罹患自閉症類群障礙的臺灣幼兒之行為與動作發展

詳目顯示 ; 罹患自閉症類群障礙的臺灣幼兒之行為與動作發展 · Behavioral and Motor Development inTaiwanese Toddlers with Autism Spectrum Disorder · 吳晏慈 · Yen-Tzu Wu. 資料載入處理中... 跳到主要內容 臺灣博碩士論文加值系統 ::: 網站導覽| 首頁| 關於本站| 聯絡我們| 國圖首頁| 常見問題| 操作說明 English |FB專頁 |Mobile 免費會員 登入| 註冊 功能切換導覽列 (178.128.221.219)您好！臺灣時間：2022/08/3108:21 字體大小：       ::: 詳目顯示 recordfocus 第1筆/ 共1筆  /1頁 論文基本資料 摘要 外文摘要 目次 參考文獻 紙本論文 QRCode 本論文永久網址: 複製永久網址Twitter研究生:楊又菁研究生(外文):Yu-ChingYang論文名稱:罹患自閉症類群障礙的臺灣幼兒之行為與動作發展論文名稱(外文):BehavioralandMotorDevelopmentinTaiwaneseToddlerswithAutismSpectrumDisorder指導教授:吳晏慈指導教授(外文):Yen-TzuWu口試日期:2017-07-31學位類別:碩士校院名稱:國立臺灣大學系所名稱:物理治療學研究所學門:醫藥衛生學門學類:復健醫學學類論文種類:學術論文論文出版年:2017畢業學年度:105語文別:英文論文頁數:106中文關鍵詞:自閉症類群障礙、幼兒時期、行為、動作、早產、極低出生體重外文關鍵詞:ASD、Toddlers、Behavior、Motor、Preterm、VLBW相關次數: 被引用:0點閱:229評分:下載:0書目收藏:0 自閉症類群障礙(簡稱自閉症)是一種神經發展障礙性疾病，其核心症狀為社交溝通缺損與侷限、重複的固著行為和興趣。

過去研究顯示自閉症兒童異常的行為與動作發展問題常在嬰幼兒階段出現，然而過去研究較少使用標準化的發展測驗工具評估自閉症幼兒的動作發展問題，亦無針對臺灣自閉症兒童的相關研究。

此外，過去研究發現極低或超低出生體重早產兒較正常足月兒有較多的自閉症狀特質與較高的危險性罹患自閉症，然而過去並無探討足月出生且罹患自閉症之幼兒與極低出生體重早產幼兒的發展差異。

因此，本研究之目的為探討臺灣足月自閉症幼兒的動作與行為發展表現，並和同齡之足月正常幼兒與極低出生體重早產幼兒的發展做比較。

本研究共招募15位年齡30或36個月大的足月自閉症幼兒、15位正常足月幼兒、與30位極低出生體重早產幼兒。

受試兒童接受行為發展與動作功能的評估。

行為發展測量包括:(1)父母填寫一歲半至五歲兒童行為檢核表之問卷;(2)使用自動化行為追蹤系統測量幼兒在自由玩耍情境下的行為軌跡與興趣場域;以及(3)父母填寫重複行為量表修訂版之問卷。

幼兒的動作發展使用皮巴迪動作發展量表第二版測量多項的動作功能。

研究使用曼-惠特尼U檢驗各項發展指標在足月自閉症幼兒、極低出生體重早產幼兒，與正常足月幼兒間的組別差異，並使用簡單線性回歸比較自閉症或極低出生體重且早產的因素之於行為與動作發展問題的效應。

研究結果顯示，在一歲半至五歲兒童行為檢核表之問卷結果中，足月自閉症幼兒在其中四種精神疾病導向問題、六種窄帶行為症狀、內顯與外顯問題、及總行為問題的分數均顯著高於正常足月幼兒；相反地，極低出生體重早產幼兒在情感問題、廣泛發展性問題、情緒反應、身體抱怨、退縮、注意力問題及內顯問題的分數，均與正常足月幼兒的分數相當。

並且，自動化行為追蹤系統發現，足月自閉症幼兒較正常足月幼兒停留在周邊場域的時間較長、進入父母場域所花的時間較短、以及在轉圈動作時有較高的旋轉角速度；然而，極低出生體重早產幼兒與正常足月幼兒的表現相當。

再者，重複行為量表修訂版的問卷結果發現足月自閉症幼兒相較正常足月幼兒，在總分、固著性行為、固定行為(抗拒變化，堅持事物維持原樣)與受限行為(受限的關心範圍、感興趣與活動範圍)的分數均顯著較高；然而，極低出生體重早產幼兒在與正常足月幼兒的分數並無顯著差異。

