研究背景與目的：價值導向記憶 (value-directed remembering, VDR)乃針對即時環境控制並保留未來將使用的訊息，是人類記憶有效使用的關鍵。注意力不足過動症混合表現型 (attention deficit hyperactivity disorder, combined type; ADHD-C)除不專注、過動、衝動等症狀造成生活功能、領域及活動之重大且顯著的缺損外，學者們也提出許多「多重路徑模型」理論解釋該疾病的神經機制，包含酬賞、動機關聯反應等缺損。本研究採用VDR派典探討ADHD-C兒童與典型發展兒童，對於不同價值資訊的記憶效能，並以功能性磁振造影儀器 (fMRI)探討參與者執行VDR作業時，其選擇性記憶之神經基礎。
方法：招募共40名台灣本地出生、成長，並就讀台灣地區國民小學之中、高年級兒童（9-12歲），其中20名典型發展兒童為一般組，另20名兒童經由精神科醫師診斷為ADHD-C型並納入臨床組。參與者閱讀5份不同字詞與分數價值任意配對的表單，探討其回憶高價值的字詞的情形是否有所差異；fMRI部分則運用全腦分析及ROI分析進一步探究其腦部活化情形。
結果：一般組參與者無論在哪種情境下皆未觀察到酬賞相關腦區的活化；然在更寬鬆的閾值之下 (uncorrected p < .01)，可看到些許尾狀核 (caudate neucleus)的活化，反映一般組價值導向記憶神經機制之潛在趨勢。臨床組在價值線索階段的ROI分析中，其酬賞相關腦區有多處達顯著；另在左側額下迴島蓋部 (IFG p. Opercularis)顯著活化，然該結果可能反映臨床組對高價值刺激有一定程度的敏感性，然其記憶策略運用不佳。本研究在兩組皆發現到許多語意歷程相關腦區的活化；此外，當實驗環境轉換時，臨床組需經過較多練習回合才可得到顯著的價值效果。
結論：行為結果顯示兩組參與者之價值效果較過去研究薄弱，但仍可觀察到參與者回憶高價值字詞明顯較低價值字詞多，反映本研究在某種程度上仍可測量到參與者的價值導向記憶能力。然價值效果薄弱可能影響到後續腦部影像分析在中腦酬賞結構區域 (VTA & NAcc)的顯著性。另，ADHD-C兒童難以「針對即時環境進行控制，持續調整自身認知和情緒，以便管理對不同情境或活動的認知資源」，顯示ADHD-C兒童在處理壓力情形時較難彈性運用適切的認知及行為策略。本系列研究將在下個階段，對ADHD兒童價值導向記憶能力缺損方面進行介入研究；將針對ADHD兒童在結構環境與自然環境中評估訊息歷程的缺損，設計關於認知控制與情緒控制的治療方案，提升其價值導向記憶能力，並探討介入前後的效果。

Objective: This study examined how children with and without attention-deficit hyperactivity disorder-combined type (ADHD-C) performed on a selectivity task, and the neural mechanism of selectivity memory. Method: The revision of value-directed remembering (VDR) task included two-word Traditional Chinese phrases, each phrase was paired to a value point. After presented 24 point-word pairs, participants were asked to recall the items and to maximize their score (which is the total score of the items they recalled). Participants were 9-12 years old children with ADHD-C (n = 20) and without ADHD (n =20). The task was conducted with an fMRI scanner. Results: The findings suggested that the value effect was weaker than the past studies, but we still observed that the high-value words were recalled more than lower-value words, which indicates that this study could still measure the VDR ability to some extent. In the ROI analysis of children with ADHD-C, the results indicated that they were sensitive to high-value stimulus, but their memory strategy was not well used. In addition, the activation of brain regions related to many semantic processes was found in both groups, and the findings in children without ADHD-C were more obvious. Conclusions: It is more difficult for children with ADHD-C to use cognitive and behavioral strategies efficiently when they deal with stress situations. We will next conduct a VDR ability intervention study in response to the defect of children with ADHD in the structural environment and natural environment.

壹、中文文獻
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莊若蘭（民104）。記憶策略對於ADHD兒童在價值導向記憶上之影響（未出版之碩士論文）。成功大學行為醫學研究所學位論文，1-76。
黃惠玲（民97）。注意力缺陷過動疾患研究回顧。應用心理研究，40，197-219。
詹雅雯、陳信昭、郭乃文（民95）。注意力缺失／過動疾患不專注型與合併型之多面向注意力功能分析。臨床心理學刊，3，85-92。
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魯逸（民107）。兒童價值導向記憶缺損相關的活化腦區：fMRI初探研究（未出版之碩士論文）。成功大學行為醫學研究所學位論文，1-110。

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