隨著醫療的進步，極低出生體重早產兒的存活率顯著提升，但長期追蹤研究顯示即使沒有伴隨重大疾病或明顯感覺神經損傷的極低出生體重早產兒童(Very Low Birth Weight, VLBW)在認知、動作、行為表現和社交功能等，都較同齡足月兒童表現差。學校是學齡孩童執行職能活動中的重要場所，學校活動涵蓋學業成就與非學業活動，學校功能表現則包含學生在學校之非學業活動的參與度和能力表現。根據國際健康功能與身心障礙分類系統（International Classification of Functioning, Disability and Health, ICF）的架構來看，目前VLBW兒童學齡期的相關研究較著重於身體功能和活動的向度，部分探討他們學校表現的研究也以學業成就或人際社交等非學業活動，並無研究探討他們在學校的整體表現或參與度。因此本研究的目的為探討發展正常的VLBW兒童學齡時期的學校功能表現，並探討可能的影響因子。本研究樣本由「財團法人台灣早產兒基金會」南區的VLBW長期追蹤計畫中招募40位學齡兒童（平均月齡= 108.9，SD = 18.4），對照組以性別和年齡配對，為40名足月產且發展正常之學童（平均月齡= 110.4，SD = 19.7）。以『學校日常功能評量表』評估個案的學校功能表現，研究結果顯示VLBW兒童在學校的整體參與度，以及教室和操場遊戲的參與度均顯著比對照組兒童差，且不論在肢體或認知行為活動上都需要老師較多的輔助，大部分的活動表現也較對照組兒童差。以ICF的架構來看，VLBW兒童學校參與度的相關因子，主要為親職壓力與父母社經地位等環境因子，而非過去研究所著重的身體功能。因此未來臨床上VLBW兒童的療育目標，可強化其學校功能和參與度，並且應協助家長減輕其親職壓力，增進VLBW學齡兒童的學校功能表現。

Improvement in medical and neonatal care had resulted in increased survival rate for children born with very low birth weight (VLBW). Studies revealed that the VLBW children without major disability have more behavioral, cognitive, motor or social problems than full-term born children. Children engage in many academic and non-academic activities in school environment. School functional performance is defined as student`s participation and performance of non-academic school tasks. There was no study investigating the school functional performance of children born with very low birth weight. The aim of this study was to investigate the school functional performance and possible related factors of VLBW children at school age. We recruited 40 VLBW children (mean age 108.9 months, SD = 18.4) and 40 age- and sex-matched full term controls (mean age 110.4 months, SD = 19.7). All participants have normal development and intelligence. The School Function Assessment-Chinese version was used to assess school functional performances include participation, task supports and activity performances. Significant differences were found in overall participation, especially in classroom and playground. VLBW children significantly needed more task supports from their teachers, and their activity performances were significantly poorer than the controls. The major factors of school participation were parent stress level and socioeconomic status, classified as environment factors according to International Classification of Functioning, Disability and Health-Children and youth version. The findings of this study provide evidences that VLBW children had poorer long-term outcomes than their peers and affected their school participation. School intervention should focus on their participation, and also provide supports for parents of children with VLBW.

Abidin, R. A. (1995). Parenting stress index, third edition: Professional maual. Odessa, FL: Pyschological Assessment Resourse.
Anderson, P. J., & Doyle, L. W. (2008). Cognitive and educational deficits in children born extremely preterm. Seminars in Perinatology, 32, 51-58. doi: 10.1053/j.semperi.2007.12.009
Barre, N., Morgan, A., Doyle, L. W., & Anderson, P. J. (2011). Language abilities in children who were very preterm and/or very low birth weight: A meta-analysis. Pediatrics, 158, 766-774.e761. doi: 10.1016/j.jpeds.2010.10.032
Bayless, S., Pit-ten Cate, I. M., & Stevenson, J. (2008). Behaviour difficulties and cognitive function in children born very prematurely. International Journal of Behavioral Development, 32, 199-206. doi: 10.1177/0165025408089269
Bayless, S., & Stevenson, J. (2007). Executive functions in school-age children born very prematurely. Early Human Development, 83, 247-254. doi: 10.1016/j.earlhumdev.2006.05.021
Begega, A., Mendez Lopez, M., de Iscar, M. J., Cuesta-Izquierdo, M., Solis, G., Fernandez-Colomer, B., . . . Arias, J. L. (2010). Assessment of the global intelligence and selective cognitive capacities in preterm 8-year-old children. Psicothema, 22, 648-653. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2104449
Briscoe, J., Gathercole, S. E., & Marlow, N. (2001). Everyday memory and cognitive ability in children born very prematurely. Journal of Child Psychology and Psychiatry, 42, 749-754. doi: 10.1111/1469-7610.00771
Case-Smith, J., & Rogers, J. (2004). School-based occupational therapy. In J. Case-Smith (Ed.), Occupational therapy for children (5 ed., pp. 795-824). Maryland Heights, MO: Mosby Elsevier.
