自閉症類群疾患幼兒語言能力相關因素：共享式注意力與模仿

Correlates of Language Abilities in Young Children with Autism Spectrum Disorders: Joint Attention and Imitation

本研究目的為探究自閉症類群疾患幼兒早期社會溝通能力：共享式注意力與模仿，在語言能力發展所扮演的角色。受試者為131名自閉症類群疾患幼兒，平均生理年齡約30個月。修改台灣版兩歲期自閉症篩檢工具（Taiwanese version of the Screening Tool for Autism in Two-Year-Olds, T-STAT），測量主動性共享式注意力、回應性共享式注意力、物體操作模仿及手勢動作模仿能力；以穆林發展量表（Mullen Scales of Early Learning, MSEL）及適應行為評量系統第二版（Adaptive Behavior Assessment System-II, ABAS-II）測量語言能力。結果發現：主動性共享式注意力、回應性共享式注意力、物體操作模仿及手勢動作模仿能力，皆與MSEL的語言理解、語言表達、整體語言，及ABAS-II溝通適應，出現顯著正相關。控制生理年齡及非語言認知能力後，回應性共享式注意力，可以預測所有語言能力指標；另一個重要的預測能力，則是手勢動作模仿能力，可以預測MSEL的語言表達與整體語言能力。結論：回應性共享式注意力是最能預測語言發展的能力，代表自閉症類群疾患幼兒可以注意他人分享注意力的焦點，瞭解他人的分享意圖，是早期語言學習相當重要的因素。此外，增進自閉症類群疾患幼兒對社會互動的興趣，亦可以促進其語言表達能力的發展。本研究結果支持共享式注意力及模仿能力，在語言發展的重要性，提供早期療育訓練目標設計的參考。

Purposes: This study examines the role of early social-communicative skills (i.e., joint attention and imitation) in the development of the language abilities of young children with autism spectrum disorders (ASDs). Method: There are 131 young children with ASDs, with a mean chronological age of about 30 months. The Taiwanese version of the Screening Tool for Autism in Two-Year-Olds (T-STAT) was modified and used for measuring early social-communicative skills, including initiating joint attention (IJA), responding joint attention (RJA), object imitation, and manual imitation. With reference to previous studies, the IJA was divided into full-IJA (F-IJA) and partial-IJA (P-IJA). A structured tool and the parent-report scale were both used to measure language abilities, including the Mullen Scale of Early Learning (MSEL) and the Communication Subscale in Adaptive Behavior Assessment System-II (ABAS-II). Results: The results of this study showed that, F-IJA, P-IJA, RJA, object imitation, and manual imitation were significantly related to receptive language, expressive language, and overall language from MSEL, and communicative ability from ABAS-II. Hierarchical regression analysis was used to control chronological age and non-verbal cognitive ability. The results of hierarchical regression analysis showed that, the strongest predictor of receptive language, expressive language, and overall language from MSEL, as well as communicative ability from ABAS-II, was RJA. In addition, manual imitation was the second predictor of language abilities, as it could predict the development of expressive language and overall language according to MSEL. However, neither object imitation nor IJA could predict the development of language abilities. Conclusions: The results of this study revealed that RJA was the robust predictor of language abilities in young children with ASDs. Young children with ASDs could correctly follow their partner when directing their attention, and understand the intention, which is a critical factor of early language development. Generally speaking, when young children with ASDs experience interesting social interactions and engagements, it could enhance their expressive language development. The results provide the implications to design the goals and skills for the early intervention in young children with ASDs.