自閉症青少年社交焦慮的相關因素

Abstract

背景: 社交溝通和互動障礙是自閉症類群障礙症（autism spectrum disorder-ASD）患者是常見的核心症狀之一，影響其人際互動和交友等。而青春期對 ASD 個案是一個關鍵時期，他們面臨加劇的社交需求和期望可能導致社交焦慮的增加(自閉症患者的社交焦慮盛行率約 40%)。社交功能困難包括難以理解非語言提示、啟動和維持對話、考慮他人觀點和發展適當的友誼等，這些困難可能導致社交孤立和社交焦慮。已有研究強調降低這些障礙以減輕社交焦慮的重要性。另外，自覺的社交勝任感是影響 ASD 青少年心理健康的關鍵因素，低落的自覺社交勝任感與高社交焦慮有關。在 ASD 個案中，感覺處理困難也是普遍存在的，感覺敏感或非典型感覺反應可能導致其在社交場合中的壓力和焦慮加劇，因此了解感覺處理與社交焦慮之間的關係，對認識ASD青少年所面臨的社交挑戰至關重要。台灣對ASD 的研究多集中在孩童階段，尚無針對ASD青少年的社交焦慮做深入探討。考慮到 ASD 青少年社交焦慮的高發生率及其對社交互動的影響，了解 ASD青少年面臨的社交焦慮問題，以及自覺社交勝任感、社交技能挑戰和感覺處理困難 等因素如何影響社交焦慮，對於臨床實務和教育環境的發展將可提供有價值的見解以設計適當有效的介入計畫。 目的: 本研究目的為使用家長評量及青少年自評的問卷探討影響自閉症青少年社交焦慮的因素。研究結果將使我們更加了解自閉症青少年的社交焦慮情況，及與之相關的可能因素，可作為預防與介入的參考。 方法:本研究主要透過學校、診所、自閉症相關社群招收經診斷為自閉症類群障礙症之受試者，並邀請其同學、鄰居或朋友作為對照組。兩組年紀均介於 10-16 歲，無語文理解障礙。家長完成社交溝通問卷(SCQ)、社交技巧改進評量問卷(SSIS);學生自評社交焦慮量表(SAS)、青少年自我概念剖析量表(SPPA)以及青少年/成人感覺處理能力剖析量表 (AASP)。研究資料主要以獨立t檢定比較兩組差異，並以皮爾森相關及線性迴歸分析，探討自閉症狀、社交技巧、自覺社交勝任感、感覺處理能力與社交焦慮間的相關及預測因子。 結果:自閉症類群障礙症組比起正常發展組呈現更嚴重的自閉症狀、較差的社交技巧、較多的問題行為、較低的自覺社交勝任感，較高頻率的感覺低登入及感覺敏感;兩組在社交焦慮則沒有顯著差異。問題行為、自覺社交勝任感、低登入、感覺敏感和感覺逃避，皆與高社交焦慮相關，其中自覺社交勝任感及感覺敏感為自閉症青少年社交焦慮的預測因子。 結論: 根據皮爾森相關分析結果顯示，自閉症青少年的社交焦慮與社交技巧、自覺社交勝任感、感覺處理能力皆有相關。而根據迴歸分析結果顯示，自覺社交勝任感和感覺敏感可以預測自閉症青少年的社交焦慮。研究結果有助於了解自閉症青少年社交焦慮的預測因子，提供家長、教育相關單位、醫療及臨床工作者擬定適合的預防與介入方案之參考，減低社交焦慮相關問題。

Background: Social communication and interaction difficulties are common core symptoms in autistic individuals, impacting their interpersonal interactions and friendships. Adolescence is a crucial period for autistic individuals, as they face intensified social demands and expectations, which may lead to increased social anxiety. Social functioning difficulties include challenges in understanding nonverbal cues, initiating, and maintaining conversations, considering others' perspectives, and developing appropriate friendships, which can result in social isolation and anxiety (affecting approximately 40% of autistic individuals). Previous research has emphasized the importance of reducing these barriers to alleviate social anxiety. Self-perceived social competence is a key factor affecting emotional well-being in autistic adolescents, with low self-perceived social competence being correlated with high social anxiety. Sensory processing difficulties are also commonly present in autistic individuals, potentially exacerbating their stress and anxiety in social situations. Therefore, understanding the relationship between sensory processing and social anxiety is crucial for understanding the social challenges faced by autistic adolescents. Research on ASD in Taiwan has primarily focused on early childhood, with limited in depth exploration of social anxiety in autistic adolescents. Considering the high prevalence of social anxiety in autistic adolescents and its impact on social interactions, understanding the social anxiety issues faced by autistic adolescents, as well as how factors such as self-perceived social competence, social skill challenges, and sensory processing difficulties affect social anxiety, can provide valuable insights for clinical practice and educational environments. This understanding also can help design appropriate and effective intervention programs. Objective: The purpose of this study is to explore the predictors of social anxiety in autistic adolescents using questionnaires completed by both parents and adolescents themselves. The results of the study will provide a better understanding of the predictors of social anxiety in autistic adolescents and serve as a guide for prevention and intervention strategies. Methods: This study recruited participants diagnosed with autism spectrum disorder (ASD) through schools, clinics, and autism-related communities, and invited their classmates, neighbors, or friends to participate as the control group. The age range for both groups was between 10 and 16 years old, with no language comprehension impairments. Parents completed the Social Communication Questionnaire (SCQ) and the Social Skills Improvement System Rating Scales (SSIS), while adolescents completed the Social Anxiety Scale (SAS), the Self-Perception Profile for Adolescents (SPPA), and the Adolescent/Adult Sensory Profile (AASP). Independent t-tests were conducted to compare differences between groups in autism symptom severity, social skills, behavioral problem, self-perceived social competence, sensory processing, and social anxiety. Pearson correlation was applied to examine the correlations among the aforementioned variables. Additionally, multiple linear regression analyses were conducted to explore the predictors of social anxiety. Independent variables included autism symptom severity, social skills, problem behaviors, self-perceived social competence, and sensory processing. Results: Compared to the typically developing group, autistic individuals exhibited more severe autism symptoms, poorer social skills, more problem behavior, lower self-perceived social competence, higher levels of low registration and sensory sensitivity. However, there was no significant difference in social anxiety between the two groups. In Pearson correlation, more problem behavior, lower self-perceived social competence, high levels of low registration, high sensory sensitivity, and high sensory avoiding are all correlated with higher social anxiety. Among these factors, self-perceived social competence and sensory sensitivity are effective predictors of social anxiety. Conclusion: The results of Pearson correlation indicate that social anxiety in autistic adolescents is correlated with their problem behavior, self-perceived social competence, and sensory processing abilities. In the results of the multiple linear regression analysis, we found that self-perceived social competence and sensory sensitivity are the factors that can predict social anxiety in autistic adolescents. These findings contribute to understanding the factors associated with social anxiety in autistic adolescents, providing parents, educational institutions, healthcare professionals, and clinicians with a guide for developing appropriate prevention and intervention strategies.