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研究生:陳奕汶
研究生(外文):CHEN,YI-WEN
論文名稱:學齡前語言發展遲緩與早發型抽動症兒童主要照顧者憂鬱/焦慮情緒與子女內化問題行為之相關:以台灣中部地區為例
論文名稱(外文):Correlation between depression/anxiety in the primary caregivers of preschool children with early-onset Tic disorder and their children's internalizing problems: a case study in central Taiwan
指導教授:李仁豪李仁豪引用關係
指導教授(外文):Ren-Haul Li
口試委員:林曉芳呂信慧
口試委員(外文):Hsiao-Fang LinHsin-Hui Lu
口試日期:2024-06-25
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:心理學系臨床心理學碩士班
學門:社會及行為科學學門
學類:心理學類
論文種類:學術論文
論文出版年:2024
畢業學年度:112
語文別:中文
論文頁數:180
中文關鍵詞:主要照顧者焦慮憂鬱兒童行為檢核表早發型抽動症語言發展遲緩學齡前兒童內化問題行為
外文關鍵詞:the primary caregiveranxietydepressionAchenbach System of Empirically Based Assessment (ASEBA) Child Behavior Checklist (CBCL)early onset Tourette's syndromelanguage delayPre-school Childreninternalizing problems
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中文摘要
研究目的在探討1.5-5歲學齡前語言發展遲緩與早發型抽動兒童個案其主要照顧者焦慮/憂鬱情緒,分析兒童內化問題(包含情緒反應、焦慮憂鬱、抱怨身體不適及退縮問題)是否與主要照顧者憂鬱/焦慮相關。研究於2022年05月至2023年11月,於中部地區收取整理266位個案,最終得對照組113位及疾病組153位(包含語言發展遲緩組70位、早發型抽動症組49位及共病組34位)。主要照顧者填答研究者自編之「兒童行為與主要照顧者情緒相關因素調查」結構式問卷,其情緒透過STAI-T及CES-D收集;子女內化問題行為透過阿肯巴克兒童行為檢核表收集。將研究資料編碼後,採SPSS 29.0統計分析。研究結果如下:
一、 不同組別主要照顧者評估兒童的內化問題(包含情緒反應、焦慮憂鬱、抱怨身體不適及退縮問題)有差異( p<.001),事後比較檢定發現內化問題行為量尺分數共病組較語言發展遲緩組有顯著差異
( p=.007);單純早發型抽動症組分數較語言發展遲緩組在內化量尺分數(p=.049)有顯著差異。
二、 共病組相對於對照組在主要照顧者憂鬱對兒童於內化問題行為的預測上更為明顯。在控制「年齡」後,主要照顧者憂鬱對兒童內化問題行為量尺的預測效果中,共病組簡單斜率達顯著水準(p <.001),而對照組則不顯著。條件化分析發現相較於對照組,只有「共病組」主要照顧者憂鬱情緒對兒童各內化問題行為效果皆仍然顯著(p <.001)。
三、 疾病組相對於對照組在主要照顧者焦慮特質對兒童於內化問題行為的預測上更為明顯。在控制「年齡」後,主要照顧者焦慮兒童內化問題行為量尺的預測效果中,語言發展遲緩組簡單斜率達顯著水準
(p <.001),而對照組則不顯著。條件化分析發現相較於對照組,只有「語言發展遲緩組」主要照顧者焦慮特質對兒童內化問題行為效果仍顯著(p <.001)。
依據研究收案地區、對象與方法等面向的研究限制下,研究結果盼提供臨床上關注早發型抽動症兒童及其主要照顧者情緒相關訊息。盼提供臨床醫師或臨床助人工作者,有關學齡前語言發展遲緩共病早發型抽動症兒童內化行為問題鑑別診斷之參考,以及未來臺灣中部地區本土化學術理論研究相關建議。

