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系統識別號 U0026-2706201811411700
論文名稱(中文) 早期發展正常之極低出生體重早產兒於學齡前與入學期間執行功能受損與介入研究
論文名稱(英文) Development and Interventions for Executive Function Deficits in Preschool and School-age Children Born Very Low Birth Weight with Normal Early Development
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 106
學期 2
出版年 107
研究生(中文) 沈慶華
研究生(英文) Ching-Hua Shen
學號 s86044020
學位類別 碩士
語文別 中文
論文頁數 170頁
口試委員 指導教授-郭乃文
口試委員-黃朝慶
口試委員-黃惠玲
中文關鍵字 極低出生體重早產兒  執行功能  學齡前與入學期間兒童  神經心理治療  複合式訓練模組 
英文關鍵字 VLBW  EF  preschool and school-age  neuro  neuropsychotherapy  composite neuropsychological training model 
學科別分類
中文摘要 目的:研究指出早期發展正常之早產兒於六歲入學期間之非語文工作記憶、計畫,以及認知彈性等執行功能平均顯著差於同齡足月出生的正常兒童,抑制能力平均也有較差趨勢(Ni, Huang, & Guo, 2011)。本研究欲針對早期發展正常之極低出生體重早產兒進行長期追蹤,以探討學齡前與入學期間執行功能發展之變化,並參照足月出生之正常兒童表現建立執行功能發展模式,篩選出發展遲緩者;進一步整合具有療效證據支持之執行功能訓練方案,以探討運用以神經心理治療理論與生態化素材精神所建構之「複合式訓練模組」介入執行功能之成效。
方法: 本研究分別針對「執行功能受損」與「執行功能介入」兩個部分進行探討。在「執行功能受損」方面,早產組與足月組為年齡介於六至十歲之兒童。其中,早產組來自「財團法人中華民國早產兒基金會」轉介之台南區2002年8月至2011年12月出生之極低出生體重早產兒,以矯正年齡十二、二十四個月於貝萊嬰幼兒發展量表第二版(BSID-II)之心理發展指標分數(MDI)和動作發展指標分數(PDI)或第三版(Bayley-III)的認知、語言,以及動作組合分數,與五歲時於魏氏幼兒智力量表修訂版中文版(WPPSI-R)之全量表分數(FSIQ)作為早期發展正常之指標,納入分數高於70分者,排除視覺障礙、聽覺障礙、腦性麻痺,以及智能不足等疾患,分別納入六歲組共230位,八歲組共111位,以及十歲組共57位。足月組則來自台南市國小中自願參與之正常兒童,分別納入六歲組共100位,八歲組共100位,以及十歲組共60位。執行功能衡鑑包含四個部分:工作記憶以魏氏兒童智力測驗中文版第四版(WISC-IV)之逆序背誦記憶廣度分測驗與Knox’s方塊仿效測驗(KCT)評估、計畫能力以倫敦塔(ToL)評估、認知彈性以威斯康辛卡片分類測驗(WCST)評估,以及抑制能力以廣泛性非語文注意力測驗(CNAT)評估。在「執行功能介入」方面,介入組為年齡介於六至十歲之兒童,其來自上述所建立之執行功能發展追蹤資料庫,以足月出生正常兒童之表現建立執行功能發展模式,將各項指標分數落於3~25%者視為較差(Fair, F),2%以下者則視為差(Poor, P),篩選出具有兩項以上功能表現落於遲緩者,分別納入六歲組共5位早產組和1位足月組、八歲組共5位早產組,以及十歲組納入4位早產組和2位足月組。本研究所設計著重於執行功能訓練之治療方案,為一套運用神經心理治療理論與生態化素材精神所建構之「複合式訓練模組」,適用於學齡前與入學期間之兒童,針對工作記憶、抑制能力、認知彈性,及抑制能力等四項執行功能部件進行直接強化,內容包括:廣泛性記憶力訓練系統(Comprehensive Memory Training System, CMTS)、「動腦玩,玩腦動」(Executive FUNction Training, EFT),以及多元生態化素材。以兩至三人為一組之小團體,進行每週一次兩小時,期長十週,共二十小時之介入。所有個案均接受前、後測評估,並從日常行為功能與神經心理功能兩層次之指標分析療效。
結果:在「執行功能受損」方面:(1)在控制足月出生正常兒童之年齡、性別、社經地位後,結果仍顯示六歲早產組之工作記憶、計畫能力、認知彈性,以及抑制能力之平均顯著差於同年齡足月組;(2)隨年齡發展,八歲與十歲早產組與同年齡足月組兒童之執行功能平均未呈現顯著差異;(3)第一、二次參與追蹤之八歲早產組,及八歲足月組之人口學變項、心智功能,以及執行功能平均皆無顯著差異,此可排除重複施測對執行功能表現之影響;(4)早產組19名參與六歲、八歲,及十歲追蹤且未曾因執行功能發展遲緩而接受介入者之長期追蹤資料顯示,其於執行功能各項指標之平均分數會隨年齡發展顯著進步;(5)於六歲執行功能遲緩者,至八歲時仍有顯著高比率落於遲緩範圍;於八歲執行能遲緩者,至十歲時仍有高比率落於遲緩範圍。在「執行功能介入」方面:(1)於日常行為功能層次上,照顧者報告介入能使3名個案從遲緩進步至正常、12名達滿足,僅2名雖有進步但仍落於遲緩範圍;(2)於神經心理功能層次上,17名個案皆至少有一項執行功能部件達進步且正常。
結論:早期發展正常之極低出生體重早產兒於六歲時雖仍有執行功能發展遲緩之情況,然隨著年齡發展,至八歲與十歲時,其於執行功能各項指標之表現已達同年齡足月組平均,此所呈現之執行功能發展模式可作為未來早期介入之實徵基礎。運用以神經心理治療理論與生態化素材精神所建構之「複合式訓練模組」,不僅能有效提升學齡前與入學期間兒童之執行功能,同時也兼具多元性與趣味性,促使訓練者能更為有效針對兒童之特性彈性運用,除了增加適用性,也利於未來推廣。
