臺灣博碩士論文加值系統

背景與目的：在先前的研究已開發出兩套適合台灣學齡前兒童動作發展量表，分別為「學齡前兒童動作發展篩檢問卷（Development Motor Screening Scale for Preschool Children，簡稱DMSSPC）」和「學齡前兒童動作發展評估量表（Development Motor Assessment Scale for Preschool Children，簡稱DMASPC）」。目前臨床上大多使用傳統的紙本測驗，需要花費較多人力和時間施測，而電腦化適性測驗（computerized adaptive testing，簡稱CAT）是一種會依據受試者能力給予適當題目作答之測驗，可減少不必要的題目及時間，因此本研究目的為開發並驗證DMSSPC-CAT和DMASPC-CAT，研究分為兩個階段進行，第一階段為發展兩個CAT量表，並在第二階段透過標準化工具對驗證兩個CAT量表。
方法：研究對象為3到72月齡的學齡前典型發展嬰幼兒，樣本來自於「幼兒發展資料庫先期研究」以及台灣北、中、南地區之托嬰中心、幼兒園或健兒門診。本研究皆使用實徵資料（empirical data），第一階段共招募698位嬰幼兒（352位男生、346位女生）之家長填寫DMSSPC和361位嬰幼兒（195位男生、166位女生）接受DMASPC測驗，此階段利用試題反應理論（item response theory，簡稱IRT）分析兩套量表，以開發DMSSPC-CAT和DMASPC-CAT，包含粗大動作和精細動作兩向度，並同時模擬研究不同測驗長度（5、10、15、20、25題和不限制題數）之表現。第二階段為再招募99位嬰幼兒（52位男生、47位女生）之家長填寫DMSSPC（其中有89位嬰幼兒接受PDMS-2測驗）和75位嬰幼兒（37位男生、38位女生）皆接受DMASPC和PDMS-2測驗，此階段為驗證測試DMSSPC-CAT和DMASPC-CAT，使用皮巴迪動作發展量表第二版（Peabody Developmental Motor Scales 2nd ed.，簡稱PDMS-2）作為效標。本研究使用BILOG-MG軟體分析IRT參數（試題鑑別度、試題困難度），並用SPSS軟體進行組內相關係數（intra-class correlation coefficient，簡稱ICC）和皮爾森相關係數（Pearson correlation coefficient）檢測，ICC用於檢測CAT分數與DMSSPC及DMASPC原量表之間的效度；皮爾森相關係數則是用於DMSSPC-CAT及DMASPC-CAT與PDMS-2之間的效標關聯效度。
結果：第一階段中，DMSSPC之IRT分析結果顯示粗大動作和精細動作兩向度之試題鑑別度分別為0.27-3.19和0.11-2.02，試題困難度平均分別為-0.38和0.70。DMSSPC-CAT模擬研究結果顯示，粗大動作和精細動作兩向度之信度分別為0.764-0.929和0.777-0.915；在DMSSPC-CAT和DMSSPC兩者之估計能力值相關中，除了DMSSPC-CAT-5為中度相關外，其餘測驗長度皆達高度相關（ICC≥0.860）。而在DMASPC之IRT分析結果顯示粗大動作和精細動作兩向度試題鑑別度分別為0.42-2.01和0.36-2.06，試題困難度平均分別為0.65和0.43。DMASPC-CAT模擬研究結果顯示，粗大動作和精細動作兩向度之信度分別為0.757-0.918和0.744-0.912；在DMASPC-CAT和DMASPC兩者之估計能力值相關中，除了DMASPC-CAT-5為中度相關外，其餘測驗長度皆達高度相關（ICC≥0.883）。第二階段驗證測試顯示，DMSSPC-CAT粗大動作和精細動作兩向度平均作答題數分別為14.72題和11.14題；信度分別為0.904-0.927和0.894-0.914；DMSSPC-CAT和DMSSPC兩者之估計能力值達高度相關（粗大動作ICC=0.935、精細動作ICC=0.923）；DMSSPC-CAT之估計能力值與PDMS-2達高度相關（粗大動作r=0.935、精細動作r=0.923，p<0.001）。DMASPC-CAT粗大動作和精細動作兩向度平均作答題數分別為13.31題和12.77題；信度分別為0.905-0.911和0.877-0.911；DMASPC-CAT和DMASPC兩者之估計能力值達高度相關（粗大動作ICC=0.909、精細動作ICC=0.869）；DMASPC-CAT之估計能力值與PDMS-2達高度相關（粗大動作r=0.984、精細動作r=0.981，p<0.001）。
結論：DMSSPC-CAT和DMASPC-CAT皆具有優良的信度、效度及效率，可準確評估學齡前兒童動作發展能力，並相較於紙本測驗能大幅減少79-89%的題數，亦即可以有效地縮短人力和施測時間。DMSSPC-CAT和DMASPC-CAT是個相當實用的臨床工具，且適合用於學齡前兒童。

