| 摘要: | 目的：探討國小一年級及六年級確診為注意力不足過動症孩童與一般孩童生活型態危險因子的相關性。
方法: 以臺北市文山區為研究地區，並且以學校為取樣單位，採用問卷調查孩童行為表現、孩童生活型態、孩童成長過程健康史、母親懷孕及生產史等資料，以t-test 和chi-square 分析注意力不足過動症與無注意力不足過動症的差異性，並用Multivariable logistic regression 分析重要危險因子。
結果:共回收904 份問卷，經醫師確診為注意力不足過動症個案共30 位。另經由中文版Swanson, Nolan, and Pelham–IV (SNAP-Ⅳ)量表推估疑似案例為38 位，兩者共佔全樣本的7.5%，與台灣研究盛行率6.3%~12.04%，全球盛行率研究5-10 %相符。由分析注意力不足過動症確診個案發現，注意力不足過動症孩童相關危險因子有:孩童性別為男性(Odds ratio=3.92，95% CI=1.59-9.70，p=0.001)、小孩曾有頭部外傷(Odds Ratio=3.57，95% CI = 1.31-9.78，p =0.008)；母親懷孕時家人有吸菸行為(二手菸)(Odds Ratio=2.82，95% CI =1.22-6.52，p =0.011)；平均每天使用3C 電子產品達2 小時以上(Odds Ratio=2.16，95% CI=1.03-4.54，p =0.038)；孩童持續六個月出現注意力短暫(Odds Ratio=8.37，95% CI =3.71-18.90，p <0.001)、動作協調性不良(Odds Ratio=19.36，95% CI=8.08-46.40，p <0.001)、記憶力較差(Odds Ratio=6.38，95% CI= 2.58-15.78，p <0.001)等危險因子。本研究發展的注意力不足過動症高危險群預測表大於等於3 分時的具有良好的Negative prediction value (98.6 %)，因此可以有效預測當預測量表小於3 分的情況下，該孩童較不會有此疾病。
結論: 現有的注意力不足過動症篩選量表，以兒童已經表現出來的症狀為測量標的，本篇分析危生活型態險因子與注意力不足過動症的關聯性，並且嘗試融合注意力不足過動症的危險因子與症狀做為篩選高危險群的工具。研究發現的生活方式危險因子，是可以減少暴露或預防接觸，而老師和家長通常為最早發現孩童症狀的第一線人員，應多加宣導讓孩童遠離危險因子，減少兒童高危險族群發展成注意力不集中過動症的可能性。
Purpose：Explore the lifestyle related risk factors between children, grade one and six, diagnosed with attention deficit hyperactivity disorder (ADHD) and the normal children.
Method: The study was conducted in the Wenshan district, Taipei, Taiwan. The schools were used as sampling units. Using questionnaire surveys, the child's behaviours,lifestyles, health histories, fetal conditions, and birthing conditions were collected. The data was analyzed with t-test and chi-square analysis to determine the difference between children with ADHD and children without ADHD by multivariable logistic regression analysis. Finally, recipient operating curve (ROC) was used to develop a prediction scale for assessing the risk of ADHD.
Results: The total number of effective questionnaires gathered for this study was 904. There were 30 individuals that were clinically diagnosed with ADHD previously. Determined by the Chinese version of the SNAP-IV rating scale, another 38 suspected ADHD cases were indentified. The
high risk factors identified from the diagnosed ADHD cases are the following: male gender (Odds ratio = 3.92, 95% CI = 1.59-9.70, p=0.001), history of head trauma (Odds Ratio = 3.57,95% CI = 1.31-9.78, p =0.008), mother was exposed to second-hand smoke during pregnancy (Odds Ratio = 2.82, 95% CI = 1.22-6.52, p =0.011), two hours (or more) of averaged daily electronic device usage (Odds Ratio = 2.16, 95% CI = 1.03-4.54, p =0.038), child exhibited shortattention spans for 6 or more consecutive months (Odds Ratio = 8.37, 95% CI = 3.71-18.90,p<0.001), poor body coordination(Odds Ratio = 19.36, 95% CI = 8.08-46.40, p<0.001), and poor
memories(Odds Ratio = 6.38, 95% CI = 2.58-15.78, p<0.001). The high risk group prediction scale developed in this study had a good negative prediction value of 98.6 %, when the score was larger or equal to 3. Therefore we can effectively predict that when a child scored less than 3 on
the prediction scale, there is a reduced chance that the child has ADHD.
Conclusion: The present study incorporated the ADHD symptoms with lifestyle factors in constructing a screening tool for ADHD. The teachers and parents should be educated to keep children away from the preventable high risk factors, in order to reduce the possibilities of children in the high risk group from developing into ADHD. |
