臺灣博碩士論文加值系統

亞斯伯格症(Asperger’s disorder, AD)是一種廣泛性發展疾患，社會互動困難為其主要核心症狀之一。過去研究認為心智推測能力(theory of mind, ToM，或譯為心智理論能力)缺損是亞斯伯格症患者產生社會互動困難的主要因素。國內外的學者及實務工作者嘗試以各種治療方式來改善此類兒童的社交技巧及心智推測能力，其中之一即為認知行為治療(cognitive behavioral therapy, CBT)。CBT模式對各種心理疾患的療效已得到許多國內外實徵研究的支持，然而國內有關運用CBT治療亞斯伯格症兒童的療效研究很少，且在研究設計上有明顯瑕疵，故本研究採用前後測控制組設計，檢驗一認知行為治療方案對亞斯伯格症學齡兒童的立即療效，並追蹤其療效之持續性。
本研究參與者分為實驗組及控制組，兩組各包含8名國小三到五年級智能正常的亞斯伯格症男童。實驗組接受認知行為團體治療，每週一次，每次90分鐘，共計10次，其家長並接受5次的家長說明會，以瞭解亞斯伯格症症狀、行為改變技術、心智推測能力等概念。控制組則為臨床招募之個案，並無接受此類團體治療，家長亦無接受家長說明會。本研究採控制組前後測設計，比較兩組參與者於前測、後測及追蹤之變化。所採用之療效指標為亞斯伯格症症狀嚴重度、社會化行為及心智推測能力，評估工具包括：(1) Gilliam亞斯伯格症量表；（2）文蘭適應行為量表第二版調查晤談版「社會化領域」量表：（3）修訂文蘭適應行為量表教室版「社會化領域」量表；（4）眼神辨識測驗兒童版；（5）心智理論測驗。在前測、後測及追蹤評估三個時間點，家長與教師完成Gilliam亞斯伯格症量表、文蘭適應行為量表第二版調查晤談版「社會化領域」量表或修訂文蘭適應行為量表-教室版—「社會化領域」量表。參與者則接受眼神辨識測驗與心智理論測驗。
所得資料經採用無母數統計方法分析後，結果顯示實驗組家長認為參與者在接受治療後，其症狀嚴重度及社會化行為有立即的改善，參與者的層次二心智推測能力（初級非真信念）亦有立即顯著的進步，且持續至追蹤期，顯示此CBT方案對參與者具有某些立即與持續療效。此外，參與者的情緒辨識能力於追蹤期有顯著的進步，顯示某些能力的進步需要較長的時間方能顯現。然而，實驗組教師報告參與者的症狀嚴重度與社會化行為均無顯著改變，顯示治療效果不易類化至學校情境。
本研究結果支持部分研究假設，亦即此一CBT方案確實能立即改善亞斯伯格症學齡兒童在家之症狀嚴重度與社會化行為，以及提升某些心智推測能力，且部分立即療效可持續至追蹤期，但此治療效果無法類化到學校情境。未來研究需進一步釐清，此類方案中究竟因兒童團體治療與家長說明會對療效的各別影響。此外，為促進療效的類化效果，建議未來可在研究中或臨床實務上發展教師參與的治療方案，或在學校情境中進行治療。

As one of the pervasive developmental disorders, Asperger’s disorder (AD) is characterized by difficulties in social interaction. Previous studies have suggested that such difficulties in social interaction might be partly due to a deficit in theory of mind(ToM). Many intervention programs, including cognitive behavioral therapy (CBT) programs, have been developed to improve the theory of mind and social skills for children with Asperger’s disorder. There were some empirical supports for the effectiveness of CBT on many childhood disorders, however, more rigorous research is needed to examine the efficacy of CBT on children with Asperger’s disorder in Taiwan. This study intended to examine the immediate and lasting effect of a CBT program, designed to promote social skills and theory of mind, on school-age children with Asperger’s disorder.
Two groups of participants were recruited for this study: the experimental group and the control group. Each group included eight boys with Asperger’s disorder. They were 9 to 11 year-old with average intelligence. The CBT program included 10 weekly group sessions for AD children (90 minutes each) and five psycho-educational meetings for parents to acquire knowledge about AD symptoms , behavior modification, and theory of mind. The control group maintained their regular visit to the out-patient clinic and no CBT program was provided to the children or parents in the control group. A pretest - posttest control group design was used to compare the performance of two groups on various measures at pretest, posttest and followup. Five measures were used: (1) Gilliam Asperger’s Disorder Scale (GADS); (2) Vineland Adaptive Behavior Scales-2nd Edition-interview version (VABS-II)-Socialization subscale; (3) Vineland Adaptive Behavior Scale-Classroom version (VABS)- Socialization subscale; (4) Children’s version of the Reading the Mind in the Eyes Test (Eyes Test); and (5) Theory of Mind Test (ToM Test). Parents and teachers rated the participating children on their AD symptoms (GADS) and socialization behaviors (VABS-II or VABS). All the children were administered the Eyes Test and the ToM Test.
Nonparametric statistical test were used to analysis the data.The results partly support an immediate effect of this CBT program on the experimental group. The pre-post comparison showed significant improvements in parental ratings of the experimental group in AD symptom severity and socialization behaviors. The experimental group also obtained immediate and lasting significant improvement in second-order flase belief, one of the aspect of ToM. A delayed improvement in the emotion recognition ability of the experimental group was found at followup. However, there were no significant difference in teachers’ ratings of the experimental group on AD symptom severity and socialization behaviors, indicating poor generalization effect of this CBT program to school settings.
Findings of this study partially support an immediate effect of this CBT program for Taiwanese children with Asperger’s disorder in clinical settings and at home, but with limited generalization effect in school situations. Future studies are needed to clarify the differential effect of children’s CBT group and psycho-education for parents. In addition, future study or clinical practice should promote teacher’s involvement in intervenetion for AD children or design school-based program to facilitate the generalization effect of training to school settings.

