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.

研究目的：本研究之目的，是探索高功能自閉症類群障礙（High-functioning Autism Spectrum Disorder, HFASD）兒童的執行功能表現，並以Pellicano（2011）提出的獨特性、解釋力、普遍性等觀點作為架構進行討論。獨特性方面，試圖以冷執行功能（包括認知彈性、工作記憶、反應抑制）與熱執行功能之架構剖繪HFASD兒童的執行功能表現形態；解釋力方面，是探索執行功能表現對自閉症狀嚴重度、適應行為及行為問題的預測力；普遍性方面，呼應自閉症類群障礙的高度異質性，嘗試以執行功能表現解釋研究樣本中具注意力不足／過動症特質和智能優異特質的兒童特性。 方法：以生理年齡界於7至10歲的54名HFASD兒童和27名一般發展組作為研究對象，兩組於生理年齡和智力進行配對控制，分別以七項認知作業和執行功能行為評定量表評估受試者在實驗室和日常生活中的執行功能表現，也評估智力、症狀嚴重度、適應行為、內外化行為問題表現。 結果：與一般發展兒童相較，HFASD組的執行功能呈現反應抑制的缺損最為明顯、認知彈性次之，而工作記憶則表現相對正常的獨特表現形態；且在誘發情緒和動機後，部分HFASD兒童有「避免懲罰」或「避免冒險」之作答傾向，此傾向與較嚴重的侷限重複行為有關。認知作業測得的結果和家長評估兒童的執行功能表現關聯性不大。執行功能中的抑制、轉換能力能預測侷限重複性行為的自閉症狀和內外化行為問題，然HFASD兒童的抑制能力越佳，也反映更多的內化行為困擾。此外，本研究HFASD受試樣本中具高度異質性，智能優異特質者幾乎沒有明顯的認知作業執行功能缺損，以BRIEF評估時，與非智能優異者相較具備較佳的計劃能力；而轉換、抑制及自我監控能力差可預測HFASD兒童中較高的注意力不足／過動症特質。 總結：HFASD兒童具獨特的執行功能表現形態，且HFASD的症狀表現和高度異質性可部分由執行功能所解釋，顯示執行功能缺損作為核心的認知能力假說具參考價值。進一步討論結果對於未來臨床實務中的介入價值。 / Purposes: The purpose of the study was to explore the executive function (EF) of the High-functioning Autism Spectrum Disorder (HFASD), and EF was discussed on the basis of uniqueness, explanatory power, universality proposed by Pellicano (2011). For the uniqueness, the study captures the cool EF (including cognitive flexibility, working memory, and response inhibition) and hot EF profile in children with HFASD. For the explanatory power, to examine whether EF can predict ASD symptom severity, adaptive function, and behavior problems. For the universality, concerning the significant heterogeneity within ASD, the study attempts to use EF to identify ADHD trait and intellectually gifted children within HFASD. Methods: Fifty-four children aged 7–10 years with HFASD and 27 control participants (Non-ASDs) with matched Age, Verbal, Performance, and Full Scale IQ were recruited. EF measurements include performance-based executive function task, as well as the BRIEF (Behavior Rating Inventory of Executive Functions) questionnaire completed by parents for daily life executive performance of their children. IQ, symptom severity, adaptive function, internalized and externalized behavior problems were also measured either by questionnaire or semi-structured assessments. Results: Results indicated that compared with Non-ASDs, HFASD shows the most imairment in responses inhibition, then in cognitive shifting. However, the working memory is relativily intact. When the motivation and emotion were induced during the task, an “avoidance punishment” or “avoidance risk” tendancy was observed in some children with HFASD, which is related to more restricted and repetitive symptoms. Performance-based tasks are not highly related with questionnaire-based measurement of EF. Problems with inhibition and shift ability can predict more restricted and repetitive symptoms as well as internalized and externalized behavior problems. However, when children with HFASD show better inhibition ability, they might have more internalized behavior disturbance. Furthermore, we found high heterogeneity within the study sample of HFASD.There is no significant deficits in performance-based EF tasks within intellectually gifted HFASD, and they also have higher performance on the plan scale of BRIEF. Problems with shift, inhibition, and self-monitoring can predict higher ADHD traits in children with HFASD. Conclusions: Findngs support the uniqness of EF profile in children with HFASD, and the heterogeneity within ASD can be partially explained by EF components. This indicated the importance of EF dysfunction hypothesis in ASD.The theoretical and clinical implications were discussed.

