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系統識別號 U0026-0207202014532100
論文名稱(中文) 以神經心理學為基礎之神經回饋訓練運用於注意力不足/過動特質合併疑有網路成癮之青少年
論文名稱(英文) The Effectiveness of Neuropsychological-Based Neurofeedback Training in Adolescents with Traits of Attention-Deficit Hyperactivity Disorder and Suspect of Internet Addiction
校院名稱 成功大學
系所名稱(中) 行為醫學研究所
系所名稱(英) Institute of Behavioral Medicine
學年度 108
學期 2
出版年 109
研究生(中文) 弼毓婷
研究生(英文) Yu-Ting Pi
學號 S86064012
學位類別 碩士
語文別 中文
論文頁數 133頁
口試委員 指導教授-郭乃文
口試委員-柯志鴻
口試委員-李冠瑩
中文關鍵字 神經心理回饋  神經心理治療  注意力不足/過動症  網路成癮  衝動性 
英文關鍵字 Internet Addiction  Attention Deficit and / Hyperactivity Disorder  impulsivity  Neuropsychotherapy  Neurofeedback 
學科別分類
中文摘要 目的:注意力不足/過動症(Attention Deficit Hyperactivity Disorder, ADHD)與網路成癮(Internet Addiction, IA)共病的議題在這網路科技爆發的時代越發被重視。作為兒童中常見的發展疾患,ADHD全球的盛行率高,而IA在亞洲地區也有偏高的現象。兩個疾患之間有許多共同的神經心理機制,包含較差的執行功能,尤其以衝動抑制能力最為顯而易見。其中,青少年正值額葉功能發展的時期,許多腦心智能力尚未完善的建立與穩固,這使得他們在抑制的控制上更為艱難。神經心理治療與神經生理回饋兩項治療方式已經在多項研究中被證明其療效,然將兩者結合運用的方案僅有少數文獻近年才逐漸出現,但也都顯示出對執行功能改善的效果。本研究將針對一群具有ADHD與IA傾向,年紀介於10~23歲的參與者,利用以神經心理治療為基礎的神經生理回饋進行訓練,以改善其執行功能的缺損,從而增進其日常適應能力。
方法:本研究分為兩部分,由神經心理衡鑑至神經心理治療的完整歷程。首先,比較ADHD+IA、ADHD,以及一般控制組間在量性腦波、神經心理測驗,以及日常行為中的差異。此部分總共有68位10~18歲的參與者,其中有37位ADHD確診個案,含13位同時疑似IA,與31位控制組。全部參與者皆進行廣泛性非語言注意力測驗(Comprehensive Nonverbal Attention Test, CNAT),並同時記錄其EEG腦波。另請個案與家長填寫日常行為功能相關問卷。以One-way ANOVA進行三組間的比較。第二部分則為訓練成效研究,總共11位受訓練者接受Modified Will Well Neurofeedback 訓練模組(MWWNF)介入,年齡介於10~22歲,分為8 位實驗組與3位等待組,總訓練時數為 20小時,於訓練前後各進行三層級之指標評估,含腦波、神經心理衡鑑,以及行為問卷,其中3位實驗組受訓練者中途退出,最終以拔靴法之成對樣本t檢定比較8位受訓練者前後測之表現。另亦針對治療期間之表現進行描述性紀錄。
結果:第一部分結果顯示,在行為問卷中兩個ADHD組別皆較控制組於日常注意力、執行功能,以及時間管理表現差;神經心理衡鑑亦顯示較多的衝動錯誤。然腦波表現上,ADHD+IA組於theta波與beta波的數值顯著低於ADHD組與控制組,即高警醒而低專注的表現。第二部分中,整體與個別分析結果顯示三層及療效指標皆有所進步,尤其在CNAT抑制注意力分測驗的衝動錯誤、Stroop的讀字、顏色命名與干擾效果,以及SNAP的過動/衝動分項皆全體進步。然依個別於訓練期間腦波表現、受訓練者與其家長分別之參與度等因素而在進步程度上有所差異。
結論: 本研究結果顯示在比其他組別皆警醒的情況下,ADHD+IA組仍在衝動抑制的表現較控制組差,而與ADHD組相似,且無法提升其努力專注的程度。家長評的問卷也指出他們在日常生活中較差的適應表現,進一步強調ADHD+IA在衝動控制上的不足。而8位完整接受訓練的參與者後測的進步除顯示MWWNF於衝動抑制之療效外,亦說明ADHD+IA的功能缺損可經由訓練而改善。建議未來研究繼續收入更多樣本以進一步證實其療效,並持續追蹤這些個案之表現,以確認療效之維持性。
英文摘要 There were two goals in this study. One was to discuss the differences in impulsivity through bio-psycho-social levels among ADHD+IA, ADHD and the controls. All subjects, aged 10~18, who were psychiatric referral or school referral, with a total of 37 ADHD subjects, included 13 of them comorbid with IA, and 31 controls. The other was to examine the effectiveness of MWWNF program on ADHD+IA subjects, recruited from psychiatric referral, school referral or voluntarily. In both parts, all subjects were evaluated with EEG recording while performing on CNAT and questionnaires evaluating daily life attention, executive function and time management. Though the differences in impulsivity did not show in psychological assessment nor the questionnaires, the brainwave presented significantly lower theta and beta wave in ADHD+IA group. The subjects receiving MWWNF training showed an improvement on their impulsivity through all three levels of assessments. These findings suggested that even being more alert than others while working on the tasks, ADHD+IA group still performed as impulsively as ADHD group. Furthermore, with the training of MWWNF, it is possible to reduce the impulse behaviors.
論文目次 第壹章、 緒論 1
第一節、 研究背景與動機 1
第二節、 網路成癮(IA)與注意力不足/過動症 (ADHD) 3
第三節、 神經心理治療 10
第四節、 神經生理回饋訓練 13
第五節、 研究目的與假設 16
第貳章、 研究方法 17
第一節、 研究參與者 17
第二節、 研究方法與流程 18
第三節、 研究工具 20
第四節、 治療方案與治療設備 25
第五節、 統計分析 30
第參章、 研究結果 31
第一節、 人口學變項 31
第二節、 組別間衝動性差異探討 33
第三節、 整體療效探討 40
第四節、 個別療效探討 46
第五節、 個別療效統整 87
第肆章、 討論 114
第一節、 組別間衝動性之差異 114
第二節、 MWWNF訓練療效分析 117
第三節、 研究限制 119
第四節、 研究貢獻與未來展望 121
參考文獻 122

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