學齡前兒童行為發展量表與魏氏學前幼兒智力量表修訂版測驗所得之ASD幼兒認知發展的相關性研究

The Relationship Between Development Quotient Assessed by Chinese Child Development Inventory and Intelligence Quotient Assessed by Wechsler Preschool and Primary Scale of Intelligence -Revised in Children with Autism

張家群(Chia-Chun Chang)

指導教授 ： 鐘育志

高雄醫學大學/健康科學院/心理學研究所/碩士(2012年)

https://doi.org/10.6832/KMU.2012.00053

摘要

研究目的：ASD光譜疾患（ASD）是在三歲以前即會在發展上呈現障礙的疾患，常見：社會互動、溝通及想像遊戲，及活動/興趣的固著性三大領域障礙。在醫療體系中，ASD孩童的診斷與處置，常需藉由認知或智力評估做為後續處置的參考。三歲半到六歲的一般孩童常以「魏氏幼兒智力測驗修訂版」(WPPSI-R)做為智力診斷的工具，但此工具需孩童具有一定程度的聽指令能力、注意力及合作度才可完成測驗評估，但ASD孩童由於具有上述三主要領域的發展障礙，故在使用WPPSI-R進行智力評估常遭遇重大困難，此外，由於WPPSI-R測驗耗時較長且須由具經驗的兒童臨床心理師方能施測，非每一個醫療機構皆具備此類專業人力。故迫切需要探討除了除WPPSI-R以外，有否其他替代的評估工具能提供ASD孩童整體療育所須。本研究欲探討針對台灣區域ASD幼兒而言，「學齡前兒童行為發展量表」（CCDI）作為預測WPPSI-R整體分數或各分領域分數間效度，評估以父母填答的CCDI做為WPPSI-R的預測工具是否合適。
方法：本研究共蒐集103名學齡前幼兒，包含個案組56位及對照組各47位，個案組挑選經兒童精神科醫師評估過以DSM-IV標準確診為ASD的孩童，對照組為經兒童精神科醫師評估過無ASD，但同樣具有語言或社會情緒發展遲緩之相同年齡範圍兒童。兩組兒童均由臨床心理師施行WPPSI-R認知測驗，並由父母填寫完成CCDI及「社會反應量表」（SRS）中文版。透過相關及逐步迴歸分析探討CCDI之各領域分數與發展商數（DQ）與IQ之間的相關，同時獲得研究參與者在社會互動上的量化測量。
研究結果：個案組平均年齡為5歲2個月，其中包含92.9％男性，對照組平均年齡亦為5歲2個月，包含80.9％男性。 個案組中平均全量表智商（FSIQ）為83.6?b21.8，平均發展商數（DQ）為77.2 ?b 18.2，平均SRS總分為88.7 ?b 24.8；對照組中，平均全量表智商（FSIQ）為87.1?b17.5，平均發展商數（DQ）為86.6 ?b 16.2，平均SRS總分為64.1 ?b 25.5。個案組與對照組在CCDI之DQ (p =0.01)與SRS總分間(p < 0.001)有顯著差異。相關分析顯示，在兩組中CCDI與WPPSI-R間，DQ與大部分分領域分數與WPPSI-R得分呈正相關FIQ (r= 0.16-0.75), VIQ (r=0.04-0.65) and PIQ (r=0.11-0.66) 。多元迴歸結果顯示，在個案組中，CCDI之「溝通表達」為預測FSIQ之最佳預測變項(β= 0.59, P<0.001)；在對照組中，FSIQ之最佳預測變項則為CCDI之「一般發展」(β= 0.73, P<0.001)。結論： 本研究結果為協助社會情緒發展遲緩的小兒科臨床工作者與教育工作者提供重要的資訊，顯示當急需認知評估結果但又無法取得正式測驗資料時，CCDI可以作為適當的替代工具以衡鑑或預測ASD兒童的認知發展。

關鍵字

ASD ； 學齡前兒童行為發展量表 ； CCDI ； 魏氏幼兒智力測驗 ； WPPSI-R ； 社會反應量表 ； SRS

並列摘要

Objective:The Autistic Spectrum Disorders (ASDs) are developmental disorders which symptoms usually revealed before the child’s three-year-old birthday. The typical symptoms include deficits in social interaction, communication / imaginative game play and characteristic behavioral pattern. Wechsler children's intelligence test–Revised version (WPPSI-R) will usually be arranged to assess cognitive ability of 3 to 6.5 years-old children for the purpose of providing comprehensive treatment and educational plan. However, children will have to be able to comply with instructions, maintain attention and cooperation for the test to be administered, which are all challenging tasks for children with social-emotional delay such as ASDs. Also the test is time consuming and not every hospital has clinical child psychologists on board to provide the service. This study attempts to test the validity of developmental quotients (DQ) on the Parent-completed Chinese Child Developmental Inventory (CCDI-Chinese) as an estimate of intelligence quotient (IQ) for Taiwanese preschool children with ASDs.
Methods: Total 103 preschool children were recruited. 56 of them diagnosed with ASDs were cases, while 47 children diagnosed with non-autistic preschoolers with social-emotional delay serving as controls. Cognitive assessment was administered via WPPSI-R for each child by clinical psychologist. Parents were asked to complete the Chinese Child Developmental Inventory (CCDI-Chinese) and Social Responsiveness Scale (SRS) -Chinese version. Correlational and step-wise regression model were performed to see the inter-relationship among the development quotient (DQ), its eight subscales, intelligent quotient (IQ) and quantitative measure of social reciprocity thus obtained.
Results: 92.9% of the case group was boy and the average age was 5Y2M, while 80.9% of the control group was boy with average age of 5Y2M. For the autistic case group, the average full intelligent quotient (FIQ) was 83.6?b21.8, the average DQ was 77.2 ?b 18.2 and average SRS total raw was 88.7 ?b 24.8. For the control nonautistic group, the average IQ was 87.1?b 17.5, the average DQ was 86.6 ?b 16.2 and average SRS total raw was 64.1 ?b 25.5. Case and control differed in DQ (p =0.01) and SRS total score (p < 0.001). Corelational analysis revealed that for both groups, DQ and the majority of its eight subscale correlated positively with FIQ (r= 0.16-0.75), VIQ (r=0.04-0.65) and PIQ (r=0.11-0.66) and their subsclaes. Multiliner regression revealed that Communication-Expression was the most powerful subscales of CCDI that can predict FSIQ of WPPSI in children with autism (β= 0.59, P<0.001), while General Development was the most valid DQ subscale to estimate the FIQ in control group children (β= 0.73, P<0.001). Conclusion These results bore merits for assessment of children with social-emotional delay in the filed of the pediatric general practitioners and educators. CCDI may function as an alternative tool to assess the cognitive development of children with ASDs when the data are urgently needed and no formal test arrangement are timely available.

並列關鍵字

Autism ； Wechsler children's intelligence test–Revised version (WPPSI-R) ； Chinese Child Development Inventory (CCDI) ； social response scale(SRS)

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