Factors Affecting Perceptions of Family Function in Caregivers of Children with Attention Deficit Hyperactivity Disorders

注意力不足過動症兒童之照顧者知覺家庭功能的影響因素

10.1097/jnr.0000000000000042

陳季員(Jih-Yuan Chen)；Mary-Jo Clark；張永源(Yong-Yuan Chang)；劉雅瑛(Yea-Ying Liu)；張瓊櫻(Chiung-Ying Chang)

家庭耐受力 ； 家庭支持 ； 杜克健康量表 ； 家庭評估量表 ； 注意力不足過動症 ； family hardiness ； family APGAR ； Duke Health Profile ； family assessment device ； attention deficit hyperactivity disorder

The Journal of Nursing Research

22卷3期（2014 / 09 / 01）

165 - 175

英文

背景　注意力不足過動症（attention deficit and hyperactivity disorder, ADHD）是兒童神經行為障礙最常見的疾病，30-70%的病例其病症可能會持續至成人。ADHD長期持續增加的特徵，如過動和攻擊致影響學業成績及社會互動，因而增加家庭的負荷。另影響ADHD兒童家庭功能因子的訊息也較缺乏。目的　本研究目的是檢測家庭人口學變項、特質、及家庭因素如支持、耐受力、和照顧者健康，與家庭功能結果關係間之理論性的衍生。方法　應用橫斷性研究及結構程式模式的分析，取122位注意力不足過動症兒童之家庭主要照顧者自我填寫有關人口學、收入、職業、照顧者健康、家庭支持、家庭耐受力及家庭功能的問卷，即決定應用杜克健康量表、家庭關懷度指數、家庭耐受力量表及家庭評估量表之評量。結果　利用AMOS軟體之路經及結構方程模式分析發現，模型適配度良好（χ^2 = .249, df =1, p = .613, minimum discrepancy C = .249），基準化適合度指標（goodness-of-fit index）= .999，調整基準化適合度指標（adjusted goodness of fit index）= .990，標準適合度指標（normed fit index）=.999，比較適合度指標（comparative fit index） = 1.0，平方均值估計殘差（rootmean square error of approximation）= .000：家庭功能和主要照顧者健康是透過家庭耐受力及家庭支持的直接影響力，而家庭支持即是家庭耐受力及家庭功能之間的中介變項，也是家庭耐受力及主要照顧者健康之間的中介變項。此結構模式形成的機率是55.6%。結論／實務應用　本研究發現，經由增加家庭支持、促進家庭耐受力及主要照顧者健康以增進家庭功能，可幫助護理人員提昇對注意力不足過動症兒童的評估和介入策略。

Background: Attention deficit and hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. ADHD has been shown to persist into adulthood in 30%-70% of cases. The long-term and escalating nature of ADHD creates an increasing burden on families because of the influence of hyperactivity and impulsivity on academic achievement and social interaction. There is a lack of information on factors influencing function in the families of children with ADHD. Purpose: The purpose of this study was to test theoretically derived relationships among family demographic characteristics; family factors such as support, hardiness, and caregiver health; and family-functioning outcomes. Methods: This study used a cross-sectional study and structural equation modeling approach. A self-report questionnaire collected information from 122 caregivers on demographics, income, employment, and marital status data as well as on personal health, family support, family hardiness, and family function statuses as determined, respectively, using the Duke Health Profile, Family APGAR score, Family Hardiness Index, and Family Assessment Device. Results: Structural equation modeling provided a reasonable fit to the data using AMOS (χ^2 = .249, df = 1, p = .613, minimum discrepancy C = .249), goodness-of-fit index (.999), adjusted goodness of fit index (.990), normed fit index (.999), comparative fit index (1.0), and root mean square error of approximation (.000). Results indicated a 55.6% probability of becoming the construct model, with family hardiness and family support directly affecting family function and caregiver health. Family support functioned as a mediator in the relationship between family hardiness and family function. Conclusions/Implications for Practice: The findings of this study help nurses improve professional assessments and interventions for families of children with ADHD by highlighting the importance of increased family support, promoting family hardiness, and promoting caregivers' health to improved family function.

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