注意力不足過動症兒童的感覺處理與姿勢控制之探討

研究目的：本研究旨在探討 7~10 歲的注意力不足過動症(Attention DeficitHyperactivity Disorder，簡稱 ADHD)兒童之感覺處理及姿勢控制能力，以及兩者之間的關聯，透過臨床感覺處理量表和動態平衡測試儀的測試，了解 ADHD 兒童與一般健康兒童在感覺處理和姿勢控制能力的差異，及釐清兒童使用三種不同感覺(本體覺、前庭覺、視覺)以維持平衡之策略，並檢驗臨床量表與動態平衡儀評估結果之關係，俾能提供臨床治療師更有效的介入策略之建議。研究方法及資料：研究對象為 26 名 ADHD 兒童及 18 名一般健康兒童，兒童個別接受六個感覺情境測試，以釐清兒童維持靜態姿勢平衡能力以及有效運用三種不同感覺以維持姿勢控制的比率。同時間由家長填寫感覺處理能力剖析量表 3至 10 歲中文版及學生行為評量表，評估兒童使用不同感覺處理能力以因應日常生活活動的能力，同時也透過學生行為評量表了解兒童出現問題行為的頻率。研究結果：ADHD 兒童於感覺處理、感覺調節、情緒與行為反應之三大領域全數顯著較一般健康兒童差。於六個情境測驗整體的綜合平衡能力也顯著較一般健康兒童差，並且使用本體感覺及前庭感覺維持平衡的比率也顯著低於一般健康兒童。ADHD 兒童的姿勢平衡能力與感覺處理量表之聽覺、前庭覺、觸覺以及多重感覺處理、身體姿勢與動作、還有受感覺調節影響之情緒反應，及反應閾值有顯著正相關，一般健康兒童的感覺處理能力則與姿勢平衡與感覺策略皆無顯著相關。結論與建議：ADHD 兒童維持日常生活功能的感覺處理能力，和不同感覺情境下的姿勢穩定度及運用感覺輸入維持姿勢控制的感覺策略之能力皆較一般健康兒童差。日常生活中感覺處理不佳，和較差的姿勢控制能力有相關。本研究顯示以觀察臨床行為表現為主的感覺處理量表，可以預測 ADHD 兒童的姿勢平衡能力，但無法提供一般健康兒童的姿勢平衡的能力預測。臨床工作者可藉由臨床上常使用的感覺處理能力剖析量表評估 ADHD 兒童之感覺處理能力，並依照其結果推論兒童之平衡能力，本研究之發現有助臨床工作者在有限的時間內制定更全面、且有效的完善的治療目標及介入方案。

Objective：The objectives of this study are to explore the sensory processing andpostural control function, as well as the relationship between both on 7 to 10 years oldchildren with attention deficit hyperactivity disorder (ADHD), by comparing theability to process sensory information in daily activities, and the ability to controlpostural stability, also to verify the extend of using three sensory inputs (visual,proprioceptive, vestibular) to maintain postural stability between ADHD children andtypically developed children.Methods and Materials：The subjects were 26 ADHD children and 18 healthychildren. Each child underwent the sensory organization test of Smart Balance Masterwith six sensory conditions. At the same time, the parents completed the sensoryprofile 3 to 10 years old-Chinese version and student behavior- parental version.Results：Children with ADHD had significantly poorer sensory processing abilities inall three domains of the sensory processing profile, including sensory processing,sensory modulation, emotional and behavioral responses, compared to that for healthychildren, and they adopted significantly lower ratio of somatosensory and vestibularsensory than healthy children. For ADHD children, the composite equilibrium scorewas positively correlated with three domains of the sensory profile including auditory,vestibular, tactile and multi-sensory processing, and modulation related to bodyposition and movement and those affecting emotional responses, as well as thresholdsfor response. No relationship was found between sensory profile and compositeequilibrium score for healthy children.Conclusion and Suggestion：Children with ADHD have poor sensory process abilityin performing daily activities. They also have difficulties maintaining posturalstability in environments with altered sensory information, as well as use less sensoryinputs to maintain postural control. Current study verified that observation-basedclinical assessment for sensory processing ability can predict postural control ofADHD children, yet the same result is not applicable for healthy children.Clinicians are suggested to use the results from sensory processing profile to inferpostural control ability of ADHD children, and provide more comprehensiveintervention protocol.