Abstracts
The purpose of the study was to investigate the primary caregiver anxiety/depression in children with preschool-aged language delay development and early onset tics aged 1.5-5 years, and to analyze whether children's internalizing problems ,including emotional reactions, anxiety, depression, complaints of physical discomfort, and withdrawal, were associated with primary caregiver depression/anxiety. A total of 266 cases were collected from May 2022 to November 2023 in the central region of China, resulting in 113 cases in the control group and 153 cases in the disease group (70 cases in the language delay group, 49 cases in the early-onset Tourette's syndrome group, and 34 cases in the co-morbidity group). The primary caregivers responded to the researcher-administered structured questionnaire "Survey on Emotional Correlates of Child Behavior and Primary Caregiver", and their emotions were collected through the STAI-T and the CES-D for depression and anxiety. The children's internalizing problematic behaviors were collected through Achenbach System of Empirically Based Assessment (ASEBA) -Child Behavior Checklist (CBCL). The data were coded and analyzed using SPSS 29.0.
The results of the study were as following :
1. Primary caregivers in the disease group assessed children as exhibiting internalizing problem behaviors differently than those in the control group (p<.001), by post hoc test revealed significant differences in internalizing problem behavior scale scores in the co-morbid group compared to the language delay group (p=.007), and in internalizing scale scores in the Tourette's alone group compared to the language delay group (p=.049).
2. The disease group was more likely than the control group to have primary caregiver depression as a predictor of children's internalizing problem behaviors. After controlling for "age", the simple slope of the predictive effect of primary caregiver depression on the children's internalizing problem behaviors scale was significant for the co-morbid group (p < .001), but not for the control group. Conditional analyses revealed that only the primary caregiver depression effect remained significant (p < .001) for all children's internalizing behaviors in the Co-morbidity group compared to the Control group.
3. The disease group was more significant than the control group in predicting children's internalizing problem behaviors on the primary caregiver anxiety trait. After controlling for "age", the simple slope of the predictive effect of the primary caregiver anxiety on children's internalizing problem behaviors scale was significant for the language delay group (p < .001), but not for the control group. Conditional analyses revealed that only the primary caregiver anxiety trait remained significant (p < .001) on children's internalizing problem behaviors in the "language delay group" compared with the control group.
According to the limitations of the study area, target population, and methodology, the results of this study are expected to provide clinical information about the emotions of children with early-onset Tourette's syndrome and their primary caregivers. It is hoped that this study will provide clinicians or clinical assistants with reference for the identification and diagnosis of internalizing behavioral problems in preschool-aged children with early onset Tourette's syndrome with co-morbid language developmental delays, as well as suggestions for future localized academic and theoretical research in the central Taiwan area.

摘要 IV
ABSTRACTS V
誌謝 VII
目錄 VIII
圖目錄 LIST OF FIGURES X
表目錄 LIST OF TABLES XII
第一章、 緒論 1
第一節 研究動機 1
第二節 研究目的 5
第三節 研究問題 7
第四節 名詞解釋 8
第二章、 文獻回顧與探討 12
第一節 學齡前發展遲緩兒童 12
第二節 學齡前兒童內化問題行為 22
第三節 主要照顧者憂鬱情緒及焦慮特質影響 24
第四節 變項間的相關研究 27
第三章、 研究方法 33
第一節 研究設計 33
第二節 研究假設 36
第三節 研究範圍與研究對象 38
第四節 研究工具 42
第五節 研究程序 48
第六節 資料處理與分析 50
第四章、 研究結果 52
第一節 背景變項在內化問題行為的差異分析 52
第二節 組別於兒童內化問題行為及主要照顧者憂鬱/焦慮差異分析 64
第三節 組別於主要照顧者憂鬱/焦慮和兒童內化問題行為相關分析 71
第四節 組別於主要照顧者憂鬱/焦慮與兒童內化問題行為間調節效果分析 94
第五節 小結 123
第五章、 討論 126
第一節 兒童內化問題行為相關因素 126
第二節 主要照顧者憂鬱情緒相關因素 133
第三節 主要照顧者焦慮特質相關因素 134
第四節 組別在主要照顧者情緒與兒童內化問題行為間的調節效果 137
第五節 研究限制 145
第六章、 結論與建議 147
第一節 結論 147
第二節 建議 150
參考文獻 155
一、中文參考文獻 155
二、英文參考文獻 157
附錄 174
附錄 一、彰化基督教醫院研究倫理審查委員會研究計畫許可書 174
附錄 二、彰化基督教醫院研究倫理審查委員會變更案研究計畫許可書 175
附錄 三、彰化基督教醫院研究倫理審查委員會結案審查結果通知表 176
附錄 四、問卷 177

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