學齡前自閉症光譜疾患兒童的氣質與適應

Abstract

探討自閉症光譜疾患（ASD）兒童之氣質個別差異及其與適應之間的關係，不但有助於區辨氣質與自閉症光譜疾患之心理病理，也有助於父母參與療育計畫。本研究之目的包括檢視適合做為測量ASD兒童氣質個別差異之工具、探究ASD兒童氣質個別差異對各項適應指標之預測力，及探討母親教養方式在以ASD兒童氣質預測其適應狀況中所扮演的中介或調節角色。 共有一般組兒童（3歲 至 6歲6個月）之母親150位與ASD組兒童（生理年齡3歲2個月至7歲6個月）及其母親59對參與本研究。兩組母親均填寫測量學齡前兒童氣質之兒童氣質問卷（BSQ）與兒童行為量表（CBQ），ASD組母親額外加填本研究依據Rothbart氣質理論所自行編製之自閉症光譜疾患氣質問卷（TQA）、自閉症光譜疾患檢核表（CASD）、親職壓力量表（PSI）、阿肯巴克實證衡鑑系統（ASEBA）之內化性、外化性問題行為測量、適應行為評量系統第二版（ABAS II）、以及父母管教問卷（PAQ）。此外，以魏氏幼兒智力量表-第四版（中文版）（WPPSI IV）做為檢測ASD兒童智能之工具。研究結果指出：一、ASD組與一般組兒童在BSQ與CBQ上之多數氣質向度達顯著差異，且項目分析結果顯示BSQ與CBQ中都有題項或分量表之心理計量特徵並不適合用以測量ASD兒童之氣質個別差異。以項目分析結果進行刪題後，則得以在測量ASD兒童之氣質時獲致可接受的內部一致性信度及再測信度；而本研究自編之TQA，則具良好之內部一致性信度與再測信度，可施測於ASD兒童。二、透過階層迴歸分析，在排除ASD症狀嚴重度與整體智能之預測力後，發現以上三種氣質測量工具中，都有部份氣質向度可對本研究所測量之親職壓力、內化性與外化性問題行為、適應行為等ASD兒童之適應指標具顯著預測力，不但顯示這些氣質向度為獨立於ASD之心理病理及智能之獨立構念，且為ASD兒童顯現適應之個別差異的重要來源。三、本研究並未發現ASD兒童之母親的教養方式可中介ASD兒童氣質與各項適應指標的關係，但發現母親教養方式具有調節效果；其中，母親的教養方式並無絕對的好壞，端視其與ASD兒童之各種氣質向度的最適配合而定。未來可將增進治療者與父母對ASD兒童氣質及教養方式之交互效果的了解，做為父母參與ASD兒童療育計畫之切入重點。

Investigating the predictability of temperament on the individual differences of adjustment of children with autism spectrum disorder (ASD) may not only help differentiate the construct of temperament and the psychopathology of ASD but also achieve better intervention outcome. The goal of this study was three fold. The first was to identify suitable measure of temperament for ASD children. The second was to explore the predictability of temperament on the individual differences of ASD children’s adjustment in various aspects. The third goal was to investigate whether maternal parenting style would function as a mediator or moderator on the relation between temperament and ASD children’s adjustment. One hundred and fifty mothers of normal children (3 yr. 0 mo. to 6 yr. 6 mo.) and 50 ASD children (3 yr. 2 mo. to 7 yr. 6 mo. in chronological age) and their mothers participated in this study. Mothers of both groups reported their children’s temperament by filling up the Behavior Style Questionnaire (BSQ) and Children’s Behavior Questionnaire (CBQ). Mothers in the ASD group also filled up the Temperament Questionnaire for Autism (TQA) that was developed in the current study according to Rothbart’s theory of temperament, the Checklist for Autism Spectrum Disorder (CASD) that reflects the severity of ASD symptoms, the Parenting Stress Index (PSI), the Achenbach System of Empirically Based Assessment (ASEBA) for obtaining information about ASD children’s internalizing and externalizing problem behaviors, the Adaptive Behavior Assessment System - Second Edition (ABAS - II) and the Parental Authority Questionnaire (PAQ). In addition, Wechsler Preschool and Primary Scale of Intelligence - Fourth Edition (WPPSI-IV) was conducted individually on ASD children to obtain their IQ score. Results indicated that there were significant mean differences between the normal and the ASD group on most of the temperament dimensions in BSQ and CBQ. Results of item analysis indicated that not all items and subscales in the BSQ and CBQ manifested acceptable psychometric characteristics for measuring children of ASD. Acceptable internal consistency and test-retest reliability were obtained after item deletion based on the result of item analysis. The newly developed temperament measurement of TQA revealed good internal consistency and test-retest reliability. A series of hierarchical regression analyses for different adjustment indicator yielded that after controlling for symptomatology and IQ scores, a number of the temperament dimensions in BSQ, CBQ, and TQA could still significantly predict the adjustment indicators of parenting stress, internalizing the externalizing behaviors, and adaptive behaviors. This result implied that at least some of the temperament dimensions measured in this study are valuable markers of ASD children’s adjustment and are unique constructs above and beyond the psychopathology of ASD. Maternal parenting style was not a mediator in any of the relation between temperament and ASD children’s adjustment; yet, parenting style was found a significant moderator between temperament and adjustment. Specifically, there is no absolute good or bad style of maternal parenting; ASD children’s adjustment depends on the goodness of fit between temperament and parenting. This study also suggested that enhancing therapists’ and parents’ knowledge about the interaction effect of temperament and parenting on various aspects of adjustment may be a feasible approach in the intervention programs for ASD that encourage parental involvement.