學齡前自閉症類群疾患兒童母親親職壓力相關因素：問題行為、自閉症症狀嚴重度

研究背景與目的：自閉症類群疾患（autism spectrum disorders, ASDs）兒童家長的親職壓力，顯著高於其他發展障礙的兒童。高度的親職壓力影響家長學習早期療育訓練技巧，將會妨礙早期療育的效果。在台灣，較少針對4歲以前的ASDs兒童母親探討其親職壓力與相關因素。因此，本研究探討台灣地區學齡前ASDs兒童的問題行為與症狀嚴重度，對其母親親職壓力的影響。方法：104名18-47個月大的ASDs兒童與其母親，以親職壓力量表評估母親親職壓力，兒童期行為檢核表與自閉症診斷觀察量表（Autism Diagnostic Observation Schedule, ADOS）的異常行為題目測量兒童問題行為，克氏行為量表與自閉症診斷觀察量表評估兒童自閉症症狀嚴重度。結果：ASDs兒童母親親職壓力得分，46%母親得分高於正常範圍，約3成的母親，得分達到臨床關注範圍。ASDs兒童母親親職壓力與兒童生理、心理年齡、認知功能、適應能力，及家庭社經地位，無顯著相關；親職壓力與母親知覺的問題行為和症狀嚴重度顯著正相關。階層迴歸分析，外化問題行為能預測ASDs兒童母親整體、父母因素、兒童因素親職壓力；內化問題行為能預測ASDs兒童母親兒童因素親職壓力；症狀嚴重度對親職壓力的預測力不顯著。ASDs兒童問題行為與症狀嚴重度，可以解釋母親整體親職壓力約43%的變異程度。結論：將近一半的ASDs兒童母親親職壓力得分高於正常範圍，顯示ASDs兒童母親處於高度親職壓力下。母親知覺兒童問題行為較能預測ASDs兒童母親的親職壓力，特別是外化問題行為，讓照顧者在教養上最感到壓力。本研究結果顯示改善親職壓力，需考慮家長知覺孩子的行為特徵，來設定介入目標。

關鍵字

自閉症類群疾患兒童；母親親職壓力；問題行為；症狀嚴重度

並列摘要

Background and purposes: Parents of children with autism spectrum disorders (ASDs) generally experience higher levels of parenting stress than parents of children with other developmental disabilities. The high level of parenting stress impacts parents of ASDs children on learning the skills from early intervention programs, and counteracts the effectiveness of early interventions. There are few studies examined the correlates of parenting stress focusing on mothers of young children with ASD before 4 years of age in Taiwan. Hence, the present study aims to investigate the maternal parenting stress of preschool children with ASDs in Taiwan, and the relations between behavioral problems and symptom severity of children with ASDs and maternal parenting stress. Methods: There were 104 children with ASDs aged from 18 to 47 months old and their mothers recruited in this study. The Parenting Stress Index (PSI) was used for measuring the parenting stress in mothers of young children with ASD, including child domain, parent domain, and total stress. And, the Child Behavior Checklist (CBCL) and other abnormal behaviors subscale of Autism Diagnostic Observation Schedule (ADOS) were used for measuring behavior problems. The CBCL includes internalizing problem, externalizing problem and total problem scales. In addition, both Clancy Behavior Scale (Clancy) and ADOS were used for assessing autistic symptoms. The ADOS got three scores, including social interaction, communication and total scores. Results: The results of this study showed that chronological age, mental age, cognitive abilities, adaptive functions of ASDs children and socialeconomical status of parents unrelated to maternal parenting stress. The maternal parenting stress significantly correlated to the behavioral problems on CBCL and symptoms severity on Clancy and ADOS. Hierarchical regression was used for examining predictors of parenting stress, the results of this study showed that the strong predictor of child domain, parent domain, and total stress on PSI is externalizing behaviors instead of autistic symptoms. Overally, the behavioral problems and symptom severity of ASDs children explained about 43% of variance in maternal total parenting stress. Conclusion: Almost half of mothersof children with ASDs have total scores of PSI above normal range. It shows mothers of children with ASDs bear highly parenting stress. We found that the behavioral problems reported by mother more significantly related to maternal parenting stress and it also is the strong predictor for maternal parenting stress, especially the externalizing behaviors. The results suggested designing the intervention targets for children with ASDs, it should considerate what the parent percepts behaviors of their children.