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標題: | 自閉症障礙類群兒童重複行為的相關因子分析 The Correlates of Restricted and Repetitive Behaviors in Children with Autism Spectrum Disorders |
作者: | An-Ju Chen 陳安如 |
指導教授: | 曾美惠(Mei-Hui Tseng) |
關鍵字: | 自閉症障礙類群,侷限與重複行為,影響因子, Autism spectrum disorders,Restricted and repetitive behaviors,Correlates, |
出版年 : | 2013 |
學位: | 碩士 |
摘要: | 研究背景與目的
自閉症障礙類群(Autism Spectrum Disorder, ASD)包括自閉症 (Autism)、亞斯伯格疾患(Asperger’s Disorder)及其他未註明之廣泛性發展疾患 (Pervasive Developmental Disorder Not Otherwise Specified, PDD-NOS)。根據精神疾病診斷準則手冊-第四版內文革新版 (American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, Text Revision, DSM-IV-TR),ASD的三大診斷特徵分別為:社交能力缺損、溝通障礙和重複刻板的興趣。大約有90%-97%的自閉症障礙類群兒童有侷限與重複行為出現,侷限與重複行為是自閉症障礙類群孩童的主要診斷之一,不僅影響孩童的學習、互動、更影響到各種情境的參與。「國際健康功能與身心障礙分類-兒童及青少年版」(International Classification of Functioning, Disability and Health for Children and Youth, ICF-CY) 包含健康狀況、身體功能與結構、活動、參與、情境因素(個人、環境),此參考架構整合個人健康狀態在醫學與社會方面的觀點,說明疾病、功能、個人與環境間互動的關係,不只是病理因素影響健康,且強調活動參與、情境因素的重要性。過去有許多研究探討影響自閉症障礙類群兒童侷限與重複行為的因子,但是僅限於ICF-CY其中的一、兩個領域。本研究目的,以ICF-CY為參考架構,探討學齡前與國小低年級自閉症障礙類群兒童重複行為的相關因子,即依據文獻回顧結果,自ICF-CY之身體功能與構造、活動及參與、環境及個人因素面向,各選出一至二個過去研究中有顯著相關的相關因子作為獨立變項。研究假設為:這些選自ICF-CY各個面向的因子與自閉症障礙類群兒童的重複行為都有顯著相關。 研究方法 共有八十六位自閉症障礙類群的兒童及其家長參與此研究,參與者轉介自發展中心、職能治療診所、醫學中心的復健部、學校、自閉症家長協會及中華民國自閉症基金會。本研究使用皮爾森(Pearson)相關和逐步多元線性迴歸分析,來探討次領域重複行為以及整體重複行為的相關因子。依變項包含由家長填寫的「重複行為量表」之重複行為總分,以及重複行為之五個次領域的分數:刻板行為、自傷行為、強迫行為、儀式化與同一性行為及侷限興趣。獨立變項為依據文獻回顧結果,以及ICF-CY架構,所選出可能之相關因子,包含年齡、自閉症嚴重程度、感覺處理能力、表達性語言、接收性語言、適應行為、焦慮、親子關係及壓力。 結果 結果顯示,86位個案平均月齡為68.15個月(標準差:15.60,範圍:37到105個月),有72位男生14位女生,在重複行為量表的分數中顯示大部分(37.2-60.5%)的填答分數集中在0分(從沒出現過此行為)到1分(出現過此行為,且是一個輕微程度的問題)。皮爾森相關(Pearson correlation)顯示,整體重複行為量表分數,和嚴重度(r =0.415, p <0.01)、表達性語言(r =-0.419, p <0.01)、接受性語言(r =-0.433, p <0.01)、適應行為(r =-0.308, p <0.01)有顯著相關。逐步多元線性迴歸分析的結果顯示,在整體的重複行為中,接收性語言和個案的年齡為顯著的相關因子,共解釋20.9%的變異量。在刻板行為部分,接收性語言、年齡和適應行為是顯著的相關因子,共解釋42.2%的變異量。自傷行為與強迫行為,顯著的相關因子只有接收性語言,對於兩個迴歸模型,分別解釋了26.3%和5.5%的變異量。儀式化與同一性行為,及侷限興趣部分,則沒有顯著的相關因子。 結論 此研究結果可以協助臨床工作者和照護者了解自閉症障礙類群兒童重複行為的相關因子,即孩子的接收性語言、適應行為和年齡都是重複行為顯著的相關因子,並且接受性語言是在不同重複行為次領域中最廣為出現的相關因子。即接收性語言能力差、適應行為不好和年齡大重複行為越嚴重。本研究的結果能作為未來近一步的實驗型研究,發展出有效的介入方式來降低自閉症障礙類群兒童的重複行為。 Background With a prevalence of more than 90% in both autism and PDD-NOS groups, restricted and repetitive behaviors (RRBs) affect their participation and adaptive function. International Classification of Functioning, Disability, and Health- Children and Youth version (ICF-CY) describes functioning from a holistic perspective, including health condition, body functions and structures, activity, participation, and personal and environmental factors. The ICF-CY provides a framework to describe limitations of children’s functioning and emphasizes the impact of the environmental factors on functioning from a developmental perspective. Thus, the purpose of the study was to identify correlates of RRBs in preschool and early elementary school children with autistic spectrum disorder from a holistic perspective by considering the variables from all dimensions of the ICF-CY framework. Method Eighty six children with autistic spectrum disorders were recruited from developmental centers, departments of rehabilitation at medical centers and hospitals, elementary schools. Children with identifiable neurological conditions and patient who was illiteracy or couldn't read Chinese were excluded. Restricted and repetitive behaviors were measured by Repetitive Behavior Scale-Revised (RBS-R). A range of possible correlates were including severity, sensory processing, expressive language, receptive language, adaptive behavior, age, anxiety, and parent-child relationship quality. Descriptive analysis was conducted for basic information and the observed variables. Pearson correlation investigated the relationships between five subtypes of RRBs and potential correlates. Six separate multiple linear regression models identified the correlates of each subtype of RRBs, including Stereotypy, Self-injurious Behavior, Compulsions, Rituals and Sameness, Restricted Interests, and overall restricted and repetitive behaviors. Results A total of 86 children with autism spectrum disorder aged from 37 to 105 months with 72 boys and 14 girls. The findings indicated that almost every subtype of RRBs was centralized in lower score. Pearson correlations showed that overall RRBs were significantly correlate with severity (r =0.415, p <0.01), expressive language (r =-0.419, p <0.01), receptive language (r =-0.433, p <0.01), and adaptive behavior (r =-0.308, p <0.01). The stepwise multiple linear regression model which explained 20.9% of the variance revealed that receptive language and age of participants were significant correlates of overall RRBs. As for stereotypic behavior, the stepwise multiple linear regression model showed that receptive language, age, and adaptive behavior were significant correlates and accounted for 42.2% of the variance. Regarding self-injurious behavior and compulsive behavior, the multiple stepwise linear regression model revealed that receptive language was the only significant correlate explaining 26.3% and 5.5% of the variances respectively. As for ritualistic and sameness behavior and restricted interests, no significant correlate was identified. Conclusion Knowledge of the correlates may help clinicians, parents, and school teachers develop interventions targeted at the correlates in order to effectively reduce their RRBs. Results of our study can serve as a basis for future experimental studies targeted at the correlates to ameliorate restrictive and repetitive behaviors in children with ASD. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/5927 |
全文授權: | 同意授權(全球公開) |
顯示於系所單位: | 職能治療學系 |
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