淡江大學覺生紀念圖書館 (TKU Library)
進階搜尋


下載電子全文限經由淡江IP使用) 
系統識別號 U0002-1807201610430900
中文論文名稱 以統合回歸探討ADHD的療效影響因素
英文論文名稱 The Applications of Meta-regression to Explore the Influential Factors of the Treatment Effects of ADHD
校院名稱 淡江大學
系所名稱(中) 數學學系碩士班
系所名稱(英) Department of Mathematics
學年度 104
學期 2
出版年 105
研究生中文姓名 林志濱
研究生英文姓名 Chih-Pin Lin
學號 603190140
學位類別 碩士
語文別 中文
口試日期 2016-06-16
論文頁數 138頁
口試委員 指導教授-張玉坤
委員-彭成煌
委員-楊恭漢
中文關鍵字 統合回歸  注意力不足過動症  過動症 
英文關鍵字 ADHD  Meta-regression  Methylphenidate  Atomoxetine  Behavior Therapy 
學科別分類 學科別自然科學數學
中文摘要 統合分析 (Meta-Analysis) ,是將同一臨床議題但獨立且不同的臨床研究之結果統整在一起的統計分析方式。是一種將前人研究的原始資料做再分析或僅將發表於期刊之研究結果藉由統計分析方法做量性的整合。換言之,它是針對某一議題,收集所有相關的研究和其結果,將收集到的資料予以量化及標準化,並使用統計方法分析。
注意力不足過動症(簡稱ADHD),常見的表現徵兆有注意力渙散或集中困難(Inattentive or Attention-Deficit)、活動量過多(Hyperactive)及自制力低弱(Impulsive)等主要病徵。患者還有可能因此引發併發症,而在台灣約有20多萬左右的小朋友受到ADHD的困擾,這些沒有好好治療的孩子可能會有學業成就低落、人際關係障礙及長期挫折感。有些甚至可能將來會有偏差行為或焦慮、憂鬱等等問題。學術界有關研究ADHD的論文從未間斷過。本研究的目的就是透過這些論文和其評估量表,進行統合分析,嘗試找出治療過程中會影響ADHD療效的可能因素。在診斷孩童是否患有ADHD時,最常使用的是美國精神醫學學會出版的精神疾病診斷與統計手冊 (DSM;Diagnostic and Statistical Manual of Mental Disorders),他將ADHD分為三種類型,分別為: 注意力不足,、活動量過多或衝動主導型和混和型。另外治療ADHD目前常用的方式也有三大類,分別是藥物治療(Medicine)、行為治療(Behavior Therapy)、複合性(藥物和行為)治療三種。本研究中,藥物治療包含了Methylphenidate (簡稱MPH)、Atomoxetine (簡稱ATX)和Alpha-2-Adrenergic Agonists (簡稱Alpha-2)。行為治療包含了Parents Behavior Therapy(簡稱PBT)和Teacher Behavior Therapy(簡稱TBT)。複合性治療則包含了MPH/PBT、MPH/TBT和Aphla-2/PBT。
我們將收集到的106筆研究資料,彙整資料中六項可用及可能影響ADHD療效的因素,分別為 : 發表年份(Year)、平均年齡(Age)、SMD種類類型(SMDtype)、治療方式(Treatment)、評估量表(Scale)和藥劑劑量(Dose)。分析結果發現,影響治療之效益值最顯著的因素是治療方式(Treatment),其複合性治療的效益值相較於MPH為最佳,其次為行為治療。而本研究複合性治療包含了MPH/PBT、MPH/TBT和Aphla-2/PBT三種,其中未包含的ATX/PBT或ATX/TBT。更明確的說,治療之效益值依序為: MPH/PBT > MPH/TBT > PBT > Alpha-2 > ATX > Alpha/PBT > MPH。亦即是,相較於MPH,除Alpha-2/PBT外,其餘治療方法之效益值均優於MPH,且達達統計上之顯著性 (P < 0.01)。
根據本研究結果顯示,近年來所使用的合併行為治療的治療模式,其治療之效益值以比純藥物治療有更好的治療之效益值。但行為治療一般需花費較長時間,對講求速效的時代,行為治療往往被大多數的兒童精神科醫師所排拒(至少在台灣是如此)。因此,雖然本研究結果顯示藥物治療已經不是唯一治療ADHD最有效的方式,但實際結果仍有待進一步之臨床實驗來驗證。
英文摘要 Meta-analysis is a method of statistical analysis that quantitatively synthesizes the results obtained from the same topic but independent clinical studies. It is a way to make raw data reanalysis of previous studies or synthesizes those research results quantitatively. In other words, it can be motivated from a specific topic and then collect the results of those related but independent study. We use statistical method to analyze those quantitative results after standardized.