Coster, W., Deeney, T., Haltiwanger, J., & Haley, S. (1998). School function assessment: User`s manual. San Amtonio,TX: Psychological Corporation.
Davis, D. W., Burns, B. M., Wilkerson, S. A., & Steichen, J. J. (2005). Visual perceptual skills in children born with very low birth weights. Journal of Pediatric Health Care, 19, 363-368. doi: 10.1016/j.pedhc.2005.06.005
de Kieviet, J. F., Piek, J. P., Aarnoudse-Moens, C. S., & Oosterlaan, J. (2009). Motor development in very preterm and very low-birth-weight children from birth to adolescence. Journal of the American Medical Association, 302, 2235. doi: 10.1001/jama.2009.1708
Dieterich, S. E., Hebert, H. M., Landry, S. H., Swank, P. R., & Smith, K. E. (2004). Maternal and child characteristics that influence the growth of daily living skills from infancy to school age in preterm and term children. Early Education and Development, 15, 283-304. doi: 10.1207/s15566935eed1503_3
Doyle, L. W., & Saigal, S. (2009). Long-term outcomes of very preterm or tiny infants. NeoReviews, 10, e130-e137. doi: 10.1542/neo.10-3-e130
Edwards, J., Berube, M., Erlandson, K., Haug, S., Johnstone, H., Meagher, M., . . . Zwicker, J. G. (2011). Developmental coordination disorder in school-aged children born very preterm and/or at very low birth weight: A systematic review. Journal of Developmental & Behavioral Pediatrics, 32, 678. doi: 10.1097/DBP.0b013e31822a396a
Egilson, S. T., & Coster, W. J. (2004). School function assessment: performance of Icelandic students with special needs. Scandinavian Journal of Occupational Therapy, 11, 163-170. doi: 10.1080/11038120410020737
Elgen, I., Sommerfelt, K., & Markestad, T. (2002). Population based, controlled study of behavioural problems and psychiatric disorders in low birthweight children at 11 years of age. Archives of Disease in Childhood-Fetal and Neonatal Edition, 87, F128-F132. doi: 10.1136/fn.87.2.F128
Farooqi, A., Hagglof, B., Sedin, G., Gothefors, L., & Serenius, F. (2007). Mental health and social competencies of 10- to 12-year-old children born at 23 to 25 weeks of gestation in the 1990s: A Swedish national prospective follow-up study. Pediatrics, 120, 118-133. doi: 10.1542/peds.2006-2988
Feder, K. P., Majnemer, A., Bourbonnais, D., Platt, R., Blayney, M., & Synnes, A. (2005). Handwriting performance in preterm children compared with term peers at age 6 to 7 years. Developmental Medicine and Child Neurology, 47, 163-170. doi: 10.1017/S0012162205000307
Goyen, T. A., & Lui, K. (2009). Developmental coordination disorder in “apparently normal” schoolchildren born extremely preterm. Archives of Disease in Childhood, 94, 298-302. doi: 10.1136/adc.2007.134692
Hack, M., Taylor, H. G., Drotar, D., Schluchter, M., Cartar, L., Andreias, L., . . . Klein, N. (2005). Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s. Journal of the American Medical Association, 294, 318. doi: 10.1001/jama.294.3.318
Hack, M., Taylor, H. G., Schluchter, M., Andreias, L., Drotar, D., & Klein, N. (2009). Behavioral outcomes of extremely low birth weight children at age 8 years. Journal of Developmental and Behavioral Pediatrics, 30, 122-130. doi: 10.1097/DBP.0b013e31819e6a16
Hansen, B. M., Dinesen, J., Hoff, B., & Greisen, G. (2002). Intelligence in preterm children at four years of age as a predictor of school function: A longitudinal controlled study. Developmental Medicine and Child Neurology, 44, 517-521. doi: 10.1017/S0012162201002481
Henderson, S. E., Sugden, D. A., Barnett, A. L., & Smits-Engelsman, C. (2010). Movement assessment battery for children second edition examiner`s manual. London: Harcourt Assessment.
