自閉症類群障礙症青少年於生活中即時社交參與之自覺勝任感與社交焦慮：探討調適行為之影響

Self-perceived Social Competence and Social Anxiety in Real-life Social Engagement of Adolescents with Autism Spectrum Disorder: The Impact of Coping Behaviors

吳彧(Daphne Ng Yih)

指導教授 ： 曾美惠

共同指導教授 ： 陳昱瑋(Yu-Wei Ryan Chen)

國立臺灣大學/醫學院/職能治療研究所/碩士(2021年)

https://doi.org/10.6342/NTU202100979

摘要

背景: 社交技巧缺陷為自閉症類群障礙症患者常見的核心症狀之一，導致他們在社交參與上困難重重。口語以及認知能力較好的高功能自閉症族群常會讓人低估其對於社交技巧學習的需要。比起一般同儕，高功能的自閉症患者更能夠察覺本身社交上的不足而降低他們的自覺社交勝任感，也容易感受到社會帶給他們的壓力。因此，社交參與常引發高功能的自閉症患者的社交焦慮感，不僅降低他們社交參與的意願，也會進而導致逃避社交互動的情形。調適技巧能夠作為生活中壓力與情緒的調節作用，因此好的調適行為有助於維持穩定的身心狀態並滿足個人以及環境的需求。而目前針對高功能自閉症青少年之調適行為是否能夠影響其日常社交活動時自覺勝任感及社交焦慮感的相關研究有限。此外，過去探討自閉症患者社交經驗的研究成果主要源自於父母的觀點與看法，並使用回顧性方法。然而，思考與感覺會受不同情境的影響而有不同，這種回顧性方法無法準確反映出青少年在不同的日常社交情境中的經驗，且受限於經驗回想過程，可能會有回想偏差。經驗取樣法(Experience sampling methodology, ESM) 以多次重複收集個案在日常生活中當下行為表現，相較於回溯性方法，經驗取樣法透過收集當下資料不僅能夠減少回憶偏差，也加強探索個人情緒經驗與日常情境之間的相互關係。迄今尚無研究探討青少年日常生活情境下的主觀社交經驗。
目的: 本研究使用經驗取樣法探討調適行為對於自閉症青少年在參與日常社交活動時自覺勝任感及社交焦慮感之影響。研究結果將有助於瞭解日常生活社交情境之當下主觀經驗與調適行為之間的關係。
方法: 本研究從自閉症相關協會、診所、學校及社交網路招募134位青少年（83名自閉症類群障礙症與51名一般發展），年齡介於10到16歲（平均=12.54，標準差=2.05）。在為期7天的研究期間，受試者需攜帶裝有Participation in Everyday Life (PIEL)問卷應用程式的手機。應用程式在參與者方便的時間提醒他們回答問卷，一天最多填答七次，記錄他們當下正在進行的活動以及他們對該情境的自覺勝任感和社交焦慮感。調適行為則以適應量表 (Coping Inventory, CI) 問卷進行評量。研究以多層次分析 (Multilevel modeling) 探討調適行為對社交情境當下的自覺社交勝任感及社交焦慮感之影響。
結果: 本研究受試者平均完成了37次ESM問卷。大部分的時間裡，兩組青少年並無進行任何社交活動。比起一般發展青少年，自閉症青少年較常與大人相處，尤其是家長。自閉症青少年與一般青少年在參加不同類型活動時的自覺勝任感無顯著差異。相較無參與活動，兩組青少年們於參與休閒活動時皆較容易有自覺勝任感。但自閉症青少年在與長輩一同參與生產性活動時的社交焦慮感較高。另外，而當自閉症青少年的環境調適行為越好，他們與同儕一起進行休閒活動時越不容易感到焦慮，然而其自覺勝任感卻較低。相反的，自閉症青少年之自我調適行為越好，則自覺勝任感較高。
結論: 本研究結果顯示調適行為對自閉症青少年參與社交活動時自覺勝任感以及社交焦慮的影響。研究結果有助瞭解自閉症青少年於不同社交情境下其情緒的影響因子，並可作為臨床工作者、醫療或教育相關單位擬定介入方案的參考依據，進而改善自閉症青少年負面的社交經驗。

關鍵字

自閉症類群障礙症 ； 社交參與 ； 自覺社交勝任感 ； 社交焦慮 ； 調適行為 ； 經驗取樣法

並列摘要

Background: Social skill deficits are the core symptom of individuals with autism spectrum disorder (ASD), which impede their participation in social activities. For those who have better social functioning and language use (i.e., high-functioning ASD), their needs for social engagement were not often addressed. Comparing with those who are lower-functioning, adolescents with high-functioning ASD may be aware of their own social problems, leading to lower levels of self-perceived social competence while engaging in social activities. Further, they are also vulnerable to co-morbid mental health difficulties, particularly social anxiety. While coping behaviors play an important moderating role between the experience of stressful life events and emotional well-being, adaptive coping behaviors help meet personal needs and manage the demands of the environment. However, there was limited research exploring the impact of coping behaviors on daily social experiences among adolescents with high-functioning ASD. In addition, retrospective interviews or questionnaires reported by parents were commonly used in research on the social experiences of individuals with ASD. However, thoughts and feelings are context-specific, and memories are easily contaminated by recall bias. Experience sampling methodology (ESM), a method to allow participants to report their actions, thoughts, and feelings in real-time, may overcome the limitations in retrospectives approaches to investigate dynamic relationships between subjective experiences and everyday real-time contexts.
Objective: This study aimed to evaluate the effect of coping behaviors on the self-perceived social competence and social anxiety in real-life social engagement of adolescents with and without ASD by using experience sampling methodology. Results of the study obtain unprecedented knowledge and illuminate the dynamic relationship between real-time experiences in social participation and coping behaviors.
Methods: A total of 134 participants (83 adolescents with ASD and 51 typically developing adolescents) aged 10-16 (M = 12.54; SD = 2.05) were recruited from ASD-related organizations, relevant clinics, schools, and social media. During the survey of seven days, they carried an iPhone, installed with Participation in Everyday Life (P.I.E.L) Survey App, to record activities that participants were doing and their perceptions of competence in the involved situation and social anxiety by prompting them randomly seven times per day during their free time. Coping Inventory (CI) was used to measure coping behaviors including coping with self and coping with environment. Multilevel modeling was conducted to examine the influence of coping behaviors on self-perceived social competence and social anxiety in real-life social engagement.
Results: All participants completed an average of 37 of a possible 49 ESM surveys in seven days. Adolescents with ASD spent more time with adults than TD adolescents, especially with parents. Most of the time all participants were found doing non-activities. However, both ASD and TD adolescents perceived higher social competence while they were engaging in leisure activities. Although there was no significant difference in self-perceived social competence between adolescents with ASD and TD in activities engagement, adolescents with ASD showed higher levels of social anxiety while doing maintenance and productive activities with adults. Adolescents with ASD were found to have lower scores in the CI than TD peers. Adolescents with ASD who had better coping with environment perceived less social anxiety in leisure activities with peers. However, self-perceived social competence was negatively associated with coping with environment but positively associated with coping with self in adolescents with ASD.
Conclusion: This study examined the impact of coping behaviors on self-perceived social competence and social anxiety in real-life social engagement of adolescents with ASD. Insights of this study can serve as a guide for evaluation and intervention to help practitioners develop strategies and educational programs targeting on coping behaviors to reduce the negative social experiences of adolescents with ASD.

並列關鍵字

autism spectrum disorder ； social participation ； self-perceived social competence ； social anxiety ； coping behavior ； experience sampling methodology

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