第一章 緒論 - 1 -
1.1 研究背景 - 1 -
1.2 研究目的 - 1 -
1.3 文獻回顧 - 2 -
1.3.1亞斯伯格症 - 2 -
1.3.2社會能力缺損 - 3 -
1.3.3 心智推測能力 - 5 -
1.3.4 心智推測教學及社交互動治療 - 9 -
1.3.5 認知行為治療 - 11 -
1.3.6 CBT應用於亞斯伯格症及其療效 - 12 -
1.4 研究假設 - 19 -
第二章 研究方法 - 20 -
2.1 研究設計 - 20 -
2.2 研究對象 - 20 -
2.3 研究工具 - 21 -
2.3.1 收案評估工具 - 21 -
2.3.2 療效評估工具 - 22 -
2.3 研究步驟 - 26 -
2.3.1 招募與篩選個案 - 27 -
2.3.2 收集前測資料 - 27 -
2.3.3 進行治療方案 - 28 -
2.3.4 收集後測資料 - 28 -
2.3.5 收集追蹤期資料 - 28 -
2.4 治療方案內容 - 29 -
2.4.1 治療目標 - 29 -
2.4.2 團體結構及方案流程 - 29 -
2.4.3 各次團體內容 - 30 -
2.4.4 治療概念與技巧 - 33 -
2.5 倫理考量 - 35 -
2.5.1臨床試驗許可 - 35 -
2.5.2 資料收集前之說明 - 36 -
2.5.3 資料收集過程 - 36 -
2.5.4 教師評估 - 36 -
2.5.5 資料後續處理 - 36 -
2.6 資料分析 - 37 -
第三章 研究結果 - 38 -
3.1 參與者基本資料 - 38 -
3.2 亞斯伯格症症狀嚴重度 - 39 -
3.2.1 家長評估 - 39 -
3.2.2 教師評估 - 43 -
3.3 社會化行為 - 47 -
3.3.1 家長評估 - 48 -
3.3.2 教師評估 - 52 -
3.4 心智推測能力 - 55 -
3.4.1 眼神辨識測驗兒童版 - 55 -
3.4.2 心智理論測驗 - 57 -
第四章 討論 - 61 -
4.1 方案的立即療效 - 61 -
4.1.1 症狀嚴重度及社會化行為 - 61 -
4.1.2 心智推測能力 - 63 -
4.2 方案的持續療效 - 64 -
4.3 方案的療效類化 - 66 -
第五章 結論與建議 - 68 -
5.1 總結 - 68 -
5.2 研究限制 - 68 -
5.2.1 方案設計 - 68 -
5.2.2 參與者變項 - 69 -
5.2.3 研究對象的限制 - 69 -
5.2.4 研究工具的限制 - 69 -
5.2.5 評估者的一致性 - 69 -
5.3 研究建議 - 70 -
5.3.1 實驗設計 - 70 -
5.3.2 研究工具 - 70 -
5.3.3 評估者 - 70 -
5.3.4 團體治療方案 - 71 -
參考文獻 - 72 -
附錄A：受訪同意書 - 87 -
附錄B：同意臨床試驗證明書 - 89 -
附錄C：GADS使用授權書 - 91 -
附錄D：Vinland-II晤談版使用授權書 - 92 -
附錄E：VABS使用授權書 - 93 -
附錄F：眼神辨識測驗兒童版使用授權書 - 94 -

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