認知行為團體治療在注意力不足過動兒童的臨床應用

Cognitive-Behavioral Group Intervention for Children with Attention Deficit Hyperactivity Disorder

注意力不足過動症是以衝動、注意力短暫、自我中心和思考缺乏彈性為特徵，其產生的人際困擾層出不窮。本研究之目的在於運用認知行為團體治療模式，透過團體的互動來協助其學習自我控制和人際技巧，以增進其在家、在校的團體適應。四位工作人員分為二組帶領注意力不足過動兒童團體和家長團體進行這項研究，本篇報告主要以兒童團體為主。團體成員是小學三、四年級七名（六男一女）患過動症兒童，團體治療每週一次，每次一小時，為期12次。透過團體討論、腦力激盪、遊戲、繪畫、角色演練、自我對話等活動，於12次治療中依序學習如何放鬆自己、認識問題、解決問題的各種可能方法、後果的考量、情境改變時如何彈性因應、情緒的適當表達、以及如何站在他人立場想事情、如何自我肯定等主題，並將這些主題隨時在團體進行互動中加以練習、應用。研究發現大部分的成員在使用所教的問題解決的方法、和治療師相處、和其他成員相處、以及專心度等方面有進步；4/7的成員在家有嘗試所教的問題解決的方法；其他未參與治療之專業人員於治療前後的評估，發現多數成員的過動症症狀改善，情緒困擾有降低，學校適應困擾程度有改善。

Children with attention deficit hyperactivity disorder (ADHD) have the characteristics of impulsivity, short attention span, egocentricism, and rigid thinking, which cause many problems in their interpersonal relations. The aim of the study is to apply cognitive-behavioral group intervention to ADHD children to enhance their self control and social skills, which in turn will improve their school and family adjustment. The children's group and their parents' group were led separately by four professionals. This paper summaries the results of the children's group. The group was composed of seven children, one girl and six boys, in third or fourth grade of elementary school. The group met for one hour each week for a total of twelve sessions. Through group activities, the children learned and practiced the following themes: problem recognition, alternative and consequential thinking, outcomes evaluating and back-up plans creating, expressing feeling, cooperation, listening, ignoring, assertiveness, etc. The results show that all of the children except one improved in their problem solving skills, interpersonal relationship and concentration (sustained attention) in group. Four out of seven could generalize problem solving strategies at home and also showed improved school adjustment. In the blind expert evaluation, before and after the group treatment, most of the children improved in their ADHD symptoms and the severity of emotional disturbance decreased.