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題名：數位親職訓練雛型系統之建構與應用分析-以注意力缺失暨過動症為例
作者：陳靜怡
作者(外文)：Ching-I Chen
校院名稱：國立彰化師範大學
系所名稱：輔導與諮商學系所
指導教授：高淑貞
學位類別：博士
出版日期：2012
主題關鍵詞：數位親職訓練；注意力缺失暨過動症；過動症教養策略查詢；Digital parental training；Attention deficit and hyperactivity disorder；ADHD parental training technology
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本研究的目的在以問題行為評估與行為治療模式，建置一個可用於處理國小學齡過動兒童問題行為的數位親職訓練雛型系統，並初探應用此雛型系統在實務工作領域，對聚焦過動兒問題行為、提供適用教養策略、與照顧者依據教養策略內容教養過動兒的應用分析。回應的研究問題包括雛型系統建構經驗與系統使用經驗，並依此分為：第一部分建置數位親職訓練雛型系統的程序與結果，與第二部分在臨床實務應用數位親職訓練雛型系統的結果與訪談分析。
第一部分建置的數位親職訓練雛型系統分五階段，系統先藉由輸入問題事件與症狀行為澄清過動兒問題，隨後再依據五種行為評估要素，進行篩選過動兒可能的行為表現。第三階段是系統依據操作者選用的要素內容，提供合適的症狀選項。第四階段則是系統再依據選用的症狀內容提供合適的教養策略。系統在最後則呈現選用的策略內容提供給操作者應用。第二部分的臨床實務應用方面，本研究邀請七位從事兒童治療的臨床心理師參與研究，並進行平均4.57週的系統正式使用測試。研究參與者在研究期間的應用對象有32人，共進行44次完整的系統查詢，並以追蹤使用經驗訪談作結束。
本研究以系統資料庫的內容分析、參與者的系統使用行為資料分析與使用經驗訪談分析作為研究的結果討論。相關研究結果如下：
一、數位親職訓練雛型系統以完整理論架構提供查詢流程、並有豐富的症狀行為與教養策略內容，讓受訪者運用方便，有利於增進專業知能與新手學習。本系統提供完整ADHD問題行為與教養策略查詢步驟，包括問題描述、具體行為觀察內容、症狀分類、與建議可執行的教養策略，可協助受訪者聚焦過動兒問題、進行個案問題概念化，並伴隨提供多樣化、條列清晰的教養策略步驟，方便運用在實務工作中，是一個有利於增進專業知能、或成為訓練新手治療師增進會談與治療知能的工具。
二、數位親職訓練雛型系統運用資訊系統資料處理的優點，以簡易、快速方式進行行為評估與提供適用的教養策略。本系統運用資訊系統穩定、快速且可大批處理資料的優點，以專家系統精神建置簡易、便利的查詢系統，可依據受訪者行為評估內容，
進行個別化問題行為與提供對應的教養策略建議。
三、數位親職訓練雛型系統適用於國小學齡的ADHD症狀行為與教養策略查詢，但缺乏ADHD共病症狀與伴隨困擾行為之問題解決策略。受訪者表示本系統適用於國小學齡、具ADHD症狀行為的學童，然而，此系統未能提供多方位的問題觀察層面與合適的教養策略內容，若運用在非典型ADHD與伴隨困擾行為之過動兒，容易忽略過動兒其他合併問題或治療需求。
四、數位親職訓練雛型系統適用初次會談評估，可針對親職需求，提供一份個別化教養策略計畫。受訪者表示本系統具有快速整理過動兒問題行為與簡化閱讀查詢過程的優點，非常適合運用於初次會談評估，可以讓受訪者在一小時會談時間內，有效進行簡易問題行為評估，並針對親職需求，提供一份個別化、有具體建議、且可直接使用的策略內容，是一個便利進行親職訓練的系統資料庫。
五、數位親職訓練雛型系統可達到初步處理孩子困擾的目的，但尚未達到自動進行親職自我訓練的目標，現階段不建議直接提供過動兒父母使用，須由專業人員陪同下操作較佳。受訪者表示本系統最佳功能表現在加強親職教養能力、澄清與掌握過動兒問題、幫助家屬學習與孩子相處，並達成初步處理孩子困擾的可能。然而策略內容過於專業，且解釋性不足，過動兒家屬須透過受訪者解說、轉換說明、或示範指導，才能確實執行策略內容，因此尚未能達到親職自我訓練的目標。
六、數位親職訓練雛型系統症狀與教養策略資料庫分類內容不對等，影響受訪者選用結果。依據九大核心障礙類型分類，本系統平均2.9個症狀可對應到1個教養策略。但資料庫內容偏重於專注力與情緒挫折問題行為，且提供較少的專注力與活動量教養策略內容，故資料庫內容不對等現象影響症狀之於教養策略的對應比例，亦影響系統在症狀對應策略架構的穩定性。建議平衡核心障礙的症狀內容，並增加各類型的教養策略內容，改善系統資料庫對應架構的穩定性。
The purpose of this study is to construct a digital parental training prototype technology and investigate its applicability in a clinic setting on children with attention-deficit / hyperactivity disorder (ADHD) behavior at the elementary school level. The prototype technology relies on observed behavioral assessment and behavioral theory. The test design involves searching problem behaviors, providing care-givers with appropriate strategies of working with children with problems, and then evaluating the care-givers on how they use the strategies on these children with ADHD. The outline of the challenges met during this study as presented in this report is summarized separately below in two parts: that of gaining experience in constructing this prototype technology and that of operating it to obtain acceptable data. The discussion of the entire study is provided in three parts: the content of data-bases at this prototype technology, analysis of participants’ operational behaviors, and follow-up interview analysis.