Hoff, B., Hansen, B. M., Munck, H., & Mortensen, E. L. (2004). Behavioral and social development of children born extremely premature: 5-year follow-up. Scandinavian Journal of Psychology, 45, 285-292. doi: 10.1111/j.1467-9450.2004.00407.x
Hollingshead, A. B. (1975). Four factor index of social status. New Haven, CT: Yale University.
Howe, T. H., Sheu, C. F., Wang, T. N., Hsu, Y. W., & Wang, L. W. (2011). Neuromotor outcomes in children with very low birth weight at 5 years of age. American Journal of Physical Medicine & Rehabilitation, 90, 667-680. doi: 10.1097/PHM.0b013e31821a703f
Hunter, J. G. (2004). Neonatal intensive care unit. In J. Case-Smith (Ed.), Occupational therapy for children (pp. 688-754). Maryland Heights, MO: Mosby Elsevier
Hutchinson, E. A., De Luca, C. R., Doyle, L. W., Roberts, G., Anderson, P. J., & for the Victorian Infant Collaborative Study Group. (2013). School-age outcomes of extremely preterm or extremely low birth weight children. Pediatrics, 131, e1053-e1061. doi: 10.1542/peds.2012-2311
Hwang, J. L. (2005). The reliability and validity of the school function assessment-chinese version. OTJR: Occupation, Participation & Health, 25, 44-54. doi: 10.1002/oti.195
Isaacs, E. B., Lucas, A., Chong, W. K., Wood, S. J., Johnson, C. L., Marshall, C., . . . Gadian, D. G. (2000). Hippocampal volume and everyday memory in children of very low birth weight. Pediatric Research, 47, 713-720. doi: 10.1203/00006450-200006000-00006
Jansson-Verkasalo, E., Valkama, M., Vainionpaa, L., Paakko, E., Ilkko, E., & Lehtihalmes, M. (2004). Language development in very low birth weight preterm children: A follow-up study. Folia Phoniatrica et Logopedica, 56, 108-119. doi: 10.1159/000076062
Johnson, S., Hollis, C., Kochhar, P., Hennessy, E., Wolke, D., & Marlow, N. (2010). Autism spectrum disorders in extremely preterm children. Pediatrics, 156, 525-531.e522. doi: 10.1016/j.jpeds.2009.10.041
Johnson, S., Wolke, D., Hennessy, E., & Marlow, N. (2011). Educational outcomes in extremely preterm children: neuropsychological correlates and predictors of attainment. Developmental Neuropsychology, 36, 74-95. doi: 10.1080/87565641.2011.540541
Kusuda, S., Fujimura, M., Sakuma, I., Aotani, H., Kabe, K., Itani, Y., . . . Nishida, H. (2006). Morbidity and mortality of infants with very low birth weight in Japan: Center variation. Pediatrics, 118, e1130-1138. doi: 10.1542/peds.2005-2724
Law, M., King, G., King, S., Kertoy, M., Hurley, P., Rosenbaum, P., . . . Hanna, S. (2006). Patterns of participation in recreational and leisure activities among children with complex physical disabilities. Developmental Medicine & Child Neurology, 48, 337-342. doi: 10.1017/S0012162206000740
Lee, E. S., Yeatman, J. D., Luna, B., & Feldman, H. M. (2011). Specific language and reading skills in school-aged children and adolescents are associated with prematurity after controlling for IQ. Neuropsychologia, 49, 906-913. doi: 10.1016/j.neuropsychologia.2010.12.038
Lemons, J. A., Bauer, C. R., Oh, W., Korones, S. B., Papile, L. A., Stoll, B. J., . . . for the NICHD Neonatal Research Network. (2001). Very low birth weight outcomes of the national institute of child health and human development neonatal research network, January 1995 through December 1996. Pediatrics, 107, e1. doi: 10.1542/peds.107.1.e1
