臺灣博碩士論文加值系統

背景與目的：泛自閉症障礙症候群（autism spectrum disorder，簡稱自閉症）是一種神經發展障礙的疾病，主要核心症狀包括社會溝通障礙及刻板固著的興趣與行為。除了上述二大核心症狀，自閉症也常合併患有共病症，包括注意力不足過動症與動作障礙等。自閉症的核心症狀與共病症不僅影響兒童的發展與情緒行為表現，也會限制兒童在日常生活的適應性行為功能。過去的文獻大多針對核心症狀對兒童情緒行為與功能表現的影響，卻鮮少探討共病症是否對於自閉症兒童的情緒行為表現與日常生活功能有負面的影響。因此，本研究的目的是要探討自閉症的共病症，包括注意力不足過動症與動作障礙對於學齡期高功能自閉症兒童的情緒行為表現與適應性行為表現的影響。方法：本研究共納入44名7-11歲的高功能自閉症兒童，其中20名無合併注意力不足過動症的自閉症兒童中有9名（45%）同時合併動作障礙，而24名有合併注意力不足過動症的兒童中則有13名（54%）同時合併動作障礙。本研究使用布魯茵克斯-歐西瑞斯基動作精練度評量工具第二版評估兒童的動作能力，判斷自閉症兒童是否合併有動作障礙、粗大動作障礙與精細動作障礙。兒童的情緒行為問題是使用兒童行為檢核表進行評量，包括總行為問題、內隱性行為問題、外顯性行為問題與八大向度情緒行為問題。兒童在學校的適應性行為表現將由學校教師填寫文蘭適應性行為量表–教室版，以瞭解兒童在學校生活的功能表現。統計分析是使用2 × 2的雙因子變異數分析來分別探討二種共病症對自閉症兒童的情緒行為與適應性行為表現的影響。結果：合併注意力不足過動症會使學齡期高功能自閉症兒童有較多的注意力問題、外顯性行為與攻擊行為問題，也會讓無合併動作障礙的自閉症兒童的適應性動作技巧與社會化技巧表現較差。合併動作障礙則會讓自閉症兒童有較多的社會問題，以及較差的適應性日常生活技巧與溝通技巧，其中粗大動作障礙主要影響兒童的動作技巧與溝通技巧，而精細動作障礙則主要影響日常生活技巧。然而，注意力不足過動症與動作障礙對自閉症兒童的行為的影響也會因兒童的智能表現而有改變。結論：注意力不足過動症與動作障礙的共病症會影響兒童在不同面向的情緒行為與適應性行為表現。本研究的結果有助於瞭解共病症對高功能自閉症兒童的行為表現的影響，並作為自閉症兒童的家長、老師以及臨床專業人員在臨床上教養與介入治療的參考。未來研究應考量其他可能的影響因素，以針對自閉症兒童的情緒行為與適應性行為表現做更全面性的探討。

Background and purpose: Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders characterized by limitations in social interaction and communication, as well as restricted interests and repetitive behaviors. In addition to core symptoms, children with ASD often have various comorbidities, including attention deficit hyperactivity disorder (ADHD) and motor disorder (MD). These core symptoms and comorbidities have adverse impacts on socioemotional behaviors and adaptive functioning of children with ASD. Previous studies mostly focused on the effect of core symptoms on children with ASD, but rarely explored the impact of comorbidities. Hence, the purpose of this study was to determine the impact of comorbidities, including ADHD and MD, on emotional/behavior problems and adaptive functioning of school-aged children with high-functioning ASD. Methods: This study recruit 44 children with high-functioning ASD aged from 7 to 11 years, 20 children without and 24 children with ADHD. Among the 20 children who were diagnosed with ADHD, 9 (45%) also had MD. Among the 24 children without ADHD, 13 (54%) also had MD. The Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition was used to assess children’s motor ability. The Child Behavior Checklist was used to assess children’s socio-emotional behavior, including total problem, internalizing behavior problem, externalizing behavior problem and eight syndrome of emotional/behavior problems. Children’s adaptive functioning in school was reported by school teachers using the Vineland Adaptive Behavior Scale. Statistical analyses were conducted using 2x2 Analysis of variance (ANOVA) to examine the impact of ADHD and MD on emotional/behavior problems and adaptive functioning of children with ASD. Results: In school-aged children with high-functioning ASD, comorbidity of ADHD significantly increased children’s attention problems, aggressive behaviors and externalizing behaviors as well as worsened children’s adaptive motor skills and socialization skills. On the other hand, comorbidity of MD increased social problems, worsened adaptive daily living skills and communication skills in children with high-functioning ASD. Furthermore, the impacts of ADHD and MD on ASD children’s emotional/behavior and adaptive functioning were moderated by children’s intellectual ability. Conclusions: Comorbidities of ASD, including ADHD and MD, have adverse impacts on children’s emotional/behavior and adaptive functioning. The results of this study help understand the impact of comorbidities on behaviors and functioning on children with ASD and provide important clinical information for teachers and medical professionals. Future research needs to consider other possible influencing factors to better investigate behaviors and functioning of children with ASD.

論文口試委員審定書 ii
誌謝 iii
中文摘要 iv
英文摘要 vi
第一章 前言 1
第一節 背景 1
第二節 論文目的 4
第三節 研究問題及假設 4
第二章 文獻回顧 6
第一節 自閉症的核心症狀及共病症 6
第一項 核心症狀 6
第二項 共病症 7
第二節 自閉症兒童的情緒行為問題 10
第三節 自閉症兒童的適應性行為表現 12
第三章 方法 15
第一節 受試者 15
第二節 測量工具 15
第三節 研究流程 19
第四節 統計方法 19
第四章 結果 21
第一節 受試兒童 21
第二節 合併注意力不足過動症與/或動作障礙對自閉症兒童在情緒行為表現的影響 22
第三節 合併注意力不足過動症與/或動作障礙對自閉症兒童在適應性行為表現的影響 22
第五章 討論 24
第一節 合併注意力不足過動症與/或動作障礙對自閉症兒童在情緒行為表現的影響 24
第二節 合併注意力不足過動症與/或動作障礙對自閉症兒童在適應性行為表現的影響 25
第三節 研究限制 29
第六章 結論 30
參考資料 31
附錄 52
附錄一 兒童知情書 52
附錄二 家長同意書 55

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