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系統識別號 U0026-0812200914015341
論文名稱(中文) 以「學齡前兒童行為發展量表」篩檢發展遲緩的診斷效度研究
論文名稱(英文) Diagnostic Validity of Chinese Child Development Inventory in Screening Children with Developmental Delay
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 95
學期 2
出版年 96
研究生(中文) 朱倍毅
研究生(英文) Pei-yi Chu
電子信箱 peiyichu2003@yahoo.com.tw
學號 s8692105
學位類別 碩士
語文別 中文
論文頁數 70頁
口試委員 指導教授-柯慧貞
召集委員-黃惠玲
口試委員-洪碧霞
中文關鍵字 貝萊嬰兒發展量表  ROC曲線  學齡前兒童行為發展量表  發展遲緩  診斷準確度  敏感度 
英文關鍵字 Chinese Child Development Inventory (CCDI)  development delay  diagnostic accuracy  sensitivity  Receiver Operating Characteristic (ROC) curve  Bayley scales of Infant Development-II (BSID-II) 
學科別分類
中文摘要 【研究目的】
柯慧貞等人(民96)更新「學齡前兒童行為發展量表」(Chinese Child Development Inventory,簡稱CCDI)常模,改善舊常模代表性不佳的問題,計分上除原先的發展年齡外,又另加入常態化標準分數。然而,CCDI新常模缺乏同時效標關聯效度資料;故本研究主要的目的是以貝萊嬰兒發展量表第二版(Bayley scales of Infant Development-II,簡稱BSID-II)為效標測驗,建立「學齡前兒童行為發展量表」(Chinese Child Development Inventory,簡稱CCDI)的同時效標關聯效度,並探討CCDI標準分數用做篩檢發展遲緩時的最佳篩檢分數(cutoff point);進一步檢視與比較標準分數與發展年齡兩種不同計分系統的診斷準確度指標。
【研究問題】
1) 探討CCDI與BSID-II的相關性;2) 以心智發展指數(mental developmental index,簡稱MDI)為效標,探討CCDI各向度標準分數在不同篩檢點的診斷準確度指標,建立Receiver Operating Characteristic ( ROC )曲線,決定最佳篩檢分數;3) 以動作發展指數(motor developmental index,簡稱PDI)為效標,探討CCDI一般發展、粗動作與精細動作向度的標準分數在不同篩檢點的診斷準確度指標,建立ROC曲線,決定最佳篩檢分數;4) 以BSID-II為效標測驗,探討與比較CCDI在發展年齡低於實足年齡20%與30%的篩檢點下的診斷準確度指標。
【研究方法】
本研究為橫斷研究(cross-sectional study),以立意取樣法(purposive sampling)由兒童發展門診、早產兒追蹤門診與在社區刊登研究廣告等方式徵求研究參與者,共取樣93名學齡前兒童,年齡範圍從12到42個月,平均年齡為26.69個月(標準差5.911個月),40位女生與53位男生。研究參與者了解其權利與義務後,簽署研究同意書。每位兒童接受BSID-II施測同時,請家長填寫基本資料與CCDI問卷。
【結果】
1. 探討CCDI與BSID-II之相關性:以皮爾森積差相關法(Pearson product moment correlation)求CCDI與BSID-II的相關性,發現MDI與各向度的標準分數及發展年齡皆為顯著中高度相關。各向度以標準分數計分,則MDI與概念理解及一般發展相關最高。各向度以發展年齡計分,則MDI與一般發展及概念理解相關最高。PDI與各向度為中低度相關,且不論以標準分數或發展年齡計分,粗動作與PDI的相關最高。
2. 探討CCDI用做發展遲緩篩檢工具時的最佳篩檢分數:以MDI與PDI為診斷效標,將研究參與者分為「發展遲緩」(MDI<85或PDI<85)與「發展正常」(MDI>=85或PDI>=85),以列聯表(crosstabulation)分析標準分數在不同篩檢點下的診斷準確度指標,以找出診斷效率最佳的分界分數;以ROC曲線(receiver operating characteristics curve)下面積,比較不同向度的整體準確度。結果發現:
(a) 以MDI為效標時,一般發展的整體準確度最佳,並且發展分數於85分具理想篩檢功效,敏感度為80.8%,特異度為90.5%,正確率為87.1%,其陽性預測值為80.0%,而陰性預測值為90.5%。其餘七向度的整體準確度介於.720到.843(p< .05)。
(b) 以PDI為效標時,粗動作、精細動作與一般發展的整體準確率顯著高於隨機診斷。三向度各篩檢點之敏感度與特異度皆未同時達80%的理想標準,然綜合各指標,粗動作量表分數8分是較佳篩檢點,敏感度為81.0%,特異度為77.8%。
3. 發現以發展年齡低於實足年齡的20%為篩檢點時,僅對MDI有較高的篩檢效力,其中以一般發展、概念理解與溝通表達的正確率達80%以上。以發展年齡低於實足年齡的30%為篩檢點時,發現各向度對MDI與PDI具高特異度、低敏感度的篩檢特性。
【結論與討論】
以MDI為效標時,一般發展的整體準確度最佳,發展分數於85分具理想篩檢功效,敏感度與特異度都達80%以上。粗動作與精細動作對PDI有較佳整體準確度,然各篩檢點之敏感度與特異度皆未同時達80%的理想標準,建議進行動作篩檢時,CCDI須結合其他篩檢工具。建議將發展年齡的篩檢點設定為低於實足年齡20%,此時CCDI對MDI的篩檢功效最大。本研究顯示CCDI以新常模計分具良好同時效標關聯效度,為兼具實用性與研究性的學齡前兒童發展篩檢工具。
英文摘要 【Purpose】
The concurrent criterion-related validity of the Chinese Child Development Inventory (CCDI) was assessed with a mental development index (MDI) and psychomotor development index (PDI) measured by the Bayley scales of Infant Development-II (BSID-II). In addition, the cut-off points of standard scores in eight subscales were investigated for identifying developmental delays. And the diagnostic accuracy indicators of standard scores and developmental ages were both further examined and compared.
