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研究生:許聖慈
研究生(外文):Sheng-TzuHsu
論文名稱:泛自閉症兒童及青少年的手足:廣泛自閉症表現型特質與其生活適應
論文名稱(外文):Broader autism phenotype and life adjustment of children’s and adolescents with ASD sibling in Taiwan
指導教授:徐畢卿徐畢卿引用關係
指導教授(外文):Bih-Ching Shu
學位類別:碩士
校院名稱:國立成功大學
系所名稱:護理學系
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:中文
論文頁數:152
中文關鍵詞:自閉症類群障礙症廣泛自閉症表現型手足疾病感受手足關係手足生活適應
外文關鍵詞:autism spectrum disordersbroad autism phenotypeillness perceptionsibling relationshipsibling life adjustment
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自閉症類群障礙症患者議題受到台灣與國外新聞媒體及雜誌的熱烈討論,引起社會大眾一連串的回響與關注。本研究目的為探討自閉症類群障礙症、注意力不足過動症類群、正常兒童及青少年手足其廣泛自閉症表現型、手足疾病覺知、手足關係、手足適應之差異性。故本研究將採橫斷式調查之個案對照組研究方法,以結構性問卷及相關測驗進行自閉症類群障礙症、注意力不足過動症類群、正常兒童及青少年手足研究調查,其共涵蓋基本人口學問卷、電腦版威斯康辛卡片分類(Wisconsin Card Sorting Test-computer Version 4, WCST-CV4)、自閉症光譜量表(Autism- spectrum Quotient, AQ)、疾病覺知問卷修訂版(Illness Perception Questionnaire Revised, IPQ-R)、手足關係量表(Sibling Relationship Questionnaire, SRQ)、長處與困難問卷量表(Strengths and Difficulties Questionnaire, SDQ)。本研究經人體試驗委員會(IRB)審查通過後,採知情同意方式由研究者本人向受試者及家長說明後收集相關資料。以南部某精神專科醫院進行收案,共69位手足受試者,其中自正常組有32位,自閉症類群障礙症有19位、注意力不足過動症類群有18位。
研究結果發現:三組手足基本人口學資料性別上有顯著性差異。三組罹病個案基本人口學與疾病統計資料顯示性別、參與早期療育上有顯著性差異。家長的基本人口學統計資料顯示職業上有顯著性影響。三組廣泛自閉症表現型之自閉症光譜(AQ)顯示在社交技巧、對細節的注意力上有顯著性差異影響。三組疾病手足在廣泛自閉症表現型之WCST-CV4持續度中斷上有顯著性差異影響。三組疾病手足在疾病感受之比較上,時間感急/慢性、治療控制、情緒表徵、致病因素有顯著性差異影響。三組疾病手足在手足關係上無顯著性差異。三組疾病手足在手足生活適應上無顯著性差異影響。
本研究結果可提供醫療照護人員於廣泛自閉症之個案有更深入之評估與認識,並可進一步發展及提供其個別性之心理健康之活動與照護,以提升其手足適應。
Summary
The study aims to investigate the autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD) and broad autism phenotype in normal children and adolescents and to look into their differences in sibling illness perception, sibling relationship and sibling adaption. There were totally 69 sibling subjects. 32 of them were of non-disordered group, 19 of them were of autism spectrum disorders (ASD) group and 18 of them were of ADHD group.The results show that AQ of the broad autism phenotype of the three groups shows significant differences in the aspects of social skills and the attention to details. There are significant differences among the continuity interruption of WCST-CV4 for broad autism phenotype of the three groups. In the aspect of illness perception, the three groups have significant differences in acute/chronic sense of time, treatment control, emotional expressions and the causes of diseases. Yet, there is no significant difference in the sibling relationship of the 3 groups, neither in their sibling adaption.
Background:
The autism spectrum disorders have been enthusiastically discussed with great attention in media and journals at home and abroad and have received attentive responses from the public. The study aims to investigate the autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD) and broad autism phenotype in normal children and adolescents and to look into their differences in sibling illness perception, sibling relationship and sibling adaption.
Method:
A cross-sectional survey of normal-disorder sibling pairs was adopted in the study with structural questionnaires given for tests on the subjects consisting of patients with ASD, patients with ADHD, normal children and adolescent siblings. The survey was conducted with basic demographic questionnaires, along with Wisconsin card sorting test-computer version 4 (WCST-CV4), autism-spectrum quotient (AQ), illness perception questionnaire revised (IPQ-R), sibling relationship questionnaire (SRQ) and strengths and difficulties questionnaire (SDQ). The study was certified by the Institutional Review Board (IRB), and consents were received from the subjects and their parents who were informed of the test contents by the explanation made by the researcher before related data were collected from a psychiatric hospital in southern Taiwan.
