臺灣博碩士論文加值系統

背景/目的：
注意力缺損過動症（Attention-Deficit/Hyperactivity Disorder，簡稱ADHD）是一種始於兒童期的神經發展障礙疾患，常持續於成年期，儘管藥物治療已證實能改善ADHD部分症狀，但該疾患仍可能會干擾職業或社會功能，造成成人患者損害。本研究系統性回顧成人ADHD非藥物治療研究，並對不同心理治療法或藥物治療結合心理療法之療效進行分析和比較。
研究方法：
在PsychINFO、PsycARTICLE和Medline等資料庫，檢索於1987年1月至2017年12月期間發表的研究文獻，納入標準為（1）研究對象為成人ADHD；（2）療效研究；（3）採用心理介入療法，排除了（1）質性研究；（2）書籍或文獻綜論；（3）統合分析研究；（4）重複研究，共計有16篇研究文獻、包含21個治療介入的研究結果進行了統合分析。
研究結果與討論：
本研究結果顯示，所有心理介入療法對於成人ADHD整體功能指標皆有顯著的正面效益，對於改善注意力缺損、憂鬱、焦慮情緒與自尊等有中度至高度之間的療效。比較不同療法的治療效果，個別認知行為治療與神經回饋療法對於改善ADHD症狀和憂鬱情緒有更好的治療成效。本研究支持將心理治療納入成人ADHD患者治療方案的重要性。

Background/Objective:
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that initially characterized as a childhood disorder, however it often persists into adulthood. Despite pharmaceutical treatments have shown scientific evidence of efficacy to improve some symptoms of adult ADHD, the disorder itself interferes with social or occupational functions and consequently causes impairments in adult patients. The purpose of the study is to systematically review the therapeutic effects of psychological intervention or combining with the pharmaceutical interventions for adult ADHD.

Method:
A literature search was carried out in PsychINFO, PsycARTICLE and Medline for studies published between January 1987 to December 2017. Inclusion criteria for the review were (1) study participants were adult ADHD (2)therapeutic effects study (3)psychological intervention. Studies were excluded if (1) qualitative study (2) book or literature review (3) meta analysis study (4) identical studies. A total of 16 articals which including 21 treatment effects were identified for meta-analyses.

Results:
All psychological-based interventions showed medium-to-large effects on global functions index for adult ADHD. The therapeutic effects on the decrease of attention deficits, depression, anxiety, and an increase of self-esteem were moderate. Individual cognitive-behavioral therapy as well as neurofeedback indicated better effects on ADHD symptoms and depression compared to other modality of intervention. Our findings support the importance of incorporating the psychological interventions into the treatment regime for adult patients with ADHD.

目錄
第一章 緒論 1
第一節　研究背景與動機 1
壹、成人ADHD之困境 1
貳、流行病學的資料 2
參、ADHD對成人生活之影響 3
肆、ADHD藥物治療 3
第二節 研究目的與問題 4
壹、研究目的 4
貳、研究問題 4

第二章 文獻回顧 6
第一節 ADHD診斷的歷史演變 6
第二節 ADHD對成人的影響 7
第三節 成人ADHD非藥物治療 9
壹、認知行為取向的心理治療 9
貳、正念取向心理療法 11
參、神經回饋療法 11
肆、心理教育療法 12
伍、研究問題 12

第三章 研究方法 14
第一節 研究流程與資料處理 14
壹、研究文獻蒐集與篩檢 14
貳、變項編碼 17
參、計算效果量 17
肆、檢驗同質性 19

第四章 研究結果與分析 20
第一節 研究樣本特徵與總體治療介入效果量 20
第二節 治療形式、介入次數、有無回家作業之總體效果量 32
壹、團體治療與個別治療之總體效果量分析 32
貳、療程介入次數之總體效果量分析 33
參、有回家作業與無額外練習之總體效果量分析 35
肆、團體治療與個別治療的介入次數之總體效果量分析 36

第三節 各種心理治療法的效果量分析 38
壹、認知行為團體療法之總體效果量分析 39
貳、認知行為個別療法之總體效果量分析 39
參、正念團體療法之總體效果量分析 40
肆、神經回饋療法之總體效果量分析 40
伍、其他治療介入療法之總體效果量分析 41
陸、聯合治療法總體效果量分析 41
柒、不同治療法之總體效果量比較 42

第四節 各種效果指標的效果量分析 45
壹、ADHD整體核心症狀的總效果量分析 45
貳、注意力不足核心症狀的總效果量分析 45
參、過動/衝動核心症狀的總效果量分析 46
肆、憂鬱情緒的總效果量分析 46
伍、焦慮情緒的總效果量分析 47
陸、自尊的總效果量分析 48
柒、臨床整體功能的總效果量分析 48
捌、生活品質的總效果量分析 49
玖、不同效果指標的效果量比較分析 49

