本研究目的主要探究：(1)幼兒園大班至國小二年級注意力不足過動症兒童與典型發展兒童之聽寫、抄寫之寫字正確與寫字品質表現；(2)注意力不足過動症兒童與典型發展兒童之寫字表現相關因子與寫字表現迴歸預測模型；(3)寫字困難之注意力不足過動症兒童、寫字正常之注意力不足過動症兒童與典型發展兒童的寫字相關因子表現之差異性。本研究對象為16名認知、語言發展正常幼兒園大班之注意力不足過動症兒童與16名認知、語言發展正常國小一年級之注意力不足過動症兒童，以及32名與注意力不足過動症兒童年齡、性別、慣用手配對之典型發展兒童。參與兒童在第一次評量時接受認知、語言、精細動作、視動整合、識字量測驗、自編字形覺知測驗、自編寫字測驗(聽寫字、仿寫字)，並於半年後的第二次評量再次進行精細動作、視動整合、識字量測驗、自編字形覺知測驗、自編寫字測驗與基本讀寫字綜合測驗追蹤。本研究分析包含三個部分，第一部分以重複量數單因子變異數分析統計方式分析組別與年齡兩項因子對聽寫、仿寫之寫字正確與寫字品質之影響；第二部分以皮爾遜積差相關係數統計方式分析字形覺知、識字量、精細動作精確度、手部靈巧度與精細動作整合因子與寫字表現之相關性，並以階層迴歸分析統計方式找出寫字表現重要的預測因子；第三部分則是以單因子變異數分析統計方式分析寫字困難之注意力不足過動症兒童、寫字正常之注意力不足過動症兒童與典型發展兒童在寫字相關因子表現之差異性。研究結果顯示，注意力不足過動症兒童與典型發展兒童在幼兒園大班至國小二年級是寫字表現快速發展的時期。在聽寫寫字正確表現，在幼兒園大班至小一上學期的組別、年齡、組別×年齡交互作用效果皆達顯著；在小一下學期至小二上學期的組別與年齡之主要效果亦達顯著，顯示注意力不足過動症兒童聽寫寫字正確表現在幼兒園大班至小二上學期有明顯成長，但表現顯著低於典型發展兒童。在仿寫寫字正確表現，在幼兒園大班至小一上學期的組別、年齡、組別×年齡交互作用效果皆達顯著，而小一下學期至小二上學期的組別、年齡、組別×年齡交互作用效果皆未達顯著，顯示注意力不足過動症兒童仿寫寫字正確表現在幼兒園大班至小一上學期有明顯成長，但表現顯著低於典型發展兒童，而在小一下學期至小二上學期仿寫寫字正確表現則與典型發展兒童接近。在寫字品質部分，注意力不足過動症兒童的字體大小不一、部件比例失衡與超出格子比例顯著高於典型發展兒童。在寫字表現相關因子部分，注意力不足過動症兒童與典型發展兒童的寫字表現與字形覺知、識字量、精細動作精確度、精細動作整合與手部靈巧度有顯著相關，而其中字形覺知能力是聽寫字表現重要的預測因子，而手部靈巧度則是抄寫字表現重要的預測因子。寫字困難與寫字正常之注意力不足過動症兒童視動整合能力皆顯著低於典型發展兒童，而寫字困難之注意力不足過動症兒童其精細動作表現顯著低於典型發展兒童，但寫字正常之注意力不足過動症兒童精細動作表現則未與典型發展兒童有顯著差異，顯示寫字困難之注意力不足過動症兒童精細動作表現不佳更為顯著。針對研究結果，本文進行討論並於文末提出結論與建議。

