兒童青少年強迫症量表編製之研究

摘要

本研究旨在編製一份具有良好信、效度的兒童青少年強迫症量表，做為篩選性評估之用途。本研究以國小五年級至高中職三年級學生為研究對象，研究樣本分為預試樣本（383人）、正式施測樣本（2221人）、重測信度樣本（365人）及效標關聯效度樣本。研究工具包括自編之「兒童青少年強迫症量表」，以及「兒童強迫症量表修訂版（The Children’s Obsessional Compulsive Inventory Revised, ChOCI-R）」、「台灣簡明版世界衛生組織生活品質問卷」、「台灣版多向度兒童青少年焦慮量表」、「貝克兒童及青少年量表第二版中文版」，所得資料以SPSS統計軟體進行各種統計分析。研究結果如下：
一、兒童青少年強迫症量表共計50題，分成強迫症狀檢核（包含強迫思考19題和強迫行為21題）及強迫症狀嚴重度（10題）兩個分量表。
二、信度考驗
（一）內部一致性係數：總量表Cronbach’s α係數為.936，強迫症狀檢核分量表Cronbach’s α係數為.928，強迫症狀嚴重度分量表Cronbach’s α係數為.836，顯示本量表具有良好的內部一致性信度。
（二）重測進度：總量表間隔四週之重測信度為.79，強迫症狀檢核分量表為.76，強迫症狀嚴重度分量表為.65，顯示本量表在時間的穩定性頗佳。
三、效度考驗
（一）內容效度：量表題目經指導教授及4位專家學者根據題目所屬定義內涵進行審查，合格率高達99%，顯示本量表具有良好的內容效度。
（二）效標關聯效度：本量表與兒童強迫症量表修訂版的相關係數介於.47至.81之間；與台灣簡明版世界衛生組織生活品質問卷的相關係數介於-.13至-.41之間；與台灣版多向度兒童青少年焦慮量表的相關係數介於.20至.38之間；與貝克兒童及青少年量表第二版中文版的相關係數介於.42至.68之間，相關係數皆達.05或.01顯著水準，顯示本量表具有同時效度。
（三）建構效度：本研究利用因素分析法考驗量表的因素內涵，結果大致符合原設計構念。
本研究根據研究結果提出建議，供實務工作及未來研究之參考。

The development of Obsessional Compulsive Scale for Children and Adolescents

Abstract

The purpose of this study was to develop a reliable and valid Obsessional Compulsive Scale for Children and Adolescents, which was provided for assessment and screening. The subjects in this study were the fifth and sixth grade students of elementary school, and students of junior, senior and vocational high school, consisted of a pre-test sample (n=383), a formal sample (n=2221), a test-retest reliability sample (n=365), and four criterion-related validity sample (n=355, 355, 353, 79). The instruments of this study included Obsessional Compulsive Scale for Children and Adolescents developed by the researcher, Children’s Obsessional Compulsive Inventory Revised (ChOCI-R), Taiwan Version of World Health Organization Quality of Life questionnaire- brief version (Taiwan Version WHOQOL-BREF), Multidimensional Anxiety Scale for Children- Taiwan Version (MASC-TV), and Beck Youth Inventories- Second Edition- Chinese Version (BYI-Ⅱ-Chinese Version). The data collected were analyzed by SPSS 18.0. The results of this study were listed as follows:
1.The Obsessional Compulsive Inventory for Children and Adolescents consisted of 50 items, composed of 2 subscales: (1) Obsession and compulsion symptoms which consisted of 19 items assessing obsession symptoms and 21 items assessing compulsion symptoms, and (2) Obsession and compulsion severity (10 items).
2.Reliability
(1)The Obsessional Compulsive Inventory for Children and Adolescents demonstrated adequate internal consistency, with Cronbach’s α coefficient of .936, .928, and .836 for the whole scale, the subscale of obsession and compulsion symptoms, and the subscale of obsession and compulsion severity, respectively.
(2)The test-retest reliability coefficients over a 4-week period were .79 for the whole scale, .76 for the subscale of obsession and compulsion symptoms, and .65 for the subscale of obsession and compulsion severity, which demonstrated good reliability.
3.Validity
(1)The items of Obsessional Compulsive Scale for Children and Adolescents were examined by the adviser and 4 expert researchers and scholars, and the qualified percentage reached to 99%, which demonstrated good content validity。
(2)The Obsessional Compulsive Scale for Children and Adolescents was significantly correlated with ChOCI-R (r= .47~.81, p< .01), Taiwan Version WHOQOL-BREF (r= -.13~-.41, p< .05 or .01), MASC-TV (r= .20~.38, p< .01), and BYI-Ⅱ-Chinese Version (r= .42~.68, p< .01), which demonstrated concurrent validity.
(3)Concerning Construct validity, this study tested the factor content of each subscale by applying factor analysis, and the results corresponded with the original concept in creation.
Based on the results, suggestions for practice and future researches were offered.

