本論文主旨在探討自閉症病患對於情緒節律(emotional prosody)在聽覺上的區辨(discrimination)、理解(comprehension)及在口語上的表達(production)能力。結果顯示，聽覺區辨並非自閉症患者在處理情緒語音上的問題所在。其在情緒語音的聽覺理解及口語表達上則呈現顯著障礙。經由聲學分析，自閉症患者情緒語音表達的平均基礎頻率(mean fundamental frequency)、基礎頻率範圍(fundamental frequency range)及時長(duration)除了在覆述生氣的情緒語音外，並未隨情緒情境的轉換而呈現顯著的起伏變化。一般聽眾亦難由自閉症患者的情緒語音表達中，判斷其情緒狀態。Baron-Cohen (1995)所提出的自閉症成因－"心智閱讀障" (mindblindness)和情緒理解及表達間的關連性在文中將進行檢視。此外，本文亦自語言發展(language development)及語言歷程(language processing)的觀點探討自閉症患者在超音段(suprasegmental)上理解與表達異常的徵結所在。 / This study investigated the autistic children's ability to discriminate, comprehend, and produce emotional (features of anger, happy, and sad) speech prosody based on tasks involving behavioral (linguistic/emotional) as well as structural (acoustic) features. The preliminary results indicate that the discrimination of acoustic features might not be the main problem of autistic deficiency in processing emotional prosody. Subjects' utterances were subjected to acoustic analysis to examine the variations of mean Fo, Fo range and duration under specific emotional condition. The results revealed that the autistic subjects tended to produce various emotional prosody with less Fo variations. The autistic subjects were also less reliable than normal subjects at transmitting emotional contrasts when judged from the listener's perspective. To understand the nature of this clinical deficiency, autistic patients' impairment in integrating relevant pragmatic information and their " mindblindness (deficiency in mindreading, Baron-Cohen, 1995)" have to be taken into consideration as well. These clinical cases pose fundamental questions in language development and models of language processing (comprehension and production).

No description available.

臨床上我們觀察到：自閉症患者在社會互動上有明顯障礙。因此，我們企圖在這個大問題下，以社會互動中最主要的訊息來源—臉部表情為出發點，探討自閉症者所知覺的世界中，他們如何處理臉部表情所展現的情緒訊息及社會意義。 根據文獻回顧，我們知道：臉孔辨識歷程與一般物體辨識歷程不盡相同而有其特性。相較於一般物體，臉孔辨識更需依賴對輪廓構型訊息的有效掌握。因此，本研究企圖回答以下問題：「自閉症患者在辨識他人臉部表情上是否有所缺陷」？如果是的話，（1）「自閉症患者在辨識他人臉部表情上的缺陷係因臉孔辨識的機制上有所缺陷嗎」？還是（2）「自閉症患者在辨識他人臉部表情上的缺陷是因從他人臉部表情讀取情緒訊息上有所困難」？本研究試圖以人臉辨識與表情辨識的差異性，並改良過去研究在方法學上的爭議以回答這兩個問題。 實驗一「人臉辨識」作業以立即比對作業與延宕配對作業，檢驗自閉症組、發展遲緩組、一般兒童組及成人組其在物體與臉孔之倒立效果。研究結果顯示：除了自閉症組外，三組受試者在人臉辨識的作業表現上，都有相當穩定的臉孔倒立效果，自閉症組的臉孔倒立效果顯著地較其它三組小，而在物體辨識上與常人無異，此與「中樞連貫缺陷」假設相符應：自閉症患者在高層次知覺的困難在於他們無法從環境中將訊息加以整合，擅於以局部特徵來理解，並認為這是使他們產生較小的臉孔倒立效果之因。實驗一顯示：自閉症患者的確「在辨識他人臉部表情上有所困難」，卻「並非因其在臉孔辨識的機制上有所缺陷」。 因此，我們第二個研究問題即是：「自閉症患者在辨識他人臉部表情上的缺陷是因從他人臉部表情讀取情緒訊息上有所困難嗎」？因此，實驗二以同一組臉孔刺激材料，以人臉辨識與情緒辨識作業，以探討自閉症組、一般兒童組與發展遲緩組的作業表現。從實驗二所得到的結果也支持這樣的看法。在實驗二的「人臉辨識」作業中，要求受試者對目標人臉進行辨識時，三組受試者所受到的「臉部表情干擾效果」並無顯著差異。但在實驗二的「表情辨識」作業中，當要求受試者對目標情緒進行辨識時便發現：自閉症組在辨識臉部表情上的缺陷，極大部分是發生在辨識不同人的表情變化情境下。而之所以自閉症患者在辨識同一人的表情相同與否表現較佳，依據「中樞連貫缺陷」假設的看法則認為，自閉症患者使用他們擅長以局部特徵瞭解整體的能力克服在他們在處理作業上的困難。此外，實驗二對兩作業表現的比較結果亦支持：大腦對於辨識人臉以及辨識情緒顯示是由不同的系統進行處理。 因此從本研究的兩個實驗，我們可以清楚地回答：自閉症患者在辨識他人臉部表情上的困難確實非因臉孔辨識的機制上有所缺陷而是從他人臉部表情讀取並理解情緒訊息上有所困難，尤其是發生在辨識不同人的表情變化情境下。而之所以自閉症患者在辨識同一人的表情表現較佳，是因為自閉症患者使用其擅長以局部特徵瞭解整體的能力克服在他們在處理作業上的困難。而自閉症患者在這些作業中的種種行為表現，都可以運用「中樞連貫缺陷」假設得到不錯的解釋。

