题名

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

并列篇名

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

DOI

10.6251/BEP.20150302

作者

廖御圻(Yu-Chi Liao);郭乃文(Nai-Wen Guo);陳信昭(Shin-Jaw Chen);蔡幸芳(Hsing-Fang Tsai);蘇倍儀(Bei-Yi Su)

关键词

注意力缺陷/過動疾患 ; 注意力監控 ; 神經心理治療 ; 神經生理回饋 ; ADHD ; CATS ; meta-attention ; neurofeedback ; neuropsychotherapy

期刊名称

教育心理學報

卷期/出版年月

47卷2期(2015 / 12 / 01)

页次

281 - 304

内容语文

繁體中文

中文摘要

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。

英文摘要

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.

主题分类 社會科學 > 心理學
社會科學 > 教育學
参考文献
  1. Liu, Y.,Liu, S.,Shang, C.,Lin, C.,Tu, C.,Gau, S.(2006).Norm of the Chinese Version of the Swanson, Nolan and Pelham, Version IV Scale for ADHD.Taiwanese Journal of Psychiatry,20(4),290-304.
    連結:
  2. 詹雅雯、陳信昭、郭乃文(2006)。注意力缺失/過動疾患不注意型與合併型之多面向注意力功能分析。臨床心理學刊,3(2),85-92。
    連結:
  3. Amen, D. G.,Carmichael, B. D.(1997).High-resolution brain SPECT imaging in ADHD.Annals of Clinical Psychiatry,9(2),81-86.
  4. Amen, D. G.,Paldi, F.,Thisted, R. A.(1993).Brain SPECT imaging.Journal of the American Academy of Child and Adolescent Psychiatry,32(5),1080-1081.
  5. American Psychiatric Association(2013).Diagnostic and statistic manual of mental disorders.Arlington, VA:American Psychiatric.
  6. American Psychiatric Association(2000).Diagnostic and statistic manual of mental disorders.Washington, DC:Author.
  7. Arns, M.,de Ridder, S.,Strehl, U.,Breteler, M.,Coenen, A.(2009).Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis.Clinical EEG and Neuroscience,40(3),180-189.
  8. Barkley, R. A.,Grodzinsky, G.,DuPaul, G. J.(1992).Frontal lobe functions in attention deficit disorder with and without hyperactivity: A review and research report.Journal of Abnormal Child Psychology,20(2),163-188.
  9. Barry, R. J.,Clarke, A. R.,Johnstone, S. J.(2003).A review of electrophysiology in attention-deficit/hyperactivity disorder: Qualitative and quantitative electroencephalography.Clinical Neurophysiology,114(2),171-183.
  10. Bradley, R. H.,Caldwell, B. M.,Rock, S. L.,Hamrick, H. M.,Harris, P.(1988).Home observation for measurement of the environment: Development of a HOME inventory for use with families having children 6 to 10 years old.Contemporary Educational Psychology,13(1),58-71.
  11. Burgess, P. W.,Shallice, T.(1996).Confabulation and the control of recollection.Memory,4(4),359-411.
  12. Butnik, S. M.(2005).Neurofeedback in adolescents and adults with attention deficit hyperactivity disorder.Journal of Clinical Psychology,61(5),621-625.
  13. Cappas, N. M.,Andres-Hyman, R.,Davidson, L.(2005).What psychotherapists can begin to learn from neuroscience: Seven principles of a brain-based psychotherapy.Psychotherapy,42(3),374-383.
  14. Clarke, A. R.,Barry, R. J.,McCarthy, R.,Selikowitz, M.(2001).Age and sex effects in the EEG: Differences in two subtypes of attention-deficit/hyperactivity disorder.Clinical Neurophysiology,112(5),815-826.
  15. Cohen, J.(1988).Statistical power analysis for the behavioral sciences.Hillsdale, NJ:Lawrence Erlbaum.
  16. Cohen, R. A.(2014).The neuropsychology of attention.New York, NY:Springer.
  17. Cohen, R. A.,Kaplan, R. F.(1993).Attention as a Multicomponent Process - Neuropsychological Validation.Journal of Clinical and Experimental Neuropsychology,15(3),379-379.
