自閉症類群疾患幼兒語言能力與社會能力相關因素：氣質與共享式注意力

氣質與共享式注意力，在早期語言、社會能力的發展上，扮演的角色不容忽視。年幼自閉症類群疾患（autism spectrum disorders, ASDs）氣質、共享式注意力的表現，對其語言能力、社會能力的影響值得注意。因此，本研究將探討 3 歲以下的 ASDs 幼兒氣質、共享式注意力的表現，及其對語言能力、社會能力之影響。方法：研究對象為生理年齡 18 至 36 個月的 54 位 ASDs 幼兒與 52 位發展遲緩幼兒。以幼兒氣質量表中文版（Chinese Toddler Temperament Scale, CTTS）評估九大氣質；學步期自閉症篩檢工具（Screening Tool for Autism in Toddlers-Taiwan Version, T-STAT），測量完整主動性共享式注意力、部分主動性共享式注意力，和反應性共享式注意力。穆林早期學習量表（Mullen Scales of Early Learning, MSEL）、適應行為評量系統第二版(Adaptive Behavior Assessment System-Second Edition, ABAS-II），和兒童行為問題檢核表（Child Behavior Checklist, CBCL），分別測量語言能力和社會能力。結果：ASDs 組和發展遲緩組在堅持度、注意力分散度，和反應閾出現顯著差異，ASDs 組的持續性較低、注意力不易分散，需要較多刺激引起反應。此外，ASDs 組共享式注意力出現顯著障礙。ASDs 組，除反應強度和與語言表達顯著相關外，氣質和語言能力無顯著相關；此外，活動量越高、適應性越差、情緒越負向，內、外化行為及整體問題嚴重度越高；活動量越高、越退縮、情緒越負向、堅持度越低，適應能力表現越不好。共享式注意力和語言能力、適應能力達顯著相關，但是和問題行為無顯著相關。結論：ASDs 幼兒的共享式注意力出現顯著障礙，但僅有三項氣質與發展遲緩幼兒出現顯著差異。ASDs 幼兒共享式注意力和語言能力、適應能力顯著相關，氣質則與問題行為有顯著相關，指出氣質與共享式注意力，在早期發展可能扮演不同角色。

關鍵字

自閉症類群疾患；共享式注意力；氣質；語言能力；問題行為

並列摘要

Background and objectives: Both temperament and joint attention (JA) play an important role for development of language abilities and social abilities in early childhood, especailly for autism spectrum disorders (ASDs). Therefore, the purposes of this study were to explore temperament and JA in children with ASDs less than age of 3 years, and investigate the impact on language abilities and social abilities . Method: There are 106 participants, including 54 children with autism spectrum disorders, and 52 children with developmental delay (DD), with chronological age between 18 and 36 months.The Chinese Toddler Temperament Scale (CTTS) used to measure nine temperament dimensions . The Screening Tool for Autism in Toddlers-Taiwan Version (T-STAT) was modified and used to measure initiating joint attention (IJA) and responding joint attention (RJA). The IJA was divided into full-IJA (F-IJA) and partial-IJA (P-IJA). The Mullen Scales of Early Learning (MSEL) was used to measure language abilities. Adaptive Behavior Assessment System-Second Edition (ABAS-II) and Child Behavior Checklist (CBCL) were used to measue social abilities。 Result: There were significant differences between ASDs group and DD group on the dimensions of Persistence, Distractability and Threshold. ASDs group was lower persistence, lower distractability and needed more stimulus to response. In addition, JA in children with ASDs showed significantly impairment than children with DD. In ASDs group, there were no significant correlation between temperament and language abilities, except for intensity and expressive language showed significantly correlated. However, the internalizing, externalizing and total problems for those who had higher activity levels, lower adaptability and higher negative mood were severe. In addition, for those who had higher activity levels, withdrawal, negative mood, and lower persistence, their adaptive functioning was poor. Finally, JA correlated significantly to language abilities and adaptive functioning instead of problem behavior. Conclusion: There are significant differences between toddlers with ASDs and those with DD on three temperament dimensions. And, toddlers with ASDs showed impairments on JA. In addition, JA correlated to language abilities and adaptive functioning, and temperament correlated to problem behaior. The results indicates that temperament and JA play different roles in the early development.