Background: Two motor development scales suitable for Taiwanese preschool children were developed in our earlier research. One was the Development Motor Screening Scale for Preschool Children (DMSSPC) and the other the Development Motor Assessment Scale for Preschool Children (DMASPC). Clinically, they are often applied through paper-based tests which require more labor and time to administer. In comparison, the computerized adaptive test (CAT) is to adentify the appropriate test items in accordance with the ability of the testee to reduce unnecessary items and time. Therefore, this study aims to develop and validate of the DMSSPC-CAT and DMASPC-CAT. The study is executed in two stages: develop the two CAT scales in the first stage and validate two CAT scales by gold standard tools in the second stage.
Methods: This study collects 3- to 72-month-old preschool children with normal development. The samples come from the results of the “Kids in Taiwan: National Longitudinal Study of Child Development & Care: a pilot study” and daycare canters, kindergartens and child outpatient departments of hospitals in northern, central and southern Taiwan. Only empirical data are adopted. In the first stage, 698 parents with children (352 male and 346 female) are recruited to fill out the DMSSPC and 361 young children (195 male and 166 female) receiving the DMASPC test. The item response theory (IRT) is adopted to analyze the two scales in order to develop the DMSSPC-CAT and DMASPC-CAT, including gross motor (GM) and fine motor (FM) domains. At the same time, simulations are conducted to examine the performance under different stopping conditions (5, 10, 15, 20, 25 and unlimited number of questions). In the second stage, 99 parents with children (52 male and 47 female) accept the invitation to fill out the DMSSPC (with 89 young children taking the PDMS-2 test) and 75 young children (37 male and 38 female) receive both the DMASPC and PDMS-2 tests. The DMSSPC-CAT and DMASPC-CAT are validated by gold standard the Peabody Development Motor Scale 2nd ed. (PDMS-2). Afterwards, the BILOG-MG software is applied to analyze the IRT parameters (item discrimination and item difficulty), and SPSS is also used to test the intra-class correlation coefficient (ICC) and Pearson correlation coefficient. The ICC is used to test the validity between the CAT scores and original scores of DMSSPC and DMASPC. The Pearson correlation coefficient is used to test the criterion-related validity between the the DMSSPC-CAT and DMASPC-CAT with PDMS-2.
Results: In the first stage, the results of IRT analysis reveal the item discrimination and item difficulty values of two GM/FM domains of DMSSPC are 0.27-3.19/0.11-2.02, and -0.38/0.70. The simulation study results show that the reliability values of two GM/FM domains of DMSSPC are 0.764-0.929/0.777-0.915. The correlations between the estimated abilities of DMSSPC-CAT at all stooping conditions and DMSSPC had high correlations (ICC≥0.860) except the DMSSPC-CAT-5 and DMSSPC. The results of IRT analysis reveal the item discrimination and item difficulty values of two GM/FM domains of DMASPC are 0.42-2.01/0.36-2.06, and 0.65/0.43. The simulation study results show that the reliability values of two GM/FM domains of DMASPC are 0.757-0.918/0.744-0.912. The correlations between the estimated abilities of DMASPC-CAT at all stooping conditions and DMASPC had high correlations (ICC≥0.883) except the DMASPC-CAT-5 and DMASPC. In the second stage, the validation test showed that the average tested items of the DMSSPC-CAT in the GM/FM domains were 14.72/11.14. The reliability values of the GM/FM domains in the DMSSPC-CAT are 0.904-0.927/0.894-0.914. The correlations between the estimated abilities of DMSSPC-CAT and DMSSPC had high correlations (GM/FM ICC: 0.935/0.923). The correlations between the estimated abilities of DMSSPC-CAT and PDMS-2 had high correlations (GM/FM r: 0.959/0.956, p<0.001). The validation test showed that the average tested items of the DMASPC-CAT in the GM/FM domains were 13.31/12.77. The reliability values of the GM/FM domains in the DMASPC-CAT are 0.905-0.911/0.877-0.911. The correlations between the estimated abilities of DMASPC-CAT and DMASPC had high correlations (GM/FM ICC: 0.909/0.869). The correlations between the estimated abilities of DMASPC-CAT and PDMS-2 had high correlations (GM/FM r: 0.984/0.981, p<0.001).
Conclusion: The DMSSPC-CAT and DMASPC-CAT developed in this study prove to have excellent reliability and validity and good efficiency. They can accurately asses the motor development ability of preschool children and reduce the tested items to 79-89%. In other words, DMSSPC-CAT and DMASPC-CAT need much less labor and time to administer. Therefore, DMSSPC-CAT and DMASPC-CAT are practical and effective clinical assessment for the motor development of preschool children.

