目的：過去研究顯示，早期發展正常之極低出生體重早產兒，於六歲學齡前進行神經心理功能衡鑑，其工作記憶、計畫能力、認知彈性等核心執行功能仍顯著低於足月出生之同齡兒童。已有足夠證據支持，執行功能可經由訓練提昇，早期的訓練可減少未來學業、成就上的落差，但目前對於早產兒學齡前執行功能介入研究甚少，且兒童執行功能短期介入多為電腦化工作記憶訓練，部分研究結果顯示對於不同功能的移轉效果有限。因此，本研究欲發展一套適用於學齡前兒童之「組合式訓練模組」，訓練多項執行功能。

方法：本研究樣本來自於「財團法人中華民國早產兒基金會」所推廣的“全國極低體重早產兒兩歲追蹤檢查計畫”中，2013年4月至2014年4月年齡6歲台南區早期發展正常之早產兒童（排除5歲前智能不足、聽覺障礙、視覺障礙與腦性麻痺之早產兒）。以廣泛性非語文注意力測驗、倫敦塔、威斯康辛卡片分類測驗、Knox方塊仿效測驗與魏氏兒童智力測驗中文版第四版之記憶廣度分測驗作為執行功能衡鑑工具，分別測量其抑制能力、計畫能力、認知彈性以及非語文、語文工作記憶。執行功能衡鑑結果，任兩項以上表現低於足月出生組兒童Q1（25%）分數者納入收案，進行為期八週、每週兩次、每次1.5小時的組合式訓練模組。此模組結合電腦廣泛性記憶力訓練系統（Comprehensive Memory Training System, CMTS）與自編生態化訓練，以二至三人小團體方式進行，完成訓練並參與後測者共12人；對照組足月出生、發展正常之六歲兒童，來自台南市國小共六十名，依照其年齡（月數）分為前測常模組、後測常模組各三十人。

結果：早產組兒童介入前，其非語文工作記憶（1項/1項）、計畫能力（2項/6項）、認知彈性（8項/8項）、抑制能力（4項/12項）皆有指標差於同齡對照組兒童，且智力表現雖在正常範圍，統計上仍顯著低於對照組。經由為期八週訓練後，比較早產組兒童前、後測表現，非語文工作記憶（1項/1項）、計畫能力（3項/6項）、認知彈性（5項/8項）、抑制能力（1項/12項）表現皆有指標進步；對照同齡正常兒童，在非語文工作記憶、計畫能力、認知彈性表現未有任一指標差於同齡常模；而抑制能力僅餘一項（1項/12項）指標差於常模對照組。顯示早產組兒童在四項執行功能，包含工作記憶、計畫能力、認知彈性以及抑制能力皆有顯著進步。

討論：本研究結果顯示此融合電腦「廣泛性記憶力訓練系統」與「自編生態化訓練方案」之組合訓練模組可以有效提昇早產兒童多項核心執行功能，減少與正常同齡兒童執行功能的落差。未來宜持續追蹤其移轉效果與長遠療效性。此訓練模組亦可廣泛適用其他學齡前執行功能不足之兒童。

Background and Objective: Study showed that Six-year-old children born very low birth weight (VLBW) still have executive function（EF）deficits even with normal early development. Studies supported that EFs can be improved by regular training. Computerized training is the most useful and popular program to improve children’s EFs, but the transfer effect has been narrow. Therefore, we innovated a combinative training model for six-year-old presoolers with EFs deficits.

Methods: 12 VLBW preeschoolers with more than two EFs deficits join the training for one and a half hours a day, 2 days a week, over 8 weeks. This combinative training model consists of computerized and noncomputerized training. The normal group included 60 six-year-old children who were born healthy and developed normally.

Results: The training showed siginificant improvent in nonverbal working memory, cognitive flexibility, planning and inhibition. After training, there was no siginificant difference between training and normal groups except one index of inhibition.

Conclusion: This study showed that the new combinative training model can improve VLBW preeschoolers’ core EFs. Future studies should follow-up on its generalization and long-term effect.

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