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    Title: 以ex-Gaussian分配探討注意力不足過動症(Attention Deficit/ Hyperactivity Disorder, ADHD)不同亞型患者在能量調節歷程的差異
    Exploration of the differences in effort regulation among ADHD subtypes - based on ex-gaussian distribution
    Authors: 黃守廉
    Hwang, Shoou Lian
    Contributors: 許文耀
    高淑芬
    Hsu, Wen Yau
    Gau, Susan Shur Fen
    黃守廉
    Hwang, Shoou Lian
    Keywords: 注意力不足過動症
    能量調節歷程
    ex-Gaussian分配
    反應時間
    ADHD
    effort regulation
    ex-Gaussian
    Reaction Time
    Date: 2010
    Issue Date: 2013-09-03 13:28:53 (UTC+8)
    Abstract: 前言:由於注意力不足過動症（Attention Deficit/ Hyperactivity Disorder, ADHD）患者在不同的認知作業具有一致的反應模式-他們的反應時間慢且變異量大，已有學者們認為這與他們在能量調節缺損有關。
    研究目的：一、以ex-Gaussian的估計參數（μ、σ、τ）分析ADHD患者在柯能氏持續表現作業(Conners’ Continuous Performance Test, CCPT) 的反應時間，探討與釐清不同能量調節歷程（事件速度與作業時間長度）可能的影響。二、藉由行為量表以及CCPT的錯誤反應與參數的關係，推論μ、σ、τ可能的心理涵義。三、以能量調節歷程（ISI與Block）與ex-Gaussian的估計參數（μ、σ、τ）的關係，探討不同ADHD亞型患者在能量調節的可能問題。四、由於時間知覺作業與注意力資源分配有密切關連性，因此本研究也想探討不同ADHD亞型患者時間知覺作業（時間再製單一與雙重作業）的表現與能量調節的關係。五、從不同發展階段討論ADHD亞型患者與對照組在ex-Gaussian參數的差異是否會隨著年齡發展而有所改變。
    方法:本研究受試包括261位ADHD混合型(ADHD-Combined Type)患者(221位男生，84.7%)，151位ADHD注意力不足型(ADHD-Inattentive Type)患者(128位男生，84.8%) 以及161位對照組受試(124位男生，77.0%)。測量工具包括: 1)中文版K-SADS-E 臨床診斷會談，2) 中文版短式柯能氏家長版/教師版量表，3) 中文版注意力不足過動症 (SNAP-IV)父母/教師量表，4) 柯能氏持續表現作業，5) 時間再製雙重作業，6) 魏氏兒童智力量表中文版第三版。
    結果:1) 相較於對照組受試，ADHD患者有較快的μ以及較大的σ與τ，並且τ的效果量最大，與過去的研究相符。2) ISI/Block增加，皆會使得ADHD患者在τ的增加量顯著大於對照組受試；但ISI放慢會使得個體的μ變慢，Block增加卻只會影響ADHD患者的μ加快；ADHD患者與對照組在σ的差異只在ISI的變化，在Block中的σ沒有顯著組別差異。3) 從行為量表與參數的關係，τ與ADHD患者的核心症狀普遍具有關連性；在CCPT的錯誤反應與參數的關係發現μ與誤判錯誤，τ與漏判錯誤的關係最為密切。4) 在ADHD亞型的比較，ADHD-C患者在μ顯著快於ADHD-IA患者，但是兩組在τ沒有顯著的差異。5) ADHD亞型在時間再製作業同樣受到時距與作業複雜度的影響，當時距愈長（17秒）與對照組有顯著差異。再者，τ是解釋時間估計變異量中最重要的參數。6) 在兒童與青少年期的比較，ADHD患者與對照組在τ的差異沒有改變。不過在青少年期ADHD亞型在μ皆顯著比對照組快，但是在σ沒有差異。
    討論:本研究不但釐清ADHD患者的反應時間特性，也支持認知能量模式對於ADHD患者病理的描述。再者，研究也發現ADHD不同亞型具有類似的能量調節缺損的歷程，他們在時間知覺作業的結果也支持注意力資源與能量調節具有理論的複核效度，在不同發展時期的比較也再次顯示τ是ADHD患者與對照組受試的主要差異。本研究認為ex-Gaussian參數是估計認知能量模式中的能量庫的適當測量方式，並可藉由認知能量的病理模式建構介入與治療的方向。

     
    Background: Literature documents that the reaction time (RT) assessed by a variety of neuropsychological tasks is typically both slower and more variable in individuals with attention-deficit hyperactivity disorder (ADHD) than the controls. Some studies further lent evidence to support a relationship between the RT patterns and the difficulty of effort regulation in ADHD.
