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

Differentiating the Deficit of Attention Components in Attention-Deficit/Hyperactivity Disorder-Combined and Inattentive Subtypes

10.6550/ACP.200612_3(2).0004

詹雅雯(Ya-Wen Jan)；陳信昭(Shin-Jaw Chen)；郭乃文(Nai-Wen Guo)

注意力缺陷／過動症 ； 亞型 ； 神經心理 ； 注意力 ； ADHD ； Subtypes ； Neuropsychology ； Attention

臨床心理學刊

3卷2期（2006 / 12 / 01）

85 - 92

繁體中文

目的：本研究目的在探討注意力缺失／過動疾患－不注意型(ADHD Predominantly Inattentive Type，ADHD-I)與合併型(ADHD Combined Type，ADHD-C)於多向度注意力評估表現上之差異。了解該兩亞型兒童在注意力運作機制上的缺損，期能對該疾患的病理機制與認知復健訓練有進一步貢獻。 方法：經醫師確定診斷為ADHD-I和ADHD-C的兒童各32名，兩組之年齡、智力分數與家庭社經地位相當。以廣泛性非語文注意力測驗(Comprehensive Non-verbal Attention Test Battery, CNAT)為衡鑑工具，此工具具有多層次、多向度的指標。 結果：和常模相較，ADHD-C和ADHD-I在CNAT不同的分測驗上分別呈現出多項不同類型的錯誤。針對反應正確率達75%以上的分測驗討論反應時間，結果發現僅有ADHD-C在轉逆原則分測驗上的反應時間呈現缺損。而兩亞型相比，ADHD-C在集中、搜尋、抑制性注意力、與抗拒分心等分測驗的衝動錯誤，在集中注意力、搜尋注意力、與抗拒分心的漏失錯誤，在轉逆原則的違反錯誤，以及在各分項測驗之反應時間表現上均較ADHD-I差，而ADHD-I唯在搜尋注意力的遲緩錯誤數高於ADHD-C。 結論：結果顯示正常智力的ADHD-C組在注意力缺損面向較ADHD-I來得廣，涵蓋Cohen所提到的知覺選擇、注意力持續、注意力資源、以及反應選擇之四面向。而ADHD-I特別呈現在go/no-go典範分測驗的衝動錯誤，和相較於ADHD-C有較多遲緩錯誤的問題，顯示其偏失於注意力的持續和反應的選擇。這些發現有助於未來為各亞型患者建立個別化的認知復健計畫。

Objective: This study investigated the difference of attention problems between the subtypes of Attention-Deficit /Hyperactivity Disorder (ADHD) from a neuropsychological perspective. Methods: Participants were grouped by diagnosis: 31ADHD-C (combined type) and 31ADHD-I (inattentive type). There were no significant differences in age, IQ scores, and social economic status between subtypes. Each participant received a neuropsychological examination and was administered the comprehensive non-verbal attention test battery (CNAT). Results: The ADHD-C and ADHD-I groups showed different error patterns in every subtest as compared to normative data. A further analysis of the subtests' reaction times with 75% accuracy rates found that only the ADHD-C group showed deficit in the principle reverse task. When compared to the ADHD-I group, the ADHD-C group showed more impulse errors, missing errors, commission errors and a significantly longer reaction time in many of the subtests. However, the ADHD-I group had significantly more delayed errors in the searching task than the ADHD-C group. Conclusion: The results indicated that with average IQ score, the ADHD-C group had more deficits than the ADHD-I group in several attention components, including sensory selection, sustained attention, attention resource, and response selection based on Cohen's attention model. While the ADHD-I group had deficits in sustain attention and response selection. These findings would be helpful in designing individualized cognitive rehabilitation programs for the two ADHD subtypes.

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