高、低功能自閉症類群障礙症兒童適應行為表現型態

研究背景與目的：過去研究，較少針對學齡前高、低功能自閉症類群障礙症（autism spectrum disorder, ASD）適應行為進行探究。本研究主要目的是以有台灣常模的適應行為評量系統第二版中文版（Adaptive Behavior Assessment System-Second Edition, ABAS-II）評量台灣學齡前兒童適應行為表現，並釐清認知功能及自閉性症狀嚴重度，二者與適應行為的關聯。方法：研究對象為2至5歲學齡前兒童，依其診斷與發展商數，區分為高功能自閉症類群障礙症（High-Functioning Autism Spectrum Disorder, HFASD）組72名、低功能自閉症類群障礙症（Low-Functioning Autism Spectrum Disorder, LFASD）組62名，及發展遲緩（Development Delay, DD）組41名；配對LFASD組與DD組兒童之生理年齡、心理年齡，及發展商數。以ABAS-II評估適應行為表現，包含：概念知能（Conceptual, CON）、社會知能（Social, SOC）及實用技巧（Practical, PRA）三適應領域；以穆林早期學習量表（Mullen Scales of Early Learning, MSEL）評量認知能力；以自閉症診斷觀察量表（Autism Diagnostic Observation Schedule, ADOS）評量自閉性症狀嚴重度。結果：HFASD兒童在各適應領域皆顯著高於LFASD兒童。CON領域，HFASD兒童高於DD兒童，LFASD與DD兒童無顯著差異；SOC與PRA領域，HFASD與DD兒童無顯著差異，LFASD兒童低於DD兒童。HFASD兒童的適應行為表現呈現「SOC = PRA < CON」的型態，各適應領域行為表現與發展商數無顯著差異；LFASD兒童呈現「SOC = PRA = CON」，各適應領域表現皆顯著高於其發展商數；DD兒童呈現「CON < SOC = PRA」的型態，各適應領域表現皆顯著高於其發展商數。HFASD兒童適應行為表現與心理年齡、發展商數無顯著相關，SOC與ADOS社交互動障礙有顯著負相關；LFASD兒童各適應領域表現皆與發展商數有顯著正相關，且與自閉性症狀顯著負相關。結論：本研究發現學齡前LFASD兒童適應行為表現，落後於DD兒童；HFASD兒童適應行為表現，並未落後於DD兒童。此外，高、低功能ASD兒童呈現不同適應行為型態，此型態反映出認知能力對適應型態的影響，尤其在CON的表現。本研究提供臨床工作者早期篩檢與介入的參考。

關鍵字

自閉症類群障礙症；台灣常模；適應行為；認知；症狀嚴重度

並列摘要

Background and Objectives: In past studies, few studies examined the adaptive behavior in high-functioning and low-functioning preschool children with autism spectrum disorder (ASD). This study examined the adaptive behavior of children with ASD and assessed correlates (i.e., cognitive ability and ASD symptomology) of adaptive behavior using the Adaptive Behavior Assessment System-II (ABAS-II) which is based on Taiwanese norm. Methods: The participants, aged 2-5, were assigned into three groups according to diagnosis and development quotient (DQ), including 72 High-Functioning Autism Spectrum Disorder (HFASD), 62 Low-Functioning Autism Spectrum Disorder (LFASD), and 41 Development Delay (DD). Children in LFASD group and DD group were matched on chronological age, mental age (MA), and DQ. The ABAS-II was used to assess each child’s adaptive behavior, including Conceptual (CON), Socialization (SOC), and Practical (PRA) domains. The Mullen Scales of Early Learning (MSEL) was used to measure cognitive ability. The Autism Diagnostic Observation Schedule (ADOS) was used to assess ASD symptomology. Results: Children with LFASD had significant deficits compared to children with HFASD in every adaptive domain. In CON, children with DD had significant deficits compare to children with HFASD, and there was no significant difference between children with LFASD and with DD. In SOC and PRA, there was no significant difference between children with HFASD and with DD, and children with LFASD had significant deficits compared to children with DD. Children with HFASD had a profile of adaptive behavior in which “SOC = PRA < CON”. There was no significant discrepancy between adaptive behavior and DQ in children with HFASD. Children with LFASD had a profile of adaptive behavior in which “SOC = PRA = CON”. Children with DD had a profile that indicates “CON < SOC = PRA”. The children’s DQ is significantly lower than their adaptive behaviors in both children with LFASD and with DD. In children with HFASD, there was a significant negative relationship between SOC and ADOS social disability, but no other significant relationship was found between adaptive behavior and MA, DQ, and ASD symptomology. In children with LFASD, the relationship between adaptive behaviors and DQ was positive, and negative relationships were found between adaptive behaviors and ASD symptomology. Conclusion: The results indicate as compared to children with DD, children with LFASD exhibited significantly greater deficits in adaptive behavior. The adaptive behaviors in children with HFASD weren’t worse than children with DD. The unique adaptive patterns of HFASD and LFASD reflect the effect of cognitive that especially demonstrate on CON. This study supports the early screening and intervention to clinical workers.