學齡前自閉症類群障礙症兒童之氣質、情緒調節與共親職

自閉症類群障礙症（Autism spectrum disorder, ASD）幼兒的情緒困難是父母、老師及臨床工作者重視的議題，過去研究指出情緒困難的主要原因並非情緒，而是情緒調節出現困難，Thompson(1994)之多重途徑說定義情緒調節是「個體為了某個目的，去監控、評估和調整情緒反應的內在、外在歷程」，並主張情緒調節可透過多種不同的途徑進行，因此，影響情緒調節主要的因素可分成內在及外在因素，Kopp和Neufeld(2003)指出影響情緒調節的內在因素包括年齡、氣質、語言能力，另外，對ASD兒童來說，ASD症狀亦是影響情緒調節的重要因素(Samson, Phillips, et al., 2014)；在這些因素當中，本研究欲以Rothbart之氣質理論探討ASD幼兒氣質對情緒調節的影響。除了兒童個人特質的影響，環境對情緒調節同樣具有影響力，且指出個人內在特質對情緒調節影響，並非永遠不變，會與環境進行交互作用。因此，本研究採用Minuchin的家庭系統觀，將父母作為一個次系統，也就是父母在教養時互相支持和抵制的共親職，進而探究母親覺察到的共親職對ASD幼兒情緒調節造成的影響，並進一步探究內在因素（氣質）及外在因素（共親職）兩者交互作用對情緒調節的影響力。本研究採用橫斷式研究設計，共49對3至7歲ASD幼兒及其母親參與研究。請母親填答幼兒情緒調節策略量表、兒童行為量表（Child Behavior Questionnaire, CBQ）、共親職關係量表（Coparenting Relationships Scale, CRS）、自閉症類群障礙症檢核表（Checklist for Autism Spectrum Disorder-Chinese Version, CASD）蒐集ASD幼兒的情緒調節、氣質和母親覺察到的共親職、以及ASD症狀分數的資料，此外，以魏氏幼兒智力測驗（WPPSI-IV）蒐集ASD幼兒之語文理解指數分數（VCI）。研究發現如下：一、症狀分數可以正向預測「發洩安撫策略」，並負向預測「認知型情緒調節類型」及「認知引導策略」，顯示幼兒ASD症狀表現或許可以做為他們調節情緒及環境的策略，但可能因而阻礙發展其他情緒調節；語言理解指數分數正向預測「行為型情緒調節類型」及「攻擊策略」，顯示語言能力越好ASD幼兒因自身社交溝通能力缺損，語言表達不符合社會規則，容易被誤會成言語攻擊；二、控制症狀分數及語言理解指數分數後：ASD幼兒的外化啟動性（surgency）氣質可顯著預測「行為型情緒調節類型」、「攻擊策略」、「發洩安撫策略」，顯示探索環境動機高的ASD幼兒，較容易受到阻礙及挫折，易衝動地用攻擊或發洩安撫策略將情緒發洩出來；ASD幼兒的努力控制（effortful control）氣質可顯著預測「認知型情緒調節類型」、「尋求照顧者」、「認知引導」策略，顯示不論ASD幼兒是否具高外向啟動性，學習認知型情緒調節類型、尋求照顧者、及認知引導策略的關鍵仍是其努力控制的特質；三、不論是支持性（supportive coparenting）或耗損性共親職（undermining coparenting），對情緒調節類型及策略未達顯著預測力；進一步發現，支持性共親職在ASD幼兒的努力控制預測「認知型情緒調節類型」以及「認知引導策略」時，具有調節的效果，顯示在父母彼此支持、合作的氣氛下，可以強化ASD幼兒的努力控制對「認知型情緒調節類型」以及「認知引導策略」的正面影響。本研究結果發現在ASD幼兒症狀分數及語言理解指數分數之外，氣質得以描繪ASD幼兒情緒調節之間的樣貌；另外，本研究發現支持性共親職可作為氣質與情緒調節之間調節變項，本研究亦能使父母了解到彼此的合作對ASD幼兒發展認知型情緒調節類型及認知引導策略具有良好的影響。

關鍵字

自閉症類群障礙症；學齡前兒童；氣質；共親職；情緒調節

並列摘要

The issue of emotion difficulty in children with Autism Spectrum Disorder (ASD) is often concerned by their parents, teachers and clinics. Researchs found that emotion difficulty is due to deficit of emotion regulation instead of emotion itself. Therefore, it is known that emotion regulation is a vital capability for ASD children. Emotion regulation is defined as “the extrinsic and intrinsic processes responsible for monitoring, evaluating, and modifying emotional reactions… to accomplish one’s goal’’ (Thompson, 1994). Emotion can be regulated through a variety of processes. Kopp and Neufeld (2003) indicated that emotion regulation would be predicted by chronlogical age, temperment, and verbal ability (intrinsic processes). ASD symptoms is one of predictor for emotion regulation in ASD group (Samson, Phillips, et al., 2014). This study is to investigate the predictability of temperament of ASD preschooler as intrinsic processes in emotional regulation. Based on Minuchin family systems theory (1985), dyadic relations in family between parent behavior should be deemed. Coparenting refers to how mothers and fathers coordinate their parenting efforts and supportive or undermine each other in their roles as parents. This study also investigated the predictability of coparenting as extrinsic processes in emotional regulation. Furthermore, Interaction effect of temperament and coparenting would be he examined as well. This study applies as cross-sectional study. Fourty-nine pairs of ASD children (aged from 3 to 7) and their mother were participated in this investigation. Several questionnaires were filled by mother: Youth Emotion Regulation Questionnaire (YERQ) for obtaining emotion regulation types and strategies, the Child Behavior Questionnaire (CBQ) for obtaining ASD children’s temperament, the Coparenting Relationships Scale (CRS) for obtaining supportive and undermining coparenting, the Checklist of Autism Spectrum Disorder (CASD)for obtaining the severity of ASD symptoms. The Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition (WPPSI-IV) was conducted individually on ASD children to obtain their Verbal comprehension index (VCI). ASD symptomatology was the preticator variables of higher venting strategy, lower cognitive emotion regulation type and verbal express strategy. It implies that ASD syndrome (CASD) would become as a kind of strategy but also interfere ASD children to develop other strategies. VCI was the preticator variable of higher acting emotion regulation type and aggression strategy. It impies that due to social communication deficit, ASD children’s verbal expression would be misinterpreted as verbal agreesion. A series of hierarchical regression analyses for different emotional regulation types and strategies indicators yielded after controlling for CASD and VCI. Temperament of surgency was the predicator variable of acting emotion regulation type and its strategies. It implies that ASD children who intend to approach environment experience more frustrations. And then, they would act out impulsively. Temperment of effortful control was the predicator variable of cognitive emotion regulation type, seeking caregiver, and cognitive behavior strategies. It implies that effortful control of ASD is key characteristic for fostering cognitive emotion regulation type, seeking caregiver, and cognitive behavior strategies regardless of surgency and negative affectivity. Interactions of effortful control temperament and supportive coparenting could predict cognitive emotion regulation type and cognitive behavior strategies. ASD Children's effortful control was associated with greater emotion regulation type and cognitive behavior strategies enhanced by their parents were with higher supportive coparenting. This study suggests that temperament can illustrate the topography of emotion regulation in ASD children except for symptomatology and VCI. Otherwise, supportive coparening is a mediator in the relationship of temperament and emotion regulation. It enhances therapists’ and parents’ knowledge that coparenting strengthens the effect of effortful control effectively.