以互動式繪畫分析自閉症類群障礙症孩童的交互行為

Using Interactive Drawing to Analyze Reciprocity in Children with Autism Spectrum Disorders

邱琇蔓(Hsiu-Man Chiu) ； 尤姿婷(Tzu-Ting Yu) ； 蔡景宏(Ching-Hong Tsai) ； 李幸蓉(Hsing-Jung Li) ； 陳官琳(Kuan-Lin Chen)

《職能治療學會雜誌》 36卷1期 (2018/06) Pp. 28-55

https://doi.org/10.6594/JTOTA.2018.36(1).02

摘要

交互行為(reciprocity)是二人之間一來一往的互動型態，交互行為缺損是自閉症類群障礙症(autism spectrum disorders, ASD)孩童的核心特徵之一。現行ASD孩童交互行為的評估工具有二項限制：（一）以照顧者填答問卷或訪談方式者較主觀；（二）以遊戲情境作為客觀觀察方式者，受限於ASD孩童口語能力，低估交互行為。因此，本研究以不需要口語表達的互動式繪畫測驗(Interactive DrawingTest, IDT) 探討ASD孩童的交互行為，分為二部分：（一）探討ASD孩童的IDT分數與遊戲情境中交互行為之相關性；（二）從IDT圖畫中歸納ASD孩童的交互行為特徵。本研究以IDT、交互社交行為觀察(Reciprocal Social Behaviors Observation, RSBO) 分別評估ASD孩童在互動式繪畫、遊戲情境的交互行為。共52位6至12歲ASD 孩童參與本研究，平均具中等語言理解能力。第一部分皮爾森相關係數(Pearson correlation coefficients)結果顯示在IDT中表現愈高比例合作繪畫的ASD孩童，在RSBO中也表現愈多的交互行為輪替次數(r=.369，p=.007)及運用愈多的行為元素(r=.393，p=.004)。在第二部分中，研究者可根據ASD孩童在IDT中表現的合作動機、合作技巧及個人風格，將其交互行為特徵分為五類型：合作型、中庸型、固著型、引導型、低動機型。本研究提供臨床人員以不需要口語能力的互動式繪畫評估ASD孩童的交互行為，藉此辨認ASD孩童的交互行為類型，以擬定社交互動療育計畫。

關鍵字

自閉症類群障礙症 ； 交互行為 ； 互動式繪畫

並列摘要

Reciprocity is the to-and-fro interactive pattern between two individuals. Reciprocity impairment is one of the core features in children with autism spectrum disorders (ASD). However, the current reciprocity measures for children with ASD have two major drawbacks: (1) the caregiver questionnaires or interviews are not objective; (2) the measures of objective observation may underestimate reciprocity of children with ASD due to their limited verbal ability. To better explore reciprocity in children with ASD, the Interactive Drawing Test (IDT), which requires no verbal exchange, was used in this study to examine correlations between reciprocity in the IDT and play contexts; and delineate the reciprocity features of children with ASD. The IDT and the Reciprocal Social Behaviors Observation (RSBO) were respectively used to measure the reciprocity in drawing and playing contexts. A total of 52 children with ASD aged 6 to 12 years having moderate verbal comprehension ability on average were recruited. The results of Pearson correlation coefficients showed that children with ASD who had higher percentages of collaborative drawing performed more turn-taking of reciprocity (r=.369, p=.007) and elements of social behaviors (r=.393, p=.004). The reciprocity features of children with ASD could be classified into five types─collaborative, moderate, restrictive, guided, and low motivation─according to their collaborative motivation, collaborative skills, and personal styles exhibited in the IDT. This study provides clinicians a way of using interactive drawing to measure reciprocity in children with ASD for identifying the reciprocity type and planning corresponding interventions to improve social interaction in children with ASD.

並列關鍵字

Autism Spectrum Disorders ； Interactive Drawing ； Reciprocity