臺灣學齡期自閉症兒童的休閒活動參與表現

Leisure Participation in School-aged Children with Autism Spectrum Disorder in Taiwan

何紫菱(Tzu-Lin Ho)

指導教授 ： 陳麗秋

國立臺灣大學/醫學院/物理治療學研究所/碩士(2016年)

https://doi.org/10.6342/NTU201602801

摘要

背景與目的：泛自閉症障礙症候群是一種神經發展疾患，主要核心症狀為社會互動與社會溝通障礙以及侷限的興趣或刻板重複的行為，此外患者也常伴隨有動作問題。自閉症的核心症狀以及動作等相關問題都會影響患者在日常活動的表現，包括休閒活動的參與。許多西方文獻指出自閉症兒童在休閒活動的參與較一般發展兒童少而且侷限，然而針對亞洲或臺灣自閉症兒童休閒活動參與的相關文獻卻十分不足，目前亦沒有研究探討自閉症兒童的動作能力對休閒活動參與表現的影響。本篇研究目的是要探討文獻中常用的兒童參與及愉悅評估量表（Children’s Assessment of Participation and Enjoyment，簡稱CAPE）以及兒童活動偏好量表 （Preferences for Activities of Children，簡稱PAC），使用在臺灣學齡期自閉症兒童的再測信度，並且比較臺灣學齡期自閉症兒童與一般兒童在休閒活動參與表現的異同，也進一步探討伴隨動作問題是否讓自閉症兒童在休閒活動參與表現更為侷限。方法：本研究共招募21名7-10歲的自閉症兒童，使用CAPE / PAC原始55項活動與中文版61項活動評估兒童的休閒活動參與表現，並於至少一周後再次施測，此外也使用布魯茵克斯-歐西瑞斯基動作精練度評量工具第二版 （Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition，簡稱BOT-2）評估兒童的動作能力。本計劃也納入21名一般發展兒童作為對照組，其性別、年齡以及居住地都對照自閉症組兒童。研究結果使用組內相關係數（Intra-class Correlation Coefficient）來檢驗自閉症組兒童在兩次CAPE / PAC評量的再測信度，以獨立樣本t檢定（Independent t-test）來比較自閉症組與對照組兒童，以及有無伴隨動作問題的自閉症組兒童在參與休閒活動的活動種類、參與強度、從事活動的對象、地點、參與時的愉悅度以及對活動偏好程度的差異。結果：在完成二次休閒活動參與評估的16名自閉症兒童中，不論使用原始55項或是中文版的61項活動，CAPE與PAC各個測量面向的再測信度都是可接受至良好（組內相關係數0.57-0.90）。在總體的休閒活動參與的表現，自閉症組兒童在參與的活動多樣性、總體參與強度以及從事活動的對象，分數皆明顯低於對照組兒童（所有p<0.01），但在個人參與強度以及從事活動的地點，兩組兒童則沒有顯著的差異（所有p>0.05）。在完成BOT-2測驗的19名自閉症組兒童中，共有7名兒童有動作困難，這些伴隨動作問題的自閉症兒童在總體休閒活動的個人參與強度以及從事活動的對象皆顯著低於沒有動作問題的12名自閉症兒童（p<0.05），但是在參與的活動多樣性、總體參與強度、從事活動的地點、參與時的愉悅度以及對活動偏好程度，則沒有顯著差異（所有p>0.05）。結論：在臺灣，原始CAPE / PAC與中文版使用於自閉症學童都有可接受至良好的再測信度。整體而言，自閉症學童在休閒活動的表現較一般兒童侷限，伴隨動作問題則又更加限制了自閉症兒童在休閒活動的參與。本研究的結果可以幫助國內家長、教師以及臨床專業人員瞭解自閉症兒童在休閒活動參與的狀況，並且作為設計介入計畫的參考。未來研究應考量其他可能影響活動參與的因素，並增加受試者人數，以針對自閉症兒童的休閒活動參與以及動作問題的影響做更全面性的探討。

關鍵字

泛自閉症障礙症候群 ； 休閒活動 ； 參與 ； 動作問題 ； 學齡期

並列摘要

Background and purpose: Autism Spectrum Disorder (ASD) is a group of neurodevelopmental disorders characterized by limitations in social interaction and communication, restricted interests and repetitive behaviors. In addition, children with ASD often suffer from motor impairments as well. These core and related symptoms of ASD restrict children’s functioning in daily living, including participation in leisure activities. Western studies have shown that children with ASD demonstrate restricted leisure participation, especially in physical activities. However, little is known about leisure participation of children with ASD in Asian countries. Furthermore, no research has investigated the impact of motor impairments in participation of children with ASD. The purposes of this study were to examine the test-retest reliability of Children’s Assessment of Participation and Enjoyment (CAPE) / Preferences for Activities of Children (PAC) in Taiwanese children with ASD, to compare leisure participation performance between school-aged children with ASD and healthy peers, and to investigate the effect of motor impairments in leisure participation of children with ASD. Methods: Twenty-one children with ASD aged from 7 to 10 years were assessed for their leisure participation using CAPE / PAC and were re-assessed at least a week later. They were also examined for gross and fine motor performance using Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition. Twenty-one age-, gender- and residence-matched healthy children were also recruited to serve as the control group. Intra-class Correlation analysis was conducted to examine the test-retest reliability of CAPE / PAC in children with ASD. Independent t-test analyses were applied to investigate the differences in leisure participation between children with ASD and healthy peers, and between children with ASD with and without motor impairments. Results: Both the original and the Chinese versions of CAPE / PAC showed acceptable to good test-retest reliability in children with ASD (Intra-class Correlation Coefficient = 0.57-0.90). Comparing to healthy peers, children with ASD demonstrated restricted participation in leisure activities. Children with ASD participated in less varieties of leisure activities, with lower intensity and with a narrower range of exposure to other people (p<0.01). However, no significant difference was found in personal intensity and location between ASD and control groups (p>0.05). Children with ASD and with motor impairments showed lower personal intensity and less involved with others than those without motor impairments (p<0.05). Conclusions: In Taiwan, both the original and the Chinese versions of CAPE / PAC have acceptable to good test-retest reliabilities in children with ASD. Children with ASD exhibit reduced leisure participation comparing to their peers. Motor impairments further restricts performance in leisure activities of children with ASD. The results of this research inform parents, teachers and clinicians about restrictions of leisure participation in children with ASD in Taiwan and may help the design and implementation of interventions programs to promote participation of these children. Future research needs to consider other factors that may affect children’s participation and increase the sample size to investigate the effects of ASD and motor impairments in children’s leisure participation.

並列關鍵字

Autism Spectrum Disorder ； Leisure ； Participation ； Motor impairments ； School age

參考文獻

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