關鍵詞：注意力不足過動症、寫字、字形覺知、精細動作、視動整合

The aims of this study were to: (1) investigate accuracy and quality of dictation and copying tasks in ADHD children and TD children followed from kindergarten to second grade; (2) identify underlying correlating factors and regression prediction models of the writing performance in the ADHD and TD groups respectively; (3) compare performance across ADHD children with writing difficulty, ADHD children with normal writing ability and TD children based on the above-mentioned correlating factors. Sixteen kindergarten ADHD children and sixteen first grade ADHD children with normal cognitive and language development and an equal number of age, gender and preferred hand matched controls were recruited. All participants received TONI-4, PPVT-R, BOT-2, word recognition test, self-designed orthographic awareness test and self-designed writing test(dictation and copying tasks); after six months, BOT-2, word recognition test, self-designed orthographic awareness test, self-designed writing test and the Basic Reading and Writing Comprehensive Test(BRWCT) were administered to the same participants. Three methods of analysis were conducted: one-way ANOVA with repeated measures used to analyze the effects of group and age factors on writing performance; Pearson Product-Moment correlation and hierarchical regression model used to identify the correlating factors and prediction models of writing performance; one-way ANOVA used to compare the performance on the correlating factors across ADHD children with writing difficulty, ADHD children with normal writing ability and TD children. The results showed that ADHD children and TD children had developed rapidly in writing performance from kindergarten through second grade. There were significant group, age and group×age interaction effects on dictation performance in kindergarten and first grade children. Significant group and age effects on dictation performance in first and second grade children were also found, which indicated that ADHD children showed significant improvement in dictation from kindergarten through second grade, though still fell behind their TD peers. There were significant group, age and group×age interaction effects on copying tasks in kindergarten and first grade children, while no significant effects were found in first and second grade children. These results suggested that copying performance in ADHD children, though not as good as their TD peers, improved significantly from kindergarten through first grade. However, there was no significant difference in copying performance between ADHD and TD children in second grade. As for writing quality, ADHD children have significantly more problems in maintaining proportionate character size and component size. Orthographic awareness, word recognition, fine motor precision, fine motor integration and manual dexterity were significantly correlated with writing performance in ADHD children and TD children. Orthographic awareness was the most important predictor for dictation and manual dexterity was an important predictor for far-point copying. Both ADHD children with and without writing difficulty had poorer visual-motor integration than TD children while only ADHD children with writing difficulty had poorer fine motor precision and manual dexterity than TD children, which revealed that fine motor ability was worse in ADHD children with writing difficulty. Discussion about the results and suggestions for further research were provided.

Keywords: ADHD, fine motor, handwriting, orthographic awareness, visual-motor integration

