自閉症類群幼兒共享式注意力、模仿與語言能力；以及共享式注意力、適應功能與自閉症症狀的關係

研究背景及目的：共享式注意力及模仿能力，是早期重要的社會溝通能力；然而，很少研究針對3歲以下自閉症類群幼兒，同時探究共享式注意力與模仿能力，和語言能力、適應功能及症狀嚴重度的關係。因此，本研究的目的以3歲自閉症類群幼兒為對象，探究共享式注意力與模仿能力，在語言能力、適應功能及症狀嚴重度的角色。方法：受試者為113名自閉症類群幼兒，平均生理年齡約30個月。修改台灣版兩歲期自閉症篩檢工具，測量主動性共享式注意力、反應性共享式注意力、物體模仿及動作模仿能力。主動性共享性注意力，區分為完整主動性共享式注意力與部分主動性共享式注意力。分別以穆林發展量表測量（Mullen Scales of Early Learning, MSEL），適應行為評量系統第二版（Adaptive Behavior Assessment System-II, ABAS-II）及自閉症診斷量表（Autism Diagnostic Observation Schedule, ADOS）測量語言能力、適應功能與自閉症症狀。結果：主動性共享式注意力、反應性共享式注意力、物體模仿及動作模仿能力，皆與語言理解、語言表達、語言心理年齡、ABAS-II溝通分數、ABAS-II整體適應功能、ABAS-II各適應領域及自閉症症狀嚴重度顯著相關。階層迴歸結果，控制生理年齡及非語言認知能力後，反應性共享式注意力及動作模仿，可以預測整體語言能力；反應性共享式注意力及物體模仿，可以預測ABAS-II溝通分領域；反應性共享式注意力，可以預測語言理解能力；反應性共享式注意力及動作模仿可以預測語言表達。適應功能部份，反應性共享式注意力，可以預測適應功能概念知能及社會知能領域。症狀嚴重度，部份主動性共享式注意力與反應性共享式注意力，皆能預測症狀嚴重度。結論：整體語言能力及ABAS溝通分領域，反應性共享式注意力都是最有力的預測因子，代表注意他人分享注意力的焦點，瞭解他人的分享意圖，是語言學習重要的因素。動作模仿預測結構化測驗的整體語言能力，物體模仿預測照顧者填寫的ABAS溝通分領域，顯示物體模仿與動作模仿的功能不一樣。適應功能，反應性共享式注意力能預測概念知能及社會知能領域；症狀嚴重度，部份主動性共享式注意力及反應性共享式注意力，能預測症狀嚴重度，顯示跟隨他人注意力的焦點，對日常適應功能及症狀嚴重度很重要；此外，具備部份與他人分享的動機，也會影響症狀嚴重度。共享式注意力及模仿能力，在語言發展具有重要角色，也影響適應功能及症狀嚴重度，對早期介入的設計有幫助。

關鍵字

共享式注意力；自閉症類群；症狀嚴重度；語言能力；模仿能力；適應功能

並列摘要

Background and objectives：Joint attention and imitation ability were the important social communication abilities in early childhood. However, there were few studies to investigate the correlates of language abilities, adaptive functioning, and autism symptom severity in young children with autism spectrum disorders (ASD) less than age of 3 years. Therefore, the purposes of this study were to measure JA and imitation in children with ASD less than age of 3 years, and investigate the relationships between these two social-communicative abilities, and language abilities, adaptive functioning, and autism symptom severity. Method：There are 113 participants with ASD, with mean age about 30 months. The Screening Tool for Autism in Two-Year-Olds, Taiwan version (T-STAT)(Chiang , Wu, Liu, & Hou, 2012) was modified and used to measure the social-communicative abilities, including initiating joint attention (IJA), responding joint attention (RJA), object imitation, and manual imitation. The IJA was divided into full-IJA(F-IJA) and partial-IJA(P-IJA). Both structured tool and parent-report scale was used to measure language abilities, including the Mullen Scales of Early Learning (MSEL)(Mullen, 1995) and Communication domain in Adaptive Behavior Assessment System -II (ABAS-II)(Harrison & Oakland, 2003). ABAS-II was used to measure adaptive functioning and Autism Diagnostic Observation Schedule (ADOS)(Lord, Rutter, DiLavore, & Risi, 1999) was used to measure symptom severity. Result：The results of this study showed that F-IJA, P-IJA, RJA, object imitation and manual imitation were all significantly related to receptive language, expressive language, overall language, communicative ability, all domains of adaptive functioning and symptom severity. Hierarchical regression was used for controlling the chronological age and non-verbal cognitive ability. The concurrent predictors of overall language ability were RJA and manual imitation. Additionally, the concurrent predictors of communicative ability were RJA and object imitation. For receptive language, the predictor was RJA. For expressive language, the predictors were RJA and manual imitation. Furthermore, the concurrent predictor of cognitive and social domain of adaptive functioning was RJA. The concurrent predictors of symptom severity were P-IJA and RJA. Conclusion：The results of this study revealed that RJA was the robust predictor of language abilities. Children with ASD could correctly follow partner’s directing attention, it could enhance language development. In addition, manual imitation could predict language abilities measured by structured assessment, whereas object imitation could predict communicative ability measured by parent-report scale. For adaptive functioning, cognitive domain and social domain were predicted by concurrent RJA. Symptom severity was predicted by concurrent P-IJA and RJA. Suggesting that following partner’s directing attention could enhance adaptive functioning and reduce symptom severity. Otherwise, sharing a focus with partners could reduce symptom severity. The results provide a direction to design the early intervention program for young children with ASD.