背景：
注意力不足過動症是一種兒童神經發展的疾患，研究目的為了解非藥物治療上復健治療的使用情形。
方法：
依據全民健康保險研究資料庫2008年到2012年的復健資料中，篩選出年齡3-12歲孩童做研究對象，再將孩童以ICD-9-CM的診斷分成注意力不足過動症及非注意力不足過動症兩大族群，探討兩者之間在復健資源使用上的差異，並找出相關因子。
結果：
使用卡方檢定、獨立樣本t檢定和多元迴歸分析，發現在接受復健資源的兒童當中，注意力不足過動症平均占18.5%，人數逐年上升，就診次數也是逐年上升，比非過動症來的高。男女比大約3:1(p<0.001)。學齡兒童比例比學齡前來的高(p<0.001)。復健資源的使用最多在基層診所，占60%(p<0.001)。非教學醫院占70%以上(p<0.001)。地區方面則是台北市的就診最高、東區最低(p<0.001)。不論是每年的平均費用、平均次數、年度總費用過動症都比非過動症來的高(p<0.001)。在預測過動症的資源使用上，平均費用、平均次數、年度總費用受到過動症與否、年度、人口學特質、醫院特性和地區等各項因素影響(p<0.001)。
結論：
過動症孩童日益增多，復健資源上的使用日益增加，健保點值仍偏低，且資源分配嚴重不均，值得訂定相關政策協助孩童，減輕家庭負擔和減少社會成本，值得關切。

Background:
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder in children. The research goal is to understand the situation on the use of non-drug treatment rehabilitation treatment.
Method:
According to the National Health Insurance Research Database rehabilitation materials from 2008 to 2012, selected children aged 3-12 years would be included in the research objective, The children who are diagnosed by ICD-9-CM will be divided into two groups; attention deficit hyperactivity disorder and non-attention deficit hyperactivity disorder; to discuss the differences in the use of resources on rehabilitation, and find relevant facts.
Result:
Using chi-squared test, independent sample t test and multiple regression analysis, we found that children receiving rehabilitation resources diagnosed as attention deficit hyperactivity disorder are on average of 18.5%. The number of patients and the frequency are increasing year by year. The ADHD group compared to non-ADHD one is more, while the male to female ratio is 3: 1 (p <0.001). The proportion of school-age children with ADHD was identified as being higher than in preschool (p <0.001). The most use of rehabilitation resources is at clinics, accounting for 60% (p <0.001). Non-teaching hospitals accounted for more than 70% (p <0.001). Regional aspects of treatment are highest in Taipei, in contrast to Eastern which is the lowest (p <0.001). No matter whether it is the average cost per year, the average number of times or annual total cost, ADHD group is more than non-ADHD one (p <0.001). The prediction of rehabilitation resources usage on ADHD, the average cost, average frequency, the total annual cost are affected by factors such as whether ADHD has been diagnosed or not, timing of rehabilitation use, demographic characteristics, and speciality of hospitals and regions (p <0.001).

Conclusion:
The number of children with ADHD and the use of resources on rehabilitation is increasing, but health care point value is still low, and severe uneven distribution of resources is concerned. It will be worthwhile setting policies to assist children to reduce the family burden and the social costs in the future.

論文審定書 i
誌謝 ii
摘要 iii
ABSTRACT iv
目錄 vi
圖次 viii
表次 viii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第二章 文獻探討 3
第一節 注意力不足過動症 3
第二節 流行病學及發生率 5
第三節 疾病成因 5
第四節 治療方法 6
第五節 資源使用情形 7
第三章 研究方法 11
第一節 研究架構 11
第二節 資料來源與研究樣本 11
第三節 研究變項 13
第四節 研究流程 14
第五節 資料處理及分析方法 16
第四章 研究分析與結果 17
第一節 描述性統計分析 17
第二節 推論性統計分析 26
第五章 綜合討論 42
第一節 討論 42
第二節 限制 46
第三節 結論 47
一、中文文獻 49
二、英文文獻 49

中文文獻
陳怡心 (2012)。注意力缺陷過動症兒童之門診復健醫療耗用及其相關因素分析。 國防醫學院公共衛生學研究所碩士論文
王憲政(2009)。台灣注意力不足過動症門診量變化與藥物治療使用之分析。長庚大學醫務管理研究所碩士論文。
蔡忠志、楊斯年、諶立中、張文瓊、錢慶文(2009)。ADHD兒童與非ADHD兒童之醫療利用及費用之差異。臺灣精神醫學,23(4),296 -306。
英文文獻
Angold, P. G., Sadler, J. P., Hill, M. O., Pullin, A., Rushton, S., Austin, K., . . . Thompson, K. (2006). Biodiversity in urban habitat patches. The Sicence of Total Enviorment, 360(1-3), 196-204. doi: 10.1016/j.scitotenv.2005.08.035
Austerman, J. (2015). ADHD and behavioral disorders: Assessment, management, and an update from DSM-5. Cleveland Clinical Journal of Medicine, 82(11 Suppl 1), S2-7. doi: 10.3949/ccjm.82.s1.01
Bielicka, I., & Kibalenko, T. (1968). Developmental disturbances in children of mothers with dysthyreosis--epidemiological aspect.Psychiatrie,Neurologie und Medizinische Psychologie Beihefte, 8-9, 136-143.
