國民小學注意力不足過動症兒童適應行為功能缺損初探

Adaptation Impairment in Primary School Children with Attention Defi cient Hyperactivity Disorder: A Pilot Study

目的：注意力不足過動症 （ADHD） 是一種神經發展障礙，造成適應功能缺損。本研究 在探討 ADHD 對兒童家庭與學校適應功能的影響。方法：採病歷回溯的方式，回溯 2014 年 01 月至 2017 年 07 月之間，初診診斷為 ADHD 國小兒童，收集學生適應調查表資料， 共 44 位兒童。研究問卷為教育部特殊教育工作小組出版之「學生適應調查表」。依據年齡 分布分為低年段（1 到 3 年級）與高年段（4 到 6 年級）兩組，比較兩組與一般兒童在學校 及家庭的適應功能差異。結果：整體適應功能在所有年段中 ADHD 顯著低於常模。在學校 適應上，兩組 ADHD 兒童在各向度上皆顯著地於相對應一般兒童組 （p < 0.01 or p < 0.01）。 家庭適應方面，低年段 ADHD 兒童在溝通能力 （p < 0.01）、自我指導 （p < 0.001） 顯著低於常模 （n = 281 vs 33）。高年段則在居家生活 （p < 0.01）、人際關係適應 （p < 0.001）、溝通能力 （p < 0.001）、自我指導 （p < 0.001 ） 的表現顯著低於常模的兒童 （301 vs. 11）。結論：本研究發現 ADHD 整體適應較一般兒童差，建議在規劃 ADHD 心理社會介入方案時，應考量不同年齡 層、不同情境在適應功能上相對強弱處，做個別化的介入方案。

Objectives: Attention defi cit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsive symptoms, that impair social, academic or occupational functions, resulting in multiple functional defi cits. This study was to investigate the impact of ADHD on children's family and school adaptive function. Methods: A retrospectively observational study was conducted at a medical center. We reviewed the medical records of newly diagnosed children with ADHD during January 2014 through July 2017. We enrolled ADHD children who had fi lled Student Adaptive Behavior Scale (SABS). We compared SABS scores between junior grade students (school year grade 1-3 years) or senior grade group (school year grade 4-6 years), and those of typical children of same grade group. Results: We enrolled 44 children in this study. The overall adaptive function was signifi cantly poorer in ADHD groups (p < 0.5). In school adaptation, both grade ADHD groups got signifi cantly lower score in all subscales (p < 0.01 or p < 0.01). In family adaptation, compared to typical children junior grade ADHD students was found to have signifi cant poorer adaptation in communication skills (p < 0.01), and self-directing (p < 0.001). Compared to typical children senior-grade ADHD students showed signifi cant poorer adaptation in performance in home life (p < 0.01), interpersonal adaptation (p < 0.001), communication skills (p < 0.001), and self-directing (p < 0.001). Conclusion: Overall adaptation of ADHD children was worse than the average children. In designing of a treatment plan for ADHD, clinician should consider the different impact in adaptive function, to make comprehensive and individualized intervention program.