動作遲緩兒童之精熟動機與父母互動行為關係

Abstract

背景與目的：幼兒的精熟動機為影響日後成就動機或其他功能領域發展的重要因素之一。動作發展是發展遲緩中最早被偵測，因此了解動作發展遲緩幼兒之動機及其相關因素非常重要。父母互動行為會影響動機，然而極少有文獻探究動作遲緩幼兒之精熟動機與父母互動行為之相關。因此本研究目的有二：(1)比較動作遲緩兒童與認知年齡配對之一般兒童的精熟動機異同，包含物體、粗大動作及社會工具性動機、及精熟愉悅表達性動機；(2)探究動作遲緩兒童精熟動機與父母互動行為之相關。研究方法：配對病例對照研究設計，從台北地區兩醫療中心徵召生理年齡為24至42個月，認知與精細動作年齡為15個月以上之22名動作遲緩兒童；另經由廣告或台大兒醫大樓健兒門診徵召與遲緩兒童認知年齡及性別相配對之一般兒童22名。兒童與其母親於一天內於行為觀察室接受同一測試者進行精熟動機及「兒童教導量表」之測試。物體、粗大動作、社會、與精熟愉悅動機分數由母親填寫之「精熟動機問卷量表」而得；父母互動行為由測試者使用「兒童教導量表」觀察母親與兒童於教導活動中之互動行為，而得「對訊息的敏感度」、「對壓力的反應」、「促進社會情緒成長」及「促進認知成長」四種分數。統計方法：以獨立t檢定比較遲緩兒童與一般兒童之精熟動機有無顯著差別，顯著水準α設為0.05，單尾檢定；對遲緩兒童，以皮爾森迴歸檢驗父母互動行為指標與各精熟動機分數有無顯著相關，對有顯著相關變項，再以控制精熟動機相關之變數下，用淨相關檢驗精熟動機與父母互動行為之關係，。顯著水準α設為0.05，雙尾檢定。結果：去除效度不佳之測試結果，總計20名遲緩兒童與17名一般兒童納入分析，由母親自填之「精熟動機問卷量表」之分析顯示，遲緩兒童的工具性動機都顯著的低於一般兒童，表達性動機則與一般兒童無顯著差別。於動作遲緩兒童，母親對壓力的反應之分數與其粗大動作動機有顯著正相關；其餘父母互動行為指標與兒童精熟動機無顯著相關。討論：動作遲緩兒童的工具性精熟動機較一般兒童低，表達性動機則無顯著差別，可能因動作遲緩兒童之身體功能上受限，以致進行任務之行動持續度較一般兒童低。此外，遲緩兒童母親的主觀感受也可能是影響精熟動機分數之因素。在教導活動之親子互動中，對動作遲緩兒童的壓力反應較好之母親其兒童之粗大動作動機也較高，可能是這些動作遲緩兒之粗大動作障礙相對較嚴重，父母若察覺到孩子的壓力並給適當的回應，會協助孩子於肢體動作之自信心，進而持續粗大動作任務。結論：動作遲緩兒童相較於認知年齡配對之一般兒童，工具性精熟動機較低；於動作遲緩兒童，對兒童的壓力反應較好之母親其兒童之粗大動作動機也較高。然對於影響精熟動機的相關因子和父母親職技巧是否能增進孩子精熟動機須進一步研究。

Background and Purpose: Mastery motivation is an important predictor of later achievement motivation and other developmental outcomes in children. Motor delay (MD) is the earliest detected sign among all developmental domains in children with developmental delays. Therefore, understanding mastery motivation and its related factors in children with MD will be critical for early intervention services. Parental interactive behavior would influence the development of mastery motivation. However, few studies have been investigated the relationship between parental interactive behavior and mastery motivation in children MD previously. The purposes of this study were: (1) to investigate the differences of mastery motivation on 3 instrumental mastery motivation indices (Object, Gross motor, Social) and 1 expressive mastery motivation index (Mastery Pleasure) between children MD and children developing typically (DT); (2) to examine the relationship between parental interactive behavior and mastery motivation in children with MD. Methods: This was a matched case-control study. 22 children MD aged 24-42 months were recruited from two medical centers in the Taipei area. And 22 mental age and gender matched children DT were recruited from the advertisement or well-baby clinics in one medical center. The parent-child dyads received the Nursing Child Assessment Teaching Scale (NCATS) by a trained tester and the Dimensions of Mastery Questionnaire (DMQ) in a child observation laboratory in one day. Four indices of mastery motivation were measured by the DMQ that was rated by mothers. Four indicators of parental interactive behavior (Response to Child’s Distress, Sensitivity to Cues, Social-Emotional Growth Fostering and Cognitive-Growth Fostering) were measured through observation of parental interactive behavior on one teaching task using the NCATS. Statistical analysis: Independent t tests were used to examine the differences of the four indices of mastery motivation between MD and DT groups (α=0.05; one-tailed). Pearson correlation was used to analyze the correlation between 4 indicators of parental interactive behavior and 4 indices of mastery motivation in MD group (α=0.05; two-tailed). For significant variables, partial correlation was used to further examine the correlation between mastery motivation and parental interactive behavior under the control of possible confounders. Results: 20 children MD and 17 children DT had valid data to further analysis. The MD group had significantly lower instrumental mastery motivation (Object, Gross Motor, and Social) than DT group. The expressive mastery motivation was not significantly different between two groups. In the MD group, the Response to Child’s Distress of NCATS was positively and significantly correlated with Gross Motor Persistence on the DMQ. The other parental interactive behavior indictors were not significantly correlated with any indices of mastery motivation. Discussions: The results showed that children MD had significantly lower instrumental mastery motivation, but not the expressive mastery motivation than the children DT. The physical impairment of children MD might make the task persistence difficult, and maternal subjective perceptions might also influence the scores of DMQ. For children MD, the better the mother responded to child’s distress the higher duration of gross motor task persistence the children had. Most children MD had more severe gross motor limitations; persistence of gross motor tasks might need more emotional support from parents to establish self-efficacy of gross motor tasks. Conclusions: Children MD had lower scores of Object, Gross Motor, and Social mastery motivation than mental age matched children DT. Higher Response to Child’s Distress was significantly correlated with Gross Motor mastery motivation in children MD. A further study is needed to investigate the influencing factors of mastery motivation rated by parents, and whether programs enhancing parental skill will affect children’s mastery motivation.