學前至低年級注意力不足過動症兒童寫字表現之探究

Abstract

本研究目的主要探究：(1)幼兒園大班至國小二年級注意力不足過動症兒童與典型發展兒童之聽寫、抄寫之寫字正確與寫字品質表現；(2)注意力不足過動症兒童與典型發展兒童之寫字表現相關因子與寫字表現迴歸預測模型；(3)寫字困難之注意力不足過動症兒童、寫字正常之注意力不足過動症兒童與典型發展兒童的寫字相關因子表現之差異性。本研究對象為16名認知、語言發展正常幼兒園大班之注意力不足過動症兒童與16名認知、語言發展正常國小一年級之注意力不足過動症兒童，以及32名與注意力不足過動症兒童年齡、性別、慣用手配對之典型發展兒童。參與兒童在第一次評量時接受認知、語言、精細動作、視動整合、識字量測驗、自編字形覺知測驗、自編寫字測驗(聽寫字、仿寫字)，並於半年後的第二次評量再次進行精細動作、視動整合、識字量測驗、自編字形覺知測驗、自編寫字測驗與基本讀寫字綜合測驗追蹤。本研究分析包含三個部分，第一部分以重複量數單因子變異數分析統計方式分析組別與年齡兩項因子對聽寫、仿寫之寫字正確與寫字品質之影響；第二部分以皮爾遜積差相關係數統計方式分析字形覺知、識字量、精細動作精確度、手部靈巧度與精細動作整合因子與寫字表現之相關性，並以階層迴歸分析統計方式找出寫字表現重要的預測因子；第三部分則是以單因子變異數分析統計方式分析寫字困難之注意力不足過動症兒童、寫字正常之注意力不足過動症兒童與典型發展兒童在寫字相關因子表現之差異性。研究結果顯示，注意力不足過動症兒童與典型發展兒童在幼兒園大班至國小二年級是寫字表現快速發展的時期。在聽寫寫字正確表現，在幼兒園大班至小一上學期的組別、年齡、組別×年齡交互作用效果皆達顯著；在小一下學期至小二上學期的組別與年齡之主要效果亦達顯著，顯示注意力不足過動症兒童聽寫寫字正確表現在幼兒園大班至小二上學期有明顯成長，但表現顯著低於典型發展兒童。在仿寫寫字正確表現，在幼兒園大班至小一上學期的組別、年齡、組別×年齡交互作用效果皆達顯著，而小一下學期至小二上學期的組別、年齡、組別×年齡交互作用效果皆未達顯著，顯示注意力不足過動症兒童仿寫寫字正確表現在幼兒園大班至小一上學期有明顯成長，但表現顯著低於典型發展兒童，而在小一下學期至小二上學期仿寫寫字正確表現則與典型發展兒童接近。在寫字品質部分，注意力不足過動症兒童的字體大小不一、部件比例失衡與超出格子比例顯著高於典型發展兒童。在寫字表現相關因子部分，注意力不足過動症兒童與典型發展兒童的寫字表現與字形覺知、識字量、精細動作精確度、精細動作整合與手部靈巧度有顯著相關，而其中字形覺知能力是聽寫字表現重要的預測因子，而手部靈巧度則是抄寫字表現重要的預測因子。寫字困難與寫字正常之注意力不足過動症兒童視動整合能力皆顯著低於典型發展兒童，而寫字困難之注意力不足過動症兒童其精細動作表現顯著低於典型發展兒童，但寫字正常之注意力不足過動症兒童精細動作表現則未與典型發展兒童有顯著差異，顯示寫字困難之注意力不足過動症兒童精細動作表現不佳更為顯著。針對研究結果，本文進行討論並於文末提出結論與建議。

關鍵詞：注意力不足過動症、寫字、字形覺知、精細動作、視動整合

The aims of this study were to: (1) investigate accuracy and quality of dictation and copying tasks in ADHD children and TD children followed from kindergarten to second grade; (2) identify underlying correlating factors and regression prediction models of the writing performance in the ADHD and TD groups respectively; (3) compare performance across ADHD children with writing difficulty, ADHD children with normal writing ability and TD children based on the above-mentioned correlating factors. Sixteen kindergarten ADHD children and sixteen first grade ADHD children with normal cognitive and language development and an equal number of age, gender and preferred hand matched controls were recruited. All participants received TONI-4, PPVT-R, BOT-2, word recognition test, self-designed orthographic awareness test and self-designed writing test(dictation and copying tasks); after six months, BOT-2, word recognition test, self-designed orthographic awareness test, self-designed writing test and the Basic Reading and Writing Comprehensive Test(BRWCT) were administered to the same participants. Three methods of analysis were conducted: one-way ANOVA with repeated measures used to analyze the effects of group and age factors on writing performance; Pearson Product-Moment correlation and hierarchical regression model used to identify the correlating factors and prediction models of writing performance; one-way ANOVA used to compare the performance on the correlating factors across ADHD children with writing difficulty, ADHD children with normal writing ability and TD children. The results showed that ADHD children and TD children had developed rapidly in writing performance from kindergarten through second grade. There were significant group, age and group×age interaction effects on dictation performance in kindergarten and first grade children. Significant group and age effects on dictation performance in first and second grade children were also found, which indicated that ADHD children showed significant improvement in dictation from kindergarten through second grade, though still fell behind their TD peers. There were significant group, age and group×age interaction effects on copying tasks in kindergarten and first grade children, while no significant effects were found in first and second grade children. These results suggested that copying performance in ADHD children, though not as good as their TD peers, improved significantly from kindergarten through first grade. However, there was no significant difference in copying performance between ADHD and TD children in second grade. As for writing quality, ADHD children have significantly more problems in maintaining proportionate character size and component size. Orthographic awareness, word recognition, fine motor precision, fine motor integration and manual dexterity were significantly correlated with writing performance in ADHD children and TD children. Orthographic awareness was the most important predictor for dictation and manual dexterity was an important predictor for far-point copying. Both ADHD children with and without writing difficulty had poorer visual-motor integration than TD children while only ADHD children with writing difficulty had poorer fine motor precision and manual dexterity than TD children, which revealed that fine motor ability was worse in ADHD children with writing difficulty. Discussion about the results and suggestions for further research were provided.

Keywords: ADHD, fine motor, handwriting, orthographic awareness, visual-motor integration