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題名：注意立缺陷過動症兒童與憂鬱傾向母親親子互動研究
作者：李佩秦
作者(外文)：Pei-chin Lee
校院名稱：高雄師範大學
系所名稱：特殊教育學系
指導教授：鈕文英
學位類別：博士
出版日期：2009
主題關鍵詞：注意力缺陷過動症兒童；憂鬱傾向母親；親子溝通；行為觀察法；Children with attention deficit hyperactivity disorder；mother with depressive symptoms；parent-child communication；behavioral observation
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ADHD兒童對於指令遵從度低、活動量高、行為衝動，ADHD兒童的教養對於父母而言，是一件相當大的挑戰；且ADHD家長相較於一般家長，有較高的親職壓力及憂鬱症狀，本研究將探討兒童的ADHD診斷以及母親的憂鬱傾向，相較於一般親子，對於親子中性溝通及衝突溝通時，親子互動的情緒互動的彈性、互動時的情緒反應方式、以及親子互動情緒的順序造成的差異。
本研究招募四至六年級ADHD男童和憂鬱傾向母親(憂鬱母親組)10對親子，ADHD兒童和一般母親(一般母親組)15對，以及18對同齡的一般親子(對照組)共三組，以實驗的研究設計，在仿自然環境的標準化空間中，進行中性主題以及居家中日常生活的衝突主題討論；影片資料之分析是以特定情緒編碼系統二十碼的版本，由四位編碼員在不知研究參與者之組別的情況下，針對親子互動時的情緒狀態進行編碼。特定情緒編碼系統二十碼的版本，共有20個情緒代碼，將情緒分為正向情緒、中性情緒、負向情緒三大類；而負向情緒類別又分為較主動表達負向情緒的負向參與情緒類，以及被動表達負向情緒的負向不參與情緒類。
研究結果發現，三組親子的互動彈性無顯著差異，而且在衝突情境中，相較於中性情境，親子會經歷顯著較多不同的親子情緒狀態的組合；但是單位時間內親子情緒轉變的次數，在倆情境中，無顯著的差異。顯示四至六年級男童與母親在衝突溝通時，雙方能表達正、負向的情緒，而且親子可以保持互動時情緒的彈性，包容對方的負向情緒，未陷入雙方皆負向且無法改變的僵化情緒對峙狀態。
一般母親組以及對照組的母親，在中性情境中，相對於衝突情境有顯著較多的正向情緒時間百分比；然而，憂鬱母親組的母親，在中性及衝突兩情境中，正向情緒時間百分比無顯著差異，中性溝通情境正向情緒時間百分比是三組最低，而衝突情境時，正向情緒百分比是三組母親最高。ADHD兒童的憂鬱傾向母親，在親子互動時，正向情緒的表達較為平淡，在輕鬆愉快的互動中，較無法給予兒童鼓勵、溫暖、表達關心的正向情緒；ADHD兒童的憂鬱傾向母親需要專業的協助，處理其憂鬱症狀，以及評估其親子關係的品質與安排可能的介入協助。
台灣親子互動的方式也呈現母親與孩子之間互動行為與情緒相互影響的動態系統，親子互動是一個雙向的、由親方與子方相互影響的過程，同時會因溝通情境，母親與孩子個體的因素，如兒童的ADHD診斷、母親的憂鬱症，親子互動時的情緒反應因而不同。
ADHD兒童的心理衛生照護及教育輔導工作，應該要重視親子關係與互動品質，同時服務的對象也要納入照顧者，特別是憂鬱母親。未來研究建議以更多的研究參與者以增加統計考驗力，同時加入一般兒童憂鬱傾向母親組的親子，以更加釐清母親的憂鬱傾向與兒童的ADHD診斷對於親子關係之交互作用。
Raising a child with attention-deficit hyperactivity disorder (ADHD) is an incredible challenge for parents because of the child noncompliant, overactive, and demanding behavior. Parents of children with ADHD had higher rates of depression and parental distress. This study was designed to examine the differences of parent-child interaction quality, including flexibility, affective expression, and interaction sequence in neutral discussion and conflict discussion for children with ADHD and mothers with significant depressive symptoms.
The participants included ten dyads with childhood ADHD and maternal depressive symptoms, fifteen dyads with childhood ADHD only and eighteen normal dyads. Video recording of parent-child communication was conduct in a laboratory. Contents of parent-child communication included neutral and conflict issues. Specific Affect Coding System- 20 codes version was used to count the duration of affective expression including positive engagement, negative engagement, negative disengagement, and neutral categories of affect. Four Coders blind to the status of each dyad coded the film using Observer 7.0 software.
The results showed there were no group differences in terms of interaction flexibility among three dyad groups. There were no condition differences in terms of emotional transition per minute among the dyads. In the conflict condition, compared with the neutral condition, mother-child dyads experienced more affect combinations of the mother and the child. Boys of 4th to 6th grade and his mother would express positive as well as negative emotion when they had conflicts. They can move from positive emotion to negative emotion, and negative emotion to neutral emotion and so on. The dyads are not trapped in a mutual negative and rigid interaction pattern.
Mothers of the normal dyads and of the dyads of children with ADHD and normal mothers have significant higher positive engagement emotion in the neutral condition than in the conflict condition. However, depressed mothers of children with ADHD have no significant positive emotion time percentages between the neutral condition and the conflict condition. Among three groups of mothers, depressed mothers have highest time percentage of positive emotion in the conflict condition, and lowest time percentage of positive emotion in the neutral condition. Maternal depression has been showed to have flat affect and it is showed in the group of mothers with depressive symptoms and of children with ADHD. These depressed mothers show less encouragement, warmth, and positive affection toward their children with ADHD in the relaxed interaction condition. The depressed mothers might need professional assistance to deal with their depression symptoms, to evaluate their quality of parent-child interaction as well as to arrange intervention accordingly.
Dynamic systems theory can explain the interaction pattern of children with ADHD and their mothers with depressive symptoms. The interaction behavior of children and their mothers are in a tightly linked manner, with the emotional expression of each member being significantly related to the antecedent emotion of the other. Communication condition, attributes and variables of the child and the mother such as childhood ADHD and maternal depressive symptoms may play a role to the quality of parent-child interaction.
Implications of this study are suggested. Mother-child interaction should be an important part of mental health care and education for children with ADHD. The recipients of services should include mothers, especially mothers with depressive symptoms. Future research should recruit more dyads to increase study power. A group of normal children and depressed mother might help to verify the role of maternal depressive symptoms in parent-child interaction. Adolescents’ interaction with parents should be included in future research using conflict resolution research protocol.
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