以氣質為基礎的預期指導於學齡前自閉症類群障礙症兒童的成效

為了了解兒童的個別差異，氣質已在學術領域中建立紮實的理論背景，而國外氣質研究者也發展並使用根基於氣質理論與實務結合之方案，然而，在台灣仍未發展出較為完整、結構化且可用之方案。因此，本研究目的在於架構學齡前以氣質為基礎的介入方案，並研究其實徵證據。　　Hepburn（2003）曾提及有心理發展障礙的兒童將有相同或更大的問題行為風險，若將預期指導方案提供給有特殊需求的兒童及父母，可能會有更大的效益。Thomas與Chess（1977）亦強調氣質特徵與環境的交互關係，展現較為難養氣質傾向的自閉症類群障礙症（Autism spectrum disorder, ASD）兒童，也常與環境要求間呈現低適配度。本研究嘗試發展出以氣質為基礎的預期指導方案（簡稱氣質預期指導），透過針對學齡前的一般發展兒童（Typical development, TD）與ASD兒童的母親進行氣質預期指導，提升母親對於氣質構念與內涵的認識，並探討此預期指導方案對於母親氣質知識、母親親職壓力與兒童問題行為的療效。　　本研究招募26對TD親子與15對ASD親子參與氣質預期指導，方案包含六週針對兒童氣質所設計之客製化氣質預期指導資訊，每週透過即時通訊軟體傳送給母親。母親於氣質預期指導前完成填答基本資料表、兒童行為模式問卷（Behavioral Style Questionnaire, BSQ100）、自閉症類群障礙檢核表（華文版）（Checklist for Autism Spectrum Disorder-Chinese Version, CASD-C）；此外，施測魏氏幼兒智力量表第四版中文版（Wechsler Preschool and Primary Scale of Intelligence Fourth Edition, WPPSI-IV）蒐集兒童之全量表智力分數；母親於氣質預期指導前、後皆請填答氣質知識量表（Knowledge About Temperament Survey, KATS）、親職壓力量表（第四版簡式中文版）（Parenting Stress Index, Fourth Edition Short Form, PSI-4-SF）、阿肯巴克實證衡鑑系統（Achenbach System of Empirically Based Assessment）（ASEBA）。　　透過變異數分析進行分析，本研究發現以下三項結果，一、氣質預期指導有助於提升ASD組及TD組母親的氣質知識分數。二、提升母親的氣質知識有助於降低ASD組母親親職壓力的親子失功能互動分數，但在TD組無明顯療效。三、在ASD組中，兒童症狀嚴重度越輕微，內化性問題行為分數下降越多，而氣質預期指導對於TD組的問題行為無明顯療效。　　本研究作為氣質預期指導的前導研究，架構氣質預期指導方案，初步討論方案於母親親職壓力與兒童問題行為的療效，讓父母與臨床實務者能針對兒童氣質因材施教。

關鍵字

以氣質為基礎的預期指導；自閉症類群障礙症；氣質；氣質知識；問題行為；親職壓力

並列摘要

Temperament has established a solid theoretical framework for understanding children's individual differences, the researches of temperament interventions have been developed and conducted programs based on temperamental theory and practice. However, studies about temperamental intervention are still limited in Taiwan. The purpose of this study is to develop a preschooler temperament-based intervention program and investigate the empirical support. 　　Hepburn (2003) suggested that children with developmental disabilities are at equal or greater risk of developing problem behaviors than typical developing (TD) children, anticipatory guidance approaches may have even greater potential for assisting parents of children with special needs. Thomas and Chess (1977) emphasized the transactional relations between children’s temperamental characteristics and environment. Hence, children with autism spectrum disorder (ASD) who had more difficult temperament shows low compatibility of temperament with the surrounding environment, resulting in poor goodness-of-fit. The goal of this study was twofold, first was to conduct a temperament-based anticipatory guidance for helping mothers of children with ASD and TD to understand temperament, second was to analyze the utility of this program on children’s problem behaviors, mothers’ temperament knowledge, and parenting stress. 　　26 mothers and their children with TD, 15 mothers and their children with ASD participated in the Temperament-Based Anticipatory Guidance including a six-week program. Both groups of mothers received temperamental concepts, their own child's temperament via internet communication software, and were asked to complete a basic information questionnaire, temperamental knowledge checklist, Behavioral Style Questionnaire (BSQ100), Checklist for Autism Spectrum Disorder-Chinese version (CASD-C), Knowledge about Temperament Survey (KATS), Parenting Stress Index, fourth edition short form (PSI-4-SF) and Achenbach System of Empirically Based Assessment (ASEBA). In addition, Wechsler Preschool and Primary Scale of Intelligence Fourth Edition (WPPSI-IV) were used to collect full-scale IQ of children. 　　According to the results of ANOVA analysis, this study's findings are as follows: First, the program does improve the temperament knowledge scores of mothers of children with ASD and TD. Second, for the ASD group, improving mothers' temperament knowledge reduces the scores of parent-child dysfunctional interaction in parenting stress, but no significant effect was found in the TD group. Third, in the ASD group, less severe symptoms correlated with more internalizing problems they have, while the program had no significant effect on problem behavior in the TD group. 　　As a pilot study of temperament-based anticipatory guidance, this study designed a program, and preliminarily discusses its utility on mothers' temperament knowledge, parenting stress, and children's problem behavior, so that parents and clinical practitioners may use different teaching methods or treatments according to children’s temperament.