中文版幼兒動作協調問卷之心理計量特性之研究

Abstract

研究目的: 發展協調障礙在國外的盛行率為4%至10%。而在台灣地區，7~8歲國小學童發展協調障礙之盛行率為3.5%，9~10歲為17.9%。然而，目前為止還沒有公開的研究關於學齡前孩童的動作發展協調之研究。發現動作發展遲緩孩童並給予及時的介入是小兒工作者的重要議題。在所有診斷發展遲緩的評估工具中，問卷是最有效率的工具，且動作發展問卷是最被廣泛使用的工具。因此，本研究的目的是編譯中文版幼兒發展協調問卷，此問卷是根據動作發展問卷設計且對象為3~4.9歲的兒童，我們擴展此問卷的年齡到5.9歲，研究對象為學齡前的孩童。此研究的第二個目的為建立中文版本之初步心理計量特性。 研究方法: 首先將幼兒動作發展協調問卷翻譯為中文並作跨文化的編譯及修訂。研究對象為1124位社區幼稚園的小朋友(平均年齡=59.05月， 標準差=8.40月，女生=530(47.2%), 男生=594(52.8%))，年齡皆在3~5.9歲間。所有小朋友的家長皆須填答中文版幼兒動作發展協調問卷。內在一致性檢驗為使用所有社區樣本的小朋友，再測信度檢驗為使用115位間隔二至三星期之社區樣本的小朋友(平均年齡=57.29月, 標準差=9.81月) 。施測者間信度檢驗為比較教師和家長填答同一位小朋友的分數，共48分(平均年齡=57.53月, 標準差=9.80月)。驗證性因素分析檢驗為使用社區樣本。區辨效度檢驗為比較發展協調障礙組、疑似發展協調障礙組、及非協調障礙組之中文版幼兒動作發展協調問卷之分數。同時效度檢驗為計算中文版幼兒動作發展協調問卷之分數和第二版兒童動作能力測驗之分數。敏感性及特異性檢驗為使用社區樣本。 結果: 此問卷的內在一致性為0.95，代表有高度的內在一致性。再測信度為0.97，代表好的再測信度。施測者間信度為0.45，代表差的施測者間信度。驗證性因素分析的值支持最初的三個因素模式(CFI=0.999, NNFI=0.998, RMSEA=0.028, SRMR=0.014, χ2=109.51,df=58)。區辨效度在單因子變異數分析顯示組間的幼兒動作協調問卷有統計上的顯著(F(2,159=24.41), p<0.001)。同時效度部分，第二版兒童動作能力測驗的總分和幼兒動作協調問卷總分有中度相關(N=162, r=0.52, p<0.001)。已MABC-2≦15%為標準，LDCDQ-C≦15%為切點時，敏感度為96%，特異性為68%。 結論: 本研究結果顯示，中文版幼兒動作發展協調問卷使用在台灣時具有可接受的信度及效度。且三個因素模式提供我們建立孩童治療活動的參考。因為LDCDQ-C無法區辨發展協調障礙組和疑似發展協調障礙組，因此，我們建議診斷發展協調障礙孩童最洽當的方法為將幼兒動作發展協調問卷當作篩檢工具，使用更進一步的標準化動作測驗為確認診斷的工具。

Objectives: In Taiwan, the estimated prevalence of Developmental Coordination Disorder (DCD) is 3.5% and 17.9% in children of ages between 7 and 8, and between 9 and 10, respectively. However, to our knowledge, no published studies are concerned with the prevalence of DCD in preschool children of 3 to 5 years old. Identifying children with DCD for timely intervention is a critical issue for pediatric professionals. Among the assessment tools for DCD, questionnaires are the most efficient, and the Development Coordination Disorder Questionnaire (DCDQ) is a widely used questionnaire. Little DCDQ (LDCDQ) based on DCDQ was developed for children between the ages of 3-4.9years old by Rihtman, Wilson, & Parush (Rihtman, Wilson, & Parush, 2010). The aims of this study were to translate and culturally adapt the LDCDQ into Chinese and examine its psychometric properties when used with Taiwanese preschool children. Methods: The LDCDQ was translated and culturally adapted into Chinese (LDCDQ-C). The participants were 1124 typically developing children (mean age=59.05 months, SD=8.40 months) from eight nursery schools and fourteen kindergartens in Taiwan. Among them, there were 530 girls (47.2%) and 594 boys (52.8%).. All children were aged between 3 to 5.9 years. Parents of all the children completed the LDCDQ-C. Test-retest reliability was examined by using 115 typically developing children (mean age=57.29 months, SD=9.81 months) in a 2-3 week interval. Inter-rater reliability was examined by comparing the 48 questionnaires (mean age=57.53months. SD=9.80 months) filled out by teachers with those by parents. The discriminant validity was examined by comparing the LDCDQ-C total scores of DCD, suspect DCD, and non-DCD groups as defined by their performance on the MABC-2. The concurrent validity was examined by computing the correlation between the total scores of LDCDQ and those of the MABC-2 on 162 children. The sensitivity and specificity were examined using the 15th of the MABC-2 as the criterion and15th of the LDCDQ-C as the cutoff. Results: As regards internal consistency, Cronbach alpha was 0.95 which was above the acceptable level of 0.70. The test-retest reliability with a 2-week interval for the total score was r = 0.97, indicating good test-retest reliability. The inter-rater reliability between the child’s teacher and parents was r =0.45, indicating poor inter-rater reliability. Results of confirmatory factor analysis showed that the fit indices for the three-factor model were CFI=0.999, NNFI=0.998, RMSEA=0.028, SRMR=0.014, χ2=109.51, and d.f.=58, indicating a good fit. One-way ANOVA showed a significant group difference in the total score of the LDCDQ-C (F(2,159)=24.41, p<0.001). The results of post hoc tests, using the Scheffe’s test, showed that the non-DCD group scored significantly higher than the DCD (p<0.001) and the suspect DCD group (p<0.001) but the latter two groups did not differ significantly (p=0.781, mean difference= 2.32).The total score of LDCDQ-C showed moderate correlation with the total score of the MABC-2 (N=162, r=0.52, p<0.001). The sensitivity was 0.96 and the specificity was 0.68. Conclusions: This questionnaire demonstrated an acceptable reliability and validity when used in Taiwanese preschoolers. Furthermore, the three-factor model provides implication for establishing children’s treatment program. However, due to the fact that the LDCDQ-C can’t differentiate children with DCD from suspect- DCD, further standardized performance-based assessments are recommended to confirm children’s motor coordination problems and the degree of severity.