First, the procedures and data-bases on construction of the digital parental training prototype technology are presented. The procedure of the parental training prototype technology is a five-stage process as follows: the technology requires a user to clarify the event and related situation first. Then, based on the event, the technology provides the user with five behavioral factors to assess a child’s performance. At the third stage, the technology presents appropriate list of symptoms from which to select. At the fourth stage, the technology presents appropriate list of strategies from which to select. Finally, the user chooses useful strategies and applies those strategies on children with ADHD.
In the second part, the operational experiences and follow-up interview analysis of feedback about using the digital parental training prototype technology is discussed. Seven clinical psychologists were invited to test and, indeed, tested this parental training prototype technology over a period of 4.57 weeks on average. During the testing period, 44 trials with 32 subjects were performed. All participators were interviewed at the end of this study. The following are the findings:
1. Under the clear behavioral theory structure, the digital parental training prototype technology provides a set of behavior-strategy checking procedure, with a variety of problem behaviors and training strategies. This technology includes the problem description, the observed behaviors, the symptom clarification, and the useful strategies. Thus, this technology increases the professional knowledge and is good for new-learner.
2. Taking advantage of the digital information system, the digital parental training prototype technology is easy to use, able to assess problems and supports useful strategies in a very short time. When constructed with expert system in mind, this technology can take advantage of the stableness and quickness of the computer function to support personal problem-strategy checking system.
3. Although the capabilities of the digital parental training prototype technology can be applied on children with ADHD at the elementary school, the lack of ADHD combination symptoms and solutions of associated problem behaviors limits these capabilities. Even though some participants state that the digital parental training prototype technology do support a set of behavior-strategy checking procedure and the concept of behavioral treatment, and they find it easier to apply on children with ADHD at the elementary school, additional shortcomings exists. This technology only focuses on behavioral patterns and dose without taking a variety of different observed factors and related strategies into account. In this regards, if this technology is to be used in a population of non-typical ADHD children, the user needs to be aware of the different points of view of the problem and the probable necessity of additional treatments and considerations.
4. The digital parental training prototype technology can be used during an intake session to provide a personal parental training plan to deal with the child’s problem. Some participators state that one of advantages of this technology includes the ability to clarify a problem and give useful strategies within one hour. One other advantage of this technology includes a variety data base of treatment and parental training strategies. Thus, based on parental opinions and benefits, this technology helps the clinical psychologist and the care-giver to identify child’s problem and to select a personal and useful strategy easily and quickly.
5. The digital parental training prototype technology can reduce the child’s behavior problem at the very first level, but it is not able to become an automatic parental training technology in its current design form. The result of this study does not suggest that parents use it by themselves. Parents still need a professional individual to help them in using this technology. Some participants believe that this technology can help upgrade the parental ability, clarify the child’s problem behavior, let parents learning how to get along with their child, and deal with the child’s problem behavior at the first level. However, the content of operation, the explanation and description of symptoms and strategies are too difficult to understand and translate into the daily life of a child. During the testing period, participators need to help parents or care-givers choose correct items and come up an appropriate strategy. In addition, combined with professional explanation, description and role play of strategies, parents are able to understand and implement the strategy at home.
6. Due to the imbalance in the number of comparison within symptoms and strategies data base, the option of participants’ selecting the appropriate item is affected. Under the 9 code difficult types, there are 2.9 symptoms when compared to one strategy in average. However, there are more items on attention difficulty and emotional disturbance in the symptom data base, and less attention increase and action stableness in the strategy data base. The imbalance between the two data bases decreases the appropriate comparison analysis and causes the imbalance of the structure on this technology. It is suggested that more strategy data base be added among the 9 code difficult types in order to balance the comparison and to increase the stableness of the structure on this technology.
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