    Objectives:
    1) To explore the moderating effects from effort regulation (the inter-stimulus intervals (ISI) and Block) on three parameters (μ, σ, τ) of ex-Gaussian distribution of the reaction time of the Conner’s Continuous Performance Test (CCPT) among individuals with ADHD as compared with the controls;
    2) To examine the association between the ex-Gaussian parameters and ADHD symptoms and the response errors in the CCPT to infer the psychological meanings of ex-Gaussian parameters (μ, σ, and τ);
    3) To understand effort regulation for the ADHD-Combined Type (ADHD-C) and ADHD-Inattentive Type (ADHD-IA) by examining the relationship between effort regulation process (ISI and Block effects) and ex-Gaussian parameters (μ, σ, and τ);
    4) To compare the performance in the time reproduction dual tasks and its relationship with ex-Gaussian parameters (μ, σ, and τ) among the ADHD-C, ADHD-IA, and controls;
    5) To examine the developmental change of ex-Gaussian parameters (μ, σ, and τ) and to test the difference among the two age groups (adolescent vs. child) with three diagnostic groups (ADHD-C, ADHD-IA, and controls) on ex-Gaussian parameters.
    Methods:
    We assessed 261 participants with DSM-IV ADHD-C (221 Boys, 84.7%), 151 participants with ADHD-IA (128 Boys, 84.8%), and 161 typically developing controls (124 Boys, 77.0%). Their age ranged from 6 to 16 years old. All the participants and their parents were interviewed with the Chinese version of the Kiddie Epidemiologic Version of the Schedule for Affective Disorders and Schizophrenia to confirm the psychiatric diagnosis of ADHD and other psychiatric disorders. Participants also received the Chinese versions of the Conners’ Parent Rating Scale-revised: Short Form (CPRS-R: S), the Conners’ Teacher Rating Scale-revised: Short Form (CTRS-R: S), the Swanson, Nolan, and Pelham, version IV scale (SNAP-IV)-Parent/Teacher Forms, the Time Perception Single and Dual Tasks, the CCPT and Intelligence (WISC-Ⅲ).
    Results: Participants with ADHD had a smaller μ and larger σ and τ with the largest effect sizes from τ. As ISI/Block increased, the magnitude of greater τ in participants with ADHD than controls increased. As the ISI increased, μ became slower in both groups; as the Block increased, μ became smaller only noted in participants with ADHD. There were significant group differences (ADHD/control) in σ estimation across different ISIs rather than in different Block levels. Regarding the association between ADHD symptoms and ex-Gaussian parameters (μ, σ, and τ), only τ was related to ADHD symptoms. Moreover, μ was correlated with commission errors of the CCPT; τ was correlated with omission errors of the CCPT.
    ADHD subtypes analysis revealed that participants with ADHD-C had smaller μ than participants with ADHD-IA without significant difference in τ; there was no subtype difference in time reproduction but the differences between the ADHD and control groups were magnified with increased time intervals and task complexity. Moreover, the variance of the time reproduction performance can be explained well by τ.
    As to the developmental comparison (children vs. adolescents), larger τ in participants with ADHD than control participants did not vary between child and adolescent participants. On the other hand, there were development changes in μ and σ estimates. For example, adolescents with ADHD had smaller μ than the controls without group difference in σ.
    Discussion: This study contributes not only to our understanding about RT in ADHD, but also to provide evidence to support the Cognitive-Energetic Model for ADHD. The findings also demonstrated similar compensation in effort regulation between the ADHD-C and ADHD-IA. Moreover, the findings support the cross-validity between time perception and effort regulation. Among the three ex-Gaussian parameters, τ is the most significant index to differentiate ADHD from non-ADHD. Finally, this study provides strong evidence to support the ex-Gaussian parameter as an appropriate method to assess the energetic pool of the Cognitive-Energetic Model for ADHD. A theoretical model for intervention can be established by taking the pathological model of Cognitive-Energetic Model for ADHD as reference.
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