英文摘要 The aim of this study was to investigate the development of executive function(EF) deficits in preschool and school-age children born very low birth weight(VLBW)with normal early development, and innovated a composite neuropsychological training model focused on EFs for preschool and school-age with EFs deficits. This study was conducted in three groups. The VLBW group included 230 children at the age of 6, 111 children at the age of 8, and 57 children at the age of 10. The Full-term group included 100 children at the age of 6, 100 children at the age of 8, and 60 children at the age of 10. Two levels of instruments were applied for evaluating four kinds of EFs, including working memory, planning, cognitive flexibility, and inhibition. The Training group included 5 VLBW and 1 Full-term children at the age of 6, 5 VLBW children at the age of 8, and 4 VLBW and 2 Full-term children at the age of 10 with more than two EFs delayed. This composite neuropsychological training model focused on EFs combined with Comprehensive Memory Training System(CMTS), Executive FUNction Training(EFT), and multi-ecological materials. The training was conducted in 2-hour sessions, once a week, persisted for 10 weeks.The study revealed that the average EFs of VLBW group was significantly inferior to the Full-term group at the age of 6, but it would be comparable with the Full-term group when it up to the age of 8 and 10. In addition, 19 VLBW children were traced all at the age of 6, 8, and 10, found the average EFs significantly progressed with age which excluded learning effect. Children who had EFs deficits at the age of 6 had significantly higher rate of showing EFs deficits at the age of 8, or children who had EFs deficits at the age of 8 had higher rate of showing EFs deficits at the age of 10. Results show composite neuropsychological training model can enhance executive functions in children with EFs deficits.
論文目次 摘要 I
第壹章 緒論 1
第一節、執行功能 1
一、執行功能之定義 1
二、執行功能發展與衡鑑 4
第二節、早產兒 12
一、早產兒之定義 12
二、早產兒心智功能發展與後遺症 13
第三節、早產兒之執行功能 15
一、早產兒之執行功能發展 15
二、早期發展正常早產兒之執行功能遲緩 18
第四節、執行功能之神經心理治療 21
一、神經心理治療 21
二、著重於執行功能之神經心理治療 23
第五節、研究動機與問題假設 29
一、研究動機 29
二、研究假設 31
第貳章 研究方法 32
第一節、研究流程與架構 32
第二節、研究對象 34
一、研究參與者篩選與招募 34
第三節、研究工具 37
一、早期發展之回溯性資料 37
二、基本資料問卷 39
三、心智發展衡鑑 41
四、執行功能衡鑑 42
第四節、著重於執行功能訓練之神經心理治療 49
一、複合式訓練模組 49
二、以複合式訓練模組介入執行功能之方案內容 51
第五節、統計分析 53
第參章 結果 54
第一節、人口學統計分析 54
一、 早產組之取樣代表性 54
二、早產組與足月組之組間差異分析 55
第二節、執行功能表現分析 61
一、早產組與足月組之組間執行功能差異分析 61
二、 足月組之執行功能發展模式 74
三、 早產組與足月組之組間執行功能遲緩分析 80
四、 早產組之組內執行功能遲緩分析 84
第三節、長期追蹤執行功能發展分析 86
一、檢驗測驗重複施測對執行功能表現之影響 86
二、檢驗早產組執行功能隨年齡之發展變化 94
第四節、著重於執行功能訓練之神經心理治療療效分析 101
一、介入組之人口學統計分析 101
二、個別療效分析 105
第肆章 討論 134
第一節、「執行功能受損」探討 134
第二節、著重於「執行功能介入」之神經心理治療療效探討 136
第三節、研究限制 140
第四節、研究貢獻與展望 141
參考文獻 143
附錄 163
附錄一、六歲早產組之取樣代表性 163
附錄二、八歲早產組之取樣代表性 167
附錄三、十歲早產組之取樣代表性 169

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