參考文獻

一、中文部份

吳明隆（2011）。SPSS統計應用學習實務：問卷分析與應用統計。新北市：易習圖書。
李浩銘、蔡欣記、林喬祥（2005）。強迫症。慈濟醫學，17，27-33。
台灣版世界衛生組織生活品質問卷發展小組（2005）。臺灣簡明版世界衛生組織生活品質問卷之發展及使用手冊（第二版）。臺北市：台灣版世界衛生組織生活品質問卷發展小組。
侯淑英、顏正芳、黃美鳳、王鵬為、葉怡君（2010）。強迫症患者的生活品質和其相關因子。高雄醫誌，26，397-407。
洪子棋（2008）。探討強迫症患者之焦慮、憂鬱症狀與自殺意念之相關。臺北醫學大學護理學研究所碩士論文，未出版，臺北市。
洪儷瑜、陳學志、卓淑玲（2008）。貝克兒童及青少年量表第二版中文版使用手冊。臺北市：中國行為科學社。
姚開屏（2002）。台灣版世界衛生組織生活品質問卷之發展與應用。台灣醫學，6，193-200。
黃政昌（2003）。強迫症門診患者的臨床特徵與聯合治療效果之分析研究。國立臺灣師範大學教育心理與輔導研究所博士論文，未出版，臺北市。
顏正芳（2010）。台灣版多向度兒童青少年焦慮量表指導手冊。臺北市：心理。

