自閉症類群障礙症青少年心理社會生活品質之相關因子探討

Abstract

前言 生活品質為一多維度概念，世界衛生組織將生活品質定義為個人在其文化和價值背景下對生活狀況的認知，涉及其目標、期望、標準和關切。自閉症類群障礙症 (Autism Spectrum Disorder, ASD) 為一種神經發展疾病，包含社交溝通及社交互動的缺損與侷限、重複的行為、興趣或活動模式等二項核心特徵。研究顯示相較於正常發展或其它診斷族群，自閉症類群障礙症(ASD)生活品質較低。對於ASD青少年而言，社交功能障礙可能對於此階段日益複雜的人際互動造成不利影響，進而影響友誼的建立與品質以及社交活動的參與，這些困難很可能進一步影響心理健康與生活品質。若能深入瞭解影響ASD青少年心理與社會生活品質的相關因素，將能夠更有效地提供介入治療方案，從而提升他們的整體生活品質。 據我們所知，目前尚無研究探討影響ASD青少年社會心理生活品質的因子。在過去的文獻中，關於ASD青少年生活品質影響因素的研究多集中於個別因子，或是少數的特定因子與生活品質的相關性，未能同時考量自閉症核心問題和因應能力。雖青少年已具備自我感知能力，且其看法可能與家長觀察不完全一致，大多數研究未能同時從青少年的主觀感受和家長的客觀評量面向來探討心理社會生活品質的影響因子。此外，很多研究的研究對象年齡涵蓋較廣年齡範圍，未能針對青少年族群，使得研究結果難以精準地解釋ASD青少年的社會心理生活品質。這些限制限制臨床工作人員和研究人員對於ASD青少年的心理社會生活品質相關因子的了解。 因應這些先前研究的侷限，本研究針對ASD青少年的社會溝通障礙之主觀感受和家長的客觀評量以及ASD青少年的因應行為來探討其社會心理生活品質影響因子，獨立變項包含青少年的自覺社交勝任感、自覺社交焦慮，家長評量之自閉症症狀嚴重度、社交技巧、問題行為和因應行為，以期彌補現有研究的不足。

方法 本研究納入83位ASD青少年（平均年齡：12.3歲，SD：2.18）。研究人員先取得家長知情同意書後，才進行資料蒐集。本研究由青少年自填社交勝任量表、青少年社交焦慮量表，以及兒童生活品質量表第四版蒐集其心理社會生活品質。家長填寫社會性溝通問卷、社交技巧評估量表之社交技能和問題行為分量表，以蒐集ASD青少年之核心症狀及行為表現，另由家長填寫因應評量表以蒐集ASD青少年之因應行為。 本研究以描述性統計分析各量表之平均分數及標準差。以皮爾森相關係數分析自覺社交勝任感、自覺社交焦慮，自閉症症狀嚴重度、社交技巧、問題行為和因應行為、年齡、性別與心理社會生活品質之相關性，並以多元線性迴歸探討ASD青少年心理社會生活品質之預測因子。

結果 多元線性迴歸分析顯示與ASD青少年心理社會生活品質相關因子包含：自覺社交勝任感、自覺社交焦慮、問題行為 (ps < .05)。然而，自閉症嚴重度、社交技巧、因應能力並非ASD青少年心理社會生活品質之相關因子 (ps > .05)。

結論 本研究發現ASD青少年之自覺社交勝任感、自覺社交焦慮、以及問題行為程度皆是心理社會生活品質之相關因子。本研究結果可提供臨床工作者依據ASD青少年自覺社交勝任感、自覺社交焦慮、問題行為設計能有效提升ASD青少年心理社會生活品質之個別化治療計畫。

Introduction The World Health Organization (WHO) defines quality of life (QoL) as an individual's perception of their position in life within their cultural and value context, encompassing their goals, expectations, standards, and concerns. Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by two core features: deficits in social communication and social interaction, and restricted, repetitive patterns of behavior, interests, or activities. Studies have shown that individuals with ASD generally have lower QoL compared to those with typical development or other diagnoses. For autistic adolescents social dysfunction can negatively impact increasingly complex social interactions during this developmental stage, potentially affecting formation and quality of friendships and participation in social activities. These difficulties are likely to further influence mental health and QoL. A better understanding of the factors affecting the psychosocial QoL in adolescents with ASD can facilitate more effective interventions, thereby improving their overall QoL. To our knowledge, no studies have yet explored the factors associated with the psychosocial QoL in autistic adolescents. Previous research on factors influencing QoL in this population has often focused on individual factors or the relationship between a few specific factors and QoL, without simultaneously considering the core issues of autism and coping abilities. Additionally, many studies include a wide age range of participants, making it difficult to accurately interpret findings specific to the adolescent population. Furthermore, studies have highlighted the importance of understanding the perspective of autistic youth to enhance their quality of life. To address these limitations, this study explored the factors influencing the psychosocial QoL in autistic adolescents by examining adolescents’ subjective perceptions of social competence and social anxiety in addition to objective evaluations of symptom severity, social skills, problem behaviors, and coping behaviors by parents. The results of the study are essential for informing clinical practice and research to enhance autistic adolescents’ psychosocial QoL, promoting their overall development and well-being.

Methods This study included 83 autistic adolescents (mean age: 12.3, SD:2.18). Data collection commenced only after obtaining parental informed consent. Adolescents completed the Social Competence Scale, the Social Anxiety Scale for Adolescents, and the Pediatric Quality of Life Inventory (PedsQL) Version 4.0 to assess their psychosocial QoL. Parents completed the Social Communication Questionnaire, the Social Skills Improvement System (SSIS) Rating Scales measuring social skills and problem behaviors, and the Coping Inventory to collect data on the core symptoms and coping behaviors of autistic adolescents. Descriptive statistics were used to analyze the mean scores and standard deviations of each measure. Pearson correlation coefficients were applied to analyze the relationships between perceived social competence, perceived social anxiety, autism symptom severity, social skills, problem behaviors, coping behaviors, age, gender, and psychosocial QoL. Multiple linear regression were conducted to identify associated factors of psychosocial QoL in autistic adolescents.

Results Multiple linear regression analysis revealed that higher levels of perceived social anxiety and problem behaviors are associated with lower psychosocial quality of life, while higher levels of perceived social competence is associated with better psychosocial quality of life. The severity of autism, social skills, and coping abilities were not significantly associated with the psychosocial quality of life in autistic adolescents.

Conclusion This study found that low perceived social competence, high social anxiety, and a high frequency of problem behaviors are associated with poor psychosocial quality of life in autistic adolescents. Findings from this study can inform clinicians in designing individualized intervention plans aimed at effectively improving the psychosocial quality of life in autistic adolescents by addressing their perceived social competence, social anxiety, and problem behaviors.