目的：「適應行為」為早產兒發展過程中重要的功能行為，生理因素方面，早產兒的出生體重越低會影響其適應行為越不佳；社會因素方面，社經地位在不同先天疾病族群兒童當中皆被證實為影響適應行為的重要因素；神經心理因素方面，早產兒的認知執行功能與適應行為有重要關聯，且執行功能會中介懷孕週數對適應行為的影響(Loe et al., 2015; Loe et al., 2014; Taylor et al., 2006)。然目前僅少數研究探討認知執行功能與適應行為的關聯，且未有研究同時考量生理、社會以及神經心理因素對其適應行為的影響。本研究欲探討不同懷孕週數的早期發展正常早產兒，同時分析出生體重、社經地位以及認知執行功能何者為對適應功能影響最大的重要因素。
研究方法：受試者皆為學齡前六歲之兒童。早產組來自財團法人中華民 國早產兒基金會」所轉介之台南區2006年至2015年出生且符合早期發展正常收案標準之極低出生體重早產兒，並將早產組依據懷孕週數分為超早產組90名、極早產組120名；足月組則來自台南市幼兒園和國小當中自願參與且符合收案標準之足月出生兒童，共90名。以文蘭適應行為量表中文編譯版作為評估適應行為之工具，以二因素社會地位指數進行社經地位評估，以魏氏兒童智力測驗第四版(WISC-IV)之記憶廣度分測驗、Knox方塊仿效測驗(KCT)、倫敦塔(ToL)、威斯康辛卡片分類測驗(WCST)、廣泛性非語文注意力測驗(CNAT)作為評估認知執行功能之工具。
結果：(1)比較超早產組、極早產組與足月組兒童的適應行為差異，結果顯示超早產組與足月組在社會化領域有明顯差異，且適應行為隨懷孕週數增加而逐漸提升。
(2)溝通領域在三組皆受工作記憶影響最大，計畫能力和認知彈性對早產組的溝通領域影響較大。社會化領域受認知彈性影響最大，出生體重則對超早產組與足月組的社會化領域影響最大。動作技巧領域主要受認知彈性影響，極早產組則受出生體重影響。整體而言，早產組的適應行為較受認知執行功能和出生體重影響，足月組則主要受社經地位影響。
結論：本研究結果顯示，綜合考量出生體重、社經地位和認知執行功能後，早產兒的適應行為主要受神經心理功能影響，尤其是計畫能力與認知彈性對其影響最大。足月兒童的適應行為則主要受社經地位影響。這顯示早產兒與足月兒童在適應行為的影響因素上存在差異，並反映出早產兒的執行功能發展對其適應行為發展具有重要影響，神經心理功能對早產兒的適應行為發展有重要影響，強調早期介入執行功能訓練的重要性。

Previous studies have shown that birthweight, socioeconomic status, and cognitive executive functions(CEFs) are each important factors are associated with adaptive behavior in children. However, there are limited studies simultaneously examined the effect of physiological, social, and neuropsychological factors on adaptive behavior. This study aims to investigates the adaptive behavior of preterm children with normal early development across different gestational ages, focusing on the impact of birthweight, socioeconomic status, and CEFs. Participants included 90 extremely-preterm children, 120 very-preterm children, and 90 full-term children, all measures were assessed at six years old. Adaptive behaviors were assessed with the Vineland Adaptive Behavior Scales(II)-Chinese Revision Edition. Four CEFs were measured through various tests: working memory, planning ability, cognitive flexibility, and inhibition ability. The results showed that, working memory had the greatest impact in the communication domain across all groups, while planning ability and cognitive flexibility significantly affected the preterm groups. In the socialization domain, cognitive flexibility was the most influential factor, with birthweight significantly impacting the extremely-preterm and full-term groups. The motor skills domain was primarily influenced by cognitive flexibility, with birthweight being a significant factor for the very preterm group. Overall, the adaptive behavior of preterm children was more influenced by CEFs and birthweight, whereas the full-term group was mainly influenced by socioeconomic status. These findings indicate that neuropsychological factors, particularly planning ability and cognitive flexibility, have the greatest effect on preterm children’s adaptive behavior, while socioeconomic status is the primary influence for full-term children.

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