此外，足月自閉症幼兒在皮巴迪動作發展量表第二版的總動作、粗大動作及精細動作分數均顯著低於正常足月兒，並且足月自閉症幼兒有較高比率落於動作極差的等級；然而，極低出生體重早產兒只有在移位分數較正常足月兒低落。

此外，研究發現自閉症因素與精神疾病導向問題、外顯問題、總問題分數、與移位動作分數，均比極低出生體重且早產因素有更高的相關性。

本篇研究結果顯示，30與36個月的足月自閉症幼兒表現多樣的行為問題與低落的動作功能。

雖然極低出生體重合併早產這個因素，會與外顯問題與低落的移位功能有關，其對於行為和動作發展問題的影響低於自閉症。

在臨床應用上，本篇研究顯示全面且早期介入自閉症幼兒的行為與動作發展問題是有必要的。

BackgroundandPurposes:Studieshavesuggestedthatbehavioralandmotordevelopmentalproblemstypicallyoccurintheearlychildhoodofpeoplewithautismspectrumdisorder(ASD).However,fewstudieshaveusedstandardizeddevelopmentalassessmentinstrumentsforevaluatingearlymotordevelopmentaldisordersintoddlerswithASD.Furthermore,very-low-birth-weightpreterm(VLBW-PT)toddlerswerefoundtoexhibitmoreautistictraitsandahigherriskofASDthanfull-term(FT)toddlers.However,developmentaldifferencesbetweenFTtoddlerswithASD(FT-ASD)andVLBW-PTtoddlershaverarelybeenevaluated.Therefore,thepresentstudyinvestigatedthebehavioralandmotordevelopmentofTaiwanesetoddlerswithASDandcomparedthedevelopmentbetweenFT-ASD,FTtypicallydeveloping(FT-TD),andVLBW-PTtoddlers.Methods:Intotal,15FT-ASD,15FT-TD,and30VLBW-PTtoddlersaged30or36monthswereincludedinthisstudy.Alltoddlers’behavioralperformanceswereexaminedusingtheChildBehaviorChecklistforAges1.5–5(CBCL/1.5–5)andtheRepetitiveBehaviorScale-Revised(RBS-R).Behavioraltrajectoryandinterestswereexaminedinafreeplaysituationbyusingtheautomatedbehavioraltrackingsystem.Toddlers’motorfunctionswereexaminedusingthePeabodyDevelopmentalMotorScales,SecondEdition(PDMS-2).TheMann–WhitneyUtestwasconductedtoexaminethedifferencesineachdevelopmentalindicatoramongthegroups.ForthebehavioralormotorindicatorsforwhichbothFT-ASDandVLBW-PTtoddlersdifferedsignificantlycomparedwithFT-TDtoddlers,asimplelinearregressionanalysiswasconductedtodeterminetheeffectsofASDversusVLBWandPretermbirth.Results:TheresultsindicatedthatFT-ASDtoddlersachievedsignificantlyhigherCBCL/1.5–5scoresthanFT-TDtoddlersforfourDiagnosticandStatisticalManualofMentalDisorders(DSM)-OrientedScales;sixNarrow-bandsyndromes;andInternalizing,Externalizing,andTotalProblems(allp’s<0.05).Bycontrast,VLBW-PTtoddlersandFT-TDtoddlershadcomparablescoresforAffectiveandPervasiveDevelopmentalProblems,EmotionallyReactive,SomaticComplaints,Withdrawn,AttentionProblemsandInternalizingProblems.Furthermore,thebehavioraltrackingdatarevealedthatFT-ASDtoddlersspentsignificantlylongerdurationsinperipheralareas,hadlesslatencytoapproachtheparent,andhadhigherabsoluteangularvelocitiesofrepetitiveturningmovementsthanFT-TDtoddlers(allp’s<0.05),whereasVLBW-PTandFT-TDtoddlershadcomparablebehavioraltrackingresults.Moreover,FT-ASDtoddlershadhighertotalRBS-Rscoresandstereotyped,sameness,andrestrictedbehaviorsubscalesscoresthanFT-TDtoddlers(allp’s<0.05),whereasVLBW-PTandFT-TDtoddlershadcomparableRBS-Rscalesscores.Inaddition,themotorfunctionassessmentresultsrevealedthatFT-ASDtoddlersachievedsignificantlylowermotorscoresandahigherproportionofpoorclassificationintheTotal,Gross,andFineMotorScalesofthePDMS-2thanFT-TDtoddlers(allp’s<0.05),whereasVLBW-PTandFT-TDtoddlershadcomparablemotorscores,exceptforlocomotionscores,whichwerelowerinVLBW-PTtoddlers.ThehighereffectsofASDonseveralbehavioralandmotorindicatorswereassociatedwithhigherscoresfortheDSM-OrientedScales(β=1.8–2.5),Externalizing(β=6.8),andTotalProblems(β=24.8);andlowerlocomotionscores(β=-1.7)comparedwiththeeffectsofVLBWandPretermbirth(allp’s<0.05).ThepresentfindingsrevealedthatFT-ASDtoddlersexhibitedhighdegreesofvariousbehavioralproblemsandpoormotorfunctionsattheagesof30and36months.AlthoughVLBWandpretermbirthmaybeassociatedwithexternalizingproblemsandpoorlocomotionskills,theireffectsonbehavioralormotorperformancesweremilderthanthoseofASD.ThepresentfindingssuggestthatcomprehensiveinterventionsfocusedonmultiplebehavioralandmotordevelopmentaldomainsarenecessaryfortoddlerswithASD. Tableofcontenti中文摘要vEnglishAbstractviiChapterI.Introduction11.1Background11.2Thesispurpose61.3Researchquestionsandhypotheses6ChapterII.LiteratureReview82.1BehavioraldevelopmentandproblemsinyoungchildrenwithAutismSpectrumDisorder(ASD)82.1.1Developmentalchangeofrestrictedandrepetitivepatternsofbehavior/interests(RRBs)intypicaldevelopmentandASD92.1.2MeasurementsofRRBsinyoungchildrenwithASD112.2MotordevelopmentanddeficitsinyoungchildrenwithASD142.2.1MotordeficitsandtheassociationwithASDinearlychildhood152.2.2AssessmentofmotordevelopmentinyoungchildrenwithASD152.3Behavioralandmotordevelopmentinvery-low-birthweight(VLBW)pretermchildren162.3.1VLBWpretermtoddlersandtheriskofdevelopingASD192.3.2BehavioralandmotordevelopmentbetweenyoungchildrenwithASDandatypicallydeveloping(ATD)children21ChapterIII.Method253.1Participants253.2Experimentalprocedures263.3Measurements273.4Trainingofassessors333.5Statisticalanalysis34ChapterIV.Result364.1Subjectcharacteristics364.2BehavioralproblemsassessedusingtheChildrenBehaviorChecklistforages1.5–5years(CBCL/1.5-5)374.3Restricted,repetitivepatternsofbehaviors(RRBs)assessedusingtheRepetitiveBehaviorScale-Revised(RBS-R)384.4MotordevelopmentsassessedusingthePeabodyDevelopmentalMotorScales,SecondEdition(PDMS-2)394.5EffectsofASDversusVLBWandpretermbirthonbehavioralandmotorproblems39ChapterV.Discussion425.1BehavioralproblemsinTaiwanesetoddlerswithASD425.2BehavioraltrajectoriesandinterestsinTaiwanesetoddlerswithASD435.3RRBsinTaiwanesetoddlerswithASD445.4MotordevelopmentalproblemsinTaiwanesetoddlerswithASD465.5Behavioralandmotordevelopmentsbetweenfull-termtoddlerswithASDandVLBWpretermToddlers485.6Limitation50ChapterVI.Conclusion52References53TablesandFigures69Figure1.Thesettingofthelaboratoryroomforbehavioraltrackingexperiment69Figure2.TheHeatmapoftheToddlerswithASD,VLBWpretermchildrenandTDtoddlers70Table1.Birthanddemographicdataamonggroups71Table2-1.BehavioralproblemsassessedbyChildrenBehaviorChecklistforages1.5–5years(CBCL/1.5-5)DSM-OrientedScales72Table2-2.BehavioralproblemsassessedbyCBCL/1.5-5Empirically-BasedScales73Table2-3.ClassificationofbehavioralproblemsamonggroupsassessedbyCBCL/1.5-5Empirically-BasedScales74Table3.Behavioraltrajectoriesamonggroupsassessedbyautomatictrackingdevice77Table4.RRBsamonggroupsassessedbyRBS-R79Table5-1.MotorperformancesamonggroupsassessedbythePDMS80Table5-2.ClassificationofmotorperformancesamonggroupsassessedbyPDMS-281Table6.SimplelinearregressionfortheeffectsofASDversusVLBWandpretermbirthonbehavioralandmotorproblems83Appendix84AppendixA.Measurementsforrestrictedandrepetitivepatternsofbehavior,interests,oractivitiesinyoungchildrenwithASD85AppendixB.ComparisonsofmotordeficitsbetweenchildrenwithASDandtypicallydevelopingchildren87AppendixC.ComparisonsofbehavioraldeficitsbetweenchildrenwithASDandATDchildren88AppendixD.ComparisonsofmotordeficitsbetweenchildrenwithASDandATDchildren90AppendixE.Informedconsentform93AppendixF.Basicdemographicform99AppendixG.RepetitiveBehaviorScale-Revised(RBS-R)102 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