一、中文文獻

李宏鎰、陳柔安、張孟鈴、林宗期、周佳蓉(2013)。注意力缺陷過動症兒童之書寫表現。特殊教育季刊，128，19-26。

李連珠(1995)。臺灣幼兒之讀寫概念發展。幼教天地，11，37-68。

李瑩玓(2001)。國小寫字困難學童與普通學童寫字相關認知能力分析。國
立臺灣師範大學特殊教育研究學系碩士論文，未出版，臺北市。

李瑩玓(2004)。寫字困難學生寫字特徵之分析。師大學報：教育類，49(2)，43-64。

吳敏而、黃琪芬(1993)。幼兒對文字用途的認識。載於臺灣省國民學校教師研習會(主編)：國民小學國語科教材教法研究，3，37-46。

吳敏而(1993)。文字書本概念與閱讀能力的關係。載於臺灣省國民學校教師研習會(主編)：國民小學國語科教材教法研究，3，47-59。

林玉霞(1995)。臺灣聽力正常兒童與聽覺障礙兒童對文字書本概念表現。特殊教育與復健學報，4，249-266。

林雅芬(2008)。兒童對中文組字知識的理解。國立臺灣師範大學人類發展與家庭學系碩士論文，未出版，臺北市。

柯華葳、尹玫君(1987)。國民小學常用字及生字難度研究¬-低年級。臺北市：臺灣省國民學校教師研習會。

張宛真(2014)。探討幼兒的早期書寫表現及其影響因素。國立中央大學學習與教學研究所博士論文，未出版，桃園縣。

陳秀芬、洪儷瑜、陳慶順(2008)。國小一至三年級讀寫字困難學童基本讀寫字能力之研究。台東大學教育學報，19(2)，31-60。

陳美文(2002)。國小讀寫困難學生認知能力之分析研究。國立臺灣師範大學特殊教育學系碩士論文，未出版，臺北市。

陳莉莉、郭婉儀(2004)。學前兒童對中文字形結構的認識。基礎教育學報，13(2)，23-37。

陳惠茹(2015)。幼兒部件概念發展與認字。教育心理學報，47(1)，45-62。

黃秀文(1997)。小學一年級學童書寫形式與概念之研究。國民教育研究學報，3，121-154。

黃惠玲(2008)。注意力缺損過動疾患文獻回顧。應用心理研究，40，197-219。

萬雲英(1991)。兒童學習漢字的心理特點與教學。載於楊中芳、高尚仁(主編)，中國人。中國心-發展與教學篇(404-448頁)。臺北：遠流。

路喬甯(2011)。幼稚園大班幼兒文字與書本概念與中文認字能力之相關研究。國立臺灣師範大學人類發展與家庭學系碩士論文，未出版，臺北市。

顏孝羽、戴聖偉、黃怡璇、李亞真(2015)。部件教學合併行為治療對與注意力缺陷過動症共病寫字困難患童寫字治療效益之回朔性研究。輔仁醫學期刊，13(4)，171-183。

蕭英露(2005)。國小學童寫字表現預測因子之探討。國立成功大學職能治療學系碩士論文，未出版，臺南市。

二、英文文獻

American Psychiatric Association(2013). Diagnostic and statistical manual of mental disorder-V(5th ed.). Washington, DC: Book Promotion & Service.

Adi-Japha, E., Landau, Y. E., Frenkel, L., Teicher, M., Gross-Tsur, V., & Shalev, R. S. (2007). ADHD and dysgraphia: Underlying mechanisms. Cortex, 43(6), 700-709.

Baghban, M. (2007). Scribbles, labels, and stories: The role of drawing in the development writing. Young Children, 62(1), 20-26.

Barkley, R. A. (2006). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment(3rd ed.). New York, NY: Guilford Press.

Barkley, R. A. (2012). Executive functions: What they are, how they work, and why the evolved. New York, NY: Guilford Press.

Baydar, N., Brukr-Gunn, J., & Furstenberg, F. (1993). Early warning signs of functional illiteracy: Predictors in childhood and adolescence. Child Development, 64(3), 815-829.

Berninger, V. W., Abbott, R. D., Jones, J., Wolf, B. J., Gould, L., Anderson-youngstrom, M., & Apel, K. (2006). Early development of language by hand: Composing, reading, listening, and speaking connections; three letter-writing models; and fast mapping in spelling. Developmental Neuropsychology, 29(1), 61-92.

Berninger, V. W., & Hooper. (2006). Introduction to special issue of writing. Developmental Neuropsychology, 29(1), 1-4.

Bloodgood, J. W. (1999). What's in a name? Children name writing and literacy acquisition. Reading Research Quarterly, 34(3), 342-367.

Brown T. E. (2009). ADHD comorbidities: Handbook for ADHD complications in children and adults. Washington, DC: American Psychiatric.

Chan, L., & Louie, L. (1992). Developmental trend of Chinese preschool children in drawing and writing. Journal of Research in Childhood Education, 6(2), 93-99.

Chan, L., & Nunes, T. (1998). Children's understanding of formal and functional characteristics of written Chinese. Applied Psycholinguistics, 19(1), 115-131.

Chang, S. H., & Yu, N. Y. (2013). Handwriting movement analysis comparing first and second grades with normal on dysgraphic characteristics. Research in Developmental Disabilities, 34(9), 2433-2441.

Chen, S. Y.(2004). The relationship between Taiwanese children’s development of orthographic awareness and word recognition. Chinese Journal of Psychology, 46(3), 259-265.

Clay, M. M. (1993). Reading recovery: A guidebook for teachers in training. Portsmouth, NH: Heinemann.

Clay, M. M. (2000). Concepts about print: What have children learned about the way we print language. Portsmouth, NH: Heinemann.

Dunsmuir, S., & Blatchford, P. (2004). Predictors of writing competence in 4- to 7-year-old children. British Journal of Educational Psychology, 74(3), 461-483.

DuPaul, G., & Stoner, G. (2014). ADHD in the school: Assessment and intervention strategies. New York, NY: Guilford.

Ferguson, N. (1975). Pictographs and prereading skills. Child Development, 46(3), 786-789.

Graham, S., Fishman, E. J., Reid R., & Hebert, M. (2016). Writing characteristics of students with attention deficit hyperactive disorder: A meta-analysis. Learning Disabilities Research & Practice, 31(2), 75-89.