University of Macau / Faculty of Education

研究目的：本研究的目的，是以縱貫研究的方式探討自閉症類疾患兒童自學齡前期至學齡期的臨床診斷穩定度、自閉症狀嚴重度變化、適應行為型態與其變化、內外化行為。 研究方法：本研究納入28名自閉症類疾患與18位非自閉症類疾患，於三個時間點進行評估：時間點一平均生理年齡為2歲半、時間點二為4歲、時間點三為9歲半。本研究分析三個時間點之臨床診斷穩定度以及後兩個時間點之評估資料。症狀嚴重度方面，以自閉症診斷會談問卷修訂版之晤談評估；適應行為方面，以文蘭適應行為量表第二版評估；認知功能方面，時間點二時以穆林發展量表評估，時間點三時使用魏氏兒童智力量表第四版評估；內外化行為方面，時間點三時以阿肯巴克實證衡鑑系統中的兒童行為檢核表評估。 研究結果：本研究結果顯示，自閉症類疾患從學齡前期至學齡期的臨床診斷穩定度高，若分亞型來看，自閉性疾患的診斷穩定度比其他未註明之廣泛性發展疾患高。症狀嚴重度方面，學齡期時自閉症類疾患兒童的溝通、侷限及重複刻板行為有顯著改善，社交行為亦有改善趨勢。適應行為方面，學齡前期及學齡期皆未發現自閉症類疾患與非自閉症類疾患之表現型態有差異，兩組在社會化領域的表現皆較其他領域來得差。自閉症類疾患的適應行為於學齡期時，年齡當量顯著增加，但社會化適應行為標準分數反而退步；進一步以認知功能分組檢視，則發現高功能自閉症類疾患在日常生活技巧與社會化領域的進步幅度顯著較多。內外化行為方面，學齡期時自閉症類疾患個案的退縮/憂鬱分量尺與社會問題分量尺之分數高於非自閉症類疾患，且自閉症類疾患在退縮/憂鬱、社會問題、注意力問題等三個分量尺上，皆有超過一半的個案達到邊緣範圍以上之分數；未發現內外化行為與自閉症狀嚴重度之間的相關。 結論：自閉症類疾患兒童到了學齡期大部分仍維持臨床診斷，顯示其自閉特徵仍然穩定存在，不過症狀嚴重度的整體趨勢會隨著年紀改善；但若以個體差異來看，每位個案進步的程度呈現高異質性，每位個案症狀改變的程度可能不同。自閉症類兒童的社會化適應行為從學齡前期至學齡期皆為其弱項，雖適應行為會隨著年齡進步，但社會化適應行為仍追不上同儕程度；高功能自閉症類疾患兒童的適應行為在日常生活技巧與社會化領域的進步幅度顯著較多，可能與認知功能有關。內外化行為方面，自閉症類疾患兒童的退縮/憂鬱問題、社會問題、注意力問題較多，但與症狀嚴重度無關。 / Purposes: The purpose of this longitudinal study was to examine the stability of clinical diagnosis, symptom severity, adaptive function and enternal/external behavior from toddler to school age in children with autism spectrum disorders (ASDs). Methods: Twenty eight children diagnosed with ASDs and eighteen children with Non-ASDs participated at time 1 (mean chronological age was 2.5 years old), and then followed at time 2 (mean chronological age was 4 years old) and at time 3 (mean chronological age was 9.5 years old). This study examines the stability of clinical diagnosis from time 1 to time 3, and analyze the measurement data between time 2 and time 3. Autism Diagnostic Interview-Revised (ADI-R) was used to measure autistic symptom severity at time 2 and time 3; Vineland Adaptive Behavior Scales-II (VABS-II) was used to measure daily adaptive behavior at time 2 and time 3; Mullen Scale of Early Learning (MSEL) or Wechsler intelligence scale for children-Fourth Edition (WISC-IV) was used to measure cognitive function at two time points; Child Behavior Checklist for Ages 6-18 (CBCL/6-18) was used to measure enternal and external behavior at time 3. Results: The stability of clinical diagnosis was high from toddler age to school age, and the stability of Autistic Disorder was higher than Pervasive Developmental Disorder Not Otherwise Specified. The ADI-R scores of communication domain, repetitive and stereotyped behavior domain were decreased at school age, while reciprocal social interaction domain was also declined but no significant difference. All domains of VABS-II standard score were no significant difference between ASDs and Non-ASDs at two time point, and the score of social domain was worst in both two groups. The VABS-II standard score of