺結果 ......................................................... 122

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