Hallahan, D. P., Kauffman, J. M., & Lloyd, J. W. (1999). Instruction to learning disabilities. Boston, MA: Allyn and Bacon.

Haney, M. R., Bissonnette, V., & Behnken, K. L. (2003). The relationship among name writing and early literacy skills in kindergarten children. Child Study Journal, 33(2), 99-115.

Harvey, C., & Handerson S. (1997). Children’s handwriting in the first three years of school: Consistency over time and its relationship to academic achievement. Handwriting Review, 11, 8-25.

Heibert, E. H. (1984). A developmental sequence in preschool children’s acquisition of reading readiness skills and print awareness concepts. Journal of Applied Developmental Psychology, 5(2), 115-126.

Ho, C. S.-H., Yau, P. W.-Y., & Au, A. (2003). Development of orthographic knowledge and its relationship with reading and spelling among Chinese kindergarten and primary school children. In C. McBride-Chang & H.-C. Chen (Eds.). Chinese children’s reading development (pp. 51-71). London, UK: Praeger.

Kaiser M.-L., Schoemaker, M. M., Albaret J.-M., & Geuze, R. H. (2015). What is the evidence of impaired motor skills and motor control among children with attention deficit hyperactivity disorder(ADHD)? Systematic review of the literature. Research in Developmental Disabilities, 36, 338-357.

Kellogg, R. T. (1994). Psychology of Writing. New York, NY: Oxford University Press.

Kellogg, R. T. (1996). A model of working memory in writing. In C. M. Levy & S. Ransdell (Eds.). The science of writing: Theories, methods, individual differences, and applications (pp. 57-71). Mahwah, NJ: Erlbaum.

Lam, H. C, & Tsiu, B. M. (2013). Awareness of orthographic structure in children's learning of Chinese characters. Contemporary Educational Research Quarterly, 21(3), 83-111.

Lee, H. Y., Chen, R. A., Lin, Y. S., Yang, Y. C., Huang, C. W., & Chen, S. C. (2014). The written language performance of children with Attention Deficit Hyperactivity Disorder in Taiwan. Research in Developmental Disabilities, 35(8), 1878-1884.

Lerer, R. J., Artner J., & Lerer, M. P. (1979). Handwriting deficits in children with minimal brain dysfunction: Effects of methylphenidate (Ritalin) and placebo. Journal of Learning Disabilities, 12(8), 26-31.

Li, H., Shu, H., McBride-Chang, C., Liu, H., & Peng, H. (2012). Chinese children's character recognition: Visuo-orthographic, phonological processing and morphological skills. Journal of Research in Reading, 35(3), 287-307.

Lomax, R. G., & McGee, L. M. (1987). Young children’s concepts about print and reading: Toward a model of word reading acquisition. Reading Research Quarterly, 22(2), 237-256.

Longcamp, M., Zerbato-Poudou, M.-T., & Velay, J.-L. (2005). The influence of writing practice on letter recognition in preschool children: A comparison between handwriting and typing. Acta Psychologica, 119(1), 67-79.

Mason, J. M. (1980). When do children begin to read: An exploration of four year old children’s letter and word reading competencies. Reading Research Quarterly, 15(2), 203-227.

Mäki, H. S., Voeten, M. J. M., Vauras, M. M. S., & Poskiparta, E. H. (2001). Predicting writing skill development with word recognition and preschool readiness skills. Reading and Writing, 14(7), 643-672.

Marr, D., & Cermak, S. (2002). Consistency of handwriting in early elementary students. American Journal of Occupational Therapy, 56(2), 161-167.

Mayes, S. D., & Calhoun, S. L. (2006). Frequency of reading, math and writing disabilities in children with clinical disorders. Learning and Individual Differences, 16(2), 145-157.

Mayer, S. D., & Calboun, S. L. (2007). Learning, attention, writing, and processing speed in typical children and children with ADHD, autism, anxiety, depression, and oppositional-defiant disorder. Child Neuropsychology, 13(6), 469-493.

Mayer, S. D., Calhoun, S. L., & Crowell, E. W. (2000). Learning disabilities and ADHD: Overlapping spectrum disorders. Journal of Learning Disabilities, 33(5), 417-424.

