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研究生:何欣儒
研究生(外文):Hsin Ju Ho
論文名稱:注意力不足過動症兒童之心力與相關大腦功能異常
論文名稱(外文):Mental effort and related brain abnormalities in children with Attention-Deficit/Hyperactivity Disorder
指導教授:許嘉芬許嘉芬引用關係
指導教授(外文):C. F. Hsu
口試委員:徐儷瑜古黃守廉許嘉芬
口試委員(外文):L. Y. ShyuS. L. Gu HuangC. F. Hsu
口試日期:2023-07-04
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:2023
畢業學年度:111
語文別:中文
論文頁數:66
中文關鍵詞:心力注意力不足過動症前腦島皮層額下迴磁振造影
外文關鍵詞:mental effortattention-deficit/hyperactivity disorderanterior insular cortexinferior frontal gyrusmagnetic resonance imaging
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研究目的:逃避需要持久心力(Mental effort)工作是注意力不足過動症(Attention Deficit Hyperactivity Disorder, ADHD)的診斷標準之一,但甚少有研究檢視 ADHD 兒童的心力體驗,且過去心力相關的研究設計受到任務困難度或表現混淆,故本研究目的是探討 ADHD 兒童,在控制作業表現正確率的前提下,執行認知作業時的自評心力感受與大腦活化程度與典型發展兒童的差異,並檢視自評心力感受與心力相關腦區活化程度的關聯。
研究方法及資料:本研究總共召募 63 位 10 歲至 16 歲之兒童青少年參與者(ADHD 組 43 位、控制組 20 位),所有參與者均完成心力特質問卷和認知評估,並在磁振造影掃描下完成實驗室自行開發的視覺對比作業,其根據受試者表現彈性調整困難度,使所有受試者的正確率接近 0.7,隨後再請參與者對其心力感受評分。
研究結果:(1)家長評量顯示,相較於典型發展兒童,ADHD 兒童較不願意對於日常事物投入心力。(2)在控制作業表現正確率的情況下,ADHD 組的心力投入與控制組沒有顯著差異,但在錯誤反應時雙側腦島皮層(insular cortex, IC)和右側額下迴(inferior frontal gyrus, IFG)有較高的大腦活化。(3)控制組雙側 IC 與右側 IFG 活化程度與心力自評呈正相關;ADHD 組則沒有顯著相關。
結論與建議:家長評量顯示比起典型發展兒童,ADHD 兒童在日常生活中對於心力投入較為嫌惡。在控制作業正確率的情形下,ADHD 兒童的自評心力感受與控制組沒有差異,而 IC 和 IFG 在正確反應時沒有適當活化,反而是在錯誤反應時才有較高的活化。由於 IC 與評估與調解內在與外在訊息有關,故推測 ADHD 兒童可能在評估、監控自身狀態,特別是心力的知覺能力較弱。
Background: Avoiding tasks that require sustained mental effort is a diagnostic criterion of Attention-Deficit/Hyperactivity Disorder (ADHD). However, there was little research about the experience of mental effort in children with ADHD, and previous studies did not rule out the impact of performance or task difficulty in mental effort. The purpose of this study is to investigate subjective ratings of mental effort and brain activation between children with and without ADHD during a cognitively effortful task while controlling for task accuracy, and to investigate the correlation between subjective ratings of mental effort and brain activations.
Methods: A total of 63 participants (43 in the ADHD group and 20 in the control group, aged 10 to 16 years) participated in this study. All participants underwent a task required mental effort and controlled for accuracy during functional magnetic resonance imaging scan, and retrospectively rated their subjective feelings about the task. Participants also completed cognitive assessment and a self-developed questionnaire on mental effort.
Results: (1) The parental rating of mental effort showed that children with ADHD were less willing to engage mental effort in daily life than the control group. (2) Controlling for accuracy of the task, the ADHD group had higher brain activation during incorrect responses in the bilateral insular cortex (IC) and right inferior frontal gyrus (IFG) than the control group. (3) The activation of the bilateral IC and right IFG in the control group was positively correlated with self-rating of mental effort, whereas no significant correlation was found in the ADHD group.
Conclusion: Parental report showed that children with ADHD were more aversive to mental effort in daily life than the control group. When controlling for task accuracy, the IC and IFG area were more activation during wrong responses in children with ADHD than the typical developing children. Our results suggested that children with ADHD may have difficulties in assessing and modulate their internal state to engage in mental effort.
中文摘要i
Abstractii
目錄iv
圖目錄vi
表目錄vii
第一章 緒論 1
第二章 文獻探討 1
第一節 注意力不足過動症 2
第二節 心力 5
第三節 注意力不足過動症與心力相關的理論和研究 11
第四節 研究目的與假設 13
第三章 研究方法 14
第一節 研究參與者 14
第二節 研究工具 15
第三節 研究程序 23
第四章 結果 25
第一節 行為結果 25
第二節 功能性磁振造影結果 31
第五章 討論 37
第一節 注意力不足過動症之臨床特徵 37
第二節 注意力不足過動症之心力表現 37
第三節 投入心力與行為症狀、認知功能間的關係 39
第四節 注意力不足過動症之心力與相關腦區 40
第五節 心力相關腦區與注意力不足過動症心力自評的關聯 41
第六節 研究限制42
第六章 結論 43
參考文獻 45

圖目錄
圖一 認知能量模型 12
圖二 視覺對比辨識作業對比度圖 22
圖三 ADHD組正確和錯誤反應對照的神經反應活化區域 33
圖四 正確和錯誤反應下心力自評和視覺對比辨識作業評量與兩組間的關聯 35

表目錄
表一 兩組基本人口統計學項 26
表二 兩組照顧者知覺臨床特徵和孩童自覺臨床特徵 27
表三 兩組於克氏持續度表現測驗之平均數和標準差 28
表四 兩組於心力之平均得分和標準差 29
表五 親子知覺之心力特質的相關係數 29
表六 心力狀態與臨床症狀的相關係數 30
表七 心力狀態與認知測驗及克氏持續表現測驗的相關係數 31
表八 ADHD組大腦具較高對比反應的區域峰值活化資訊 32
表九 正確和錯誤反應神經活化與心力自評和視覺對比辨識作業評量的皮爾森相關 34
表十 研究結果摘要 36
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