學齡前自閉症類群障礙症幼童認知功能與母親心理健康對親子關係之預測研究

Abstract

親子關係品質對於學齡前自閉症類症候群 (Autism spectrum disorder, ASD) 幼童發展極為重要。根據親子關係雙向模式孩童與母親特質皆會影響親子關係品質，且過去文獻發現學齡前ASD孩童的認知功能、症狀嚴重度與母親的心理健康皆會影響親子關係，其中又以孩童的認知功能及母親的心理健康與親子關係最相關，但以往研究少同時比較兩者對親子關係的預測力，故本研究預探討在控制學齡前ASD幼童的症狀嚴重度下，幼童的認知功能與母親的心理健康狀態對親子關係之預測力。此外，也進一步比較兩者對親子關係中五個層面（滿足感、溝通、參與度、設限與自主性）的重要性。 本研究共招募29位2歲3個月至7歲學齡前自閉症類群症候群幼童之母親，邀請母親填寫「親子關係量表」、「貝克憂鬱量表」與「親職壓力量表短版」，並透過病歷查詢取得幼童心智功能測驗分數，再由主要治療師填寫「兒童期自閉症量表」。結果發現ASD幼童親子關係雖低於平均值但多為正向親子關係，僅在親子參與度與親子溝通上較顯困難。經逐步回歸分析後發現在控制幼童的症狀嚴重度下，母親的憂鬱情緒能預測親職滿足感、親子溝通、母親對幼童的設限及自主性之層面；而幼童的非語言能力能預測親職滿足感與設限層面，兩者中又以母親的憂鬱情緒最有預測力。 本研究提供臨床工作者設定治療目標之參考，學齡前ASD幼童的親子關係確實會受到幼童與母親特質影響，特別是母親憂鬱情緒與幼童的非語言認知功能，因此建議在臨床評估時，除了評估幼童的症狀嚴重度與非語言認知功能外，更須評估母親的憂鬱情緒，若改善母親憂鬱情緒則更利於建立適合幼童與母親間溫暖且穩定的親子關係。

The quality of parent-child relationships is important for the development of preschoolers in children with autism spectrum disorder (ASD). According to the bi-directional model of parent-child relationships, the characteristics of children and their mothers affect the quality of their relationships, including the cognitive functions of the child and the severity of their symptoms, as well as maternal mental health. Out of these three, the cognitive functions of the child and maternal mental health are the most related with parent-child relationships. However, very studies have investigated and considered both of children’s and their mother’s characteristics at the same time. In this study, we explored the predictors for the quality of parent-child relationships and five domains in terms of satisfaction with parenting scale, involvement, communication, limit Setting and autonomy, as well as how the severity of the child’s symptoms may affect these facets, by considering the cognitive functions of children and maternal mental health, which includes issues such as depression and parenting stress. A total of 29 mothers of children with ASD aged 27 to 84 months were recruited in this study, and they were asked to fill out three questionnaires (Parent-Child Relationship Inventory, Beck Depression Inventory, and Parenting Stress Index). The scores of children’s cognitive tests were obtained through medical records, while the scores of the severity of symptoms were obtained from Childhood Autism Rating Scale filled by therapists. Our findings showed that mothers of children with ASD indeed do encounter difficulties in parent-child communication and involvement. The results showed that maternal depression was a significant negative predictor in domains of satisfaction, communication, limit setting and autonomy in parent-child relationships, while a child’s non-verbal ability can be used to predict the domain of satisfaction and autonomy. The results of this study provide a reference for clinicians especially in considering the treatment goals of the children with ASD. The characteristics of preschoolers in children with ASD and their mothers indeed affect the parent-child relationships, especially maternal depression and children's non-verbal ability. Thus, it is suggested that assessments of the mothers’ depression and clinical intervention are needed in addition to assessments of the children’s non-verbal ability. If maternal depression can be cured, it would lead to more adequate, stable and loving parent-child relationships.