  18. Cook, I. A.,O'Hara, R.,Uijtdehaage, S. H.,Mandelkern, M.,Leuchter, A. F.(1998).Assessing the accuracy of topographic EEG mapping for determining local brain function.Electroencephalography and Clinical Neurophysiology,107(6),408-414.
  19. Couillet, J.,Soury, S.,Lebornec, G.,Asloun, S.,Joseph, P. A.,Mazaux, J. M.,Azouvi, P.(2010).Rehabilitation of divided attention after severe traumatic brain injury: A randomised trial.Neuropsychological Rehabilitation: An International Journal,20(3),321-339.
  20. Cozolino, L. J.(2010).The neuroscience of psychotherapy : healing the social brain.New York, NY:W.W. Norton.
  21. Davison, A. C.(1997).Bootstrap methods and their application.Cambridge, MA:Cambridge University Press.
  22. Evans, J.(Ed.)(2007).Handbook of neurofeedback: Dynamics and clinical application.New York, NY:Informa Helthcare USA.
  23. Fuchs, T.,Birbaumer, N.,Lutzenberger, W.,Gruzelier, J. H.,Kaiser, J.(2003).Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: A comparison with methylphenidate.Applied Psychophysiology and Biofeedback,28(1),1-12.
  24. Gau, S. S.,Shang, C. Y.,Liu, S. K.,Lin, C. H.,Swanson, J. M.,Liu, Y. C.,Tu, C. L.(2008).Psychometric properties of the Chinese version of the Swanson, Nolan, and Pelham, version IV scale - parent form.International Journal of Methods in Psychiatric Research,17(1),35-44.
  25. Gevensleben, H.,Holl, B.,Albrecht, B.,Schlamp, D.,Kratz, O.,Studer, P.,Wangler, S.,Rothenberger, A.,Moll, G. H.,Heinrich, H.(2009).Distinct EEG effects related to neurofeedback training in children with ADHD: A randomized controlled trial.International Journal of Psychophysiology,74,149-157.
  26. González-Castro, P.,Álvarez, L.,Núñez, J. C.,González-Pienda, J. A.,Álvarez, D.,Muñiz, J.(2010).Cortical activation and attentional control in ADAH subtypes1.International Journal of Clinical and Health Psychology,10(1),23-39.
  27. Grawe, K.(2007).Neuropsychotherapy: How the neurosciences inform effective psychotherapy.Mahwah, NJ:Lawrence Erlbaum.
  28. Grodzinsky, G. M.,Diamond, R.(1992).Frontal lobe functioning in boys with attention-deficit hyperactivity disorder.Developmental Neuropsychology,8(4),427-445.
  29. Gualtieri, C. T.,Johnson, L. G.(2008).Medications do not necessarily normalize cognition in ADHD patients.Journal of Attention Disorders,11(4),459-469.
  30. Heinrich, H.,Gevensleben, H.,Strehl, U.(2007).Annotation: Neurofeedback-train your brain to train behaviour.Journal of Child Psychology and Psychiatry,48,3-16.
  31. Hollingshead, A. B.(1957).Two factor index of cocial position.New Heaven, CT:Yale University.
  32. Holtmann, M.,Grasmann, D.,Cionek-Szpak, E.,Hager, V.,Panzner, N.,Beyer, A.,Poustka, F.,Stadler, C.(2009).Spezifische wirksamkeit von neurofeedback auf die impulsivität bei ADHS.Kindheit und Entwicklung,18(2),95-104.
  33. Kandel, E. R.(1998).A new intellectual framework for psychiatry.American Journal of Psychiatry,155(4),457-469.
  34. Kaufmann, L.,Zieren, N.,Zotter, S.,Karall, D.,Scholl-Burgi, S.,Haberlandt, E.,Fimm, B.(2010).Predictive validity of attentional functions in differentiating children with and without ADHD: A componential analysis.Developmental Medicine & Child Neurology,52(4),371-378.
  35. Kelly, A. M.,Garavan, H.(2005).Human functional neuroimaging of brain changes associated with practice.Cerebral Cortex,15(8),1089-1102.
