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題名 自閉症類群障礙兒童症狀嚴重度發展軌跡類型之探討
Patterns of Developmental Trajectories of Symptom Severity in Children with Autism Spectrum Disorder作者 林楷潔
Lin, Kai-Chieh貢獻者 姜忠信
Chiang, Chung-Hsin
林楷潔
Lin, Kai-Chieh關鍵詞 自閉症類群障礙症
自閉症症狀發展軌跡類型
認知功能
適應行為
城鄉差距
autism spectrum disorder
autistic symptom developmental trajectory
cognitive function
adaptive function
urbanicity日期 2019 上傳時間 7-八月-2019 16:34:12 (UTC+8) 摘要 自閉症類群障礙症（Autism Spectrum Disorder, ASD）被視為具高度異質性的發展障礙症，區辨出ASD症狀發展軌跡的類型被視為是理解ASD異質性的重要觀點。本研究追蹤六年74名來自於台灣都會地區台北市（n = 37）與鄉村地區嘉義縣市（n = 37）的ASD兒童，在兒童平均生理年齡為3歲、5歲、9歲三個時間點時測量其ASD症狀嚴重度，透過階層式群集分析搭配二因子混合設計變異數分析，區辨出橫跨學步兒期至學齡期的ASD症狀發展軌跡類型，並進一步使用多項式邏輯斯迴歸分析，探索環境背景、兒童早期特徵等對於發展軌跡類型的預測力，及用單因子變異數分析，檢視各發展軌跡類型的環境、認知功能特徵及行為問題、適應行為、親職壓力等預後表現之組間差異。研究結果區辨出「高嚴重度組」（24.32％）、「改善組」（12.16％）、「持續中嚴重度組」（21.62％）及「惡化組」（41.89％）四種ASD症狀發展軌跡；各發展軌跡類型在父母教育程度、早期認知功能、認知功能進步幅度，及國小階段的認知功能、適應行為上皆具有各自獨特的樣貌；本研究亦發現，收案地區能夠有效地預測發展軌跡組別，僅有居住在都會地區台北市的ASD兒童屬於改善組。研究結果反映出居住環境、醫療資源可行性及疾病敏感度等在ASD病程發展的重要角色。
Autism spectrum disorder (ASD) is widely known to be a highly heterogeneous neurodevelopmental disorder. Focusing on the developmental trajectories of autism severity is one of promising ways to understand the heterogeneity of ASD and may lead to a better understanding of prognosis (Baker, Smith, Greenberg, Selzer, & Taylor, 2011). However, seldom longitudinal studies have been conducted in the East, and also none of them addressed the topic of urbanicity. In this study, 74 ASD participants recruited from Taiwan metropolitan area Taipei city (n=37) and rural area Chiayi county (n=37) were assessed at three time points from toddlerhood to school age (mean age: T1 = 36.29 months, T2 = 58.78 months, T3 = 109.68 months) across 6 years. The hierarchical cluster analysis collocated with two-way mixed designed ANOVA were used to identify the subgroups of three time points on ADOS Total CSS. Similar to finding of Western sample, Taiwan ASD children can be divided into four subgroups including “high severity” (24.32%), “improving” (12.16%), “persistent moderate severity” (21.62%) and “worsening” (41.89%). Each subgroup has its own characteristics of demography, cognitive functions and adaptive functions. 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國立政治大學
心理學系
102752014資料來源 http://thesis.lib.nccu.edu.tw/record/#G1027520141 資料類型 thesis dc.contributor.advisor 姜忠信 zh_TW dc.contributor.advisor Chiang, Chung-Hsin en_US dc.contributor.author (作者) 林楷潔 zh_TW dc.contributor.author (作者) Lin, Kai-Chieh en_US dc.creator (作者) 林楷潔 zh_TW dc.creator (作者) Lin, Kai-Chieh en_US dc.date (日期) 2019 en_US dc.date.accessioned 7-八月-2019 16:34:12 (UTC+8) - dc.date.available 7-八月-2019 16:34:12 (UTC+8) - dc.date.issued (上傳時間) 7-八月-2019 16:34:12 (UTC+8) - dc.identifier (其他 識別碼) G1027520141 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/124863 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 心理學系 zh_TW dc.description (描述) 102752014 zh_TW dc.description.abstract (摘要) 自閉症類群障礙症（Autism Spectrum Disorder, ASD）被視為具高度異質性的發展障礙症，區辨出ASD症狀發展軌跡的類型被視為是理解ASD異質性的重要觀點。本研究追蹤六年74名來自於台灣都會地區台北市（n = 37）與鄉村地區嘉義縣市（n = 37）的ASD兒童，在兒童平均生理年齡為3歲、5歲、9歲三個時間點時測量其ASD症狀嚴重度，透過階層式群集分析搭配二因子混合設計變異數分析，區辨出橫跨學步兒期至學齡期的ASD症狀發展軌跡類型，並進一步使用多項式邏輯斯迴歸分析，探索環境背景、兒童早期特徵等對於發展軌跡類型的預測力，及用單因子變異數分析，檢視各發展軌跡類型的環境、認知功能特徵及行為問題、適應行為、親職壓力等預後表現之組間差異。研究結果區辨出「高嚴重度組」（24.32％）、「改善組」（12.16％）、「持續中嚴重度組」（21.62％）及「惡化組」（41.89％）四種ASD症狀發展軌跡；各發展軌跡類型在父母教育程度、早期認知功能、認知功能進步幅度，及國小階段的認知功能、適應行為上皆具有各自獨特的樣貌；本研究亦發現，收案地區能夠有效地預測發展軌跡組別，僅有居住在都會地區台北市的ASD兒童屬於改善組。