研究目的：本研究旨在探究高功能自閉症類群障礙（High-Functioning Autism Spectrum Disorder, HFASD）兒童基本的運動知覺、動物生物性運動知覺、與人類生物性運動知覺之偏好注視表現與注意力時間歷程，逐步澄清HFASD兒童的生物性運動知覺表現與社會缺損的關聯性。此外，針對自閉症類群障礙的異質性，進一步探討HFASD兒童具智能優異特質者之生物性運動知覺表現。 研究方法：本研究共招募50名7至10歲之HFASD兒童與25名配對生理年齡與智力之TD兒童。本研究採偏好注視作業，以光點呈現三種運動刺激對比的視覺配對情境：（1）基本運動知覺：物體運動配對散亂運動；（2）動物生物性運動知覺：動物運動配對物體運動；（3）人類生物性運動知覺：人類運動配對動物運動。透過眼動追蹤技術測量受試兒童觀看各運動刺激之凝視時間比例與時間歷程之凝視可能性。研究亦涵蓋智力、症狀嚴重度、及適應行為評估。 研究結果：基本運動知覺方面，TD兒童與HFASD 兒童皆對散亂運動具偏好反應。生物性運動知覺方面，整體來說，TD與HFASD兒童皆較偏好動物與人類運動。時間歷程分析顯示，HFASD與TD兒童在相同的時間窗格對動物與人類運動產生偏好興趣。此外，在動物生物性運動知覺中，於時間歷程早期階段，HFASD兒童偏好動物運動之程度低於TD兒童，且偏好動物運動的程度與社會溝通缺損具相關性，於晚期階段，兩組偏好動物運動的程度無顯著差異。在人類生物性運動知覺中，於時間歷程早期階段，HFASD兒童偏好人類運動的程度與TD兒童相當，隨時間遞增，TD兒童維持對人類運動的偏好興趣，然而，HFASD兒童對人類運動的偏好興趣則逐步遞減，至晚期階段，HFASD兒童偏好人類運動的程度顯著低於TD兒童，且與自閉症狀具相關性。考量本研究HFASD兒童樣本之異質性，結果指出智能優異的HFASD兒童對動物生物性運動的偏好程度與TD兒童相當，但在人類生物性運動知覺中，智能優異組與非智能優異組皆隨時間遞增對人類運動的偏好興趣則逐步遞減。 總結：研究結果指出，HFASD兒童對生物性運動的偏好興趣及產生偏好的速度與TD兒童無明顯差異。但HFASD兒童對人類生物性運動偏好興趣的持續度較TD兒童低落，且不因認知優勢具補償作用。整體而言，顯示HFASD兒童的生物性運動知覺表現型態在反映其社會缺損上具有參考價值。本研究也進一步探討臨床應用、研究限制與未來的研究方向。 / Purposes: This study investigated the preferential attention and attentional processing on the basic motion perception, animal biological motion perception, and human biological motion perception in children with High-Functioning Autism Spectrum Disorder (HFASD). It aimed to explore the processing of biological motion perception in children with HFASD and the association to social deficit. Moreover, concerning the heterogeneity within ASD, the study examined the biological motion perception in intellectually gifted children within HFASD. Method: Fifty children aged 7 to 10 years with HFASD and twenty-five children with typically development（TD）matched on age and IQ were recruited. The current study utilized preferential looking paradigm and motion point-light displays, demonstrating three visual comparison: (1) basic motion perception: object motion paired with scrambled motion; (2) animal biological motion perception: animal motion paired with object motion; (3) human biological motion: human motion paired with animal motion. Eye-tracking techniques were applied to measure proportion of dwell time and time course of fixation probability on each motion stimuli. Cognitive function, symptom severity, and adaptive function were also measured. Result: In basic motion perception, children with TD and HFASD preferentially attend toward scrambled motion. In biological motion perception, generally, children with TD and HFASD preferentially attend toward animal motion and human motion. Time-course analysis revealed that children with TD and HFASD attended toward animal motion and human motion at the same time window. Moreover, in animal biological motion perception, children with HFASD showed lower preferential interest in animal motion than children with TD at the early stage of time course, and there were no significnant difference between groups at the late stage of time course. The results also found that the level of preference for animal motion was associated with the severity of social communication. In human biological motion perception, children with TD and HFASD showed similar level of preferential interest in human motion at the early stage of time course; afterthat, children with TD matained preferential interest in human motion across time, but children with HFASD reduced preferential interest in human motion across time. At the late stage of time course, children with HFASD showed significantly lower level preferential interest in human motion than children with TD, and it was associated to symptom severity. Concerning the heterogeneity within the study sample of HFASD, results indicated that there was no difference on the level of preferential interest in animal motion between intellectually gifted HFASD (IG-HFASD) and TD group; however, in human biological motion perception, IG-HFASD and nonIG-HFASD group reduced preferential interest in human motion across time course compared to TD group. Conclusion: Findings suggested that children with HFASD exhibit the equivalent preferential interest and speed of attending to biological motion as did TD children. However, children with HFASD reduced referential interest in human biological motion across time course compared to TD children, and not influenced by the intellectually gifted advantage with compensation. The results implicated that biological motion perception may play an important role to understanding the social deficit in children with ASD. Theoretical and clinical implications of the study were discussed.

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.