初探數學學習障礙症學童認知缺損型態之異質性

Abstract

背景：數學學習障礙症患者可能於學習基礎數學概念、數學事實提取、計算與推理中出現困難；這些症狀不僅會影響學業表現和就業機會，亦對日常生活造成困難。過去研究多探討患者於數學核心能力上的缺損，較少分析其神經心理功能；不僅如此，近期學者證實數學學習障礙症患者具高異質性之神經心理功能缺損。有鑑於此，本研究欲分析數學學習障礙症患者多面向神經心理功能與數學核心能力，並探究兩者間的關連性；除此之外，以個案系列分析方式，檢驗每位患者於整體認知缺損型態上的異質性，並進一步試圖將該群患者的整體認知缺損型態進行分類。\n方法：本研究共招募10位國小五、六年級數學學習障礙症患者，與30位一般發展之國小五、六年級學童參與研究。所有受試者皆接受數學核心能力評估，以及多面向神經心理功能評估，包括：智力、訊息處理速度/命名速度、情節記憶（語文、視覺、數字情節記憶）與執行功能（語文工作記憶、視覺空間工作記憶、抑制能力、轉換能力、概念形成、思考流暢性），並將上述評估結果以t檢定與一般發展學童進行比較外；同時以修正t檢定，檢驗單一個案之分數與控制組是否具有顯著差異。最後，採用皮爾森相關，探討神經心理功能與數學核心能力間的關連性。\n結果：本研究發現數學學習障礙症患者具顯著之多面向神經心理功能與數學核心能力缺損；且每位患者所展現出的認知缺損型態之差異性大。其次，數學學習障礙症患者之神經心理功能與數學核心能力具明顯關連性，包括數字概念與預估智商、語文情節記憶具顯著相關；估算與視覺情節記憶具顯著相關；計算與訊息處理速度、視覺情節記憶與概念形成具顯著相關；而應用題則與語文情節記憶、轉換能力具顯著相關。最後，數學學習障礙症患者的認知缺損型態可區分為三種類型—輕微神經心理功能缺損型、特定神經心理功能缺損型，以及廣泛神經心理功能缺損型。\n結論：每位數學學習障礙症患者的認知缺損型態不同，且神經心理功能缺損的表現差異尤大。因此，即便該群體皆於學習數學上遇到困難，仍需對其神經心理功能做進一步評估與分析，方能釐清患者的整體認知缺損並提供適當的協助與治療。

Background: Mathematics learning disorder（MLD）may have difficulties in learning basic mathematical concepts, retrievaling arithmetic facts, calculation and reasoning; These symptoms will not only affect patient`s academic performance and employment, but cause their maladaptiveness in daily life. Previous studies have explored the defects of patients` mathematical ability without detailed analyses of their neuropsychological functions, which might the reason for a high heterogeneity of cognitive defective pattern of MLD. This study thus aims to analyze multi-faceted neuropsychological functions and mathematical ability of patients with MLD, and to further explore their associations. By means of case series analysis, the classification of MLD in terms of their cognitive defective pattern was presented.\nMethods: This study recruited 10 fifth and sixth grade patients with MLD and 30 typical development（TD）children. All participants will receive assessments of mathematical ability and multi-faceted neuropsychological functions, including intelligence, information processing speed/naming speed, episodic memory （verbal, visual, numerical episodic memory） and executive function （verbal working memory, visual spatial working memory, inhibition ability, switching ability, concept formation, thinking fluency）. The neuropsychological function of MLD group and TD group was tested by t test, and the modified t test was used to test whether the scores of a single case were significantly different from the TD group. In addition, the pearson correlation was used to explore the correlation between neuropsychological functions and mathematical ability.\nResults: The results showed that patients with MLD had significant deficits in neuropsychological functions and mathematical abilities, and their cognitive deficitive pattern was highly heterogeneous. Second, the neuropsychological functions were significantly correlated with mathematical abilities, such that number concept had a significant correlation with estimated IQ and verbal episodic memory; number estimates had a significant correlation with visual episodic memory; calculation had a significant correlation with information processing speed, visual episodic memory and concept formation; word problem had a significant correlation with verbal episodic memory and switching ability. The cognitive defective pattern in patients with MLD could be further divided into three subtypes: Minimal Neuropsychological Impairment, Specific Neuropsychological Impairment and Global Neuropsychological Impairment.\nConclusion: Each patient with MLD had different cognitive defective pattern, especially differences in neuropsychological deficits. Therefore, even if they all had difficulty in learning mathematics, further evaluation of their neuropsychological functions were required to clarify the patient`s overall cognitive deficits and provide appropriate assistance and treatment.