臺灣博碩士論文加值系統

目的：過去諸多研究已指出早產兒的執行功能（Executive Function, EF）較足月正常兒童差，Ni、Huang 與 Guo（2011）發現即使排除了早期發展遲緩的兒童後，極低出生體重早產兒仍有認知EF的缺損。然因過去文獻多聚焦於認知EF層面之探討，而較少探討到情緒EF層面，故本研究旨在探討早期發展正常之極低出生體重早產兒在學齡前的情緒EF是否與認知EF有類似的缺損現象，且情緒EF的缺損是否與認知EF的缺損有關。

方法：早產組來自中華民國早產兒基金會所轉介之6至7歲台南區極低出生體重早產兒，排除視障、聽障、腦性麻痺以及 12、24 個月大時貝萊氏嬰幼兒發展測驗第二版/第三版分數和5歲時魏氏幼兒智力量表智商有任何一項低於平均值兩個標準差的兒童，共116名早產兒納入分析；足月組則為58名性別、年齡、社經地位、及家庭教養環境相似的足月正常兒童。以魏氏兒童智力量表第四版中文版之記憶廣度分測驗、Knox 方塊仿效測驗、威斯康辛卡片分類測驗、倫敦塔、以及廣泛性非語文注意力測驗為評估認知EF各個面向之工具，包括：工作記憶、認知彈性、計畫能力、以及抑制能力；改編台灣兒童版情緒EF之生態衡鑑為評估情緒EF各個面向之工具，包括：心智理論、延宕滿足、以及情緒調節等能力。

結果：在認知EF方面，早產組在工作記憶、認知彈性、計畫能力、以及抑制能力表現上均較足月組差；在情緒EF方面，早產組在心智理論及延宕滿足表現上較足月組差，然在情緒調節方面兩組則未有顯著差異，進一步分析早產組較足月組顯著較差的兩項情緒EF與認知EF表現之相關，結果顯示早產組在心智理論及延宕滿足作業中較足月組差的行為指標，與認知EF表現之分析幾乎未達顯著相關，而足月組在心智理論及延宕滿足作業表現與認知EF表現之相關分析中有多個指標達顯著相關。

討論：早期發展正常的極低出生體重早產兒於學齡前的兩個情緒EF面向較足月差，包括：心智理論及延宕滿足；且兩組在認知與情緒EF缺損之相關分析呈現不同的模式，早產組的心智理論與認知EF表現之相關未達顯著差異，且延宕滿足作業中表現得較差的指標也與認知EF表現無顯著相關，可能代表早產組的情緒EF與認知EF的一致性較低，揭示了其大腦統整性較足月組低的神經心理徵象，而足月組在情緒EF與認知EF的一致性較高，可能顯示其大腦的發展更趨成熟，較能互相調整以達到具適應性的目標。

關鍵字：早產兒、極低出生體重、執行功能、熱執行功能

SUMMARY
The aim of this study was to investigate cognitive and emotional EF profile in VLBW children with normal early development at preschool age. Participants were 116 six to seven-year-old VLBW children with normal early development and 58 term children with comparable gender, home environment, and social economic status. Wechsler Intelligence Scale for Children-IV (WISC-IV), Comprehensive Non-verbal Attention Test Battery (CNAT), Tower of London (ToL), Wisconsin Card Sorting Test (WCST), Knox’s Cube Test (KCT), and Emotional EF Ecological Assessment Battery for Children in Taiwan were administered in order to evaluate cognitive EF and emotional EF in the two groups. The results showed that VLBW children with normal early development have cognitive EF deficits in working memory, cognitive flexibility, planning, and inhibition, and in emotion EF domain, they showed weaker delay of gratification and theory of mind. In order to investigate the correlation of the two emotion EF deficits which the preterm group performed poorer and cognitive EF, further analysis showed that these two groups of children have different pattern in the two EF domains’ relationships; the two domains’ significant correlations are fewer in the preterm group, whereas the term group showed stronger correlations in the two EF domains. In conclusion, this study revealed that VLBW children with normal early development have deficits in both cognitive and emotional EF, and the discrepancy between the two EF domains might indicate the immaturity of the preterm children’s brain, it may be helpful for clinicians to intervene these preterm children in advance.

Key words: Preterm, Very low birth weight, Executive function, Emotional executive function

INTRODUCTION
Based on World Health Organization (WHO)’s definition, preterm children are defined as being born before 37 weeks’ gestation. The survival rates of preterm infants have increased due to the improvements in recent neonatal care. However, the prevalence of neurodevelopmental sequelae do not decrease in this group, which means that more preterm children face challenges in the future. Children born prematurely are at high risk of developmental delay or executive dysfunction, especially those with lower birthweight. Ni, Huang and Guo (2011) further excluded the influence of early development delay and revealed that preschool preterm children with normal early development have poorer EF compared to normal full-term children. In other words, the probabilities of EF deficits are still high in those who develop normally in their early years and the difficulties may gradually emerge as they grow up. The results implied that preterm children with normal early development still require clinical attention. Previous studies primarily focused on the cognitive aspect of EF without considering the emotional aspect. Recently a distinction has been made between “cognitive EF” and “emotional EF” in the theoretical and empirical literature. Hence, the evaluation of emotional EF is necessary in order to fully understand the whole picture of EF in preterm children. The aim of this study was to investigate whether the very-low-birth-weight (VLBW; born less than 1500 g) children with normal early development have deficits in emotional EF at preschool age.

