猜猜我在想什麼？－－中文版心智推理作業的信效度研究及其在老年人的表現初探

Guess What I think? The Reliability and Validity of Chinese Theory of Mind Tasks and Performance in the Elderly

目的：個體具有預測行動者心中的想法、感受、需求與信念的能力，稱之為「心智推理」，在神經科學方面的研究顯示大腦內腹側額葉在心智推理的運作扮演重要的角色，且與社會行為有關。然而，不論是國內外均缺乏測量大腦內腹側額葉的標準化工具，此測驗的編製除了可以讓研究心智推理概念時有適當的研究工具外，同時在臨床神經心理衡鑑時，提供測量內腹側額葉功能的指標，因此本研究的目的為編製中文版本之心智推理題目並檢驗其信效度。方法：分為正常成人組及臨床組，正常成人部分共有175位，年齡介於18至88歲，其中有32位完成相隔三個月後的再測程序，臨床組部分以15位臨床診斷為高功能自閉症及亞斯伯格症候群的青少年為研究對象。結果：四大類心智推理作業的內部一致性信度介於.50至.76之間，三個月後的再測信度為.86至.92，效度部分顯示失態偵測、弦外之音及非語言之圖片心智推理作業具有可接受的信度及效度，但是初級及次級錯誤信念未達預期之信度及效度水準。

Purpose: Theory of Mind (ToM) refers to the ability to represent mental states, such as beliefs and intentions, and is distinct from the ability to represent 'real' states of affairs. It enables us to make attributions and to reason about mental states and, in doing so, to understand and predict the behavior of other people. Research has suggested that theory of mind may represent a dissociable, modular brain system that is related to, but separable from, other brain functions, including memory, language, and executive functions. Studies with neuroimaging provide further evidence that the ventromedial regions of the prefrontal cortex are associated with ToM. However, the Chinese standardized instrument of brain function of the vertromedial prefrontal cortex is lacking in Taiwan. Thus, it is indeed a pressing task to establish a related assessment tool. Validation of this tool will provide an appropriate research implement for studying the concept of mental reasoning that could also be used as a functional index of the ventromedial prefrontal cortex in clinical neuropsychological settings. The purposes of this study were to establish the reliability and validity of theory of mind tasks and to explore whether healthy elderly people exhibit impairment on those tasks. Method: 175 subjects aged from 18 to 88, and 15 subjects with autism and Asperger's syndrome, were recruited as the normal and clinical groups, respectively. We also completed test-retest measurement of 30 subjects from the normal group. The groups were controlled for level of education, level of intelligence, and memory. The materials used for the theory of mind tasks included false beliefs, Faux Pas, implication stories, and non-verbal tasks. Result: The results showed that there is acceptable reliability and validity in that Chinese theory of mind tasks except false beliefs. There is no significant difference between young and elderly adult on these tasks, even with memory function and socio-economic status taken into account.