儿童睡眠呼吸问题之影响与儿童心理衡监.pptVIP

兒童睡眠呼吸問題之影響與兒童心理衡鑑 台大醫院 臨床心理中心 張志瑄 臨床心理師 98/06/25 Neurobehavioral Morbidity Associated With Disordered Breathing During Sleep in Children: A Comprehensive Review ~Dean W. Beebe, 2006 Sleep-disordered breathing (SDB) The pathological end of the spectrum of nocturnal respiratory functioning including, but not limited to obstructive sleep apnea (OSA) 61 studies of the relationship between childhood SDB and neurobehavioral functioning Behavior regulation (Parent-rating) Hyperactivity/impulsivity Rebelliousness/aggression Inattention (+/-) Mood and emotional control Emotional instability Cognitive and academic function IQ (preschool through 1st grade) Attention executive function (parents reported problems flexibly adapting to changing demands, poor working initiation and self-monitoring, and diminished planning and organization) Sustain attention inhibit impulsive behavior (CPT) Academic performance (parent-report and school records) Language, visual perception, memory, working memory, academic achievement test (+/-) Proposed mechanism Intermittent hypoxia Animal model: structural and neurochemical changes in the hippocampus and prefrontal cortex Sleep disruption Non-SDB related sleep disruption and experimental sleep restriction in healthy children can induce some of these deficits Assessment 前測 IQ (WISC-IV) Attention (CPT) Behavioral and emotional problems (問題行為篩選量表、學生行為評量表) 後測 Working memory processing speed (WISC-IV) Attention (CPT) Behavioral and emotional problems (問題行為篩選量表、學生行為評量表) 智力 multifaceted characteristics: 包含知覺技能反應、記憶、空間分析、抽象推理… 測驗過程是一種智力行為抽樣（sampling）的過程 智力 較常使用的測驗： 魏氏智力量表 斯比智力量表 萊特（非語文）表現測驗 貝莉嬰幼兒發展量表 智力測驗 測驗的常模建立 常態分配的基本假設 標準化的施測程序 適用年齡範圍 文化差異 測驗的信效度研究 測驗材料與內容之保密性 智力測驗 影響測驗表現的因素 動機、態度、焦慮、衝動性、持續性… 分數解釋需比對年齡常模(norm) 標準分數 eg.智商 百分等級 年齡當量 智力測驗 魏氏兒童智力量表 (WISC-IV) 2007年台灣出版中文版 對象：6歲0個月～16歲11個月兒童 共14項分測驗：10項核心測驗，4項替代測驗 測量結果：全量表智商和四個指數分數(M=100，SD=15) 分測驗量表分數(M=10，SD=3) WISC-IV 四項指數分數 語文理解指數：測量語文概念形成、語文推理、和由環境習得的知識 知覺推理指數：測量知覺的和流體的推理、空間訊息處理、及