- 學位論文
自閉症類群障礙症認知異質性： 心智理論、執行功能、中心聚合能力
The Cognitive Heterogeneity of Autism Spectrum Disorder: Theory of Mind, Executive Functions, Central Coherence
摘要
研究背景：過去研究者致力於找出單一認知理論，以解釋自閉症類群障礙症（Autism Spectrum Disorder, ASD）具高度異質性的臨床表徵。其中，心智理論（Theory of Mind, ToM）缺損、執行功能（Executive Function, EF）缺損、弱中心聚合（Central Coherence, CC）傾向等三種認知理論最廣為討論。然而，實徵研究的結果顯示三種認知理論皆不足以作為單一認知理論。Happé等人（2006）遂提出多重認知異常的概念，強調三種認知表現應共同作為ASD認知能力之標記，並解釋ASD在臨床表現之異質性。本研究之目的為試圖描繪ASD在ToM、EF、CC的認知異常型態，並探究三種核心認知能力與ASD行為表徵的關係。方法：本研究納入7-12歲的高功能ASD（N = 66）與一般發展(Typical Developing, TD)兒童（N = 41），計算ASD兒童的認知異常比例，並透過邏輯迴歸檢驗三種認知能力共同預測ASD與TD兒童之分組效果，亦藉由線性迴歸檢驗三種認知能力對於特定症狀面向之解釋力。結果：1. ToM表現較弱的ASD兒童佔了近五成，為比例最高之認知異常種類，但同時檢視三種認知能力，則能標記出將近七成的ASD兒童之認知異常型態。2. 納入三種認知能力，相對於只納入一種認知能力，在邏輯迴歸中更能預測ASD與TD之間的分組。3. 針對ASD症狀與適應功能的解釋力，大致趨勢為(1) ToM較能夠解釋文蘭適應行為量表第二版（VABS-II）之溝通適應功能，亦可解釋自閉症觀察量表（ADOS）之社交面向症狀，但解釋力不及語文智商；(2) EF在控制一般智能後仍可以解釋ADOS侷限重複行為與興趣面向症狀，對於ADOS溝通與社會互動症狀、VABS-II的社會化領域的預測效果為邊緣顯著；(3) CC則可能預測自閉症診斷會談問卷（ADI-R）重複行為與興趣面向症狀，但控制生理年齡後不顯著，且整體模型解釋力較不足。另外，智能優異與否將影響上述認知預測症狀之展現。結論：整體而言，比起只檢視單一認知能力，同時納入ToM、EF、CC等三種認知能力時，將更能夠描繪ASD兒童認知層次之異質性，各認知能力對於解釋ASD之症狀不同面向亦有特定效果。
並列摘要
Background: In the last few decades, researchers have been devoted to discover a single underlying cognitive deficit to explain the impairment of Autism Spectrum Disorder (ASD). ‘Theory of Mind’ (ToM) deficits, ‘Executive Functions’ (EF) deficits, and weak ‘Central Coherence’ (CC) are the three most widely discussed accounts. However, the results of empirical researches revealed that all of these accounts were not qualified to develop into a single cognitive theory. Thus, Happé et al.(2006) proposed the concept of ‘multiple cognitive atypicalities.’ He emphasized on the combination of the atypicalities of ToM, EF, and CC to depict the cognitive profile of ASD, and explained the distinct aspect of behavioral phenotype. The aim of this study is to portray the cognitive atypicalities of ToM, EF and CC in children with ASD and to investigate the relationship between these core cognitive abilities and behavioral phenotype. Methods: In this study, 66 high-function children with ASD and 41 typical developing (TD) children at the ages of 7-12 were included. Their proportions of multiple cognitive atyticalities were calculated. Logistic regression models were applied to test whether including the cognitive abilities of ToM, EF, and CC can better differentiate the group of ASD and TD. The relationships between the cognitive abilities and behavioral symptoms were also investigated. Results: 1. Comparing with investigating only one aspect of cognitive abilities, included three aspects of the abilities of ToM, EF, & CC could reveal a more complete profile the cognitive atypicalities of ASD. 2. Including three cognitive abilities also had a better distinction between ASD and TD children in the logistic regression. 3. The regression of symptoms showed that (1) ToM explained the communication adaptive abilities measured with Vineland Adaptive Behavioral Scale-2nd Edition (VABS-II), and symptoms of social communication measured with ADOS before controlling for verbal IQ. (2) EF explained the repetitive behavior measured with ADOS even after controlling for FSIQ, and the predictive effect in the regression of social adaptive abilities measured with VABS-II were close to significant. (3) CC explained repetitive behavior measured with ADI-R before controlling for chronological age, but the model was not significant. Besides, the degree of intelligence would influence the relationship between cognitive abilities and symptoms. Conclusion: The finding of this study supports that ToM, EF, & CC would give a better portray of the heterogeneity of ASD at the cognitive level, and different cognitive abilities would better explain different aspects of ASD symptoms.