5至7歲語言遲緩兒童心智理論與父母反思功能之關聯性：以親職壓力為中介變項

本研究以語言遲緩兒童為對象，關注語言遲緩兒童的心智理論及其家長的反思功能、親職壓力之間的關聯性，探討以下五個問題 (1) 語遲組與一般組兒童的心智理論是否具顯著差異？ (2) 語遲組與一般組家長的父母反思功能是否具顯著差異？ (3) 語遲組與一般組家長的親職壓力是否具顯著差異？ (4) 兒童的心智理論與家長的父母反思功能、親職壓力是否有關聯性？ (5) 家長的親職壓力在家長的父母反思功能與兒童的心智理論間是否扮演中介角色？　　研究方法：參與受試包含5至7歲兒童及其家長，其中語言遲緩組有47位（語遲組；男孩33人，平均年齡(標準差) = 6.03(0.61) 歲）、一般發展組有43位（一般組；男孩25人，平均年齡(標準差) = 6.70(0.24) 歲）。以背景資料表蒐集人口學資料；以魏氏幼兒智力量表第四版量測兒童的語言及非語言能力；以NEPSY-II心智理論測驗量測兒童的心智理論能力，分項能力有「認知性心智理論」、「情感性心智理論」；以父母反思功能問卷蒐集家長的反思功能，分項指標有「前心智化模式」、「對心智狀態理解的肯定」、「對理解心智狀態的興趣與好奇」；以親職壓力量表量測家長的親職壓力，分項指標有「父母困擾」、「親子失功能互動」、「困難兒童」。　　研究結果： (1) 進行獨立樣本t檢定分析，發現語遲組兒童的心智理論、認知性心智理論、情感性心智理論顯著低於一般組兒童。 (2) 進行獨立樣本t檢定分析，語遲組家長的父母反思功能、對理解心智狀態的興趣與好奇顯著低於一般組家長，語遲組家長的前心智化模式顯著高於一般組家長。 (3) 進行獨立樣本t檢定分析，語遲組家長的親職壓力、親子失功能互動指標、困難兒童指標顯著高於一般組家長。 (4) 進行相關分析，發現兒童的心智理論與家長的父母反思功能間呈正相關，兒童的心智理論與家長的親職壓力間呈負相關，家長的父母反思功能與親職壓力間呈負相關。 (5) 使用PROCESS進行中介效果分析，其中家長的父母反思功能為自變項，家長的親職壓力為中介變項，兒童的心智理論為依變項，並控制兒童生理年齡，發現家長親職壓力在家長的父母反思功能及兒童心智理論間具有完全中介效果；家長的親子失功能互動指標在家長對理解心智狀態的興趣與好奇及兒童認知性心智理論間具有完全中介效果；家長的困難兒童指標在家長對理解心智狀態的興趣與好奇及兒童認知性心智理論間具有部分中介效果。　　總結：語言遲緩兒童的心智理論表現較一般發展兒童差，語言遲緩兒童家長的父母反思功能比一般發展兒童的家長較不具適應性，亦報告較高的親職壓力。當家長持有較具適應性的父母反思功能時，其兒童心智理論表現越佳，然而當家長的親職壓力越高，會使得父母反思功能受損，在兒童發展心智理論上難以發揮適切作用，兒童心智理論表現也越糟，因此在臨床上將親職壓力納入介入方案，以協助家長的父母反思功能發揮利於兒童心智理論發展的作用。

關鍵字

語言遲緩；心智理論；父母反思功能；親職壓力

並列摘要

This study focuses on the theory of mind (ToM) of children with language delays (LD) and the correlation between parental reflective functioning (PRF) and parenting stress. This study explores the following five questions: (1) Is there a significant difference in the children’s ToM between the LD group and the typical development (TD) group? (2) Is there a significant difference in the PRF between the LD group and the TD group? (3) Is there a significant difference in parenting stress between the LD group and the TD group? (4) Is there any relationship between children's ToM, PRF and parenting stress? (5) Will parenting stress play a mediation role between PRF and children's ToM? 　　Methods: This study recruited 47 children with LD (33 boys, M = 6.03 years, SD = 0.61) and 43 children with TD (25 boys, M = 6.70 years, SD = 0.24) of the ages of 5-7 years, as well as their parents. Demographic information was collected with the background information sheet. Children's verbal and nonverbal abilities were assessed with the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition (WPPSI-IV). Children's ToM was assessed with the NEPSY-II ToM subtest, including ‘cognitive ToM’ and ‘affective ToM’. PRF was assessed with the Parental Reflective Functioning Questionnaire, including ‘pre-mentalizing modes (PM)’, ‘certainty about mental states (CMS)’, and ‘interest and curiosity in mental states (IC)’. Parenting stress was assessed with the Parenting Stress Index, Fourth Edition Short Form, including ‘parental distress (PD)’, ‘parent-child dysfunctional interaction (PCDI)’, and ‘difficult child (DC)’. 　　Results: (1) Children in the LD group showed significantly lower ToM, cognitive ToM, and affective ToM than children in the TD group. (2) Parents of children in the LD group showed significantly lower PRF, including higher PM and lower IC than parents of children in the TD group. (3) Parents of children in the LD group showed significantly higher parenting stress, including higher PCDI and DC than parents of children in the TD group. (4) A positive correlation was shown between children's ToM and PRF; however, a negative correlation was shown between children's ToM and parenting stress and between PRF and parenting stress. (5) After controlling for the children's age, parenting stress had a complete mediation effect on PRF and children’s ToM, parents’ PCDI had a complete mediation effect on parents’ IC and children’s cognitive ToM, and parents’ DC had a partial mediation effect on parents’ IC and children’s cognitive ToM. 　　Conclusions: The ToM performance in children with LD was poorer than those with TD and the PRF in parents of children with LD was less adaptable than those with TD, while the parents also reported higher parenting stress. When parents demonstrated　more adaptive PRF, their children's ToM performance improved. However, when parenting stress was higher, it negatively affected their PRF, which influenced children's ToM performance. Therefore, including parenting stress in the intervention program may improve PRF and in turn benefit children’s development of ToM.