Burd, L., Klug, M. G., Coumbe, M. J., & Kerbeshian, J. (2003). Children and adolescents with attention deficit-hyperactivity disorder: 1. Prevalence and cost of care. Journal of Child Neurology, 18(8), 555-561.
Chorozoglou, M., Smith, E., Koerting, J., Thompson, M. J., Sayal, K., & Sonuga-Barke, E. J. (2015). Preschool hyperactivity is associated with long-term economic burden: evidence from a longitudinal health economic analysis of costs incurred across childhood, adolescence and young adulthood. Journal of Child Psychology and Psychiatry, and allied disciplines 56(9), 966-975. doi: 10.1111/jcpp.12437
Doshi, J. A., Hodgkins, P., Kahle, J., Sikirica, V., Cangelosi, M. J., Setyawan, J., . . . Neumann, P. J. (2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of American Academy of Child and Adolescent Psychiatry, 51(10), 990-1002 e1002. doi: 10.1016/j.jaac.2012.07.008
Gau, S. S., Chong, M. Y., Chen, T. H., & Cheng, A. T. (2005). A 3-year panel study of mental disorders among adolescents in Taiwan. The American Journal of Psychiatry, 162(7), 1344-1350. doi: 10.1176/appi.ajp.162.7.1344
Geltman, P. L., Fried, L. E., Arsenault, L. N., Knowles, A. M., Link, D. A., Goldstein, J. N., . . . Hacker, K. A. (2015). A planned care approach and patient registry to improve adherence to clinical guidelines for the diagnosis and management of attention-deficit/hyperactivity disorder. Academic Pediatrics, 15(3), 289-296. doi: 10.1016/j.acap.2014.12.002
Kawatkar, A. A., Knight, T. K., Moss, R. A., Sikirica, V., Chu, L. H., Hodgkins, P., . . . Nichol, M. B. (2014). Impact of mental health comorbidities on health care utilization and expenditure in a large US managed care adult population with ADHD. Value in Health:the journal of the International Society for Pharmacoeconimics and Outcomes Research, 17(6), 661-668. doi: 10.1016/j.jval.2014.06.002
Klassen, A., Miller, A., Raina, P., Lee, S. K., & Olsen, L. (1999). Attention-deficit hyperactivity disorder in children and youth: a quantitative systematic review of the efficacy of different management strategies. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 44(10), 1007-1016.
Klora, M., Zeidler, J., Linder, R., Verheyen, F., & von der Schulenburg, J. M. (2015). Costs and treatment patterns of incident ADHD patients - a comparative analysis before and after the initial diagnosis. Health Economics Review, 5(1), 40. doi: 10.1186/s13561-015-0078-y
Kooij, S. J., Bejerot, S., Blackwell, A., Caci, H., Casas-Brugue, M., Carpentier, P. J., . . . Asherson, P. (2010). European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry, 10, 67. doi: 10.1186/1471-244x-10-67
Korsgaard, H. O., Torgersen, S., Wentzel-Larsen, T., & Ulberg, R. (2016). Personality disorders and Axis I comorbidity in adolescent outpatients with ADHD. BMC Psychiatry, 16, 175. doi: 10.1186/s12888-016-0871-0
Lange, A. M., Daley, D., Frydenberg, M., Rask, C. U., Sonuga-Barke, E., & Thomsen, P. H. (2016). The Effectiveness of Parent Training as a Treatment for Preschool Attention-Deficit/Hyperactivity Disorder: Study Protocol for a Randomized Controlled, Multicenter Trial of the New Forest Parenting Program in Everyday Clinical Practice. JMIR reseacrch protocols, 5(2), e51. doi: 10.2196/resprot.5319
Le, H. H., Hodgkins, P., Postma, M. J., Kahle, J., Sikirica, V., Setyawan, J., . . . Doshi, J. A. (2014). Economic impact of childhood/adolescent ADHD in a European setting: the Netherlands as a reference case. European Child and Adolescent Psychitayt, 23(7), 587-598. doi: 10.1007/s00787-013-0477-8
Leibson, C. L., Katusic, S. K., Barbaresi, W. J., Ransom, J., & O'Brien, P. C. (2001). Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder. JAMA, 285(1), 60-66.