Attention Deficit Hyperactivity Disorder (ADHD) is a psychiatric disorder of the neurodevelopmental type. It is characterized by problems paying attention, excessive activity, or difficulty controlling behavior which is not appropriate for a person's age. Patients may also lead to complications. In Taiwan, there are more than 200 thousands children were diagnosed with ADHD. Without appropriate treatment, it may cause ADHD children low academic achievement, interpersonal barriers and long-term frustration. Some ADHD children may even have behavior problems, anxiety, and depression in the future. For years and years, the academic research papers on ADHD has never stopped. In this study, we use meta-analysis and meta-regression to explore the potential influential factors of the treatment effects of ADHD.
To diagnose ADHD, the most commonly use method is according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). ADHD has three subtypes: inattentive, hyperactive-impulsive, and combined. To treat ADHD, there are three commonly used methods, named Medication, Behavior Therapy and Combined (Medication plus Behavior Therapy). In this study, according to the collected articles, we have Methylphenidate (MPH), Atomoxetine (ATX) and Alpha-2-Adrenergic Agonists (Alpha-2) in medication, Parents Behavior Therapy (PBT) and Teacher Behavior Therapy (TBT) in behavior therapy, and, in combined treatment, we have MPH/PBT, MPH/TBT and Aphla-2/PBT.
We identified 106 studies involving 13365 children with ADHD for inclusion in our meta-analysis. Among them, the potential influential factors were: publication year (Year), mean age (Age), type of SMD (SMDtype), treatments (Treatment), outcome measures (Scale), and medication dosage (Dose).
The treatment was a significant factor on the treatment effect. Among them, the effect sizes of the combined treatment (MPH+PBT and MPH+TBT) were significantly higher than that of MPH alone. More specifically, the order of effect sizes among those treatment methods were: MPH/PBT > MPH/TBT > PBT > Alpha-2 > ATX > Alpha/PBT > MPH. That is, the effect sizes of all other treatments were significantly higher than that of the MPH monotherapy (except Alpha-2+PBT) with p-values < 0.01.
Accordingly, the combined behavior therapy is more effective on treat ADHD compare to medication alone (monotherapy) in the recent years. However, the behavior therapy is time consuming. To the era of emphasis on quick, the behavioral therapy is excluded by most of the child and adolescent psychiatrists (at least in Taiwan). Although in this study, we showed that one medication (monotherapy) was not the most effective treatment for AHDH child. A further clinical trial on this topic is highly recommended.
