使用兒童行為檢核表評估與篩檢學齡前自閉症類群疾患兒童

Using Child Behavior Checklist for Assessing and Detecting Preschool Children with Autism Spectrum Disorders

游雯涵(Wen-Han Yu)

指導教授 ： 鍾昆原

共同指導教授 ： 吳進欽(Chin-Chin Wu)

高雄醫學大學/人文社會科學院/心理學系碩士班/碩士(2015年)

https://doi.org/10.6832/KMU.2015.00076

摘要

研究目的：自閉症類群疾患（autism spectrum disorders, ASDs）兒童常伴隨情緒和行為問題。ASDs兒童的情緒和行為問題往往加重患者社交、溝通上的障礙，及照顧者的壓力。「兒童行為檢核表（Child Behavior Checklist for age 1.5-5，簡稱CBCL/1.5-5）」被廣泛用來評估學齡前兒童的情緒和行為問題。過去學界研究嘗試以CBCL/1.5-5篩檢ASDs兒童；然而，台灣沒有相關研究發表。因此，本研究探究CBCL/1.5-5，運用在學齡前ASDs兒童的情緒和行為問題評估及篩檢效度。
研究方法：249名生理年齡在48個月以下的兒童，包括：99名ASDs兒童、114名發展遲緩兒童、和36名一般發展兒童，由家長填寫CBCL/1.5-5，評估兒童的情緒和行為問題。
研究結果：主量尺中的內化問題、症狀量尺中的退縮，及DSM導向量尺中的廣泛性發展問題，ASDs組高於發展遲緩組與一般發展組；此外，主量尺中的整體問題、症狀量尺中的注意力問題，ASDs組顯著高於一般發展組。ASDs組和發展遲緩組，退縮、廣泛性發展問題和內化問題量尺鑑別力高。使用訊號偵測理論決定最佳切截分數，退縮分量尺以T分數66分（原始分數5分）作為切截分數，敏感度和特異度分別為72%和70%；廣泛性發展問題分量尺以T分數70分（原始分數9分）作為切截分數，敏感度和特異度分別為71%和63%；內化問題量尺以T分數63分（原始分數17分）作為切截分數，敏感度和特異度分別為63%和62%。ASDs組和一般發展組，退縮、廣泛性發展問題、注意力問題、內化問題和整體問題量尺的鑑別力高。一樣以訊號偵測理論決定最佳切截分數，退縮分量尺以T分數62分（原始分數4分）作為切截分數，敏感度和特異度分別為83%和83%；廣泛性發展問題分量尺以T分數65分（原始分數7分）作為切截分數，敏感度和特異度分別為77%和78%；注意力問題分量尺以T分數56分（原始分數4分）作為切截分數，敏感度和特異度分別為73%和64%；內化問題量尺以T分數60分（原始分數14分）作為切截分數，敏感度和特異度分別為75%和64%；整體問題量尺以T分數59分（原始分數48分）作為切截分數，敏感度和特異度分別為71%和64%。本研究結果顯示以CBCL/1.5-5中的退縮和廣泛性發展問題分量尺在一般社區樣本和臨床樣本中篩檢ASDs兒童，具可接受的篩檢效度。
研究結論：CBCL/1.5-5篩檢ASDs兒童的效度，退縮和廣泛性發展問題分量尺具中度篩檢效度，可以考慮做為臨床場域中篩檢ASDs的工具。

關鍵字

自閉症類疾患 ； 兒童行為檢核表 ； 情緒和行為問題 ； 早期篩檢 ； 敏感度 ； 特異度

並列摘要

Purpose: Children with autism spectrum disorders (ASDs) usually accompanied emotional and behavioral problems. Children with emotional and behavioral problems could result in more impairments on their social and communication, thus make stress on their caregiver. Child Behavior CheckList 1.5-5 (CBCL/1.5-5) is a tool for evaluating emotional and behavioral problems of preschool children and is used CBCL/1.5-5 to screen ASDs children. However, there is no research in Taiwan. In this study, the CBCL/1.5-5 is used to assess and detect preschool children with ASDs.
Methods: 249 children less than aged 48 months old, including 99 children with ASDs, 114 children with developmental delay (DD), and 36 children with typical development (TD). The CBCL/1.5-5 was completed by the caregivers for measuring emotional and behavioral problems of all children.
Results: ASDs group is higher than DD group and TD group on internalizing problems of broadband scales, withdrawn subscale of, syndrome scales of, and pervasive developmental problems subscales of DSM-direct scale. In addition, ASDs group is higher than TD group on total problems of main scales and attention problems subscale of syndrome scales. All of withdrawn, pervasive developmental problems and internalizing problems are better index for distinguishing children with ASDs from children with DD. Using signal detection procedure, T-score of 66 on the withdrawn subscale as the cut-off to distinguish children with ASDs from those with DD, the sensitivity and specificity were 72% and 70%, respectively; T-score of 70 on the pervasive developmental problems subscale as the cut-off to distinguish children with ASDs from those with DD, the sensitivity and specificity were 71% and 63%, respectively; T-score of 63 on the internalizing problems subscale as the cut-off to distinguish children with ASDs from those with DD, the sensitivity and specificity were 63% and 62%, respectively. All of withdrawn, pervasive developmental problems, attention problems, internalizing problems and total problems are better index for distinguishing children with ASDs from children with TD. Using signal detection procedure, T-score of 62 on the withdrawn subscale as the cut-off to distinguish children with ASDs from those with TD, the sensitivity and specificity were 83% and 83%, respectively; T-score of 65 on the pervasive developmental problems subscale as the cut-off to distinguish children with ASDs from those with TD, the sensitivity and specificity were 77% and 78%, respectively; T-score of 56 on the attention problems subscale as the cut-off to distinguish children with ASDs from those with TD, the sensitivity and specificity were 73% and 64%, respectively; T-score of 60 on the internalizing problems subscale as the cut-off to distinguish children with ASDs from those with TD, the sensitivity and specificity were 75% and 64%, respectively; T-score of 59 on the total problems subscale as the cut-off to distinguish children with ASDs from those with TD, the sensitivity and specificity were 71% and 64%, respectively. The results revealed that using the withdrawn and pervasive developmental problems subscale as a screening index for detecting children with ASDs, it showed accepted validity.
Conclusions: Used the CBCL/1.5-5 as a screening tool for children with ASDs, the withdrawn and pervasive developmental problems subscale have moderate validity, suggest the two subscales can be screening tool in the clinical setting.

並列關鍵字

autism spectrum disorders ； Child Behavior Checklist/1.5-5 (CBCL/1.5-5) ； emotional and behavioral problems ； early screening ； sensitivity ； specificity

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