目錄
指導教授推薦書
口試委員審定書
致謝...................................................iii
中文摘要...............................................iv
Abstract...............................................vii
第一章 緒論...........................................1
第一節 研究背景與動機.............................1
第二節 研究目的與假設.............................3
第三節 名詞解釋...................................4
第二章 文獻探討.......................................7
第一節 嬰幼兒動作發展.............................7
第二節 試題反應理論...............................19
第三節 電腦化適性測驗.............................26
第三章 研究方法.......................................49
第一節 研究對象...................................49
第二節 研究流程...................................50
第三節 研究工具...................................53
第四節 資料分析...................................58
第四章 研究結果.......................................61
第一節 開發電腦化適性測驗之結果...................61
第二節 驗證電腦化適性測驗之結果...................86
第五章 研究討論.......................................93
第一節 電腦化適性測驗流程.........................93
第二節 模擬研究...................................98
第三節 驗證測試...................................102
第四節 研究限制與未來建議.........................108
第六章 研究結論.......................................110
參考文獻...............................................111
附錄...................................................122

圖目錄
圖1 試題特徵曲線......................................19
圖2 單向度模式........................................22
圖3 多向度模式－題間多向度測驗........................22
圖4 多向度模式－題內多向度測驗........................22
圖5 電腦化適性測驗施測流程............................26
圖6 電腦化適性測驗流程設定............................51
圖7 研究流程..........................................52
圖8 DMSSPC兩向度鑑別度之題目分布......................70
圖9 DMSSPC粗大動作受試者能力值與試題困難度分布........71
圖10 DMSSPC精細動作受試者能力值與試題困難度分布.......72
圖11 DMASPC兩向度鑑別度之題目分布.....................75
圖12 DMASPC粗大動作受試者能力值與試題困難度分布.......75
圖13 DMASPC精細動作受試者能力值與試題困難度分布.......76

表目錄
表1 零到六歲嬰幼兒動作發展里程........................9
表2 國內外動作發展篩檢量表............................17
表3 國內外動作發展評估量表............................18
表4 單向度試題反應理論模式............................24
表5 多向度試題反應理論模式............................25
表6 試題參數數值......................................27
表7 鑑別度判斷標準表..................................28
表8 能力估計法和比較..................................31
表9 選題策略..........................................33
表10 電腦化適性測驗之相關研究.........................43
表11 DMSSPC信效度.....................................55
表12 DMSSPC與PDMS-2相關（N=364）......................55
表13 DMASPC信效度.....................................57
表14 DMASPC與PDMS-2相關（N=264）......................57
表15 開發電腦化適性測驗之受試者人數分配...............63
表16 DMSSPC粗大動作之試題參數.........................68
表17 DMSSPC精細動作之試題參數.........................69
表18 DMASPC粗大動作之試題參數.........................73
表19 DMASPC精細動作之試題參數.........................74
表20 模擬研究DMSSPC-CAT不同測驗長度之表現（N=698）....81
表21 模擬研究DMASPC-CAT不同測驗長度之表現（N=361）....85
表22 驗證電腦化適性測驗之受試者人數分配...............87
表23 DMSSPC-CAT和DMASPC-CAT與PDMS-2相關...............91
表24 驗證測試DMSSPC-CAT和DMASPC-CAT之表現.............92
表25 模擬研究不同測驗長度之信度表現...................99
表26 模擬研究不同測驗長度與原量表之組內相關係數.......101
表27 驗證測試之信度表現...............................103
表28 驗證測試電腦化適性測驗與原量表之組內相關係數.....104
表29 驗證測試電腦化適性測驗與相關量表之皮爾森相關係數..105
表30 驗證測試電腦化適性測驗之效率......................107

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