social domain was reduced although the age equivalent was increased at school age, and the standard score of other domains were no significant difference between the two time points but all age equivalents were improved at school age. Dividing ASDs to high-function ASDs and low-function ASDs to analyze the growth rate of adaption behaviors, the results indicated that the growth rate of adaption behaviors were higher in high-function ASDs at daily skill domain and social domain. Children with ASDs had significant higher scores on Withdrawn/Depressed scale and Social Problem scale than Non-ASDs in CBCL, and over 50 percent of ASDs scored above the borderline range at Withdrawn/Depressed scale, Social Problem scale and Attention Problem scale. In addition, there were no significant correlations between CBCL and ADI-R. Conclusions: In summary, the study showed that most of ASDs sustained the clinical diagnosis from preschool age to school age, however, the autistic symptom severity was declined. Additionally, the improvement of symptom severity of individual ASDs was high variability. The social adaptive behavior was worst in both toddler age and school age in ASDs. Although these children with ASD developed some of adaptive behaviors in the school age, the magnitude of improvement couldn’t equal to the change of their chronological age, especially in socialization domain. The growth rate of daily skill domain and social domain were higher in high-function ASDs than low-function ASDs, might associated with cognitive function. More Children with ASDs had withdrawn/depressed problem, social problem and attention problem, but there were not related to autistic symptom severity.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第19645号 / 人健博第37号 / 新制||人健||3(附属図書館) / 32681 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 三谷 章, 教授 村井 俊哉, 教授 精山 明敏 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

京都大学 / 0048 / 新制・論文博士 / 博士(生命科学) / 乙第13135号 / 論生博第17号 / 新制||生||51(附属図書館) / 京都大学大学院生命科学研究科高次生命科学専攻 / (主査)教授 米原 伸, 教授 垣塚 彰, 教授 影山 龍一郎 / 学位規則第4条第2項該当 / Doctor of Philosophy in Life Sciences / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18642号 / 医博第3941号 / 新制||医||1006(附属図書館) / 31556 / 京都大学大学院医学研究科医学専攻 / (主査)教授 古川 壽亮, 教授 髙橋 良輔, 教授 福山 秀直 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(理学) / 甲第18841号 / 理博第4099号 / 新制||理||1589(附属図書館) / 31792 / 京都大学大学院理学研究科生物科学専攻 / (主査)教授 正高 信男, 准教授 後藤 幸織, 教授 岡本 宗裕 / 学位規則第4条第1項該当 / Doctor of Science / Kyoto University / DGAM

