高功能自閉症類群障礙兒童心智理論與執行功能之探究：與症狀嚴重度及適應行為之關聯性

研究目的：本研究主要目的為探究高功能自閉症類群障礙（High-functioning Autism Spectrum Disorder, HFASD）兒童心智理論與執行功能之關聯性，並探索心智理論與執行功能表現能否反映其自閉症狀嚴重度及適應行為差異。此外，呼應自閉症類群障礙的異質性，嘗試以心智理論與執行功能表現描繪具注意力不足過動症特徵HFASD兒童之特性。研究方法：本研究共招募生理年齡7-10歲的66名HFASD兒童與40名一般發展兒童，接受一項心智理論作業（含諷刺及隱喻分測驗）與三項執行功能作業（強勢反應抑制、抑制分心物干擾及心智彈性），並評估其智力、自閉症症狀、注意力不足過動症症狀與適應行為表現。研究結果：相關性分析結果顯示，心智理論與執行功能作業之間顯著的相關性普遍存在於HFASD組，一般發展組則僅有強勢抑制反應時間與心智理論作業有顯著的負相關。缺損型態結果指出近四成HFASD兒童的心智理論與執行功能皆無缺損，僅心智理論缺損以及僅執行功能缺損的人數比例則相當；此外，具注意力不足過動症特徵的HFASD兒童更容易發生心智理論的缺損。行為症狀方面，不同缺損型態略能反映HFASD兒童的自閉症狀嚴重度，且心智理論與執行功能皆呈現缺損的HFASD兒童有更嚴重的溝通症狀；然而，此缺損型態無法反映出HFASD兒童的適應行為問題。總結：學齡HFASD兒童的心智理論與執行功能之間仍具有顯著的相關性，且心智理論與執行功能缺損型態可反映HFASD兒童部分的自閉症狀嚴重度，凸顯同時考量執行功能與心智理論的重要性。

關鍵字

高功能自閉症類群障礙症；心智理論；執行功能；自閉症狀；適應功能；注意力不足過動症特徵

並列摘要

Purposes: The purpose of the study was to explore the relationship of the Theory of Mind (ToM) and Executive Finction (EF) in children with High-functioning Autism Spectrum Disorder (HFASD), and explore whether the performance of ToM and EF can reflect severity of autistic symptom and adaptive function. In addition, concerning the heterogeneity within ASD, the study was also attempted to use ToM and EF to identify ADHD trait within HFASD. Methods: Sixty-six HFASD children and fourty typically development (TD) children were recruited, and all children were aged 7-10 years. Participants were assessed on a battery of tasks measuring ToM (including irony and metaphor) and EF (including inhibition control and cognitive flexibility). IQ, autism severity, ADHD trait and adaptive function were also measured. Results: Performance on ToM and EF tasks was significantly related to each other in the HFASD group, while there was only a significant negative correlation between ToM and reaction time of prepotent inhibition in the TD group. Examination of the pattern of EF-ToM impairments in the HFASD group, indicating nearly 40% children with HFASD demonstrated intact EF and ToM, while the propotions of impaired ToM and impaired EF were equivalent; furthermore, the children with HFASD combining with ADHD trait proned to demonstrate impaired ToM. The pattern of EF-ToM impairments can explain the severity of autistic symptom. HFASD children who demonstrated impaired EF and ToM also showed more symptoms in communication. However, the pattern of EF-ToM impairments cannot explain the adaptive function. Conclusions: A significant relationship were revealed between ToM and EF in the shool-aged children with HFASD. Autism severity can be partially explained by the pattern of EF-ToM impairments. The results indicated the importance roles of both the EF and ToM to explain the heterogeneity of HFASD.