以眼動證據探討自閉症類群障礙幼兒的社會注意力：社會定向、共享式注意力與觀察學習

研究背景與目的：過去探討自閉症類群障礙症（Autism Spectrum Disorder, ASD）的心理病理機制主要皆集中於認知取向，尤以心智理論（theory of mind）為解釋ASD社交溝通及互動方面缺損的核心。然而，體現心智取向（enactive mind approach）認為，ASD兒童可能在早期缺乏對社會訊息的偏好注意，使其知覺經驗偏離一般發展的軌跡，進而影響後續的社會認知能力與社會適應行為。因此，本研究旨在探討ASD幼兒的視覺社會注意力表現，檢驗社會注意力表現與社會缺損的關聯性，進一步探討不同認知能力ASD幼兒的社會注意力表現是否具異質性，繼而回應社會注意力表現用於區別ASD與典型發展（typically developing, TD）幼兒的有效性。研究方法：本研究共納入59名2-4歲的ASD幼兒與25名配對心理年齡的TD幼兒（1-2.5歲）。採自由觀看的作業典範，以眼動追蹤技術量測幼兒社會定向、共享式注意力與觀察學習等三類的社會注意力表現。本研究亦涵蓋認知能力、症狀嚴重度與適應行為的評估。研究結果：(1)社會定向方面，ASD幼兒較TD幼兒更多凝視背景、更少凝視嘴部；反應性共享式注意力方面，ASD幼兒較TD幼兒少正確地跟隨視線，且跟隨的時間較慢、對目標物的第一凝視時間亦較短，而主動性共享式注意力之表現兩組未有顯著差異；觀察學習方面，ASD幼兒較TD幼兒少凝視他人命名後的物品，亦較少凝視他人操作物品時的動作區域。(2)以非語言認知能力將ASD幼兒分為高、低功能兩組，發現ASD幼兒的社會定向表現不因認知能力而有所不同，但凝視眼部與高功能ASD幼兒較少的症狀、較佳的適應有關，而凝視嘴部與低功能ASD幼兒較少的症狀有關；反應性共享式注意力的表現亦不因認知能力而有所不同，且較多正確地跟隨他人視線，皆與兩組ASD幼兒較少的症狀有關，但更長的第一凝視時間，反而與低功能ASD幼兒較多的侷限重複行為有關；主動性共享式注意力以高功能ASD幼兒表現較差，觀察學習則以低功能ASD幼兒表現較差，且觀察學習的表現亦與低功能ASD幼兒較少的症狀、較佳的適應有關。(3)社會定向是區別ASD與TD幼兒最有效的指標，可達70%的敏感度與96%的特異度；合併社會定向、反應性共享式注意力與觀察學習三項指標，可達98%的敏感度與68%的特異度；在邏輯迴歸中控制兩組認知能力的差異，社會定向與反應性共享式注意力的表現仍能預測ASD與TD的分組。結論：研究結果指出，ASD幼兒的社會定向、共享式注意力與觀察學習之表現均有異常，且各面向的社會注意力之間具有關聯，亦與ASD的症狀與適應有關。整體而言，反映社會注意力可能為ASD的早期心理病理機制，且眼動追蹤方法可能作為標定ASD社會注意力異常的有效篩檢工具。

關鍵字

自閉症類群障礙症；社會注意力；社會定向；共享式注意力；觀察學習；眼動追蹤技術；症狀嚴重度；適應行為

並列摘要

Background and Purposes: Previously, psychopathological studies of Autism Spectrum Disorder (ASD) has mainly focused on cognitive deficit, especially for “theory of mind”, the core theory of explaining dysfunction of social communication and interaction in individuals with ASD. However, through the point of “enactive mind approach”, children with ASD may lack of preferent attentions about social informations in the early stage, which causes their development of perceptive experiences to be deviant from the typical individuals, later on influencing their social cognitive ability and social adaptive behavior. Therefore, this study aimed to investigate the visual social attention in children with ASD and its association with social deficit. Further, concerning the heterogeneity within ASD, the study examined the social attention of children with ASD in different cognitive level, moreover discussing on applying social attention to discriminate children with ASD from children with typical development. Methods: 59 children aged 2-4 years with ASD and 25 children with typical development (TD) were recruited to be matched on mental age. The current study utilized free-viewing paradigm, and applied eye-tracking techniques to measure the indexes of social-orienting, joint attention, and observational learning. Additionally, cognitive function, symptom severity, and adaptive function were also assessed. Results: (1) In social orienting task, children with ASD spent proportionally less time viewing the mouth and more time viewing the background. In responding joint attention (RJA) task, children with ASD tracked less correctly with other’s gaze, and the gaze-following response latency was slower, anticipatory gaze duration to the target object was shorter as well. Results showed no significant difference between groups in initiating joint attention (IJA) task. In observational learning tasks, children with ASD spent proportionally less time viewing the named object and the motion area. (2) The children with ASD has been divided into two groups through nonverbal DQ, high- and low-function respectively. No difference has been showed between two groups in social orienting task. For children with high-functioning ASD (HFASD), it showed that fixation on eyes is correlated with less symptoms and better adaptation, whereas for children with low-functioning ASD (LFASD), fixation on mouth was correlated with less symptoms. No difference has been showed between HFASD and LFASD group in RJA task, and correctly gaze-following was correlated with less symptoms in both groups. In IJA task, children with HFASD initiated joint attention slower than children with LFASD. In observational learning task, children with LFASD performed worse, and fixation on target object was showed to be correlated with their less symptoms and better adaptions. (3) Social-orienting was the most accurate indicator to discriminate ASD from TD, with sensitivity of 70%, and specificity of 96%. Combining social-orienting, RJA, and observational learning, it discriminated ASD from TD with sensitivity of 98%, and specificity of 86%. While controlling DQ, still, social-orienting and RJA could significantly discriminate ASD from TD in the logistic regression. Conclusions: Findings suggested that children with ASD perform abnormally in social-orienting, joint attention and observational learning. Also, these sides of social attention were intercorrelated, which were also correlated with ASD symptoms and adaption. The results implicated that social attention could be one of the early psychopathological mechanism of ASD, and eye-tracking method could be an effective screening tool in defining social attention abnormality in ASD.

並列關鍵字

Autism spectrum disorders ； Social attention ； Social orientation ； Joint attention ； Observational learning ； Eye-tracking ； Symptom severity ； Adaptive function