自閉症類疾患孩童之適應行為與感覺處理障礙及情緒行為問題之相關

Relationships among adaptive behavior, sensory processing dysfunction and emotional and behavioral problems in children with autism spectrum disorder

蔣瑋齊(Wei-Chi Chiang)

指導教授 ： 曾美惠

國立臺灣大學/醫學院/職能治療研究所/博士(2017年)

https://doi.org/10.6342/NTU201704267

摘要

背景：自閉症類群障礙症 (ASD) 孩童包含社會溝通及社會互動之缺失，侷限/重複之行為、興趣等核心症狀。孩童的適應行為是家長與臨床專業人員都極為重視的議題，適應行為是個人於真實生活情境中的獨立能力，包含溝通、社會化、日常生活及動作技巧。除了核心症狀外，高比例的ASD孩童併有感覺處理功能問題及情緒行為問題。感覺處理功能問題及情緒行為問題，可能限制孩童參與日常生活和影響適應行為。過去很少研究探討感覺處理障礙、情緒行為問題與適應行為之間的關係。過去探討適應行為相關因子的研究限制，主要為：一、孩童特質與適應行為四領域關係之研究結果並不一致。二、過去研究探討適應行為四領域之相關因子，並無同時考慮年齡、性別、認知功能、症狀嚴重度等因子。三、過去並無文獻同時考量感覺處理障礙及情緒行為問題，探討兩者與適應行為間之關係。
目的: 一、同時考量孩童特徵（如：年齡、性別、認知功能、症狀嚴重度、感覺處理障礙及行為問題），探討ASD孩童適應行為四領域之相關因子。二、探討孩童特徵（如：感覺處理障礙及情緒行為問題）與適應行為之相互關係。
方法: 本研究對象為202名三至十歲之ASD孩童。以多元線性迴歸分析，以感覺處理功能分項與情緒行為問題分項，探討適應行為四領域之相關因子。以結構方程模式分析孩童特徵（如：感覺處理功能、情緒行為問題）對適應行為之影響徑路，並針對所建構之模式進行適配度考驗。
結果: 迴歸模式結果指出，適應行為溝通領域的顯著相關因子為症狀嚴重度、聽覺篩選，日常生活領域的顯著相關因子為觸覺敏感、聽覺篩選，社會化領域相關因子為症狀嚴重度、退縮問題、注意力問題，動作領域相關因子為症狀嚴重度、年齡、低反應/感覺尋求。結構方程模式結果指出，症狀嚴重度、感覺處理及情緒問題對適應行為都有直接效果，感覺處理透過情緒問題亦對適應行為有間接效果。
結論: 本研究結果顯示感覺處理功能與行為問題對自閉症孩童適應行為的影響，以及兩者對整體適應行為的影響關係之研究。研究結果可協助照顧者及臨床專業人員設計及執行適應行為的介入方案，以促進孩童的適應行為。

關鍵字

適應行為 ； 感覺處理障礙 ； 情緒及行為問題 ； 自閉症類群障礙孩童

並列摘要

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by core symptoms in social interaction and communication, and repetitive/restricted interests and behaviors. Adaptive behavior is the extent to which a person can be independent in real-life situations, including communication, socialization, daily living, and motor skills. Regarding the associated factors, few studies had investigated sensory processing dysfunction and emotional and behavioral problems as associated factors of adaptive behavior in children with ASD. Sensory processing dysfunction may limit children’s engagement in daily tasks. Emotional and behavioral problems may increase the difficulties in interacting with others and in learning the skills of adaptive behavior. In previous studies examining the associated factors of adaptive behavior, three main limitations were noted. First, the relationships between associated factors and each of the four domains of adaptive behavior remain inconsistent. Second, despite a multitude of studies examining children’s characteristics such as age, gender, cognitive functioning, and symptom severity of ASD as potential associated factors of adaptive behavior in children with ASD, few studies have investigated the relationships of these factors to adaptive behavior jointly. Third, no study has yet investigated the relationships of interaction between children’s characteristics (e.g., sensory processing dysfunction and emotional and behavioral problems) and adaptive behavior in children with ASD.
Purposes: The purpose of the study was twofold: (1) to identify the associated factors for each of the four domains of adaptive behavior considering age, gender, cognitive functioning, symptom severity of ASD, sensory processing dysfunction, and emotional and behavioral problems simultaneously, and (2) to investigate the relationships of interaction between children’s characteristics (e.g., sensory processing and emotional and behavioral problems) and adaptive behavior in children with ASD.
Method: Two hundred and two participants diagnosed with ASD aged 3 to 10 years old were recruited. Multiple linear regressions were used to examine children’s age, gender, cognitive functioning, ASD symptom severity, sensory processing dysfunction, and emotional and behavioral problems as potential associated factors for the four domains of adaptive behavior. Structural equation modeling was applied to examine hypothesized relationships among children’s characteristics and adaptive behavior.
Results: Multiple linear regression models revealed that significant associated factors of the communication domain of adaptive behavior were symptom severity and auditory filtering, and those of the daily living skills domain were tactile sensitivity and auditory filtering. Symptom severity, withdrawn problems, and attention problems were significantly related to the socialization domain. For the motor skill domain, significant associated factors included symptom severity, age, and under-responsive/seeking sensation. Structural equation modeling revealed direct links between symptom severity, sensory processing dysfunction, and emotional problems on overall adaptive behavior. In addition to direct links, sensory processing was also indirectly related to adaptive behavior through emotional problems.
Conclusion: This study examined the relationships among adaptive behavior, sensory processing dysfunction and emotional and behavioral problems in children with ASD. This study concluded that children with less sensory processing dysfunction had less emotional problems, and had better adaptive functioning. The results of the study could serve as a guide for practitioners to set effective treatment goals and design appropriate interventions.

並列關鍵字

adaptive behavior ； sensory processing dysfunction ； emotional and behavioral problems ； autism spectrum disorder

參考文獻

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