第五節　各種心理治療法在不同效果指標上的效果量分析 52
壹、各種心理治療介入對於ADHD整體核心症狀的效果量分析 52
貳、各種心理治療介入對於注意力不足症狀的效果量分析 54
參、各種心理治療介入對於過動/衝動症狀的效果量分析 55
肆、各種心理治療介入對於憂鬱情緒的效果量分析 56
伍、各種心理治療介入對於焦慮情緒的效果量分析 58
陸、各種心理治療介入對於自尊的效果量分析 59
柒、各種心理治療介入對於臨床整體功能的效果量分析 60
捌、各種心理治療介入對於生活品質的效果量分析 61

第五章 討論與建議 64
第一節 結果討論 64
壹、療效指標 64
貳、治療形式：團體治療與個別治療的比較 66
參、不同的治療介入方法 67
肆、介入次數與作業要求 69
第二節 研究限制 70
第三節 貢獻與建議 70

第六章 參考文獻 72
附件一、編碼表 82
附件二 研究樣本基本特徵表 83


表目錄
表 4-1-1 各研究效果量摘要表 21
表 4-1-2 21個研究的總效果量 30
表 4-2-1 團體治療與個別治療之總體效果量 33
表 4-2-2 不同療程介入次數之總體效果量 34
表 4-2-3 有回家作業與無額外練習之總體效果量 35
表 4-2-4.1 不同介入次數團體治療之總體效果量 36
表 4-2-4.2 不同介入次數個別治療之總體效果量 37
表 4-2-4.3 團體治療與個別治療之效果量、介入次數 38
表 4-3-1 認知行為團體療法之總體效果量 39
表 4-3-2 認知行為個別療法之總體效果量 40
表 4-3-3 正念團體療法之總體效果量 40
表 4-3-4 神經回饋療法之總體效果量 41
表 4-3-5 其他團體療法之總體效果量 41
表 4-3-6 聯合治療法之總體效果量 42
表 4-3-7.1 各種心理治療介入療法的效果量 42
表 4-3-7.2 不同治療法之療效比較 44
表 4-4-1 ADHD整體核心症狀的總效果量 45
表 4-4-2 注意力不足核心症狀的總效果量 46
表 4-4-3 過動/衝動核心症狀的總效果量 46
表 4-4-4 憂鬱情緒的總效果量 47
表 4-4-5 焦慮情緒的總效果量 47
表 4-4-6 自尊的總效果量 48
表 4-4-7 臨床整體功能的總效果量 48
表 4-4-8 生活品質的總效果量 49
表 4-4-9 各種療效指標之效果量 50
表 4-5-1.1 不同治療法對ADHD整體核心症狀之療效比較 53
表 4-5-2.1 使用不同心理治療介入對於注意力不足症狀的效果量 53
表 4-5-2.2 不同治療法對注意力不足核心症狀之療效比較 54
表 4-5-3.1 使用不同心理治療介入對於過動/衝動症狀的效果量 55
表 4-5-3.2 不同治療法對過動/衝動核心症狀之療效比較 56
表 4-5-4.1 使用不同心理治療介入對於憂鬱情緒的效果量 57
表 4-5-4.2 不同治療法對憂鬱情緒之療效比較 58
表 4-5-5.1 使用不同心理治療介入對於焦慮情緒的效果量 59
表 4-5-5.2 不同治療法對焦慮情緒之療效比較 59
表 4-5-6.1 使用不同心理治療介入對於自尊的效果量 60
表 4-5-6.2 不同治療法對自尊之療效比較 60
表 4-5-7.1 使用不同心理治療介入對於臨床整體功能的效果量 61
表 4-5-7.2 不同治療法對臨床整體功之療效比較 61
表 4-5-8.1 使用不同心理治療介入對於生活品質的效果量 62
表 4-5-8.2 各種心理治療介入療法與不同療效指標的效果量 63


圖目錄
圖 3-1 文獻流程圖 16
圖 4-1-1 以隨機效應模型之統合分析結果的森林圖 30
圖 4-1-2 21個研究總效果量漏斗圖 31
圖 4-3-7 各種心理治療介入療法之總體效果量長條圖 43
圖 4-4-9 不同效果指標統合分析結果之長條圖 51

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楊淵勝 （2010）。 成人型注意力缺損過動症患者之神經認知功能, 心理特質與社會適應功能初探。高雄醫學大學神經學科研究所學位論文，頁 1-70。

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