學齡前自閉症類群障礙症兒童內化性行為問題與親職壓力之關聯：兒童主動控制的調節與中介效果

Associations between Internalizing Behavior Problems and Parenting Stress in Preschool Children with Autism Spectrum Disorder: Moderating and Mediating Effects of Children’s Effortful Control

研究目的：自閉症類群障礙症兒童是伴隨內化性行為問題、自我調節問題的高危險群，其家長也承受較高親職挑戰。本研究旨在探討學齡前自閉症類群障礙症兒童內化性行為問題與親職壓力的關聯、兒童主動控制在兩者關係的調節與中介角色。研究方法：以54位4-6歲自閉症類群障礙症兒童及其家長為對象，施測兒童智力，家長以問卷評量兒童自閉症症狀、內化性行為問題、兒童主動控制及自身親職壓力。研究結果：控制兒童智力與自閉症症狀後，兒童內化性行為問題正向預測整體親職壓力、父母困擾、親子失功能互動及困難兒童親職壓力面向，且負向預測兒童主動控制；兒童主動控制在內化性行為問題與親職壓力間的調節效果不顯著，可部份中介內化性行為問題對整體親職壓力、困難兒童親職壓力的預測效果。研究結論：學齡前自閉症類群障礙症兒童的內化性行為問題與多面向親職壓力有直接關聯，不利兒童注意力與行為調節的發揮；兒童主動控制無法調節內化性行為問題與親職壓力的關聯，而是部分親職壓力面向的保護與中介因子。

Purpose: Children with autism spectrum disorder (ASD) usually have a high risk of suffering internalizing behavior problems and self-regulation difficulties. Their parents may also face formidable parenting challenges. The aim of this study is to investigate the direct effects of ASD-diagnosed preschoolers’ internalizing behavior problems on multifaceted parenting stress, as well as the moderator and mediator effects of children’s effortful control on the relationship between internalizing behavior problems and parenting stress. Methods: 54 Taiwanese preschoolers (4-6 year-old) with ASD and their parents participated. We assessed each child’s IQ with an individualized test. Parents completed questionnaires to rate their child’s internalizing behavior problems, effortful control, ASD symptom severity, as well as their own parenting stress. Results: The internalizing behavior problems had positive predicting effects on the indicators of parenting stress, including overall stress, parental distress, dysfunctional parent/child interaction, and difficult child. Internalizing behavior problems had a negative association with the child’s effortful control when the child’s intellectual level and ASD symptoms were controlled. Effortful control had negative effects on overall stress and difficult child parenting stress, and had mediator effects on the relationships between the internalizing behaviors and overall stress as well as difficult child parenting stress, even though there were no significant moderating effects. Conclusions: The internalizing behavior problems of preschoolers with ASD can predict parenting stress, and had an unfavorable relationship with the children’s attention and behavior regulation. Children’s effortful control mediated the association among internalizing behavior problems and some indicators of parenting stress, even though there were no significant moderating effects. Interventions targeting on children’s internalizing behavior problems which seek to enhance children’s attention and behavioral self-regulation may be helpful in releasing parenting stress for parents with preschoolers with ASD.