二、英文部份

Abramowitz, J. S., Deacon, B. J., Olatunji, B. O., Wheaton, M. G., Berman, N. C., Losardo, D., Timpano, K. R., McGrath, P. B., Riemann, B. C., Adams, T., Björgvinsson, T., Storch, E. A., & Hale, L. R. (2010). Assessment of obsessive-compulsive symptom dimensions: development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychological Assessment, 22(1), 180-198.
Abramowitz, J. S., Whiteside, S. P., & Decaon, B. J. (2005). The effectiveness of treatment for pediatric obsessive-compulsive disorder: a meta-analysis. Behavior Therapy, 36, 55-63.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders. Washington, D. C.: American Psychiatric Association.
Berg, C. Z., Whitaker, A., Davies, M., & Flament, M. F. (1988). The survey form of the Leyton Obsessional Inventory-Child Version: Norms form an epidemiological study. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 759-763.
Carter, A. S. & Pollock, R. A. (2000). Obsessive-compulsive disorder in childhood. Current Opinions in Pediatrics, 12, 325-330.
Chowdhury, U., Frampton, I., & Heyman, I. (2004). Clinical characteristics of young people referred to an obsessive-compulsive disorder clinic in the United Kingdom. Clinical Child Psychology and Psychiatry, 9, 395-401.
Clark, D. A. (2004). Cognitive-behavioral therapy for OCD. New York: Guilford.
Deacon, B. J., & Abramowitz, J. S. (2005). The Yale-Brown Obsessive Compulsive Scale: factor analysis, construct validity, and suggestions for refinement. Journal of Anxiety Disorders, 19, 573-585.
Farrell, L., Barrett, P., & Piacentini, J. (2006). Obsessive-compulsive disorder across the developmental trajectory: clinical correlates in children, adolescents and adults. Behaviour Change, 23, 103-120.
Hanna, G. L. (1995). Demographic and clinical features of obsessive-compulsive disorder in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 19-27.
Heyman, I., Fombonne, E., Simmons, H., Ford, T., Meltzer, H., & Goodman, R. (2001). Prevalence of obsessive-compulsive disorder in the British nationwide survey of child mental health. British Journal of Psychiatry, 179(4), 324-329.
Hollander, E., Kwon, J. H., Stein, D. J., Broatch, J., Rowland, C. T., & Himelein, C. A. (1996). Obsessive-compulsive and spectrum disorders: Overview and quality of life issues. Journal of Clinical Psychiatry, 19, 134-144.
Gallop, C. (2009). Cognitive behavioural assessment of OCD in children and adolescents. In Waite, P. & Williams, T (Eds.), Obsessive compulsive disorder: cognitive behaviour therapy with children and young people (pp. 33-50). New York: Routledge.
Geller, D. A. (2006). Obsessive-compulsive and spectrum disorders in children and adolescents. Psychiatric Clinics of North America, 29, 353-370.
Geffken, G. R., Storch, E. A., Duke, D., Lewin, A., Monaco, L., & Goodman, W. K. (2006). Hope and coping in family members of patients with obsessive compulsive disorder. Journal of Anxiety Disorder, 20, 614-629.
Geller, D. A., Biederman, J., Jones, J., Shapiro, S., Schwartz, S., & Park, K. S. (1998). Obsessive-compulsive disorder in children and adolescents: a review. Harvard Review of Psychiatry, 5(5), 260-273.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleishmann, R. L., Hill, C. L., Heninger, G. R., & Charney, D. S. (1989). The Yale-Brown Obsessive-Compulsive Disorder Scale: I. Development, Use, and Reliability. Archives of General Psychiatry, 46, 1006-1011.
Grabill, K., Merlo, L., Duke, D., Harford, K.-L., Keeley, M. L., Geffken, G. R., & Storch. E. A. (2008). Assessment of obsessive-compulsive disorder: a review. Journal of Anxiety Disorders, 22, 1-17.
Janzen, L. A. (2000). Assessment of obsessive-compulsive disorder in youth using parent and youth rating scales. Unpublished doctoral dissertation, University of Victoria, Victoria, British Columbia, Canada.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.
Lewin, A. B., Bergman, R. L., Peris, T. S., Chang, S., McCracken, J. T. & Piacentini, J. (2010). Correlates of insight among youth with obsessive-compulsive disorder. Journal of Child Psychology and Psychiatry, 51(5), 603-611.
MacKay, D., Piacentini, J., Greisberg, S., Graae, F., Jaffer, M., & Miller, J. (2003). The Children’s Yale-Brown Obsessive-Compulsive Scale: Item structure in an outpatient setting. Psychological Assessment, 15, 578-581.