研究目的：欲瞭解自閉症類疾患兒童，橫跨幼兒期、學齡前期至學齡期的自閉症狀發展軌跡，探究當中是否存有不同的發展軌跡，並檢視不同發展軌跡的群體在認知功能與適應行為隨時間的變化型態是否有差異，以及不同群體在早期的社會溝通能力或療育經驗上是否有差異。 方法：本研究有37名自閉症類與24位非自閉症類受試者納入分析，共測量三次：時間點一平均生理年齡為2歲半、時間點二為4歲、時間點三為8歲半。於三個時間點皆以自閉症診斷觀察量表評估自閉症狀嚴重度、以及穆林發展量表或魏氏兒童智力量表第四版評估認知功能，在時間點二與時間點三以文蘭適應行為量表第二版評估適應行為；另外，在時間點一以台灣版兩歲期自閉症篩檢工具評估社會溝通能力，以及在時間點一至時間點二之間，以電話訪問的方式紀錄兒童每週參與療育的時數。 結果：由階層式集群分析結果顯示，社交情感嚴重度校正分數可將自閉症類與非自閉症類兒童分群，並於自閉症類兒童中可再分為維持高嚴重度組與退步組。兩組自閉症類兒童於學齡時期在社交情感症狀皆呈現嚴重度明顯上升的趨勢，在認知功能與適應行為隨時間的變化型態相似，不過維持高嚴重度組在認知功能與適應行為有較低的分數（但未達統計顯著）。此外，兩組自閉症類兒童於時間點一的意圖溝通能力即有差異，不過僅共享式注意力可預測日後社交情感症狀發展軌跡之分群。 總結：由結果可見自閉症狀維持高嚴重度組，於認知功能與適應行為有較明顯缺損，推論自閉症類兒童的自閉症狀嚴重度與認知功能及適應行為並非完全獨立的變項。兩組自閉症類兒童於學齡期症狀嚴重度上升，而此趨勢在退步組兒童更為明顯。雖然本研究並未發現早期療育經驗對於社交情感症狀發展的影響，不過共享式注意力對於日後社交情感症狀有預測力。進一步討論此結果在理論與臨床實務上的應用。 / Purposes: the purpose of the study was to plot longitudinal developmental trajectories of autism symptom severity in the children with autism spectrum disorders (ASDs) from toddler age to school age. And to examine whether these different trajectories are associated with the cognitive function, adaptive behavior, early social communication skill, and early intervention experience. Methods: Thirty-seven children with ASDs and 24 children with developmental delay participated at time 1 (mean chronological age was 2.5 years old), and then followed at time 2 (mean chronological age was 4 years old) and time 3 (mean chronological age was 8.5 years old). The study assessed the autism symptom severity by ADOS and cognitive function by MSEL or WISC-Ⅳ at three time points; adaptive behavior by VABS-II at time 2 and time 3; and early social communication skills by T-STAT at time 1 and also used telephone interviews to record participants’ weekly intervention hours during time 1 to time 2. Results: In hierarchical cluster analysis, social affect calibrated severity score (CSS) could discriminate ASDs and Non-ASDs groups, also could divided ASDs into two groups, called persistent high and worsening groups. The social affect symptom severity increased at school age in both groups. On the other hand, the change of cognitive function and adaptive behavior with time showed similar pattern in the two groups. However, participants in the persistent high group have relatively lower scores of cognitive function and adaptive behavior, although did not rearch statistically significant. Furthermore, two ASDs groups at toddler showed difference in intention communication skills; however, only joint attention could predict social affect trajectory subgrouping. Conclusions: In summery, the study showed that persistent high group has more cognitive and adaptive function impairments than the worsening group in the children with ASDs. It seemed that the autistic symptom are not entirely independent with cognitive function and adaptive behavior. Moreover, the symptom severity increased at school age in both the persistent high and the worsening groups, and this trend was more significant in the worsening group. Additionally, the experience of early intervention showed no significant effects on developmental trajectories of social affect symptom; however, the joint attention was found to be an index to predict the development of social affect symptom in ASDs groups. The theoretical and clinical implications were discussed.