MATERIALS AND METHODS
The study was conducted in two groups. The VLBW group was referred from Premature Baby Foundation of Taiwan. These children have been followed up and the Bayley Scales of Infant Development II/III (BSID-II and Bayley-III) was administered at the age of 12 months and 24months, as well as Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) was administered at the age of 5. Children with visual impairment, auditory impairment, cerebral palsy, developmental indices of BSID-II/III less than 70 or full-scale IQ (FSIQ) of WPPSI-R less than 70 were excluded. At last, the VLBW group comprised 116 six to seven-year-old VLBW children with normal early development. The comparison group comprised 58 term children with comparable gender, home environment, and social economic status from local schools who volunteered to participate in the study. Multiple EF assessment tools were administered at the age of 6. Cognitive EF, including inhibition, working memory, planning, and cognitive flexibility were assessed by Comprehensive Nonverbal Attention Test Battery (CNAT), Tower of London (ToL), Wisconsin Card Sorting Test (WCST), Knox's Cube Test (KCT), and Digit Span Subtest of WISC-IV. We designed Emotional EF Ecological Assessment Battery for Children in Taiwan to assess Emotional EF, including delay of gratification, emotion regulation, and theory of mind. Independent t-test and Chi-square were used to analyze the differences between groups with the significant level at .05. Also Cohen’d was calculated to evaluate the effect size.

RESULTS AND DISCUSSION
The results showed that VLBW children with normal early development have cognitive EF deficits in working memory, cognitive flexibility, planning, and inhibition, and in emotion EF domain, they showed weaker delay of gratification and theory of mind.In order to investigate the correlation of the two emotion EF deficits which the preterm group performed poorer and cognitive EF, further analysis showed that these two groups of children have different pattern in the two EF domains’ relationships; the two domains’ significant correlations are fewer in the preterm group, whereas the term group showed stronger correlations in the two EF domains.

CONCLUSION
The results of this study suggested that even if the VLBW children are normal in early cognitive development, they might have deficits in both cognitive and emotional EF at preschool age, and the discrepancy between the two EF domains indicates the immaturity of the preterm children’s brain, it may be helpful for clinicians to intervene these preterm children in advance. Further empirical data might be necessary to establish a more comprehensive model for clinical psychological assessment and intervention in preterm children.

第壹章 緒論 1
第一節、執行功能 1
一、執行功能之定義與神經生物基礎 1
二、認知執行功能與情緒執行功能 3
三、學齡前執行功能之發展與衡鑑 5
（一）認知執行功能層面 6
（二）情緒執行功能層面 10
第二節、早產兒之執行功能 18
一、 早產兒之定義 18
二、 早產兒的大腦功能發展 18
三、 學齡前早產兒之認知執行功能 20
四、 學齡前早產兒之情緒執行功能 22
第三節、研究動機與問題假設 34
一、 研究動機 34
二、 研究問題 34
三、 研究假設 34
第貳章 研究方法 35
第一節、研究對象 35
第二節、研究工具 37
一、基本資料與功能問卷 37
二、回溯性資料 38
三、心智發展衡鑑 40
四、認知執行功能衡鑑 40
五、情緒執行功能衡鑑 43
第三節、研究程序 50
一、 人體試驗委員會之審查核准 50
二、 參與者之篩選與邀請 50
三、 實際收案 50
四、 結果分析 50
第四節、統計分析 52
第參章 研究結果 53
第一節、人口學分析 53
一、參與組與未參與組早產兒之人口學分析 53
二、早產組與足月組之人口學分析 57
第二節、早產組與足月組之認知執行功能分析 60
一、執行功能問卷 60
二、工作記憶 60
三、計畫能力 60
四、認知彈性 60
五、抑制能力 61
第三節、早產組足月組之情緒執行功能分析 64
一、心智理論作業(表3-5) 64
二、延宕滿足作業(表3-6、表3-7) 64
三、失望/去失望禮物作業(表3-8、表3-9) 65
第四節、情緒執行功能與認知執行功能之相關分析 74
（一）心智理論作業與認知執行功能表現之相關 74
（二）延宕滿足作業指標與認知執行功能表現之相關 74
第肆章 討論 89
第一節、參與者之人口學分析 89
第二節、學齡前早產兒之執行功能 90
一、學齡前早產兒之認知執行功能 90
二、學齡前早產兒之情緒執行功能 90
三、情緒執行功能與認知執行功能之關聯性 92
第三節、研究限制 94
一、研究對象之限制 94
二、研究工具之限制 94
三、研究程序之限制 95
第四節、研究貢獻與未來展望 96
參考文獻 97
中文部份 97
英文部份 98
附錄 132
附錄一 二因素社經地位指數之計算方式 132
附錄二 日常執行功能行為量表-兒童版 133
附錄三 情緒視覺類比量尺（E-VAS） 134
附錄四 延宕滿足作業之施測情境 135
附錄五 延宕滿足作業之觀察紀錄表 136
附錄六 延宕滿足作業之場地平面圖 138
附錄七 譯碼員之保密切結書 139
附錄八 心智理論作業 140

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