自閉症類群障礙症幼兒適應行為發展：縱貫研究

研究背景與目的：自閉症類群障礙症（autism spectrum disorder, ASD）幼兒適應行為發展的縱貫研究不多。因此，本研究擬探究ASD幼兒適應行為各領域的發展，了解不同次群體的表現。　　方法：研究對象為ASD幼兒共102位，每位參與者接受兩次評估，分別在生理年齡17-35個月進行第一次評估（T1），18個月後進行第二次評估（T2）。以適應行為評量系統第二版（Adaptive Behavior Assessment System-Second Edition）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；綜合後可得一般適應組合（general adaptive behavior, GAC）分數。以穆林早期學習量表（Mullen Scales of Early Learning）評估認知能力，分為：非語文發展商數（Nonverbal Development Quotient, NVDQ）及語文發展商數（Verbal Developmental Quotient, VDQ）兩種指標；以自閉症診斷觀察量表（Autism Diagnostic Observation Schedule）評估自閉症症狀嚴重度。　　結果：研究結果發現GAC分為低分且退步組（組1，64人，約佔62.75%）、低分且進步組（組2，24人，約佔23.53%）、高分且進步組（組3，14人，約佔13.73%）三個次群體。CON分為中得分且進步組（組1，59人，約佔57.84%）、低分且穩定組（組2，31人，約佔30.39%）、高分且進步組（組3，12人，約佔11.76%）三個次群體。SOC分為低分且穩定組（組1，88人，約佔86.27%）及高分且穩定組（組2，14人，約佔13.73%）兩個次群體。PRA分為低分且退步組（組1，70人，約佔68.63%）及高分且進步組（組2，32人，約佔31.37%）兩個次群體。認知功能GAC三組，VDQ皆有進步，T1時組3＞組1、組2，T2時組2、組3＞組1；NVDQ僅組2、組3有進步，T1時三組無顯著差異，T2時組2、組3＞組1。CON三組，VDQ皆有進步，T1與T2皆為組1、組3＞組2；NVDQ僅組2無進步，T1、T2皆為組1、組3＞組2。SOC兩組，VDQ皆有進步，T1時兩組無顯著差異，T2時組2＞組1；NVDQ皆無進步，T1與T2皆為組2＞組1。PRA兩組，VDQ皆有進步，T1、T2皆為組2＞組1；NVDQ僅組2有進步，T1、T2皆為組2＞組1。症狀嚴重度（ADOS總分），GAC三組，組1、組2皆顯著下降；T1時組1＞組3，組2與其他兩組無顯著差異；T2時呈現組1＞組2、組3。CON僅組1有顯著進步，T1、T2皆呈現組2＞組1、組3。SOC兩組，僅組1顯著下降，T1、T2表現無顯著差異。PRA兩組，組1的症狀嚴重度顯著下降，但T1、T2都顯著高於組2。　　結論：ASD幼兒的不同適應行為發展可分成二至三個次群體。認知功能較佳的次群體，適應行為幾乎都在T1獲中得分或高分，或在T2出現進步；認知功能較差的次群體，適應行為表現及成長幅度都較低。各次群體VDQ一致出現顯著進步，但NVDQ則非如此，適應行為進步組的NVDQ進步皆達顯著，且為該適應領域次群體中進步最多者；適應行為退步組的NVDQ維持穩定。適應行為T1中、低得分的組別或是T2進步的次群體，症狀嚴重度較可能減輕。本研究提供臨床工作者早期介入的參考。

關鍵字

自閉症類群障礙症；適應行為；認知功能；症狀嚴重度；縱貫研究

並列摘要

Background and Objectives: Few studies examined the development of adaptive behaviors in young children with autism spectrum disorder (ASD). This study examined the development of adaptive behaviors and understand the subgroups of young children with ASD. 　　Methods: 102 young children with ASD participated at time 1 (chronological age was 17-35 month old), and then followed at time 2 (18 months later). The study assessed the adaptive behaviors by Adaptive Behavior Assessment System-Second Edition, including Conceptual (CON), Socialization (SOC), and Practical (PRA) domains, and general adaptive behavior (GAC) which combined all subscales. In addition, the Mullen Scales of Early Learning was used to measure cognitive abilities, including verbal (VDQ) and nonverbal (NVDQ) domains. Finally, the Autism Diagnostic Observation Schedule was used to assess ASD symptom severity. 　　Results: The score of GAC can be divided into low and decrease group (group 1, 64 children, 62.75%), low and improve group (group 2, 24 children, 23.53%), high and improve group (group3, 14 children, 13.73%). And, the score of CON can be divided into moderate and improve group (group 1, 59 children, 57.84%), low and stable group (group 2, 31 children, 30.39%) and high and improve group (group 3, 12 children, 11.76%). In addition, the score of SOC can be divided into low and stable group (group 1, 88 children, 86.27%) and moderate and stable group (group 2, 14 children, 13.63%). Finally, the score of PRA can be divided into low and decrease group (group 1, 70children, 68.63%) and high and improve group (group 2, 32 children, 31.37%). The cognitive ability of three groups of GAC, the VDQ was improved significantly, group 3 was significantly higher than group 1 and group 2 at T1, group 2 and group 3 was significantly higher than group 1. For the NVDQ, group 2 and group 3 improved significantly, and three groups showed no difference at T1, group 2 and group 3 was significantly higher than group 1 at T2. The cognitive ability of three groups of CON, VDQ showed significantly improved, group 1 and group 3 were higher significantly than group 2 at both T1 and T2. For the NVDQ, group 2 showed no improvement, and group1 and group 3 were significantly higher than group 2 at both T1 and T2. Both groups of SOC showed improvement in VDQ, there was no significant difference between two groups at T1, while group 2 was significantly higher than group 1 at T2. For the NVDQ, both groups showed no significant difference. Group 2 was higher than group 1 at T1 and T2. The symptom severity (total score of ADOS), three groups in GAC, group 1 and group 2 showed significant decrease, group 1 was higher significantly than group 2 at T1 while group 2 showed no difference with the others. Group 1 was higher than group 2 and group 3 at T2. For the groups in CON, group 1 showed significant decrease, group 2 was higher significantly than group 1 and group 3 at T1 and T2. The classification by SOC, group 1 showed significant decrease, while there was no difference at both T1 and T2. Groups that divided by PRA, group 1 showed significant decrease, and it was higher significantly than group 2 at T1 and T2. 　　Conclusion: The development of adaptive behaviors in children with ASD children's can be divided into two to three subgroups. Children with ASD who had better cognitive ability showed moderate or high of the adaptive behavior at T1 and improvement at T2. The VDQ showed significant improvement in each subgroup. However, for the NVDQ, the adaptive behavior improved group showed significant improvement and the adaptive behavior decreased group showed stable. Children with ASD who had moderate and low score of adaptive behavior at T1 or those who showed improvement at T2, their symptom severity might decrease. This study provides the implictions of early intervention for clinical workers.