Lin, J. D., Chen, Y. H., & Lin, L. P. (2013). Outpatient rehabilitation utilization and medical expenses in children aged 0-7 years with ADHD: analyses of population-based national health insurance data. Research in Developmental Disabilities, 34(7), 2127-2132. doi: 10.1016/j.ridd.2013.03.034
Marks, D. J., Mlodnicka, A., Bernstein, M., Chacko, A., Rose, S., & Halperin, J. M. (2009). Profiles of service utilization and the resultant economic impact in preschoolers with attention deficit/hyperactivity disorder. Journal of Pediatric Psychology, 34(6), 681-689. doi: 10.1093/jpepsy/jsn112
Miodovnik, A., Harstad, E., Sideridis, G., & Huntington, N. (2015). Timing of the Diagnosis of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder. Pediatrics, 136(4), e830-837. doi: 10.1542/peds.2015-1502
Niemczyk, J., Equit, M., Braun-Bither, K., Klein, A. M., & von Gontard, A. (2015). Prevalence of incontinence, attention deficit/hyperactivity disorder and oppositional defiant disorder in preschool children. European Child and Adolescent Psychitayt, 24(7), 837-843. doi: 10.1007/s00787-014-0628-6
Page, T. F., Pelham Iii, W. E., Fabiano, G. A., Greiner, A. R., Gnagy, E. M., Hart, K. C., . . . Pelham, W. E., Jr. (2016). Comparative Cost Analysis of Sequential, Adaptive, Behavioral, Pharmacological, and Combined Treatments for Childhood ADHD. Journal of Clinical Child and Adolescent Psychology: the official journal of Society of Clinical Child and Adolescent Psychology, 1-12. doi: 10.1080/15374416.2015.1055859
Pelham, W. E., Foster, E. M., & Robb, J. A. (2007). The economic impact of attention-deficit/hyperactivity disorder in children and adolescents. Ambulatory Pediatrics: the official journal of the Ambulatory Pediatric Association, 7(1 Suppl), 121-131. doi: 10.1016/j.ambp.2006.08.002
Rimestad, M. L., Lambek, R., Zacher Christiansen, H., & Hougaard, E. (2016). Short- and Long-Term Effects of Parent Training for Preschool Children With or at Risk of ADHD: A Systematic Review and Meta-Analysis. Journal of Attention Disorders, doi: 10.1177/1087054716648775
Ronis, S. D., Baldwin, C. D., Blumkin, A., Kuhlthau, K., & Szilagyi, P. G. (2015). Patient-Centered Medical Home and Family Burden in Attention-Deficit Hyperactivity Disorder. Journal of Developmental and Behavioral Pediatrics, 36(6), 417-425. doi: 10.1097/dbp.0000000000000161
Schlander, M., Trott, G. E., & Schwarz, O. (2010). The health economics of attention deficit hyperactivity disorder in Germany. Part 1: Health care utilization and cost of illness. Der Nervenarzt, 81(3), 289-300.
Schoffski, O., Sohn, S., & Happich, M. (2008). Overall burden to society caused by hyperkinetic syndrome (HKS) and attention deficit hyperactivity disorder (ADHD). Gesundheitswesen, 70(7), 398-403. doi: 10.1055/s-0028-1082049
Strother, C. R. (1973). Minimal cerebral dysfunction: a historical overview. Annals of New York Academy of Sciences, 205, 6-17.
Tai, Y. M., Gau, S. S., & Gau, C. S. (2013). Injury-proneness of youth with attention-deficit hyperactivity disorder: a national clinical data analysis in Taiwan. Research in Developmental Disabilities, 34(3), 1100-1108. doi: 10.1016/j.ridd.2012.11.027
Wang, L. J., Lee, S. Y., Yuan, S. S., Yang, C. J., Yang, K. C., Lee, T. L., & Shyu, Y. C. (2016). Impact of negative media publicity on attention-deficit/hyperactivity disorder medication in Taiwan. Pharmacoepidemiology and Drug Safety, 25(1), 45-53. doi: 10.1002/pds.3907
Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics: the journal of the American Society for Experimental Neuro Therapeutics, 9(3), 490-499. doi: 10.1007/s13311-012-0135-8
Zametkin, A. J., Nordahl, T. E., Gross, M., King, A. C., Semple, W. E., Rumsey, J., . . . Cohen, R. M. (1990). Cerebral glucose metabolism in adults with hyperactivity of childhood onset. The New England Journal of Medicine, 323(20), 1361-1366. doi: 10.1056/nejm199011153232001
Zito, J. M., Safer, D. J., dosReis, S., Gardner, J. F., Boles, M., & Lynch, F. (2000). Trends in the prescribing of psychotropic medications to preschoolers. JAMA, 283(8), 1025-1030.