Results:
There were totally 69 sibling subjects. 32 of them were of non-disordered group, 19 of them were of autism spectrum disorders (ASD) group and 18 of them were of ADHD group. The results show that in the aspect of basic demographic data, the three test groups have significant differences in terms of sex, and the basic demographic and disease statistics of the cases in these 3 groups reveal significant differences in the aspects of sex and early treatment. In the aspect of the parents' demographic statistics, significant differences are shown among the parents' occupations. The AQ of the broad autism phenotype of the three groups shows significant differences in the aspects of social skills and the attention to details. There are significant differences among the continuity interruption of WCST-CV4 for broad autism phenotype of the three groups. In the aspect of illness perception, the three groups have significant differences in acute/chronic sense of time, treatment control, emotional expressions and the causes of diseases. Yet, there is no significant difference in the sibling relationship of the 3 groups, neither in their sibling adaption.
It is hoped that the results of this study can be provided as the reference for healthcare practitioners to conduct further in-depth evaluation and for their knowledge of the broader autism disorder cases. It is also expected that they can further develop and provide individual psychological caretaking activities and healthcare so as to improve the sibling adaption of the cases.
中文摘要 I
Abstract II
誌謝 IV
第壹章、緒論 1
第一節、研究背景及重要性 1
第二節、研究問題描述 4
第三節、研究目的 5
第貳章、文獻查證 6
第一節、自閉症類群障礙症的特徵與診斷 6
第二節、自閉症類群障礙症手足之廣泛自閉症表現型 10
第三節、自閉症類群障礙症手足之關係探討 15
第四節、自閉症類群障礙症手足之疾病感受 18
第五節、自閉症類群障礙症手足之適應概述 21
第六節、相關工具探討 25
第參章、研究方法 36
第一節、研究架構 36
第二節、名詞界定 37
第三節、研究設計 39
第四節、研究同意 41
第五節、研究工具 42
第六節、收案過程 45
第七節、研究生之訓練與準備 47
第八節、研究倫理 48
第九節、資料分析方法 49
第肆章、研究結果 52
第一節、人口學屬性資料統計 53
第二節、廣泛自閉症表現型、疾病覺知、手足關係、手足適應之常態檢定 60
第三節、三組廣泛自閉症表現型之比較 68
第四節、不同疾病組別在手足疾病感受之比較 84
第五節、不同疾病組別在手足關係之比較 85
第六節、不同疾病組別在手足適應之比較 86
第伍章、討論 89
第一節、研究對象基本屬性 89
第二節、廣泛自閉症表現型對於手足之影響 91
第三節、研究限制 97
第四節、未來研究建議 98
參考文獻 99
中文文獻 99
英文文獻 101
附錄一、家長問卷 109
附錄二、手足問卷 115
表目錄
表2-5-1、自閉症類群障礙症手足適應相關文獻整理 23
表2-6-1、廣泛自閉症表現型之相關量測比較 27
表2-6-2、手足關係量表之比較 31
表2-6-3、手足適應量表之比較 34
表3-8-1、資料分析及統計方法 50
表4-1-1、罹病個案之基本人口學與疾病統計資料 55
表4-1-2、手足的基本人口學統計資料 57
表4-1-3、家長之基本人口學統計資料 59
表4-2-1、自閉症類群障礙症組、注意力不足過動症類群組、正常手足之廣泛自閉症表現型量表(AQ)常態檢定 61
表4-2-2、自閉症類群障礙症組、注意力不足過動症類群組、正常手足之WCST常態檢定
62
表4-2-3、自閉症類群障礙症組、注意力不足過動症類群組、正常手足之疾病覺知量表常態檢定 64
表4-2-4、自閉症類群障礙症組、注意力不足過動症類群組、正常手足之手足關係量表常態檢定 66
表4-2-5、自閉症類群障礙症組、注意力不足過動症類群組、正常手足之手足適應量表常態檢定 67
表4-3-1、不同組別之手足AQ分量表之差異比較 69
表4-3-2、不同組別之手足WCST差異性檢定 71
表4-3-3、自閉症光譜量表(AQ)與威斯康辛卡片分類(WCST)分量表之相關性 73
表4-3-4、自閉症光譜量表(AQ)與威斯康辛卡片分類(WCST)、長處與困難問卷量表(SDQ)分量表之相關性 75
表4-3-5、自閉症光譜(AQ)預測型迴歸分析 76
表4-3-6、手足人口學變項影響其手足AQ之相關因素 77
表4-3-7、手足人口學變項影響其手足AQ之相關因素 78
表4-3-8、手足基本人口學與AQ之差異性檢定 79
表4-3-9、手足基本人口學與WCST之差異性檢定 80
表4-3-10、基本人口學變項之教育程度與WCST之事後檢定 82
表4-3-11、不同性別之AQ總分之差異性檢定 83
表4-3-12、不同性別之AQ總分之差異性檢定 83
表4-4-1、不同疾病組別之疾病感受差異性檢定 84
表4-5-1、不同組別在SRQ 各分量表差異性檢定及事後比較 85
表4-6-1、不同組別在SDQ各分量表差異性檢定及事後比較 86
表4-6-2、自閉症光譜量表與手足適應之關係 88
表5-2-1、三組手足在WCST計分上與學者Shu(2000)常模比較 93
表5-2-2、廣泛自閉症表現型之相關研究一覽表 96
圖目錄
圖3-1、研究架構圖 36
圖3-2、收案流程圖 46
圖4-1、收案人數說明 52
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