部件教學法合併行為治療對於注意力缺陷過動症共病寫字困難患童寫字治療效益之回朔性研究

The Effectiveness of Combined Chinese Radical Strategy with Behavior Therapy in Children of Attention Deficit Hyperactivity Disorder and Comorbid Word Writing Difficulties, A Restrospective Study

背景和目的：注意力缺陷過動症（Attention Deficit Hyperactivity Disorder， 簡稱ADHD）經常與學習障礙(Learning Disabilities) 共病，共病患童之注意力問題及學習問題皆較嚴重。然而國內對ADHD 共病寫字困難患童之寫字能力相關治療的研究並不多。本研究目的在探討部件教學法合併行為治療對注意力缺陷過動症共病寫字困難患童寫字教學之治療效益。方法：本研究回朔性收集2010 年1 月至2010 年12 月間，在本院復健科因注意力缺陷過動症共病寫字困難，而接受每週一小時共十小時之部件教學法合併行為治療的小一至小三患童，共17 位，收錄資料包含年齡、IQ、接受治療次數、有無服用ADHD藥物、有無合併讀字困難、治療前後基本讀寫字綜合測驗得分、治療前後自編聽寫測驗得分。以統計方法分析評估寫字治療成效。結果：研究結果顯示全體患童在教學字之聽寫，以及非教學字之寫字總分、抄寫與看字造詞得分有明顯進步，顯示出治療及類化效果；此外，有無服藥並未影響寫字治療成效；最後，有合併讀字困難組之患童經治療後，其讀字能力與未合併讀字困難組之能力差異縮小。結論：本研究結果支持部件教學法合併行為治療對注意力缺陷過動症共病寫字困難患童之寫字治療效益。未來可考慮將此模式拓展至學校資源班，納入國語文補救教學之一部分，使患童在校便能接受有效之復健治療。

Background: Children with Attention Deficit Hyperactivity Disorder (ADHD) often have comorbid Learning Disabilities (LD). The symptoms of ADHD and learning problems in children with ADHD and comorbid LD were more severe. However, there were seldom studies about writing therapies for children with ADHD and comorbid word writing difficulties in Taiwan. We has integrated and applied Chinese radical strategy and behavior therapy in Children with ADHD and comorbid word writing difficultes in Sijhih Cathay General Hospital since January, 2010. The aim of this study was to assess the effectiveness of combined Chinese radical strategy with behavior therapy for Children with ADHD and word writing difficulties. Methods: 17 first to third-grade children with ADHD and word writing difficulties who had participated in ten treatment sessions of combined Chinese radical strategy and behavioral therapy between January 2010 and December 2010 were retrospectively reviewed. Each session lasted for an hour per week. Clinical data including age, IQ, times of participating treatment sessions, usage of medicine for ADHD or not, having reading difficulties or not, the score in the Battery of Chinese Basic Literacy (BCBL) before and after the treatment and the score in the self-designed dictation test before and after the treatment were investigated. Results: The results indicated that all children showed significant improvements in the dictation test of target words and in the writing performance of non-target words in BCBL. There was treatment efficacy for writing abilities not only in target words but also in non-target words. Besides, there were no differences of improvement in writing abilities of children with or without medicine for ADHD. Children with reading difficulties also showed an improvement in the reading performance in BCBL test. Conclusions: Our results supported that the treatment of combined Chinese radical strategy and behavioral therapy elevated writing abilities in children with ADHD and word writing difficulties. We are looking forward to apply this treatment strategy to children with ADHD and word writing difficulties in the school settings.