克氏行為量表篩檢4歲以下自閉症類疾患兒童效度探究

Validity of the Clancy Behavior Scale for Detecting Autism Spectrum Disorders in Children Younger than 4 Years Old

研究目的：目前篩檢4歲以下自閉症類疾患兒童與發展遲緩兒童的工具不多，這個問題會妨礙自閉症類疾患兒童的早期診斷與早期療育工作。因此，本研究目的探討家長填寫的篩檢問卷「克氏行為量表（Clancy Behavior Scale）」，運用在篩檢4歲以下自閉症類疾患兒童的效度。研究方法：152名生理年齡介於18-47個月之間的兒童，包括：62名自閉症類疾患兒童與90名發展遲緩兒童，由家長填寫克氏行為量表。研究結果：本研究發現克氏行為量表，在篩檢4歲以下自閉症類疾患兒童的效度尚佳。使用訊號偵測理論決定最佳切截分數，以總分12作為切截分數，敏感度與特異度分別是.74與.73。以判別分析的結構矩陣，找出9題關鍵題目。一樣使用訊號偵測理論決定9題關鍵題目的最佳切截分數，以總分7作為切截分數，敏感度與特異度分別是.76與.76。本研究結果顯示以簡版的克氏行為量表進行篩檢，敏感度與特異度優於全部14題。因此，本研究建議用9題版作為篩檢版本，採用4題版作為初步篩檢。研究結論：本研究初步結果支持克氏行為量表可以用來當作自閉症類疾患兒童層次二篩檢工具，後續需要更多的受試者來驗證克氏行為量表的篩檢效度及篩檢指標。

Purpose: Few screening tools exist that are specific for distinguishing autism spectrum disorders (ASD) from developmental delay (DD) in children under four years old. The availability of such a tool would reduce the difficulty of early diagnosis and aid early intervention for children with ASD. The current study applied the Clancy Behavior Scale, a parent-report questionnaire, to detect ASD in children under four. Methods: Parents of 152 children from 18 to 47 months old, including 62 children with ASD and 90 children with DD, completed the measure. Results: Analysis of the data indicated that the Clancy Behavior Scale is a promising screening tool. Using a signal detection procedure, a score of 12 was used as the cut-off to distinguish children with ASD from those with DD. The sensitivity and specificity were .74 and .73, respectively. Using a discriminant analysis structure matrix, we selected 9 of the 14 items of the Clancy Behavior Scale as critical items. Using a signal detection procedure again, a score of 7 was used as the cut-off for the 9 critical items to distinguish young children with ASD from those with DD. Both the sensitivity and specificity of short form were .76 and .76, respectively. The results supported the utility of applying the short form Clancy Behavior Scale to detect ASD in young children; both the sensitivity and specificity were better than with the 14-item measure. We suggest that the 9-item form be used to assess, and that 4 items be used for the initial screening. Conclusions: The current preliminary data demonstrated that the Clancy Behavior Scale can be used as a level-two screening tool for children under four with ASD. Future studies are needed to recruit a larger sample size and to validate the accuracy of using the Clancy Behavior Scale to diagnose and screen young children with ASD.