臺灣博碩士論文加值系統

許多研究者認為心智推測能力(theory of mind, ToM，或譯為心智理論)缺損是影響亞斯伯格症(Asperger’s disorder, AD)患者出現社會互動困難的主要因素，並提出心智推測能力可分為社會認知及社會知覺層面。目前台灣已有學者發展出心智推測能力評估工具測量社會認知層面，但仍欠缺測量社會知覺層面的評估工具。Baron-Cohen等人所設計之眼神辨識測驗主要在測量心智推測能力的社會知覺層面，此測驗相對於其他測量社會認知層面的心智推測能力工具，可能跨文化的適用性較佳。鑑於台灣臨床工作上目前亟需針對AD的篩檢工具，因此本研究的目的在建立眼神辨識測驗兒童版的台灣地區性常模，並檢驗其信效度。
本研究樣本分為常模樣本及效標樣本，常模樣本為大台北地區769名三至九年級學生，所有學生均於學校利用一節課的時間以團體施測方式完成眼神辨識測驗兒童版及中華國語文能力測驗之詞彙分測驗。效標樣本主要為AD兒童、注意力缺失/過動疾患(Attention Deficit/Hyperactivity Disorder, ADHD)兒童及一般控制組兒童各23名，三組參與者在年齡、全量表智商、語文智商及作業智商相互配對。三組兒童均施測：（1）魏氏兒童智力量表第三版；（2）中華國語文能力測驗之詞彙分測驗；（3）眼神辨識測驗兒童版（包含眼神辨識作業與性別辨識作業）；（4）心智理論測驗。三組兒童的家長均填寫：（1）兒童行為檢核表；（2）Gilliam亞斯伯格症量表；（3）注意力缺陷過動症中文版SNAP-IV量表。
研究結果顯示眼神辨識測驗兒童版中的眼神辨識作業再測信度為.71，內部一致性為.40；性別辨識作業再測信度為.62，內部一致性為.51。眼神辨識作業的表現有性別與年齡差異，女性、年齡較大的參與者在此測驗上的表現較佳。一般兒童在眼神辨識作業上的表現優於ADHD兒童，ADHD兒童的表現又優於AD兒童，但其中只有AD兒童與一般兒童間的差異達到顯著。項目分析結果顯示93％的眼神辨識作業題項反應選項分佈具有跨文化的一致性，僅有兩項題項可能受文化因素的影響，出現與國外文獻不一致的結果。
研究結果支持大部分的研究假設，亦即眼神辨識測驗兒童版的表現有性別與年齡差異，此測驗具有可接受的的信效度，在臨床上可區辨AD兒童及一般兒童，但無法區辨AD及ADHD兒童，因此只適於作為AD的初步篩檢工具，不應只根據此測驗之結果作診斷。建議未來研究可針對此測驗的圖片內容及詞彙選項進行檢驗及篩選，甚至進一步以國人照片取代原測驗圖片，以提升此測驗跨文化的適用性。

Asperger’s disorder (AD) is characterized by difficulties in social interaction. Many researchers have suggested that such difficulties might be partly due to a deficit in the theory of mind (ToM), which includes social-cognitive and social-perceptive aspects. Based on the literature, Taiwanese researchers have developed some ToM tests that tap the social-cognitive aspect. However, there is a need for adequate tool to measure the social-perceptive aspect of ToM. Baron-Cohen et al. have developed the Children’s Version of the Reading the Mind in the Eyes Test (Eyes Test) to measure the social-perceptive aspect of ToM. Compared to other tests that measure the social-cognitive aspect of ToM, the Eyes Test might be relatively culture-free. Therefore, the purpose of this study is to establish a Taiwanese local norm and evaluate the psychometric properties of the Eyes Test.
This study included both a normative sample and criteria sample. The normative sample consisted of 769 3rd to 9th graders from Taipei area. The normative sample completed both the Eyes Test and Chinese Vocabulary Test in groups at their own schools. The criteria sample consisted of three groups of boys matched on their age and IQ: boys with AD, boys with Attention Deficit Hyperactivity Disorder (ADHD), and normally developing controls. These three groups were administered the (1) WISC-III, (2) Chinese Vocabulary Test, (3) Eyes Test, and (4) ToM Test. Parents of the criteria sample completed behavioral ratings for their children using the (1) Child Behavior Checklist (CBCL), (2) Gilliam Asperger’s Disorder Scale (GADS), and (3) Swanson, Nolan, and Pelham Rating Scale, Version IV (SNAP-IV).
The results showed that the Eyes Test had acceptable test-retest reliability and internal consistency (the Eyes Task: r = .71, Cronbach α= .40; the Gender Recognition Task: r = .62, Cronbach α= .51). There were significant gender and age difference in the performance of the Eyes Task, i.e., female, older participants performed better on the Eyes Task. There were also group differences in the performance of the Eyes Task among the three criteria groups. The normal controls performed better than the ADHD group which, in turn, performed better than the AD group. However, only the difference between the normal controls and AD group reached the significant level. Item analysis showed 93% of items in the Eyes Task had cross-cultural consistency in the distribution of respondents’ choices. Only two items had different results from previous findings in British studies.
Findings of this study support the hypotheses that there are gender and age differences in the performance of the Eyes Test and that the Eyes Test has acceptable reliability and validity. Clinically, the Eyes Test could differentiate AD from normal children; but it failed to differentiate AD from ADHD children. Therefore, it is recommended that the Eyes Test be used only as a screening tool, instead of as the only basis, in making a AD diagnosis. It is suggested that future studies examine and evaluate the content and response choices of the Eyes Test, or even replace the original stimulus pictures with Taiwanese pictures, to further enhance its cross-cultural applicability.