  36. Kerns, K. A.,Eso, K.,Thomson, J.(1999).Investigation of a direct intervention for improving attention in young children with ADHD.Developmental Neuropsychology,16(2),273-295.
  37. Kovatchev, B.,Cox, D.,Hill, R.,Reeve, R.,Robeva, R.,Loboschefski, T.(2001).A psychophysiological marker of attention deficit/hyperactivity disorder (ADHD) defining the EEG consistency index.Applied Psychophysiology and Biofeedback,26(2),127-140.
  38. Kropotov, J. D.,Grin-Yatsenko, V. A.,Ponomarev, V. A.,Chutko, L. S.,Yakovenko, E. A.,Nikishena, I. S.(2005).ERPs correlates of EEG relative beta training in ADHD children.International Journal of Psychophysiology,55(1),23-34.
  39. Laaksonen, R.(Ed.),Ranta, M. (Ed.)(2013).Introduction to neuropsychotherapy: Guidelines for rehabilitation of neurological and neuropsychiatric patients throughout the lifespan.New York, NY:Psychology Press.
  40. Linden, M.,Habib, T.,Radojevic, V.(1996).A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities.Biofeedback and Self Regulation,21(1),35-49.
  41. Lubar, J. F.,Swartwood, M. O.,Swartwood, J. N.,O'Donnell, P. H.(1995).Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance.Biofeedback and Self Regulation,20(1),83-99.
  42. Mann, C. A.,Lubar, J. F.,Zimmerman, A. W.,Miller, C. A.,Muenchen, R. A.(1992).Quantitative analysis of EEG in boys with attention-deficit-hyperactivity disorder: Controlled study with clinical implications.Journal of Pediatric Neurology,8(1),30-36.
  43. Medley, A. R.,Powell, T.(2010).Motivational interviewing to promote self-awareness and engagement in rehabilitation following acquired brain injury: A conceptual review.Neuropsychological Rehabilitation,20(4),481-508.
  44. Monastra, V. J.,Lubar, J. F.,Linden, M.(2001).The development of a quantitative electroencephalographic scanning process for attention deficit-hyperactivity disorder: Reliability and validity studies.Journal of Neuropsychology,15(1),136-144.
  45. Monastra, V. J.,Lubar, J. F.,Linden, M.,VanDeusen, P.,Green, G.,Wing, W.,Phillips, A.,Fenger, T. N.(1999).Assessing attention deficit hyperactivity disorder via quantitative electroencephalography: An initial validation study.Journal of Neuropsychology,13(3),424-433.
  46. Monastra, V. J.,Lynn, S.,Linden, M.,Lubar, J. F.,Gruzelier, J.,LaVaque, T. J.(2005).Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder.Applied Psychophysiology and Biofeedback,30(2),95-114.
  47. Monastra, V. J.,Monastra, D. M.,George, S.(2002).The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder.Applied Psychophysiology and Biofeedback,27(4),231-249.
  48. Pasini, A.,Paloscia, C.,Alessandrelli, R.,Porfirio, M. C.,Curatolo, P.(2007).Attention and executive functions profile in drug naive ADHD subtypes.Brain and Development,29(7),400-408.
  49. Peper, E.,Tylova, H.,Gibney, K. H.,Havey, R.,Combatalade, D.(2008).Biofeedback mastery an experiential teaching and self-training manual.Wheat Ridge, CO:Association for Applied Psychophysiology and Biofeedback.
  50. Posner, M. I.(2004).Cognitive neuroscience of attention.New York, NY:Guilford Press.
  51. Pribram, K. H.(Ed.),Luria, A. R.(Ed.)(1973).Psychophysiology of the frontal lobes.Oxford, England:Academic.
  52. Ramdass, D.,Zimmerman, B. J.(2011).Developing self-regulation skills: The important role of homework.Journal of Advanced Academics,22(2),194-218.