McBride-Chang, C. (2004). Children’s literacy development. London, UK: Arnold.

McBride-Chang C., Chung K. K.H., & Tong X. (2011). Copying skills in relation to word reading and writing in Chinese children with and without dyslexia. Journal of Experimental Child Psychology, 110(3), 422-433.

McBride-Chang, C., Zhou, Y., Cho. J. R., Aram, D., Levin, I., & Tolchinsky, L. (2011). Visual spatial skill: A consequence of learning to read? Journal of Experimental Child Psychology, 109(2),256-262.

McHale, K., & Cermak, S. A. (1992). Fine motor activities in elementary school: Preliminary findings and provisional implications for children with fine motor problems. American Journal of Occupational Therapy, 46(10), 898-903.

Nicolson, R. I., & Fawcett, A. J. (2011). Dyslexia, dysgraphia, procedural learning and the cerebellum. Cortex, 47(1), 117-127.

Noda, W., Ito, H., Fujita, C., Ohnishi, M., Takayanagi, N., Someki F., Nakajima, S., Ohtake, S., Mochizuki, N., & Tsujii, M. (2013). Examining the relationships between attention deficit/hyperactivity disorder and developmental coordination disorder symptoms, and writing performance in
Japanese second grade students. Research in Developmental Disabilities, 34(9), 2909-2916.

Overvelde A., & Hulstijn W. (2011). Handwriting development in grade 2 and grade 3 primary school children with normal, at risk, or dysgraphic characteristics. Research in Developmental Disabilities, 32(2), 540-548.

Payne T. W., & Steege N. B. Z. (2013). Working memory and distraction: Performance differences between college students with and without ADHD. Creative Education, 4(7), 37-41.

Puranik, C. S., & Lonigan, C. J. (2014). Emergent writing in preschoolers: Preliminary evidence for a theoretical framework. Reading Research Quarterly, 49(4), 453-467.

Rodríguez, C., Areces, D., García, T., Cueli, M., Loew S. J., & González-Castro, P. (2015). ADHD and writing learning disabilities: Overlapping disorders and educational implications. Insight into Learning Disabilities, 12(2),
121-146.

Schoemaker, M. M., Ketelaars, C. E. J., van Zonneveld, M., & Mulder, T. (2005). Deficits in motor control processes involved production of graphic movements of children with ADHD. Developmental Medicine and Child Neurology, 47(6), 390-395.

Shen, I.-H., Lee, T.-Y., & Chen, C.-L. (2012). Handwriting performance and underlying factors in children with Attention Deficit Hyperactivity Disorder. Research in Developmental Disabilities, 33(4), 1301-1309.

Smits-Engelsman, B. C. M., & van Galen, G. P. (1997). Dysgraphia in children: Lasting psychomotor deficiency or transient developmental delay? Journal of Experimental Child Psychology, 67(2), 164-184.

Tolchinsky-Landsmann, L., & Levin, I. (1985). Writing in preschooler: An age-related analysis. Applied Psycholinguistics, 6(3), 319-339.

Treiman, R., & Yin, L.(2011). Early differentiation between drawing and writing in children. Journal of Experimental Children Psychology, 108(4), 786-801.

van Galen, G. P. (1991). Handwriting: Issues for a psychomotor theory. Human Movement Science, 10(2), 165-191.

van Hartingsveldt, M. J., Cup, E. H. C., Hendriks J. C. M., de Vries, L., de Groot, I. J. M., Nijhuis-van de Sanden M. W.G. (2015). Predictive validity of kindergarten assessment on handwriting readiness. Research in Developmental Disabilities, 36, 114-124.

Wang, Y., McBride-Chang, C., & Chan, S. F. (2014). Correlates of Chinese kindergarteners' word reading and writing: The unique role of copying skills? Reading and Writing, 27(7), 1281-1302.

Welsh, M. C., & Pennington, B. F. (1988). Assessing frontal lobe functioning in children: Views from developmental psychology. Developmental Neuropsychology, 4(3), 199-230.

Whitehurst, G., & Lonigan, C. (1998).Child development and emergent literacy. Child Development, 69(3), 848-872.

Wu, L. Y. (2009). Children’s graphical representations and emergent writing: Evidence from children’s drawings. Early Child Development and Care, 179(1), 69-79.