執行功能、注意力缺失過動症狀與心智理論能力探討──以大學生為對象

Exploration of executive function, attention deficit hyperactivity symptoms and theory of mind in college students

注意力缺失/ 過動症（ADHD）雖為兒童期診斷，但許多症狀仍可能延續到成年期，並使個體的人際相處產生困難，許多學者認為執行功能缺損引發是引發注意力缺失、過動與衝動症狀的認知脆弱因素，此外，執行功能也可以導致個體社交技巧不足，容易被同儕拒絕之原因，心智理論能力不佳，會使個體在人際互動中較難推論他人的想法、情緒與動機等，而影響其人際關係，最終導致ADHD 個體的社會與職業困境。有關ADHD 執行功能缺損假說，過去研究大部分為兒童及青少年，但是執行功能缺損會持續至成年期，目前針對執行功能與成年後ADHD 症狀的關係，缺乏實證資料。因此，本研究的目的為檢驗執行功能是否能預測其大學生ADHD 症狀，執行功能是否能預測其心智理論能力以及執行功能對心智理論的影響是否受到ADHD 症狀所中介。本研究共招募35 位ADHD 症狀大學生與35 位正常大學生，兩組在人口學變項一致，並控制智力分數，進行執行功能與心智理論能力的評估。結果發現：控制智力分數後，執行功能可以解釋ADHD 症狀最高至62% 的變異量，而且智力分數對ADHD症狀並無影響；執行功能可以解釋大學生情感心智理論最高至17% 的變異量，智力分數則有12% 的影響；進一步的中介模式分析結果顯示，大學生執行功能透過ADHD 症狀中的缺乏注意力可以預測情感心智理論的能力表現。建議未來對於成年前期ADHD 族群，不論在教育領域，輔導介入模式或心理治療，強化執行功能將有效改善其症狀與人際關係。

Rationale/Purpose: Attention Deficit Hyperactivity Disorder (ADHD) is a common psychiatric disorder characterized by cross-situational inattention, hyperactivity, and impulsivity. Although ADHD is often diagnosed in childhood, many symptoms may continue into adulthood. These symptoms may cause the patients to have difficulty in social interactions or in their academic or professional lives. Executive function is a top-down process involving inhibitory control, working memory, and cognitive flexibility. These core abilities are the basis for higher-order executive functions such as reasoning, problem solving, and planning. The core executive functions are related to ADHD patients’ inability to persist in their behavior and to inhibit their potential responses, and such deficits eventually affect their working memory and self-regulation. Thus, research indicates that executive function deficits are the cognitive vulnerability factors that cause the symptoms of insufficient attention, hyperactivity, and impulsivity. When these executive function deficits continue into adulthood, they can lead to further impairment throughout ADHD patients’ lives. In addition, executive function deficits can also lead to insufficient social skills and rejection by peers because of the patients’ difficulties in recognizing social information. Executive function deficits are related to social cognition, the core of which is theory of mind (ToM). Poor ToM ability makes it difficult for individuals to infer other people's thoughts, feelings, and motivations in interpersonal interactions, and such difficulties will in turn affect their interpersonal relationships and ultimately lead to social and professional dysfunction in individuals with ADHD. From the developmental perspective, some researchers also believe that ToM is an ability that can only be acquired after executive function matures. Though some researchers have begun to explore the relationships among ADHD symptoms, executive function and ToM, most studies to date have focused on children and adolescents, despite executive function deficit often continuing into adulthood. That is, there is still a lack of empirical research confirming the relationship between executive function and ADHD symptoms in adulthood. Therefore, the purpose of this study was to examine whether the executive function of college students can predict symptoms of ADHD and ToM ability, and also whether the influence of executive function on ToM is mediated by ADHD symptoms. Moreover, in the past, measures of executive function have also been limited to standardized tests. To improve the ecological validity of this study, self-reported inventories were also included.