高功能自閉症學齡兒童的心智理論與口語敘說

Theory of Mind and Narrative Abilities in School-Aged Children with High-Functioning Autism

自閉症學齡兒童呈現「心智理論」能力缺陷，而且出現異常的「口語敘說」。但是，低年級高功能自閉症兒童的「心智理論」表現是否與正常發展兒童不同，並伴隨特殊的「口語敘說」風格，以及兩種能力彼此關連等議題則有待檢驗。本研究以系列心智理論及連環圖敘說作業，探索六至八歲高功能自閉症（n = 30）和配對生理年齡、整體智商及語文智商之正常發展兒童（n = 30）的心智理論與敘說表現。「心智理論」作業的結果顯示，兩組兒童心智理論分作業的難度順序類似，均為「不同欲求」、「不同信念」、「訊息知曉」、「初級錯誤信念──非預期內容」、「初級錯誤信念──非預期位置」、「情緒隱藏」及「次級錯誤信念」；另外，高功能自閉症組心智理論各分作業的通過率均低於配對組。「敘說」作業的結果顯示，兩組兒童敘說圖畫故事時的整體結構、細部的語言特徵（即，詞彙總量及詞彙變異性）相似；但是高功能自閉症組的敘說較少以「心理歸因」為主題、正確指涉故事人物意圖的比例偏低、而較常使用「敘說強調技巧」。最後，相關分析顯示，高功能自閉症兒童的心智理論作業總分與敘說的「意圖指涉正確比例」、「語意強調」及「語意不清」等指標有關。逐步回歸分析顯示，「意圖指涉正確比例」和「語意強調」最能解釋心智理論表現的變異量。

The Theory of Mind (ToM) deficit is well-documented in children with high-functioning autism (HFA). Few studies have explored the differences of ToM and narrative performances between children with HFA and typically developing children in the first and second grades. In addition, it is unclear whether ToM and narrative performances in children with HFA are related. To examine these questions, we administered a variety of ToM tasks as well as narrative tasks (with a series of comic strips) to 6- to 8-year-olds with HFA (n = 30) and typically developing children at the same ages (n = 30). Results show that the HFA and matched groups responded similarly to the difficulty rankings of the ToM tasks, with Diverse Desire (DD) being the most difficult, followed by Diverse Belief (DB), Knowledge Access (KA), False Belief -- Unexpected Content (FB-UC), False Belief -- Unexpected Location (FB-UL), Hidden Emotion (HE) and Secondary False Belief task (SFB). However, the matched group outperformed the HFA group on each ToM task. On narrative tasks, children with HFA performed similarly to the matched group in global narrative structure and specific linguistic features (e.g., total number of words and type-token ratio). However, compared with the matched group, HFA children used fewer psychological attributions, had lower ratio to correctly attribute character's intentions, and had more semantic intensifiers in their narratives. Finally, the ToM scores were significantly correlated with specific narrative features (i.e., ratio to correctly attribute character's intentions, usage of semantic intensifiers and number of ambiguous references). The stepwise regression model shows that ratio to correctly attribute character's intentions and usage of semantic intensifiers accounted for the most variances in HFA children's ToM performances.