臺灣自閉症類群障礙幼童之早期行為問題與動作發展的特徵與關聯

Abstract

研究背景：自閉症類群障礙（以下簡稱自閉症）除核心的社交互動困難與重複、侷限行為外，行為問題與動作發展困難亦為常見共併問題。由於相關發展特徵多於三歲前逐漸顯現，但臨床診斷多在三歲後確認，釐清三歲前後自閉症幼童之行為與動作發展特徵，對早期篩檢與介入具有重要意義。然而，既有研究對特定行為症候與動作發展子面向之發展表現尚未達成一致結論，且臺灣仍缺乏探討三歲前後自閉症幼童行為與動作發展特徵之研究。此外，自閉症幼童之動作發展困難常於臨床上被低估，而行為問題與動作發展之關聯性，可能有助於提升動作發展困難的早期識別與介入。惟過去研究多聚焦於核心症狀或家長填寫問卷，較少同時結合多元行為問題評估與標準化動作測驗。 目的：（1）比較臺灣自閉症幼童與非自閉症典型發展幼童之行為問題與動作發展特徵；（2）分析自閉症幼童行為問題與動作發展之關聯性，並比較上述特徵與關聯性於三歲前後之差異趨勢。 方法：本研究採次級資料分析，納入2014年至2022年間之自閉症幼童發展追蹤資料，共計124名自閉症幼童與123名非自閉症典型發展幼童（簡稱非自閉症幼童），年齡介於18至71個月。行為問題以一歲半至五歲兒童行為檢核表（Child Behavior Checklist for Ages 1.5 to 5）評估；動作發展與動作協調分別以皮巴迪動作發展量表第二版（Peabody Developmental Motor Scales, Second Edition）及兒童動作評估量表第二版（Movement Assessment Battery for Children, Second Edition）進行測量。研究採用共變數多變量變異數分析比較兩組幼童於行為與動作發展特徵之差異，並以多元線性迴歸分析探討行為問題與動作發展之關聯性。結果：相較於非自閉症幼童，自閉症幼童呈現顯著較高的行為問題T分數（T-score），尤以內化行為問題、注意力問題與總行為問題最為明顯（ηp²s = 0.03-0.19，ps < 0.01）。三歲以下自閉症幼童的行為差異主要集中於焦慮／憂鬱與退縮症候（ηp²s = 0.05-0.14，ps < 0.05），三歲以上幼童則於內化、外化、注意力及總行為問題皆出現顯著差異（ηp²s = 0.05-0.30，ps < 0.05）。在動作表現方面，自閉症幼童於總動作、粗大與精細動作發展商數，以及所有動作子面向上，表現均顯著較差（ηp²s = 0.03-0.10，ps < 0.05）。三歲以下自閉症幼童於總動作和粗大動作發展商數，以及移動與物體操弄能力顯著較差（ηp²s = 0.07-0.20，ps < 0.05），大於三歲的組別則差異擴及精細動作發展商數、平衡能力和整體動作協調（ηp²s = 0.04-0.19，ps < 0.05）。自閉症幼童之內化行為問題T分數與粗大、精細及整體動作商數呈顯著負相關 (βs = −0.3，ps < 0.01)，外化行為問題T分數則與粗大、精細及整體動作商數呈顯著正相關（βs = 0.3，ps < 0.01），而行為問題T分數與整體動作協調百分比未達顯著相關。年齡分層結果顯示，三歲以下自閉症幼童僅內化行為問題T分數與精細動作商數呈顯著負相關 [β = (−0.5)，p < 0.05]，三歲以上幼童中，內化行為問題T分數與粗大、精細、總動作商數之負相關 [βs = (−0.4) - (−0.3)，ps < 0.05]，外化行為問題T分數與粗大、總動作商數呈顯著正相關（βs = 0.3，ps < 0.05）；相較之下，非自閉症幼兒組僅於三歲以下幼童觀察到內化行為問題T分數與總動作商數之顯著負相關 [β = (−0.6)，p < 0.05]。 結論：臺灣自閉症幼童之行為與動作發展特徵於三歲前即與非自閉症幼童呈現顯著差異，且在三歲以上組別中，差異進一步擴及更多行為與動作發展面向。此外，自閉症幼童之行為問題與動作發展之間存在顯著關聯性。本研究描繪臺灣自閉症幼童的行為與動作發展特徵，有利於自閉症幼童的早期識別，並支持臨床進行更全面的行為與動作發展評估與追蹤。此外，行為與動作之關聯性可提供臨床判斷線索，協助辨識具有動作困難風險之自閉症幼童，並支持發展結合行為與動作的整合性介入，以更全面提升其發展預後。 關鍵字：自閉症類群障礙、幼童、行為問題、動作發展

