學齡前自閉症類兒童的適應行為型態與認知功能及症狀嚴重度之關連

Relating Cognitive Competence and Diagnostic Severity to Adaptive Behavior Profiles in Preschool Children with Autism Spectrum Disorders

研究目的：本研究主要探究學齡前自閉症類兒童的適應行為表現型態，並釐清認知功能及自閉性症狀嚴重程度，二者與適應行為的關連。方法：以文蘭適應行為量表第二版進行評估，招募26個月至61個月間的自閉症類兒童共81名。第一部份分析配對心理年齡、非語文心理年齡及語文心理年齡，比較生理年齡在42-52個月的32名自閉症類兒童、30名發展遲緩兒童、及31名生理年齡在27-49個月的一般發展兒童適應行為表現。第二部分分析則針對全部81名的自閉症類兒童，依發展商數區分成高低認知功能兩組，比較兩組適應行為差異。結果：第一部份輪廓分析的結果指出，在標準分數與年齡當量兩指標，指出自閉症類兒童的適應行為表現並未呈現日常生活技巧高於溝通、溝通高於社會化的自閉症型態，而是「動作 > 溝通 = 日常生活技巧 > 社會化」的表現型態，且社會化領域的標準分數與年齡當量均低於二組對照組。第二部分針對高功能及低功能自閉症類兒童的分析，也發現兩組均未呈現自閉症型態，不過兩組具相似的適應行為型態表現。若控制認知功能，以偏相關分析自閉症狀與適應行為，發現不論是高或低功能自閉類組，其ADOS（Autism Diagnostic Observation Schedule）症狀分數與適應行為各領域均無顯著相關存在。總結：本研究指出學齡前自閉症類兒童無自閉症型態適應行為表現，且即便排除認知功能影響，社會化領域的適應行為仍有顯著的缺損。

Purposes: The present study examined the profile of adaptive functioning in preschool children with autism spectrum disorders (ASDs) and its relationship to cognitive competence and severity of autistic symptoms. Methods: Adaptive behavior skills were assessed using the Vineland Adaptive Behavior Scales -- Second Edition (VABS-II). Participants were 81 ASD children with chronological age (CA) between 26 and 61 months. In the first analysis, 32 ASD children with CA between 42 and 52 months, 30 children with developmental delay (DD) (CA: 42-52 months), and 31 typical-developing children (TD) (CA: 27-49 months). They were closely matched for mental age, nonverbal mental age, and verbal mental age. The second analysis involved a total of 81 ASD children. They were divided into high functional autistic spectrum disorders (HFASD) and low functional autistic spectrum disorders (LFASD) by developmental quotient. Results: The VABS-II analysis revealed a ‘motor > communication = daily living skills > socialization’ profile as indexed by standard score and age equivalence. This was counter to the profile ‘daily living skills > communication > socialization’ presumed to be shown in autism. Overall, children with ASD lagged behind the two non-ASD groups. In the second analysis, partial correlation analysis controlling cognitive status showed that none of VABS-II domains were correlated to diagnostic features as reported by the Autism Diagnostic Observation Schedule (ADOS) in either HFASD or LFASD. Conclusions: The present findings suggest that there is no ‘autism-specific profile’ in preschoolers with ASD. Children with ASD exhibited a weakness in socialization domain even their cognitive competency was controlled.