高功能自閉症類群障礙學齡兒童心智理論能力表現之研究

Abstract

研究目的：心智理論（Theory of Mind）缺陷在過去幾十年來一直是學界所探究的主要自閉症心理病理議題之一，然而Pellicano（2011）提出自閉症心理病理理論的標準使得該理論受到挑戰。本研究旨在發展適切的心智理論作業，以了解高功能自閉症類群障礙症（Autism Spectrum Disorder, ASD）學齡兒童的心智理論表現。\n方法：本研究招募經生理年齡配對之6歲至12歲的智能優異高功能ASD學齡兒童67名以及一般發展學齡兒童51名，將鳳華（2007）發展之心智理論作業進行修訂，作業內容包括慾望或情境引起的情緒與信念、基本信念、第一階錯誤信念、第二階錯誤信念、諷刺、隱喻、失態等分測驗的評估。受試兒童接受心智理論、智能、語言、自閉症症狀嚴重度、適應行為等評估。\n結果：修訂之心智理論測驗其內部一致性信度、評分者間一致性信度以及建構效度表現尚可，「第一階錯誤信念」分測驗的信效度表現較差。高功能ASD兒童與一般發展兒童在心智理論作業得分上有很大的重疊；智能優異高功能ASD兒童整體表現雖然與一般發展兒童相當，但是較一般發展兒童使用較多錯誤的心智辯證內容；非智能優異高功能ASD兒童則是整體表現皆較一般發展兒童弱。心智理論表現雖能顯著預測部分ASD兒童於實驗情境中的社交、溝通、重複性行為症狀表現，但無法預測家長報告之症狀嚴重度和日常適應行為水準。\n結論：本研究修訂之心智理論作業尚可做為探究學齡心智理論發展之參考工具，唯部分分測驗題項內容仍建議需進一步的修訂。心智理論缺陷雖可預測實驗情境中的部分ASD症狀表現，然而智能和語言發展可能補償ASD兒童的部分心智理論能力，且並非所有ASD兒童皆表現出其缺陷，顯示ASD者的心智理論缺陷仍需要更為細膩的測量與探究。針對以上發現進行討論，並給予未來研究和實務上的建議。

Purpose：The theory of mind (ToM) deficits have been one of the main topics of psychopathology in autism spectrum disorder (ASD) in the past few decades, however, some challenges were proposed from Pellicano (2011). The purpose of the study was to develop an optimal ToM task and to explore the performance in the school-aged children with high-functioning ASD on ToM.\nMethod：Sixty-seven 6-12 years old children with HFASD and 51 chronological age matched children with typically development (TD) were recruited. The ToM Task developed by Feng Hua (2007) was modified and the task included subtests of “emotion and belief aroused by eagerness or situation”, ”basic belief”, ”1st-order false belief”, “2nd-order false belief”, “irony”, “metaphor”, “Faux Pas” etc.. Participants received assessments of ToM, intelligence, language, ASD symptom severity, and adaptive behavior.\nResult：The modified ToM Task had fair internal consistency reliability, interrater reliability, and construct validity, but the “1st-order false belief” subtest had poor reliability and validity. There was largely overlapped between HFA children and TD children on ToM task scores. Overall performance in the children with IG-HFA was as good as the children with TD, however, they made more false mental justifications than TD children; Non-IG-HFA children’s overall performance was worse than TD children. ToM performance would partially predict symptom severities of social, communication, repetitive behavior under laboratory context in ASD children, but not symptom severities and daily adaptive behaviors reported by parents.\nConclusion：The modified ToM Task could be a tool for exploring ToM development for school-aged children, however, some items are suggested to be further modified. Though the deficit of Theory of mind can partially predict ASD symptoms under laboratory context, IQ and language development might compensate partial ToM ability in children with ASD. Also, not all children with ASD having ToM deficits indicates that subtler measures and explorations on ToM deficits of ASD are needed. The suggestions for future study and practical application is discussed.