Background: Autism spectrum disorder (ASD) is characterized by core impairments in social interaction and restricted, repetitive behaviors and is frequently accompanied by behavioral problems and motor difficulties. Although behavioral and motor features often emerge before three years of age, clinical diagnosis is typically confirmed after age three, highlighting the importance of characterizing early developmental patterns. However, findings regarding specific behavioral syndromes and motor subdomains in young children with ASD remain inconsistent, and studies in Taiwanese populations are scarce. Importantly, motor difficulties in young children with ASD are often underestimated in clinical practice, and examining the associations between behavioral problems and motor development may provide clinically insights for earlier identification. However, the associations have rarely been examined using comprehensive behavioral and standardized motor assessments in early childhood. Objectives: This study therefore aimed to compare behavioral and motor profiles between ASD and non-ASD typically developing children, to investigate behavioral-motor associations, and to examine whether these profiles and associations differ before and after three years of age in Taiwan. Methods: This was a secondary data analysis study, including developmental follow-up data collected between 2014 and 2022. A total of 124 children with ASD and 123 non-ASD children aged 18-71 months were assessed using the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5), the Peabody Developmental Motor Scales-Second Edition (PDMS-2), and the Movement Assessment Battery for Children-Second Edition (MABC-2). Group differences were examined using multivariate analysis of covariance, and behavioral-motor associations were analyzed using multiple linear regression. Results: Children with ASD showed significantly higher behavioral problems T-scores than non-ASD children in internalizing domains, attention problems, and total behavioral problems (ηp²s = 0.03-0.19, ps < 0.01). Behavioral differences were specific to Anxious/Depressed and Withdrawn syndromes in children under three (ηp²s = 0.05-0.14, ps < 0.05), but involved broader domains including internalizing, externalizing, attention, and total problems in the older group (ηp²s = 0.05-0.30, ps < 0.01). Children with ASD also demonstrated significantly poorer motor quotients than non-ASD children across PDMS-2 domains (ηp²s = 0.03-0.10, ps < 0.01). Motor differences were evident in both age groups, however, the older group exhibited difficulties across a broader range including fine motor, balance ability and overall motor coordination (ηp²s = 0.05-0.19, ps < 0.05). In the ASD group, T-score of Internalizing Problems (βs = −0.3, ps < 0.05) were negatively and T-score of Externalizing Problems (βs = 0.3, ps < 0.05) were positively associated with motor quotients. T-score of behavioral problems were not significantly associated with overall motor coordination percentage. Age-stratified analyses showed that in children with ASD under three years, only T-score of Internalizing Problems were negatively associated with fine motor quotient (β = −0.5, p < 0.05). In contrast, among children aged three years and older, T-score of Internalizing Problems were negatively associated with gross, fine and total motor quotient [βs = (−0.4) to (−0.3), ps < 0.05], whereas T-score of Externalizing Problems showed positive associations with gross and total motor quotients (βs = 0.3, ps < 0.05). In contrast, a significant negative association between T-score of Internalizing Problems and total motor quotient was observed only in non-ASD children younger than three years [β = −0.6, p < 0.05]. Conclusions: Behavioral and motor developmental differences between Taiwanese young children with ASD and non-ASD children were evident before three years of age and extended to broader domains in children aged three years and older. In addition, associations between behavioral problems and motor development were observed in young children with ASD. These findings support earlier identification and comprehensive behavioral and motor assessment in clinical practice and guide integrated interventions in young children with ASD.