自閉症類幼兒社會注意力的探究

Social Attention in Young Children with Autism Spectrum Disorders

本研究主要目的在探討自閉症類幼兒的社會注意力，及它與語言的關係。社會注意力包括社會定向能力和相互注意協調能力。受試者為生理年齡3歲以下的自閉症類幼兒，生理、心理年齡配對的發展遲緩幼兒和心理年齡配對的一般發展嬰兒各20名。修正Dawson等人（1998）與Dawson等人（2004）的研究方法，來測量社會定向能力，並以早期社會溝通量表（Early Social Communication Scales, Mundy et al., 2003），評估相互注意協調能力。結果發現：（1）自閉症類幼兒社會定向能力與整體注意力定向能力顯著比發展遲緩幼兒及一般發展嬰兒差。（2）自閉症類幼兒相互注意協調能力顯著的比發展遲緩幼兒及一般發展嬰兒差。（3）鑑別3歲以下自閉症類的幼兒，相互注意協調能力比社會定向能力是更有效的指標。（4）自閉症類幼兒整體注意力定向能力和高層次反應性相互注意協調能力顯著正相關，同時，促進3歲以下自閉症類幼兒語言能力發展的關鍵能力是反應性相互注意協調能力。本研究結果指出自閉症類幼兒社會定向能力障礙在3歲以前便存在，反應性相互注意協調能力，在此語言發展階段上扮演的角色，比主動性相互注意協調能力更為重要。後續的研究可以進行縱貫的探討，以瞭解自閉症類幼兒早期社會能力發展路徑及障礙的本質。

Background and purpose of the study: While social stimuli (e.g., facial expression, name calling, and speech, etc.) are complex and unpredictable, they are important in early social development when children engage in social interaction. Failure to attend to social stimuli would impair the development of social communication. It has been shown that children with autism spectrum disorders (ASD) around the age of four has displayed social attention impairment in social orienting and joint attention (e.g., Dawson et al., 1998, 2004; Leekam et al., 2006). However, the nature of social attention and the relationships among social orienting, joint attention and language development in young children with ASD under the age of three have not been explored yet. The purpose of this study was to investigate social attention and its relation to language in young children with ASD under 36 months. Methods: The participants were 20 30-month-old children with ASD, 20 28-month-old children with developmental delay (DD), and 20 typical developing 17-month-old infants (TD). The ASD and DD groups from a local hospital in southern Taiwan were assessed and diagnosed according to DSM-IV-TR (APA, 2000) and ADOS (Lord et al., 1999) by a research team, consisting of two child psychologists and two child psychiatrists. Materials used in the study were modified from Dawson et al. (1998, 2004), including 6 social stimuli and 6 nonsocial stimuli presented randomly through one of two speakers posited in front of child's left and right sides. Social stimuli involved calling the child's name with three different emotional tones and three different two-word vocabularies as well as nonsocial stimuli consisted of hammer and electronic music, each with three different rhythms. The joint attention was measured using Early Social Communication Scales (ESCS, Mundy et al., 2003) to explore relationships among social orienting, joint attention, and language competency. Results: The results showed that social orienting and overall orienting were poorer in the ASD group than in the DD and TD groups. It was also found that children with ASD were poorer in joint attention tasks than the DD and TD groups. Additionally, joint attention was a better variable than social orienting to discriminate ASD group from non-ASD groups. Moreover, correlation analyses revealed a significant relationship between overall attention orienting and high level response to joint attention in the ASD group that was critical to language development. For both control groups, no significant relationship was found among social orienting, response to joint attention and initiation of joint attention. Conclusions: The results suggested that social attention impairments in young children with ASD are shown under age of three, and the response to joint attention is more important than initiation of joint attention to language development in children with ASD under 36 months. Further studies are needed to follow the subjects to clarify the developmental trajectory of early social development in children with ASD.