ADHD 兒童의 事態調節能力이 課題修行에 미치는 影響 : 하위유형과 자극제시율에 따른 수행의 차이 = Effect of ADHD children's State Regulation on Task Performances

다국어 초록 (Multilingual Abstract)

ADHD (Attention Deficit Hyperactivity Disorder) is one of the most common childhood disorders and it has been viewed as comprising three primary symptoms of inattention, impulsiveness, and hyperactivity (APA, 1987). On the basis of research demonstrating the functional similarity between hyperactivity and impulsivity and the functional dissimilarity between hyperactivity-impulsivity and inattention, DSM-IV delineated two types of symptoms of inattention and hyperactivity- impulsivity. As a result, three subtypes of the disorder have been proposed in the current clinical view of ADHD: predominantly inattention, predominantly hyperactive-impulsive, and combined types(DSM-IV; APA, 1994).
There is a strong possibility that the two subgroups of ADHD are two distinct disorders: One in which attentional defects are the core and one in which hyperactivity-impulsivity is the core. Previous researches, however, have not conclusively indicated exactly what the primary defect in ADHD subgroups are. They also cannot readily account for the many deficits associated with ADHD.
Most of the ADHD research and diagnosis so far focused on the cognitive ability factors, and have considered the state fluctuations of the subject during testing to be a confounding factor. This research is designed to investigate the distinctions between ADHD subgroups. Specifically, the goal of this study is to investigate the effects of state factors on cognitive functioning in ADHD children, which is needed to understand the true nature of the deficit. Based on Seargeant, Oosterlaan and van der Meere's(1999) cognitive-energetic model, this study is to identify whether poor motor control in children with ADHD is associated with a state regulation deficit.
Four research questions are as follows: 1) During a Go/No-Go task, would ADHD children respond more slowly and variably and have high error rates? 2) Would there be difference in the type of attention between ADHD combined and ADHD inattentive subtypes? 3) Would there be differences between ADHD combined and ADHD inattentive subtypes regarding externalizing problems and the type of errors? 4) During a Go/No-Go task, would subtypes of ADHD and stimulation presentation rate effect on task performance?
For this purpose, 20 ADHD combined type and 18 ADHD inattentive type and 19 control children participated in three Go/No-Go test: The first with a fast stimulus presentation rate (1 second), and the second with a medium stimulus presentation rate (4 seconds), and the third with a slow stimulus presentation rate (9 seconds). Each conditions lasted ten minutes, with 461 trials in the fast condition and 139 trials in the medium condition and 64 trials in the slow condition. Groups were compared on reaction time, reaction time variability, ommission error, and commission error.
The results of this study are as follows: 1) ADHD children reacted more slowly and variably, and made more errors than control group. 2) ADHD inattentive type children had more problems with focused attention than control group, whereas ADHD combined type children had more problems with sustained attention than control group, but there were no significant differences in types of attention between ADHD subtypes. 3) Children with ADHD combined type were more likely to have externalizing problems and more commission errors than others, however ADHD inattentive type children were more likely have ommission errors than others. 4) During the Go/No-Go task, in the medium stimulus presentation rate, ADHD combined type children had similar reaction time, reaction time variability, number of ommission error to those of the controls group, except number of commission error. They had longer reaction time and higher reaction time variability and many errors than control group in both the fast and slow conditions. ADHD in ttentive type children reacted more slowly and variably and made more errors than control group regardless of stimulus presentation conditions.
When the stimuli are presented with a medium rate, ADHD combined type children showed comparable reaction time, reaction time variability, ommission error in both the first half and second half of the task except commission error. They had longer reaction time, higher reaction time variability, and more errors in the second half of the task than the first half in both the fast and slow conditions. ADHD inattentive type children had similar reaction time, reaction time variability, and error rate in both the first half and second half of the task irrespective of the stimulus presentation conditions.
The results from this study indicate that a significant distinction exists between ADHD combined and inattentive type children, and the quality of response of ADHD combined type children is strongly related to the presentation rate. These findings suggest that the key problem of ADHD is an inability to modulate the behavioral state according to task and situational demands. Thus, ADHD combined type children are easily over- and underactivated, resulting in poor response inhibition. In contrast to ADHD combined type, ADHD inattentive type childen's poor task response is independent of the presentation rate. Consequently, poor response in this children is not explained in terms of a state regulation deficit. Each subtypes of ADHD are quite different, and thus it is necessary that adequate treatment interventions are correspondingly applied in terms of subtypes.

목차 (Table of Contents)

• Ⅰ. 서 론 = 1
• 1. ADHD의 정의 및 유형 = 3
• 2. ADHD의 행동제지 결핍 = 9
• 3. ADHD의 모델 = 15
• 4. 사태조절 능력(state regulation) = 24
• 5. 연구문제 = 32
• Ⅱ. 연 구 방 법 = 40
• 1. 피험자 = 40
• 2. 측정도구 = 42
• 3. 실험절차 = 45
• 4. 실험설계 및 자료분석 = 46
• Ⅲ. 결 과 = 48
• 1. 연령, 성별에 따른 과제수행 비교 = 48
• 2. ADHD 집단과 통제집단의 수행비교 = 50
• 3. 주의력 결핍의 유형 = 51
• 4. 외현화와 오류유형 = 55
• 5. 집단 유형과 자극 제시율이 수행에 미치는 영향 = 57
• 6. Go/No-Go, 전.후반부 및 자극제시율에 따른 집단분류 = 70
• Ⅳ. 토의 및 결론 = 75
• 참 고 문 헌 = 94
• ABSTRACT = 112
• 부 록 = 117