  53. Rossiter, D. T. R.,La Vaque, T. J.(1995).A comparison of EEG biofeedback and psychostimulants in treating attention deficit/hyperactivity disorders.Journal of Neurotherapy,1(1),48-59.
  54. Schwarz, M. S.(Ed.),Andrsik, F.(Ed.)(2003).Biofeedback: A practitioner's guide.New York, NY:The Guilford Press.
  55. Shallice, T.(1982).Specific impairments of planning.Philosophical Transactions of the Royal Society: Biological Sciences,298(1089),199-209.
  56. Stuss, D. T.,Alexander, M. P.,Shallice, T.,Picton, T. W.,Binns, M. A.,Macdonald, R.,Borowiec, A.,Katz, D. I.(2005).Multiple frontal systems controlling response speed.Neuropsychologia,43(3),396-417.
  57. Teplan, M.(2002).Fundamentals of EEG measurement.Measurement Science Review,2(2),1-11.
  58. Thompson, L.,Thompson, M.(1998).Neurofeedback combined with training in metacognitive strategies: Effectiveness in students with ADD.Applied Psychophysiology and Biofeedback,23(4),243-263.
  59. Tucha, O.,Prell, S.,Mecklinger, L.,Bormann-Kischkel, C.,Kübber, S.,Linder, M.,Walitza, S.,Lange, K. W.(2006).Effects of methylphenidate on multiple components of attention in children with attention deficit hyperactivity disorder.Psychopharmacology,185(3),315-326.
  60. Tucha, O.,Tucha, L.,Kaumann, G.,König, S.,Lange, K. M.,Stasiket, D.,Streather, Z.,Engelschalk, T.,Lange, K. W.(2011).Training of attention functions in children with attention deficit hyperactivity disorder.ADHD Attention Deficit and Hyperactivity Disorders,3(3),271-283.
  61. Vernon, D.,Frick, A.,Gruzelier, J.(2004).Neurofeedback as a treatment for ADHD: A methodological review with implications for future research.Journal of Neurotherapy: Investigations in Neuromodulation, Neurofeedback and Applied Neuroscience,8(2),53-82.
  62. Walter, H.,Berger, M.,Schnell, K.(2009).Neuropsychotherapy: Conceptual, empirical and neuroethical issues.European Archives of Psychiatry and Clinical Neuroscience,259(2),173-182.
  63. Willcutt, E. G.,Doyle, A. E.,Nigg, J. T.,Faraone, S. V.,Pennington, B. F.(2005).Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review.Biological Psychiatry,57(11),1336-1346.
  64. Yucha, C.,Gilbert, C.(2004).Evidence-based practice in biofeedback and neurofeedback.Wheat Ridge, CO:Applied Psychophysiology and Biofeedback.
  65. 余麗樺、郭乃文、黃茂雄(2002)。行政院國家科學委員會專題研究計畫成果報告行政院國家科學委員會專題研究計畫成果報告,Taipei, Taiwan:行政院國家科學委員會=National Science Council。
  66. 吳玉欣、余麗樺、陳靖、郭乃文(2000)。日常執行功能量表之發展與其因素結構及信效度研究。臨床心理學刊,4(2),86-94。
  67. 李昇恆(2012)。Tainan, Taiwan,國立成功大學行為醫學研究所=Institute of Behavioral Medicine, National Cheng Kung University。
  68. 倪子洛(2011)。Tainan, Taiwan,國立成功大學行為醫學研究所=Institute of Behavioral Medicine, National Cheng Kung University。
  69. 郭乃文(2002)。非語文性注意力與記憶力測驗指導手冊。台北=Taipei, Taiwan:台灣師大特殊教育中心=National Taiwan Normal University。
  70. 郭乃文(2003)。Taipei, Taiwan,國立台灣大學心理學研究所=Department of Psychology, National Taiwan University。
  71. 郭乃文、鄭中平(2005)。教育部社教司研究報告教育部社教司研究報告,台北=Taipei, Taiwan:教育部社教司=Department of Social Education。
  72. 陳孟筳(2010)。Tainan, Taiwan,國立成功大學行為醫學研究所=Institute of Behavioral Medicine, National Cheng Kung University。
  73. 陳榮華(2007)。WISC-IV 魏氏兒童智力量表第四版(中文版)指導手冊。台北=Taipei, Taiwan:中國行為科學=Chinese Behavioral Science。
  74. 賴培增(2011)。Tainan, Taiwan,國立成功大學行為醫學研究所=Institute of Behavioral Medicine, National Cheng Kung University。
被引用次数
  1. 蘇倍儀、廖御圻、黃冠堂、郭乃文、林育岑(2016)。運用神經回饋訓練之神經心理治療模組於重度腦傷患者改善執行功能效果分析-個案報告。臨床心理學刊,10(2),31-49。