研究結果反映出居住環境、醫療資源可行性及疾病敏感度等在ASD病程發展的重要角色。 zh_TW dc.description.abstract (摘要) Autism spectrum disorder (ASD) is widely known to be a highly heterogeneous neurodevelopmental disorder. Focusing on the developmental trajectories of autism severity is one of promising ways to understand the heterogeneity of ASD and may lead to a better understanding of prognosis (Baker, Smith, Greenberg, Selzer, & Taylor, 2011). However, seldom longitudinal studies have been conducted in the East, and also none of them addressed the topic of urbanicity. In this study, 74 ASD participants recruited from Taiwan metropolitan area Taipei city (n=37) and rural area Chiayi county (n=37) were assessed at three time points from toddlerhood to school age (mean age: T1 = 36.29 months, T2 = 58.78 months, T3 = 109.68 months) across 6 years. The hierarchical cluster analysis collocated with two-way mixed designed ANOVA were used to identify the subgroups of three time points on ADOS Total CSS. Similar to finding of Western sample, Taiwan ASD children can be divided into four subgroups including “high severity” (24.32%), “improving” (12.16%), “persistent moderate severity” (21.62%) and “worsening” (41.89%). Each subgroup has its own characteristics of demography, cognitive functions and adaptive functions. Living area is the strongest predictor to subgroups, which imply the importance of urbanicity, such as unitization of medical sources, opportunity of be detected in places outside home, on ASD developmental psychopathology. en_US dc.description.tableofcontents 第一章 緒論 1第一節 研究背景及目的 1第二節 自閉症類群障礙症之發展歷史與診斷準則 2第三節 自閉症類群障礙症的異質性 6第四節 嬰幼兒時期至學齡前期ASD發展 8第五節 學齡前期至學齡期ASD發展 10第六節 ASD症狀發展軌跡分群之縱貫研究 12第七節 台灣ASD發展軌跡相關研究與影響因子 20第八節 早期預測指標 24第九節 本研究之目的與假設 26第二章 方法 29第一節 研究對象 29第二節 研究程序 33第三節 測量工具 34第四節 分析策略 46第三章 結果 49第一節 前驅分析 49第二節 主要分析 57第四章 討論 81第一節 ASD整體症狀嚴重度發展軌跡的分群 82第二節 兒童早期特徵、環境變項對軌跡分群的預測力 84第三節 各發展組別在環境變項、認知功能及外在結果變項之差異 86第四節 台灣ASD發展異質性研究之啟示與本研究限制 91參考文獻 93 zh_TW dc.format.extent 3050886 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G1027520141 en_US dc.subject (關鍵詞) 自閉症類群障礙症 zh_TW dc.subject (關鍵詞) 自閉症症狀發展軌跡類型 zh_TW dc.subject (關鍵詞) 認知功能 zh_TW dc.subject (關鍵詞) 適應行為 zh_TW dc.subject (關鍵詞) 城鄉差距 zh_TW dc.subject (關鍵詞) autism spectrum disorder en_US dc.subject (關鍵詞) autistic symptom developmental trajectory en_US dc.subject (關鍵詞) cognitive function en_US dc.subject (關鍵詞) adaptive function en_US dc.subject (關鍵詞) urbanicity en_US dc.title (題名) 自閉症類群障礙兒童症狀嚴重度發展軌跡類型之探討 zh_TW dc.title (題名) Patterns of Developmental Trajectories of Symptom Severity in Children with Autism Spectrum Disorder en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 丘彥南、賴孟泉、徐如維、劉弘仁（2011）。DSM-5 診斷標準的改變－第一部份。台灣精神醫學會，1(3)，17-21。邱皓政（2006）。量化研究與統計分析。台北：五南圖書出版股份有限公司。許立懿（2015）。自閉症類疾患兒童自閉症狀變化與認知及適應行為關係之縱貫研究。國立政治大學心理學研究所碩士論文，台北。取自https://hdl.handle.net/11296/p4x82j陳榮華（1997）。魏氏兒童智力量表第三版－中文版指導手冊。台北：中國行為科學社。陳榮華、陳心怡（2000）。魏氏幼兒智力量表修訂版－中文版指導手冊。台北：中國行為科學社。陳榮華、陳心怡（2007）。魏氏幼兒智力量表第四版－中文版指導手冊。台北：中國行為科學社。陳榮華、陳心怡（2007）。魏氏兒童智力量表第四版－中文版指導手冊。台北：中國行為科學社。陳榮華（1997）。魏氏兒童智力量表第三版－中文版指導手冊。台北：中國行為科學社。陳榮華、陳心怡（2000）。魏氏幼兒智力量表修訂版－中文版指導手冊。台北：中國行為科學社。陳榮華、陳心怡（2007）。魏氏兒童智力量表－第四版中文版技術與解釋手冊。台北：中國行為科學社。黃毅志（2008）。如何精確測量職業地位?“改良版台灣地區新職業聲望與社經地位量表”之建構。臺東大學教育學報，19(1)，51-159。衛生福利部社會及家庭署（2015）。發展遲緩兒童通報暨個案管理服務網。取自https://system.sfaa.gov.tw/cecm/resourceView/detail2?qtype1=2&qtype2=1。Abidin, R. 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