【Research Questions】
1. Investigated the correlations between CCDI and BSID-II.
2. With MDI as criterion, surveyed the diagnostic accuracy indicators of each cut-off point in standard scores for eight subscales, and graphed out the Receiver Operating Characteristic (ROC) curves to determine the most efficient cut-off point.
3. With PDI as criterion, surveyed the diagnostic accuracy indicators of each cut-off point in standard scores for General Development, Gross Motor and Fine Motor; and graphed out the Receiver Operating Characteristic (ROC) curves to determine the most efficient cut-off point.
4. With MDI and PDI on BSID-II as criterion, investigated and compared the diagnostic accuracy indicators between 20% and 30% below-age-level cutoff points.
【Method】
The present study employed a cross-sectional study design. 93 subjects were purposive drawn from development clinic, premature follow-up clinic and volunteers in community by advertisement. 40 girls and 53 boys ranged from 12 to 42 months, with a mean chronological age of 26.69 months. When BSID-II was administered to children, the parents were asked to answer SES questionnaire and CCDI.
【Results】
1. Pearson correlation procedures revealed significantly moderate to high correlations between MDI and the General Development (GD) and Conceptual Comprehension (CC) of CCDI, and a significantly moderate correlation between PDI and the Gross Motor (GM).
2. In crosstabulation analyses, with MDI as criterion, the most efficient cut-off point is GD standard score <= 85, which with good sensitivity (80.8%) and excellent specificity (90.5%).
3. In crosstabulation analyses, with PDI as criterion, the overall accuracy of GM, FM and GD was significantly higher than random guess. Considered the diagnostic accuracy indicators among each cutoffs, the relatively efficient cut-off point is GM standard score <= 8, with sensitivity=81% and specificity =77.8%.
4. The screening efficiency of 20% below-age-level cutoff point with MDI was optimized, and the hit rates of GD, CC and Expression Language (EL) were all above 80%.
【Discussion】
A cutoff GD standard score of 85 maximized accurate classification of delayed and normal development status, with sensitivity and specificity rate both above 80%. The overall accuracy of GM and FM were optimized to predict PDI, but in each cut-off point, the sensitivity and specificity were not above 80% at the same time. Therefore, CCDI should combine other development instruments for identifying between normal or delay of motor development. In addition, the screening efficiency of 20% below-age-level cutoff point with MDI was optimized than 30% below-age-level cutoff point. This study shows that the new norm has good criterion-related validity, for both practical and research-based screening tool for the development of preschool children.
論文目次 摘要------------------------------------------------------------------------------------------
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