論文目次 第一章 緒論……………………………………………………………….1
第一節 研究背景與目的.......……………………………………1
第二節 ADHD診斷……………………………………………...2
第三節 ADHD治療……………………………………………...4
第四節 ADHD臨床診斷量表…………………………………...5
第二章 研究方法………………………………………………………….6
第一節 統合分析………………………………………………...6
第二節 統合迴歸………………………………………………...9
第三節 研究步驟……………………………………………….10
第四節 統計方法……………………………………………….14
第三章 研究結果………………………………………………………...17
第一單元 使用所有資料……………………………………….17
第一節 單一變項之統合迴歸分析………………...23
第二節 對兩個變項做統合迴歸分析……………...31
第三節 對三個變項做統合迴歸分析……………...49
第四節 對四個變項做統合迴歸分析……………...70
第二單元 使用藥物治療劑量的資料………………………….81
第一節 對各個單一或雙變項做統合迴歸分析…...86
第二節 對三個變項做統合迴歸分析……………...96
第三節 對四個變項做統合迴歸分析…………….115
第四章 結論…………………………………………………………….135
參考文獻………………………………………………………………...137
附錄……………………………………………………………………...138

圖目錄
圖3.1.1…………………………………………………………..…….….20
圖3.1.2……………………………………………………………………21
圖3.1.3……………………………………………………………………22
圖3.1.1.1………………………………………………………………….24
圖3.1.1.2………………………………………………………………….25
圖3.1.1.3………………………………………………………………….26
圖3.1.1.4………………………………………………………………….28
圖3.1.1.5………………………………………………………………….30
圖3.1.2.1………………………………………………………………….32
圖3.1.2.2………………………………………………………………….33
圖3.1.2.3………………………………………………………………….35
圖3.1.2.4………………………………………………………………….37
圖3.1.2.5………………………………………………………………….38
圖3.1.2.6………………………………………………………………….40
圖3.1.2.7………………………………………………………………….42
圖3.1.2.8………………………………………………………………….44
圖3.1.2.9………………………………………………………………….46
圖3.1.2.10..……………………………………………………………….48
圖3.1.3.1………………………………………………………………….50
圖3.1.3.2………………………………………………………………….52
圖3.1.3.3………………………………………………………………….54
圖3.1.3.4………………………………………………………………….56
圖3.1.3.5………………………………………………………………….58
圖3.1.3.6………………………………………………………………….60
圖3.1.3.7………………………………………………………………….62
圖3.1.3.8………………………………………………………………….64
圖3.1.3.9………………………………………………………………….66
圖3.1.3.10..……………………………………………………………….69
圖3.1.4.1………………………………………………………………….72
圖3.1.4.2………………………………………………………………….74
圖3.1.4.3………………………………………………………………….76
圖3.1.4.4………………………………………………………………….78
圖3.1.4.5………………………………………………………………….80
圖3.2.1……………………………………………………………………84
圖3.2.2……………………………………………………………………85
圖3.2.1.1………………………………………………………………….87
圖3.2.1.2………………………………………………………………….88
圖3.2.1.3………………………………………………………………….90
圖3.2.1.4………………………………………………………………….91
圖3.2.1.5………………………………………………………………….93
圖3.2.1.6……………………………………………………………….…95
圖3.2.2.1………………………………………………………………….97
圖3.2.2.2………………………………………………………………….98
圖3.2.2.3………………………………………………………………...100
圖3.2.2.4………………………………………………………………...102
圖3.2.2.5………………………………………………………………...104
圖3.2.2.6………………………………………………………………...106
圖3.2.2.7………………………………………………………………...108
圖3.2.2.8………………………………………………………………...110
圖3.2.2.9………………………………………………………………...112
圖3.2.2.10..……………………………………………………………...114
圖3.2.3.1……………………………………………………………...…116
圖3.2.3.2………………………………………………………………...118
圖3.2.3.3………………………………………………………………...120
圖3.2.3.4………………………………………………………………...122
圖3.2.3.5………………………………………………………………...124
圖3.2.3.6………………………………………………………………...126
圖3.2.3.7………………………………………………………………...128
圖3.2.3.8………………………………………………………………...130
圖3.2.3.9………………………………………………………………...132
圖3.2.3.10..……………………………………………………………...134

表目錄
表2.3.1…………………………………………………………..……..…10
表3.1.1……………………………………………………………………17
表3.1.2……………………………………………………………………18
表3.1.1.1………………………………………………………………….23
表3.1.1.2………………………………………………………………….24
表3.1.1.3………………………………………………………………….26
表3.1.1.4………………………………………………………………….27