Leung, G. P. K., Chan, C. C. H., Chung, R. C. K., & Pang, M. Y. C. (2011). Determinants of activity and participation in preschoolers with developmental delay. Research in Developmental Disabilities, 32, 289-296. doi: 10.1016/j.ridd.2010.10.005
Marlow, N., Hennessy, E. M., Bracewell, M. A., & Wolke, D. (2007). Motor and executive function at 6 years of age after extremely preterm birth. Pediatrics, 120, 793-804. doi: 10.1542/peds.2007-0440
McCormick M. C., B.-G. J. W.-D. K. T. J. P. G. J. (1992). The health and developmental status of very low-birth-weight children at school age. Journal of the American Medical Association, 267, 2204-2208. doi: 10.1001/jama.1992.03480160062035
Miller, M., Bowen, J. R., Gibson, F. L., Hand, P. J., & Ungerer, J. A. (2001). Behaviour problems in extremely low birthweight children at 5 and 8 years of age. Child Care Health and Development, 27, 569-581. doi: 10.1046/j.1365-2214.2001.00223.x
Mu, S. C., Tsou, K. S., Hsu, C. H., Fang, L. J., Jeng, S. F., Chang, C. H., & Tsou, K. I. (2008). Cognitive development at age 8 years in very low birth weight children in Taiwan. Journal of the Formosan Medical Association, 107, 915-920. doi: 10.1016/S0929-6646(09)60014-0
Nadeau, L., Tessier, R., & Descoteaux, A. (2009). Observed behaviours of pre-term children in a social play situation with classroom peers. Developmental Neurorehabilitation, 12, 201-206. doi: 10.1080/17518420903029485
Nezhad, M. A. H., Rahmati, M. M., & Nezhad, M. M. (2012). Relationship between social-economic status of family and adolescents student sport participation. Annals of Biological Research, 3, 4012-4016. Retrieved from http://scholarsresearchlibrary.com/ABR-vol3-iss8/ABR-2012-3-8-4012-4016.pdf
Ni, T. L., Huang, C. C., & Guo, N. W. (2011). Executive function deficit in preschool children born very low birth weight with normal early development. Early Human Development, 87, 137-141. doi: 10.1016/j.earlhumdev.2010.11.013
Oliveira, G. E., Magalhaes, L. C., & Salmela, L. F. T. (2011). Relationship between very low birth weight, environmental factors, and motor and cognitive development of children of 5 and 6 years old. Revista Brasileira de Fisioterapia, 15, 138-145. doi: 10.1590/S1413-35552011000200009
Reijneveld, S. A., de Kleine, M. J. K., van Baar, A. L., Kollee, L. A. A., Verhaak, C. M., Verhulst, F. C., & Verloove-Vanhorick, S. P. (2006). Behavioural and emotional problems in very preterm and very low birthweight infants at age 5 years. Archives of Disease in Childhood-Fetal and Neonatal Edition, 91, F423-F428. doi: 10.1136/adc.2006.093674
Roley, S. S., Janet, V. D., Cynthia, J. B., Susan, B., DeLana, H., & Deanna Iris, S. (2008). Occupational therapy practice framework: Domain & practice, 2nd edition. American Journal of Occupational Therapy, 62, 625-683. doi: 10.5014/ajot.62.6.625
Rosenbaum, P., Saiga, S., Szatmari, P., & Hoult, L. (1995). Vineland adaptive behaviour Scales as a summaryof functional outcome of extremely low birthweight children. [Abstract]. Developmental Medicine & Child Neurology Abstract, 37, 577.
