學齡前自閉症類群障礙症兒童、年長手足之氣質適配與手足關係、問題行為

自閉症類群障礙症兒童 (Autism Spectrum Disorder, ASD) 的社會能力困難是父母、老師以及臨床實務工作者重視的議題。過去已有研究指出手足關係能提升個體社會能力發展，因此，本研究將檢視學齡前ASD兒童及其年長手足之氣質，與ASD兒童手足關係、ASD兒童問題行為之關聯性，以探究適配度 (Goodness-of-fit) 構念。本研究目的如下：第一，檢視ASD兒童之母親、年長手足在知覺ASD兒童與手足間之溫暖、衝突手足關係是否具顯著差異性；第二，探討手足間氣質差異程度對於ASD兒童氣質預測ASD兒童手足關係、ASD兒童問題行為時是否具調節效果。　　本研究採用橫斷式研究設計，共63對學齡前ASD兒童（3歲0個月至7歲9個月）、及其學齡年長手足（5歲11個月至12歲11個月）、母親參與研究。母親填答：兒童氣質量表 (Behavior Style Questionnaire, BSQ72) 、學齡兒童氣質量表 (Middle Childhood Temperament Questionnaire, MCTQ) 、手足關係問卷－修訂版（家長版） (Sibling Relationship Questionnaire-Revised, SRQ-R) 、兒童行為檢核表 (Child Behavior Checklist, CBCL) 以及自閉症類群障礙症檢核表 (Checklist for Autism Spectrum Disorder-Chinese Version, CASD-C) 以蒐集ASD兒童氣質、年長手足氣質、母親知覺的手足關係、ASD兒童問題行為、以及ASD兒童症狀嚴重度等資料；年長手足則填答手足關係問卷－修訂版（兒童版） (Sibling Relationship Questionnaire-Revised,　SRQ-R) 以獲得年長手足知覺的手足關係；此外，以魏氏幼兒智力測驗 (WPPSI-IV) 、魏氏兒童智力測驗 (WISC-IV) 分別蒐集ASD兒童以及年長手足之全量表智商分數 (FSIQ) 。　　研究發現如下：一、母親、年長手足填答之衝突手足關係具顯著差異性，顯示年長手足填答之衝突手足關係較高；二、排除ASD兒童全量表智商分數、ASD兒童症狀嚴重度以及年長手足性別之影響後，基於ASD兒童於特定氣質向度之表現下，探討手足間氣質差異程度與ASD兒童手足關係、ASD兒童問題行為之關聯性。本研究發現當ASD兒童堅持度越低，且年長手足堅持度越低，則母親填答之衝突手足關係越低，該結果支持相似論；當ASD兒童反應強度越高，且年長手足反應強度越低，則母親填答之溫暖手足關係越高；當ASD兒童反應強度越低，且年長手足反應強度誒高，則母親填答之衝突手足關係越低，上述結果支持互補論；此外，當ASD兒童活動量越低，年長手足活動量越高，則ASD兒童外化性問題行為越低，上述結果亦支持互補論。　　本研究發現在排除ASD兒童全量表智商分數、ASD兒童症狀嚴重度以及年長手足性別之影響後，得以透過手足間氣質適配度描繪學齡前ASD兒童及其年長手足之手足關係以及ASD兒童的問題行為。其中，手足間氣質差異程度對於ASD兒童氣質預測ASD兒童手足關係、ASD兒童問題行為時具有調節效果。最後，本研究提供父母、臨床實務工作者在了解ASD兒童手足關係、ASD兒童問題行為時，不僅需考量手足間的氣質差異程度程度，若能將ASD兒童本身氣質特性亦納入考量，更能進一步地了解ASD兒童手足關係、ASD兒童問題行為。

關鍵字

手足關係；自閉症類群障礙症；氣質；問題行為；適配度

並列摘要

Researchers found that sibling relationship could promote the development of social ability. The social difficulties of Autism Spectrum Disorder (ASD) were highly concerned by parents, teachers, and clinical practitioners. Investigating the temperament of ASD preschoolers and their elder siblings on sibling relationship and ASD problem behaviors as to exploring the construct of Goodness-of-fit. The goal of this study was as following: First, to examine the significance of mothers versus elder siblings report of both warmth and conflictual sibling relationship exhibited by elder siblings and their brothers or sisters with ASD within sibling dyads. Second, to investigate whether the temperament difference between siblings would function as a moderator on the relation between ASD temperament and sibling relationship and ASD problem behaviors. 　　This study applied as cross-sectional study. Sixty-three pairs of ASD preschoolers (3yr 0 mo. to 7yr 9mo.) , their elderly siblings (5yr 11 mo. to 12yr 11mo.) , and their mothers participated in the study. Several questionnaires were filled up by mother as following: Behavior Style Questionnaire (BSQ72) and Middle Childhood Temperament Questionnaire (MCTQ) for obtaining the temperament of ASD preschoolers and their elder siblings; Sibling Relationship Questionnaire-Revised (Parent’s Form) for obtaining the sibling relationship perceived by mother; Children Behavior Checklist (CBCL) for obtaining ASD problem Behavior, and Checklist for Autism Spectrum Disorder-Chinese Version (CASD-C) for obtaining ASD autism symptom severity score.An questionnaires was filled up by elder sibling: Sibling Relationship Questionnaire-Revised (Children's Form) for obtaining the sibling relationship perceived by elder sibling. In addition, we collect the full scale IQ score (FSIQ) for ASD children and elder sibling through WPPSI-IV and WISC-IV. 　　The research findings are as follows: First, elder siblings have perceived more conflictual sibling relationship with ASD than mothers have perceived. Second, the lower ASD persistence temperament and lower elder sibling persistence temperament predicted the lowest conflictual sibling relationship perceived by mother, as support the “Temperament Similarity Perspective”.The higher ASD intensity temperament and lower elder sibling intensity temperament predicted the highest warmth sibling relationship perceived by mother; the lower ASD intensity temperament and the higher elder sibling intensity temperament predicted the lowest conflictual sibling relationship perceived by mother, these results supported “Temperament Buffering Perspective”.The lower ASD activity temperament and the higher elder sibling activity temperament predicted the lowest ASD external problem behavior, this result also supported “Temperament Buffering Perspective”. 　　The study implied that temperamental “Goodness-of-Fit” between ASD preschoolers and their elder sibling has illustrated the phenomenon of ASD sibling relationship and ASD problem behaviors except for ASD FSIQ, ASD symptom scores and gender of the elderly. The temperament difference between ASD and their elder siblings was found as a significant moderator between ASD temperament, sibling relationship, and ASD problem behaviors. This study suggested that enhancing the parents‘and clinical practitioners’ knowledge about not only considering the temperament difference between ASD and their siblings, but also considering the ASD own temperament characteristics as to clarifying ASD sibling relationship and ASD problem behavior.