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    Please use this identifier to cite or link to this item: http://tkuir.lib.tku.edu.tw:8080/dspace/handle/987654321/110910

    Title: 以統合回歸探討ADHD的療效影響因素
    Other Titles: The applications of meta-regression to explore the influential factors of the treatment effects of ADHD
    Authors: 林志濱;Lin, Chih-Pin
    Contributors: 淡江大學數學學系碩士班
    張玉坤;Chang, Yue-Cune
    Keywords: 統合回歸;注意力不足過動症;過動症;ADHD;Meta-regression;Methylphenidate;Atomoxetine;Behavior Therapy
    Date: 2016
    Issue Date: 2017-08-24 23:39:07 (UTC+8)
    Abstract: 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)。
    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.
    Appears in Collections:[數學學系暨研究所] 學位論文

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