高功能自閉症兒童的心智理論和口語敘說

Abstract

語用障礙是高功能自閉症兒童在社會溝通當中最明顯的語言問題，而敘說則是評估語用能力的重要面向。過去研究皆指出心智理論的缺陷是自閉症兒童語用困難的可能主因，而國內仍少見關於高功能自閉症兒童心智理論發展的系統性探究，且在國小高功能自閉症兒童研究中，亦乏語用和心智理論發展關聯的直接探究。有鑑於口語敘說是一種具生態效度的語用表現，因此本研究以一系列具發展敏感特性的不同面向心智理論作業，以及一系列心理狀態涉入程度不等的連環圖口語敘說作業為研究工具；並以60位國小低年級高功能自閉症兒童和正常發展兒童為研究對象。探究高功能自閉症兒童心智理論發展的順序，及其口語敘說特性，並更進一步探討其心智理論發展和特定口語敘說成份之間的關連。研究發現有三：(一)高功能自閉症兒童的心智理論發展有一特定順序，依難度遞增順序為：不同欲求、不同信念、訊息知曉與信念之關係、錯誤信念、外顯與真實不一致的情緒理解、第二層級錯誤信念理解。(二)高功能自閉症兒童的敘說歸因層次明顯較正常發展兒童低，以行為和物理因果關係的歸因方式居多，較少涉及心理意圖或情緒心理意圖的歸因。此外，高功能自閉症兒童意圖指涉正確比例較正常發展兒童低，但以第一人稱方式直接進入角色說話、採用語意和聲音強調的敘說頻率明顯較正常發展組高。(三)相關及迴歸分析的結果顯示，高功能自閉症兒童在意圖指涉正確和語意強調之特定口語敘說成份，與心智理論能力有較高的關連性。本研究顯示國小低年級高功能自閉症兒童的心智理論及敘說能力，和正常對照組有差異。而且出現特定的敘說特徵與心智理論的關連性，顯現高功能兒童的心智理論缺陷和語用學習困難的關連性。本研究並討論，在臨床上如何增進高功能自閉症兒童社會互動功能的意涵。

Pragmatic impairment is well documented in children with high-functioning autism (HFA), and the narrative ability is one of the major components of pragmatics.. Studies repeatedly showed that deficit of Theory of Mind (TOM) could be the most important factor accounting for the pragmatic impairment. However, few studies in Taiwan has explored various aspects of developing TOM, narrative abilities, and their relations in HFA children. he present research adopted a Scaling of Theory of Mind task to explore various aspects the TOM development in HFA. Besides, a series of comic strips were included to examine the narrative performance in elementary children with HFA. Sixty 6-8 year-old children with HFA and typically-developing children matched with chronological age and verbal ability participated in this study. Results show: (1) the order of TOM development in children with HFA is: diverse desire, diverse belief, knowledge access, content false belief, location false belief, hidden emotion, and second-order false belief (2) children with HFA usually use lower level of attribution, i.e. physical and behavioral description, instead of mental state attribution, in their narrative. In addition, when making evaluations, children with HFA seldom refer to mental contents, but use more narrative enhancers, i.e., semantic intensifiers and sound effects.(3) regression analysis shows that more appropriate referring to the mental states of characters and less semantic enhancers contribute more to the variances of TOM in children with HFA. In brief, compared with control group, children with HFA show the impairment in TOM tasks that are mastered later in typically-developing children. In addition, some aspects of narrative abilities contribute more to the TOM development in children with HFA, showing the relations between pragmatic impairment and TOM deficit. Clinical implication to improve social interaction ability in children with HFA is also discussed.