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題名:以Cohen認知神經心理學概念探討注意力功能測量研究
作者:郭乃文
作者(外文):Nai-wen, Guo (also Kuo)
校院名稱:國立臺灣大學
系所名稱:心理學研究所
指導教授:花 茂 棽 博 士
葉 怡 玉 博 士
學位類別:博士
出版日期:2003
主題關鍵詞:注意力功能認知神經心理測驗Cohenattentioncognitive neuropsychological assessmentCohen model
原始連結:連回原系統網址new window
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本研究從認知神經心理學出發,探究在復健心理學之領域,如何建立注意力衡鑑模式。注意力功能不足是臨床上最常見之認知受損後遺症,一套配合受損病理與認知訓練的衡鑑系統亟為所需。本研究從注意力的認知神經理論模式、生理與神經系統、臨床上常見注意力受損功能、以及注意力發展等四方面著手,探討注意力衡鑑之重要面相。根據這些理論基礎,回應傳統測驗理論之要求,研究者認為注意力衡鑑應具備下述四點效度驗證歷程,其一,回應建構理論;其二,具有發展實質;其三,具有臨床實質;其四,具效標效度。本研究以三個子研究分別探討之。
研究者以Cohen(1993,1998)之理論為主軸,選定感官選擇、反應之選擇與控制、影響注意力資源、以及注意力持續等四部件為衡鑑重點,並參考其他研究者之建議,發展了廣泛性非語文注意力測驗組(Comprehensive Non-verbal Attention Test Battery, 以下簡稱CNAT),包含六個層次作業,共建立了三十三個指標、二十七項指標間的假設考驗。
子研究一以六百名正常兒童與青少年檢驗 CNAT 各項建構假設和發展趨勢。以ANOVA考驗組間變項效果(年齡變項)和組內變項效果(注意力各指標假設)。子研究二以 CNAT 衡鑑六十六名創傷性腦傷患者,檢驗各指標能否呈現患者之受損;討論中重度受損腦傷患者在 CNAT 各指標上受損之比例,並嘗試由患者受傷時的神經生理檢查指標來預估患者注意力之預後。子研究三分別以一百六十六名和六十名兩組正常青少年為受試者,以傳統單項性注意力衡鑑工具(Knox''s木塊測驗、數字廣度測驗、注意力和速度測驗)、具層次特質之神經心理注意力測驗(自編修正Stroop作業)以及魏氏兒童智力測驗(第三版)為效標,探討 CNAT 之區辨效度。
子研究一結果發現,所建立來檢驗 CNAT 建構效度的二十七項假設全部與原假設符合,年齡組變項也全部顯著。不過,當中有十九項達顯著的互動效果,事後比較的結果發現,主要來由十六歲組到十九歲組的發展方向不如預期,以及其中三個指標的發展在年齡層中出現非線性變化所致。研究中發現各年齡層受試者都沒有使用精確/速度互換策略。此外,以能完成分配注意力作業為認知組高低之分類,發現以因素分析討論建構效度,高低認知組的結構略有不同。其中,在動作選擇與控制和知覺選擇兩方面的指標較為穩定地各在一個因子內。而原假設的注意力資源與持續指標,可能含有注意力資源的「結構因素」和「執行策略」兩因子,和注意力持續的「警覺程度」和「時間上持續」兩因子,與Cohen的理論也具相互呼應之功。唯反應時間平均數和標準差兩類指標,尚無法區辨。
子研究二結果發現,與七歲組、十一歲組以及十九歲組比較,中重度創傷性腦傷患者在各層次作業上都有相當比例的無法完成作業、反應時間緩慢以及高錯誤率的患者,在四種注意力部件指標上也都有相當的受損比例。以人口學變項和神經學檢查變項來預測患者在 CNAT 各指標的受損程度,結果唯有視覺昏迷指數達到顯著。此外,因為中重度患者在反應時間平均數和標準差指標上的受損模式不盡相同,回應子研究一之建構討論,此二類指標應該各具不同注意力意涵。
子研究三結果發現,CNAT 各指標與效標測驗都只達到低到中等的相關,經過以逐步複回歸、因素分析、典型相關分析等,發現 CNAT 指標和這些測驗部份重疊但典型相關係數不高,顯示臨床上應用 CNAT 自有其貢獻。此外,再次發現反應時間平均數和標準差指標與效標中的相關模式並不類似。
最後,討論 CNAT 的評價和回應Cohen的理論,並說明未來研究的方向。
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