表3.1.1.5………………………………………………………………….29
表3.1.2.1………………………………………………………………….31
表3.1.2.2………………………………………………………………….32
表3.1.2.3………………………………………………………………….34
表3.1.2.4………………………………………………………………….36
表3.1.2.5………………………………………………………………….37
表3.1.2.6………………………………………………………………….39
表3.1.2.7………………………………………………………………….41
表3.1.2.8………………………………………………………………….43
表3.1.2.9………………………………………………………………….45
表3.1.2.10..……………………………………………………………….47
表3.1.3.1………………………………………………………………….49
表3.1.3.2………………………………………………………………….51
表3.1.3.3………………………………………………………………….53
表3.1.3.4………………………………………………………………….55
表3.1.3.5………………………………………………………………….57
表3.1.3.6………………………………………………………………….59
表3.1.3.7………………………………………………………………….61
表3.1.3.8………………………………………………………………….63
表3.1.3.9………………………………………………………………….65
表3.1.3.10..……………………………………………………………….67
表3.1.4.1………………………………………………………………….70
表3.1.4.2………………………………………………………………….73
表3.1.4.3………………………………………………………………….75
表3.1.4.4………………………………………………………………….77
表3.1.4.5………………………………………………………………….79
表3.2.1……………………………………………………………………81
表3.2.2……………………………………………………………………82
表3.2.1.1………………………………………………………………….86
表3.2.1.2………………………………………………………………….87
表3.2.1.3………………………………………………………………….89
表3.2.1.4………………………………………………………………….90
表3.2.1.5………………………………………………………………….92
表3.2.1.6………………………………………………………………….94
表3.2.2.1………………………………………………………………….96
表3.2.2.2………………………………………………………………….97
表3.2.2.3………………………………………………………………….99
表3.2.2.4………………………………………………………………...101
表3.2.2.5………………………………………………………………...103
表3.2.2.6………………………………………………………………...104
表3.2.2.7………………………………………………………………...107
表3.2.2.8……………………………………………………………...…109
表3.2.2.9………………………………………………………………...111
表3.2.2.10..……………………………………………………………...113
表3.2.3.1………………………………………………………………...115
表3.2.3.2………………………………………………………………...117
表3.2.3.3………………………………………………………………...119
表3.2.3.4………………………………………………………………...121
表3.2.3.5………………………………………………………………...123
表3.2.3.6……………………………………………………………...…125
表3.2.3.7………………………………………………………………...127
表3.2.3.8………………………………………………………………...129
表3.2.3.9……………………………………………………………...…131
表3.2.3.10..……………………………………………………………...133



參考文獻 1. An Early Description of ADHD (Inattentive Subtype): Dr Alexander Crichton and `Mental Restlessness'(1798)Child and Adolescent Mental Health[dead link],Volume 6, Number 2, May 2001 , pp. 66–73 (8)
2. DSM-IV-TR, American Psychological Association (APA),2000年.
3. Swanson, Nolan, and Pelham–IV中文版,高淑芬譯
4. Primary, Secondary, and Meta-Analysis of Research : Gene V. Glass, Educational Researcher Vol. 5, No. 10 (Nov., 1976), pp. 3-8.
5. DerSimonian R, Larid N., “Meta-analysis in clinical trials”, Controlled Clinical Trials 1986; V 7; p. 177- 188.
6. Principles of Learning and Behavior, Domjam, Fifth Edition, page 70.
7. Onyskiw JE. The meta-analytic approach to research integration. Can J Nurs Reh. 1996;28(3):69-85.
8. Hedges LV, Olkin I. Statistical Methods for Meta-analysis. San Diego,California: Academic Press,INC; 1985.
9. Publication Bias in Meta-Analysis: Prevention, Assessment and Adjustments. Rothstein H ,Sutton A J,Borenstein M ed. Hardcover: Wiley; 2005.
10. 莊其穆,臨床醫師如何閱讀統合分析(Meta-analysis)的論文,Taiwan Medical Jounarl, 2011, Vol.54, No.2.
11. 注意力不足過動症,衛生福利部心理衛生專輯(03).
論文使用權限
  • 同意紙本無償授權給館內讀者為學術之目的重製使用,於2016-07-26公開。
  • 同意授權瀏覽/列印電子全文服務,於2016-07-26起公開。


  • 若您有任何疑問,請與我們聯絡!
    圖書館: 請來電 (02)2621-5656 轉 2281 或 來信