Saigal, S., & Doyle, L. W. (2008). An overview of mortality and sequelae of preterm birth from infancy to adulthood. The Lancet, 371, 261-269. doi: 10.1016/s0140-6736(08)60136-1
Saigal, S., Szatmari, P., Rosenbaum, P., Campbell, D., & King, S. (1991). Cognitive abilities and school performance of extremely low birth weight children and matched term control children at age 8 years: A regional study. Pediatrics, 118, 751-760. doi: 10.1016/S0022-3476(05)80043-5
Schappin, R., Wijnroks, L., Venema, M. M. U., & Jongmans, M. J. (2013). Rethinking stress in parents of preterm infants: A meta-analysis. PLOS One, 8, e54992. doi: 10.1371/journal.pone.0054992
Schenker, R., Coster, W., & Parush, S. (2005). Participation and activity performance of students with cerebral palsy within the school environment. Disability & Rehabilitation, 27, 539-552. doi: 10.1080/09638280400018437
Simeonsson, R. J., Carlson, D., Huntington, G. S., McMillen, J. S., & Brent, J. L. (2001). Students with disabilities: A national survey of participation in school activities. Disability and Rehabilitation, 23, 49-63. doi: doi:10.1080/096382801750058134
Singer, L. T., Fulton, S., Kirchner, H. L., Eisengart, S., Lewis, B., Short, E., . . . Baley, J. E. (2007). Parenting very low birth weight children at school age: Maternal stress and coping. Pediatrics, 151, 463-469. doi: 10.1016/j.jpeds.2007.04.012
Sullivan, M. C., Miller, R. J., & Msall, M. E. (2012). 17-year outcome of preterm infants with diverse neonatal morbidities: Part 2, impact on activities and participation. Journal for Specialists in Pediatric Nursing, 17, 275-287. doi: 10.1111/j.1744-6155.2012.00339.x
Taylor, H. G., Espy, K. A., & Anderson, P. J. (2009). Mathematics deficiencies in children with very low birth weight or very preterm birth. Developmental Disabilities Research Reviews, 15, 52-59. doi: 10.1002/ddrr.51
Taylor, H. G., Klein, N., Minich, N. M., & Hack, M. (2000). Middle‐school‐age outcomes in children with very low birthweight. Child Development, 71, 1495-1511. doi: 10.1111/1467-8624.00242
Thuy, M. L., Ment, L., Allan, W., Schneider, K., & Vohr, B. R. (2011). Executive and memory function in adolescents born very preterm. Pediatrics, 127, E639-E646. doi: 10.1542/peds.2010-1421
van Baar, A. L., Vermaas, J., Knots, E., de Kleine, M. J. K., & Soons, P. (2009). Functioning at school age of moderately preterm children born at 32 to 36 weeks' gestational age. Pediatrics, 124, 251. doi: 10.1542/peds.2008-2315
Wagner, M. O., Kastner, J., Petermann, F., & Bös, K. (2011). Factorial validity of the movement assessment battery for children-2 (age band 2). Research in Developmental Disabilities, 32, 674-680. doi: 10.1016/j.ridd.2010.11.016
Wang, T. N., Tseng, M. H., Wilson, B. N., & Hu, F. C. (2009). Functional performance of children with developmental coordination disorder at home and at school. Developmental Medicine and Child Neurology, 51, 817-825. doi: 10.1111/j.1469-8749.2009.03271.x
Wolke, D., Samara, M., Bracewell, M., Marlow, N., & Group, E. P. S. (2008). Specific language difficulties and school achievement in children born at 25 weeks of gestation or less. Pediatrics, 152, 256-262. doi: 10.1016/j.jpeds.2007.06.043
World Health Organization. (2007). International classification of functioning, disability and health -children and youth version. Geneva: Author.
Wuang, Y.-P., Su, C.-Y., & Su, J.-H. (2011). Wisconsin card dorting test performance in children with developmental coordination disorder. Research in Developmental Disabilities, 32, 1669-1676. doi: 10.1016/j.ridd.2011.02.021
Zingerevich, C., & LaVesser, P. D. (2009). The contribution of executive functions to participation in school activities of children with high functioning autism spectrum disorder. Research in Autism Spectrum Disorders, 3, 429-437. doi: 10.1016/j.rasd.2008.09.002
吳武典, 胡心慈, 蔡崇建, 王振德, 林幸台, & 郭靜姿. (2006). 托尼非語文智力測驗-再版(TONI-3). 台北: 心理.
林生傳. (2005). 教育社會學. 台北: 巨流.
翁毓芬. (2011). 親職壓力量表簡式版指導手冊. 台北: 心理.
陸莉, & 劉鴻香. (1988). 修訂畢保德圖畫詞彙測驗(PPVT-R). 台北: 心理.
黃政良. (2008). 學校日常生活功能評量使用手冊. 台北: 中國行為科學社.
劉昱志, 劉士愷, 商志雍, 林健禾, 杜長齡, & 高淑芬. (2006). 注意力缺陷過動症中文版Swanson, Nolan, and Pelham, Version IV (SNAP-IV)量表之常模及信效度. 臺灣精神醫學, 20, 290-304.
謝孟穎. (2003). 家長社經背景與學生學業成就關聯性之研究. 教育研究集刊, 49, 255-287.