目錄
指導教授推薦書
口試委員審定書
長庚大學博碩士論文著作授權書 III
誌謝 IV
中文摘要 VI
英文摘要 IX
目錄 XII
表次 XVII
圖次 XIX
第一章 緒論 - 1 -
1.1 前言 - 1 -
1.2 文獻回顧 - 3 -
1.2.1 亞斯伯格症診斷、盛行率及成因 - 4 -
1.2.2 心智推測能力 - 6 -
1.2.3 心智推測能力評估工具 - 11 -
1.2.4 眼神辨識測驗兒童版 - 16 -
1.2.4.1 眼神辨識測驗兒童版之發展 - 17 -
1.2.4.2 眼神辨識測驗兒童版之相關研究 - 19 -
1.3 研究目的及假設 - 29 -
第二章 研究方法 - 31 -
2.1 研究對象 - 31 -
2.1.1常模樣本 - 31 -
2.1.2 效標樣本 - 33 -
2.2 研究工具 - 35 -
2.2.1 魏氏兒童智力量表第三版（中文版） - 35 -
2.2.2 中華國語文能力測驗 - 36 -
2.2.3 兒童行為檢核表 - 37 -
2.2.4注意力缺陷過動症中文版SNAP-IV量表 - 38 -
2.2.5 Gilliam亞斯伯格症量表 - 39 -
2.2.6 眼神辨識測驗兒童版 - 40 -
2.2.7 心智理論測驗 - 43 -
2.3 研究程序 - 47 -
2.3.1 常模組收案與施測程序 - 47 -
2.3.2 效標組收案與施測程序 - 48 -
2.4 資料分析 - 49 -
2.4.1 常模組資料 - 49 -
2.4.2 眼神辨識測驗兒童版的信、效度檢驗 - 49 -
第三章 研究結果 - 51 -
3.1 常模資料 - 51 -
3.1.1眼神辨識作業表現的年齡及性別差異 - 51 -
3.1.2眼神辨識作業分數切截點及百分等級、T分數常模表 - 55 -
3.1.3 性別辨識作業 - 58 -
3.2 信度 - 59 -
3.2.1 內部一致性 - 59 -
3.2.2 再測信度 - 59 -
3.3 效度及項目分析 - 60 -
3.3.1 效標樣本分析 - 60 -
3.3.1.1 效標組在眼神辨識作業上的表現 - 60 -
3.3.1.2 眼神辨識作業之區辨分析 - 61 -
3.3.2 效標關連效度 - 65 -
3.3.2.1 醫師診斷為效標 - 65 -
3.3.2.2 心智理論測驗為效標 - 66 -
3.3.2.3 GADS為效標 - 67 -
3.3.3 眼神辨識作業項目分析 - 69 -
第四章 討論 - 72 -
4.1 眼神辨識作業表現之年齡及性別差異 - 73 -
4.1.1 年齡變項 - 73 -
4.1.2 性別變項 - 74 -
4.2眼神辨識測驗兒童版的信、效度分析 - 76 -
4.2.1 信度 - 76 -
4.2.2 效度 - 77 -
4.2.2.1醫師診斷為效標 - 77 -
4.2.2.2眼神辨識作業之區辨分析 - 79 -
4.2.2.3.心智理論測驗為效標 - 80 -
4.2.3.4 GADS為效標 - 82 -
4.2.3.5眼神辨識作業項目分析 - 84 -
第五章 結論與建議 - 86 -
5.1 結論 - 86 -
5.2 研究價值 - 87 -
5.3 研究限制 - 88 -
5.4 研究建議 - 89 -
參考文獻 - 91 -
附錄A：眼神辨識測驗兒童版施測指導語 - 105 -
附錄B：眼神辨識測驗兒童版施測範例 - 106 -
附錄C：眼神辨識測驗兒童版各題項之詞彙 - 107 -
附錄D：眼神辨識測驗兒童版答案紙 - 109 -

表次
表 1 1 眼神辨識測驗兒童版與成人版研究摘要 - 23 -
表 2 1 常模組之年級、性別人數分佈及平均年齡 - 32 -
表 2 2 AD、ADHD及一般控制組兒童之基本資料 - 35 -
表 2 3 研究評估工具一覽表 - 45 -
表 3 1 常模組各年級在眼神辨識作業的平均得分及標準差 - 52 -
表 3 2 常模樣本在眼神辨識作業得分之二因子變異數分析摘要表 - 53 -
表 3 3 各年級常模組男、女生的眼神辨識作業切截分數常模表 - 55 -
表 3 4 各年級常模組男生眼神辨識作業之百分等級與T分數常模對照表 - 56 -
表 3 5 各年級常模組女生眼神辨識作業之百分等級與T分數常模對照表 - 57 -
表 3 6 各年級常模組在性別辨識作業的平均得分與標準差 - 58 -
表 3 7 效標組樣本在眼神及性別辨識作業的平均得分與標準差 - 61 -
表 3 8 ROC曲線所得之眼神辨識作業切截分數及其相對敏感度與特異性 - 64 -
表 3 9 各年級組之眼神辨識作業切截分數正確區辨AD組與控制組之人數與比率 - 65 -
表 3 10 眼神辨識作業總分與心智理論測驗各層次及總分之相關性 - 67 -
表 3 11 眼神辨識作業總分與GADS各分量表及總分之相關性 - 68 -
表 3 12 英國與台灣樣本在眼神辨識作業上作答結果之項目分析 - 70 -

圖次
圖 3.1各年級常模組男、女生在眼神辨識作業之平均得分及誤差值 - 54 -
圖 3.2眼神辨識作業的ROC曲線 - 63 -

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