泛自閉症障礙青少年的執行功能缺損

Abstract

背景：目前關於泛自閉症患者的執行功能障礙研究短少且結果不一致，對自閉症症狀嚴重度和年齡對其執行功能造成之影響也未有深入探究。此外，研究自閉症症狀與執行功能之相關將可協助醫療相關專業更加瞭解此族群並發展適當的治療介入計畫。本研究之目的有三：(1)探討自閉症患者的執行功能障礙，(2)探究年齡對自閉症患者的執行功能之影響，(3)瞭解自閉症症狀與執行功能之相關。 方法：本研究收入114位自閉症患者(男性佔97.4%)，以及114位年紀、性別配對的正常人作為控制組。我們使用魏氏智力測驗和劍橋電腦化神經心理測驗來評估參與者的執行功能。為了進一步了解年齡的影響，兩組參與者也會依照年齡分為兩組：8-12歲的組別和大於13歲的組別。我們使用自閉症診斷會談和兒童行為量表-不專心分測驗的分數來分析自閉症症狀與執行功能之間的相關。 結果：相較於典型發展控制組，自閉症患者在逆背數字、空間短期記憶、空間工作記憶、計畫能力和模組轉換任務之表現顯著較差。依年齡分組，自閉症患者的計畫和模組轉換能力會因不同年齡而有所差異：只有8-12歲的自閉症參與者有損傷情形，大於13歲者則無。自閉症患者的社交互動表現和專心行為與其執行功能有顯著相關。 結論：本研究證實自閉症患者確有執行功能缺損，包括：短期記憶、計畫和模組轉換能力，其中模組轉換能力差異僅出現在8-12歲組之比較。執行功能與自閉症患者的自閉症狀嚴重度達顯著之相關性。未來研究將探討自閉症患者之為患病手足之執行功能以探查執行功能是否可為自閉症的神經認知內在表型。

Background: Although deficits in executive functions (EF) in youths with autism spectrum disorders (ASD) have been extensively studied, and yet, little is known about whether the symptom severity and chronological changes of ASD affect their performance in EF tasks. Research of the relationship between EF and symptoms of ASD will advance the knowledge of allied health professionals to understand this disorder more clearly in order to develop effective intervention program for individuals with ASD. Three primary aims of the current study are: (1) to determine whether youths with ASD have EF deficits, (2) to explore the moderating effects from age at assessments, and (3) to investigate the relationship between EF and symptoms of ASD. Methods: We assessed 114 youth with ASD (male, 97.4%) and 114 age- and sex-matched typically developing youth (TD) with the digit span backward of the Weschler intelligence scales, and the Spatial Span (SSP), Spatial Working Memory (SWM), Stockings of Cambridge (SOC), and Intradimensional/Extradimensional Shift (I/ED), of the Cambridge Neuropsychological Test Automated Battery (CANTAB) to evaluate their EFs. To understand the effects of age, we divided participants into two groups during age stratification: the ages 8-12 group and the ages > 13 group. The scores of the Autism Diagnostic Interview-Revised (ADI-R) and Inattention subtest of Child Behavior Checklist (CBCL) were used to investigate the correlation betweens EF and symptoms of ASD. Results: Compared with TD youth, youth with ASD recalled fewer digits backwardly, had shorter spatial span length in the SSP, made more total and between errors with poorer strategy uses in the SWM, solved fewer problems with minimum moves and made more mean number of moves in the SOC. In the age stratification, both youth with ASD in the two age groups showed similar deficits of working memory, but only youth with ASD aged 8-12 performed poorer than TD youth aged 8-12 in planning and set-shifting tasks. There were significant correlations between EF and reciprocal social interaction and inattention in youth with ASD. Conclusion: Youth with ASD are impaired in a wide range of EFs including working memory, planning and set-shifting (only shown in youth aged 8-12) and their EF performances were significantly correlated with symptom severity. Investigating whether executive dysfunctions can be neurocognitive endophenotypes of ASD through studying examining EFs in unsiblings of ASD will be the next step.