Merlo, L. J. & Storch, E. A. (2006). Obsessive-compulsive disorder: tools for recognizing its many expressions. Journal of Family Practice, 55, 217-222.
Merlo, L. J., Storch, E. A., Adkins, J, W., Murphy, T. K., & Geffken, G. R. (2007). Assessment of pediatric obsessive-compulsive disorder. In E. A. Storch, G. R. Geffken, & T. K. Murphy (Eds.), Handbook of child and adolescent obsessive-compulsive disorder (pp. 67-107). London, NJ: Lawrence Erbaum Associates.
Merlo, L. J., Storch, E. A., Murphy, T. K., Goodman, W. K., & Geffken, G. (2005). Assessment of pediatric obsessive-compulsive disorder: a critical review of current methodology. Child Psychiatry and Human Development, 36(2), 195-214.
Moore, P. S., Allard, S. U., & Franklin, M. E. (2006). Obsessive-compulsive disorder in children and adolescents. Journal of Clinical Outcomes Management, 13, 405-411.
Murray, C. J. & Lopez A. D. (Eds.). (1996).The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge: Harvard University Press.
Pauls, D. L., Alsobrook, J. P., Goodman, W., Rasmussen, S., & Leckman, J. F. (1995）. A family study of obsessive-compulsive disorder. American Journal of Psychiatry, 152, 76-84.
Piacentini, J., Bergman, R. L., Keller, M., & McCracken, J. (2003). Functional impairment in children and adolescents with obsessive-compulsive disorder. Journal of Children and Adolescent Psychopharmacology , 13,61-69.
Rapoport, J. L., Inoff-Germain, G., Weissman, M. M., Greenwald, S., Narrow, W., Jensen, P., Lahey, B., & Ganino, G. (2000). Childhood obsessive-compulsive disorder in the NIMH MECA study: parents versus child identification of cases. Journal of Anxiety Disorders, 14, 535-548.
Rosário, M. C., Alvarenga, P., Mathis, M. A., & Leckman, J. (2008). Obsessive-compulsive disorder in childhood. In Banaschewski, T. & Rohde, L. A. (Eds.), Biological Child Psychiatry: Recent Trends and Developments (pp. 82-94). Basel: Karger.
Shafran, R. (2001). Obsessive-compulsive disorder in children and adolescents. Child Psychology & Psychiatry Review , 6(2), 50-58.
Shafran, R., Frampton, I., Heyman, I., Reynolds, M., Teachman, B., & Rachman, S. (2003). The preliminary development of a new self-report measure for OCD in young people. Journal of Adolescence, 26, 137-142.
Steinhausen, H.-C., Peloso, M., & Metzke, C. W. (2009). Performance of the adolescent obsessive-compulsive scale in a community survey. Journal of Anxiety Disorders, 23, 218-222.
Stewart, S. E., Geller, D. A., Jenike, M., Pauls, D., Shaw, D., & Mullin, B. (2004). Long-term outcome of pediatric obsessive-compulsive disorder: A meta-analysis and qualitative review of the literature. Acta Psychiatrica Scandinavica, 110, 4-13.
Storch, E. A., Khanna, M., Merlo, L. J., Loew, B. A., Franklin, M., Reid, J. M., Goodman, W. K., & Murphy, T. K. (2009). Children’s Florida Obsessive Compulsive Inventory: psychometric properties and feasibility of a self-report measure of obsessive-compulsive symptoms in youth. Child Psychiatry and Human Development, 40, 467-483.
Storch, E. A., Murphy, T. K., Geffken, G. R., Soto, O., Sajid, M., Bagner, D. M., Allen P., Killany, E. M., & Goodman, W. K. (2005). Factor structure of the Children’s Yale-Brown Obsessive-Compulsive Scale. Journal of Clinical Child and Adolescent Psychology, 34, 312-319.
Thienemann, M., Martin, J., Gregger, B., Thompson, H. B., Dyer-Friedman, J. (2001). Manual-driven group cognitive-behavioral therapy for adolescents with obsessive-compulsive disorder: A pilot study. Journal of American Academic Child and Adolescent Psychiatry, 40, 1254-1260.
Thomsen, P. H. (2000). Obsessions: the impact and treatment of obsessive-compulsive disorder in children and adolescents. Journal of Psychopharmacology, 14(2), 31-37.
Uher, R., Heyman, I., Turner, C. M., & Shafran, R. (2008). Self-, parent-report and interview measures of obsessive-compulsive disorder in children and adolescents. Journal of Anxiety Disorders, 22, 979-990.
Waters, T. L. & Barrett, P. M. (2000). The role of the family in childhood obsessive-compulsive disorder in childhood and adolescents. Child and Adolescent Psychiatric Clinics of North America, 8, 445-460.