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.
| Identifer | oai:union.ndltd.org:CHENGCHI/G1017520131 |
| Creators | 林怡安, Lin, Yi An |
| Publisher | 國立政治大學 |
| Source Sets | National Chengchi University Libraries |
| Language | 中文 |
| Detected Language | English |
| Type | text |
| Rights | Copyright © nccu library on behalf of the copyright holders |
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