臺灣博碩士論文加值系統

ADHD相關問題行為是學齡前兒童及家長尋求醫療協助最常見的主訴，也是臨床上門診與治療的大宗，長期以來的研究支持早期偵測及早期介入對於ADHD個體在生活適應各面向中能有較好的預後。有鑑於學齡前兒童因神經發展的自然歷程以及生活情境的限制，臨床上需要完整的心理衡鑑過程及合適的測驗工具以協助ADHD的正確診斷，而學齡前兒童的測驗工具及評估方式更為受限。SNAP-IV量表是根據DSM中ADHD診斷標準所建立，因建構精確、信效度良好而廣泛使用於臨床及研究中。在高淑芬醫師等人的研究下已建立台灣學齡兒童的常模及相關信效度分析，這些心理計量特性支持中文版SNAP-IV在台灣學齡兒童的應用。然而，SNAP-IV也同樣廣泛使用於學齡前兒童，卻未有研究探討SNAP-IV量表在學齡前兒童的心理計量特性及適用性。故本研究自社區招募316名兒童（166名男童）、自醫療院所招募106名兒童（79名男童），共計422名的4至6歲兒童，由家長及教師填寫SNAP-IV量表。研究結果顯示，家長版在驗證性因素分析中三因子的適配度指標皆達標準(RMSEA = 0.078、GFI = 0.959、AGFI = 0.923、CFI = 0.981)，教師版則有部分適合度指標未達標準(RMSEA = 0.104、GFI = 0.936、AGFI = 0.881、CFI = 0.978)，家長版的再測信度(ICC = 0.79 - 0.87)與內部一致性(Cronbach’s α = 0.90 - 0.92)皆佳，教師版亦同(ICC = 0.86 - 0.88; Cronbach’s α = 0.95 - 0.95)，與ADHDT進行同時效度檢驗，在不專心、過動/衝動分量表上皆具高相關（家長版r = 0.81 - 0.84；教師版r = 0.91 - 0.91），與CBCL進行同時效度檢驗，在三項分量表上具中至高相關（家長版r = 0.60 - 0.70；教師版r = 0.75 - 0.88），家長版及教師版皆具顯著性別差異及未顯著的年齡差異。本研究顯示SNAP-IV量表在學齡前兒童的應用上具有參考價值，合併其他測驗工具、臨床晤談及行為觀察等心理衡鑑歷程，可為ADHD在學齡前的診斷與介入提供有力的資訊參考。

ADHD symptoms are the most common chief complaint when preschoolers and their caregivers visit outpatient psychiatric clinic. Past studies suggest that early diagnosis and intervention provides better prognosis and quality of life for individual with ADHD. Due to preschoolers’ neurological development are thriving at those ages, we need suitable psychological tests and assessments to correctly differentiate diagnosis. However, the psychological tests and assessments of ADHD are limited in preschoolers. SNAP-IV were developed from diagnostic criteria of ADHD in DSM, its well-construct with good reliability and validity makes SNAP-IV apply widely to research and clinic. In Taiwan, Gau et. al., established norms and analyzed psychometric properties of SNAP-IV with school-age children. Nevertheless, there’re little evidence of that the psychometric properties of SNAP-IV are applicable to preschoolers. This study recruited 316 preschoolers (166 boys) from community and 106 preschoolers (79 boys) from hospital, totally 422 preschoolers with age 4 to 6. Theirs parents and teachers were required to complete SNAP-IV and ADHDT. Moreover, 260 preschoolers participated K-CPT with parents’ agreement. Results show that parent form of SNAP-IV reach fine goodness of fit index (RMSEA = 0.078、GFI = 0.959、AGFI = 0.923、CFI = 0.981) of three factors while teacher form of SNAP-IV are not (RMSEA = 0.104、GFI = 0.936、AGFI = 0.881、CFI = 0.978). Test-retest reliability and internal consistency are also fine of parent (ICC = 0.79 - 0.87; Cronbach’s α = 0.90 - 0.92) and teacher form (ICC = 0.86 - 0.88; Cronbach’s α = 0.95 - 0.95). As to concurrent validity, inattention and hyperactivity/impulsivity subscales of SNAP-IV are highly correlated to ADHDT (parent r = 0.81 - 0.84; teacher r = 0.91 - 0.91) and CBCL(parent r = 0.60 - 0.70；teacher r = 0.75 - 0.88). There is significant gender difference and no significant age difference in both parent and teacher form. This study shows that SNAP-IV is applicable to preschoolers. With other tools of assessment, clinical interview and behavioral observation, SNAP-IV can provide useful information to correctly diagnosis ADHD in preschoolers.

目 錄
指導教授推薦書……………………………………………………
口試委員會審定書…………………………………………………
誌謝………………………………………………………………iii
中文摘要…………………………………………………………iv
英文摘要…………………………………………………………vi
目錄………………………………………………………………viii
圖目錄……………………………………………………………x
表目錄…………………………………………………………..xi
第一章：緒論…………………………………………………… 1
第二章：文獻探討……………………………………………… 6
壹、學齡前的注意力不足、過動/衝動行為症狀………… 6
貳、學齡前ADHD症狀行為的評估量表……………...… 9
參、SNAP-IV量表的發展與應用…………………..…… 12
肆、SNAP-IV量表在學齡前兒童的應用……………..… 16
伍、研究問題與假設……………………………………… 17
第三章：研究方法……………………………………………… 19
壹、研究對象……………………………………………… 19
貳、研究工具……………………………………………… 19
參、研究程序……………………………………………… 23
肆、資料分析及整理……………………………………… 23
第四章：結果…………………………………………………… 24
壹、人口統計學之描述性分析…………………………… 24
貳、探索性因素分析……………………………………… 26
參、驗證性因素分析……………………………………… 29
肆、再測信度及內部一致性……………………………… 31
伍、同時效度……………………………………………… 33
陸、性別及年齡差異……………………………………… 36
第五章：討論…………………………………………………… 38
第六章：臨床貢獻與結論……………………………………… 45
參考文獻……………………………………...………………… 47
附錄一……………………………………………...…………… 64
附錄二…………………………………………………………... 67


圖目錄

圖1 家長版驗證性因素分析………………………………… 29
圖2 教師版驗證性因素分析………………………………… 30


表目錄

表1 人口統計學之描述性分析……………………………… 25
表2 家長版探索性因素分析………………………………… 26
表3 教師版探索性因素分析………………………………… 28
表4 家長版及教師版之再測信度與內部一致性…………… 32
表5 家長版及教師版與ADHDT之同時效度……………… 33
表6 家長版及教師版與CBCL之同時效度………………… 35
表7 家長版及教師版之性別與年齡差異…………………… 37
表8 本研究與過去研究的SNAP-IV心理計量特性…..…… 42

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