以神經生理回饋為主之神經心理治療對改善注意力監控之療效研究－－以注意力缺陷／過動疾患兒童為例

The Effectiveness of Neurofeedback-Based Neuropsychotherapy on Improving Meta-Attention Functions for Children with ADHD

Arns等人（2009）後設分析指出神經生理回饋（neurofeedback, NF）訓練對注意力缺陷／過動疾患（ADHD）之注意力與行為症狀具有良好療效，但所應用之NF訓練模組需時較長，且缺乏以神經心理層面的證據來討論所強化的注意力監控功能之心智機制。本研究旨於驗證一套需時較短且融合NF和神經心理理論的神經心理治療模組，且以多層次的心智功能指標來檢驗其療效。以廣泛性注意力訓練系統（comprehensive attention training system, CATS）與自主性概念融入NF，建構一套稱為「Will Well NF（WWNF）」之神經心理治療模組，每治療期程約20小時。二十二名學齡期ADHD患者隨機分派至等候控制組（CON組）與實驗組（WWNF組）。CON組接受前測後，維持原醫囑和治療方式於十週後進行後測；WWNF組則在原醫囑和治療方式內加上十週之WWNF治療。以個案之神經心理功能、家長填答之日常功能行為問卷，以及學習適應問卷三層級指標做為療效指標。統計以二因子重複量數分析與拔靴法之相依t檢定檢驗組內改變。F-test檢測三層級療效指標結果顯示在多項指標上達顯著交互作用，皆為WWNF組進步優於CON組，分別為神經心理測驗中多項注意力指標，如遲緩錯誤數、漏失錯誤數、正確反應數，及反應時間；行為問卷中之不注意症狀數、總症狀數，及注意力指標；以及適應行為之時間管理功能等。經WWNF後，注意力監控與執行功能無論在神經心理層面與生活行為上均呈現明顯改善。雖樣本數較少，但已可實證WWNF對ADHD之療效。未來研究可增加樣本數，用以討論個別差異對療效之影響、追蹤療效之持續性，以及跨其他心智障礙患者之治療效果。

Neurofeedback (NF) training technique can effectively reduce inattention and behavioral symptoms in children with attention deficit hyperactivity disorder (ADHD) based on a meta-analysis study of Arns et al. (2009). Yet, there are two concerns that need be addressed. First, most training programs developed from the NF technique last for more than 40 hours. Second, little efforts had been put to the neuropsychological function, especially training effects on improvement of meta-attention and executive functions. Thus, this study was aimed to establish a novel neuropsychotherapy training program with a shorter training time and to investigate if it has multi-level mental function training effects. Combined Comprehensive Attention Training Systems (CATS) and the concept of autonomy throughout the whole training process with NF technique developed into a novel neuropsychotherapy program, called Will Well NF (WWNF). The training course for WWNF lasts 20 hours. Twenty-two ADHD children were randomly assigned to either a control group (CON group) or an experimental group (WWNF group). The CON group, after taking interview and pretests, kept original treatment protocols until posttests were done after 10 weeks. The WWNF group, after taking interview and pretests, received additional WWNF training for 10 weeks until posttests were done. This study used indices from three levels of evidences to discuss the curative effects, including clients’ neuropsychological functions and behavioral and learning adaptive questionnaires reported by their parents. The two-way repeated measured method (ANOVA) and bootstrapping method of a dependent T-test were used for statistical analysis. An F-test revealed that there were interaction effects in both neuropsychological and behavioral questionnaire levels. Compared to the CON group, the WWNF group made less delay errors and omission errors, more correct responses, reduced reaction time among attentional assessments in neuropsychological tasks, decreased inattention and ADHD symptoms in SNAP, and better daily attention function reported by parents in the questionnaire level. Improving time management behaviors reported by parents within WWNF group were also noted. This study suggested that ADHD children improve in mental functions, including attention monitoring and executive functions, and daily life behaviors after WWNF. Even though the sample size in this study was small, it proved the effect of WWNF. Future studies should increase the sample size to discuss individual impacts on effectiveness, follow up on the maintenance of effectiveness, and apply the method to different mental disabilities.