自閉症類幼兒社會注意力的探究

Social Attention in Young Children with Autism Spectrum Disorders

10.6129/CJP.2010.5201.04

吳進欽(Chin-Chin Wu)；姜忠信(Chung-Hsin Chiang)；虞燕婷(Yen-Ting Yu)

自閉症類幼兒 ； 社會定向能力 ； 相互注意協調能力 ； 語言能力 ； joint attention ； language ability ； social orienting ； young children with autism spectrum disorders

中華心理學刊

52卷1期（2010 / 03 / 01）

57 - 74

繁體中文

本研究主要目的在探討自閉症類幼兒的社會注意力，及它與語言的關係。社會注意力包括社會定向能力和相互注意協調能力。受試者為生理年齡3歲以下的自閉症類幼兒，生理、心理年齡配對的發展遲緩幼兒和心理年齡配對的一般發展嬰兒各20名。修正Dawson等人(1998)與Dawson等人(2004)的研究方法，來測量社會定向能力，並以早期社會溝通量表(Early Social Communication Scales, Mundy et al., 2003)，評估相互注意協調能力。結果發現：(1)自閉症類幼兒社會定向能力與整體注意力定向能力顯著比發展遲緩幼兒及一般發展嬰兒差。(2)自閉症類幼兒相互注意協調能力顯著的比發展遲緩幼兒及一般發展嬰兒差。(3)鑑別3歲以下自閉症類的幼兒，相互注意協調能力比社會定向能力是更有效的指標。(4)自閉症類幼兒整體注意力定向能力和高層次反應性相互注意協調能力顯著正相關，同時，促進3歲以下自閉症類幼兒語言能力發展的關鍵能力是反應性相互注意協調能力。本研究結果指出自閉症類幼兒社會定向能力障礙在3歲以前便存在，反應性相互注意協調能力，在此語言發展階段上扮演的角色，比主動性相互注意協調能力更為重要。後續的研究可以進行縱貫的探討，以瞭解自閉症類幼兒早期社會能力發展路徑及障礙的本質。

Background and purpose of the study: While social stimuli (e. g., facial expression, name calling, and speech, etc.) are complex and unpredictable, they are important in early social development when children engage in social interaction. Failure to attend to social stimuli would impair the development of social communication. It has been shown that children with autism spectrum disorders (ASD) around the age of four has displayed social attention impairment in social orienting and joint attention (e. g., Dawson et al., 1998, 2004; Leekam et al., 2006). However, the nature of social attention and the relationships among social orienting, joint attention and language development in young children with ASD under the age of three have not been explored yet. The purpose of this study was to investigate social attention and its relation to language in young children with ASD under 36 months. Methods: The participants were 20 30-month-old children with ASD, 20 28-month-old children with developmental delay (DD), and 20 typical developing 17-month-old infants (TD). The ASD and DD groups from a local hospital in southern Taiwan were assessed and diagnosed according to DSM-IV-TR (APA, 2000) and ADOS (Lord et al., 1999) by a research team, consisting of two child psychologists and two child psychiatrists. Materials used in the study were modified from Dawson et al. (1998, 2004), including 6 social stimuli and 6 nonsocial stimuli presented randomly through one of two speakers posited in front of child’s left and right sides. Social stimuli involved calling the child’s name with three different emotional tones and three different two-word vocabularies as well as nonsocial stimuli consisted of hammer and electronic music, each with three different rhythms. The joint attention was measured using Early Social Communication Scales (ESCS, Mundy et al., 2003) to explore relationships among social orienting, joint attention, and language competency. Results: The results showed that social orienting and overall orienting were poorer in the ASD group than in the DD and TD groups. It was also found that children with ASD were poorer in joint attention tasks than the DD and TD groups. Additionally, joint attention was a better variable than social orienting to discriminate ASD group from non-ASD groups. Moreover, correlation analyses revealed a significant relationship between overall attention orienting and high level response to joint attention in the ASD group that was critical to language development. For both control groups, no significant relationship was found among social orienting, response to joint attention and initiation of joint attention. Conclusions: The results suggested that social attention impairments in young children with ASD are shown under age of three, and the response to joint attention is more important than initiation of joint attention to language development in children with ASD under 36 months. Further studies are needed to follow the subjects to clarify the developmental trajectory of early social development in children with ASD.

1. 姜忠信、宋維村(2005)。自閉症嬰幼兒的早期診斷：文獻回顧。臨床心理學刊，2，1-10。
   連結：
2. Adrien, J. L.,Faure, M.,Perrot, A.,Hameury, L.,Garreau, B.,Barthelemy, C.(1991).Autism and family home movies: Preliminary findings.Journal of Autism and Developmental Disorders,21,43-49.
3. American Psychiatric Association(2000).Diagnostic and statistical manual of mental disorders.Washington DC:American Psychiatric Association.
4. Bakeman, R.,Adamson, L. B.(1984).Coordinating attention to people and objects in mother-infant and peer-infant interaction.Child Development,55,1278-1289.
5. Baranek, G. T.(1999).Autism during infancy: A retrospective video analysis of sensory-motor and social behaviors at 9-12 months of age.Journal of Autism and Developmental Disorders,29,213-224.
6. Bono, M. A.,Daley, T.,Sigman, M.(2004).Relations among joint attention, amount of intervention and language gain in autism.Journal of Autism and Developmental Disorders,34,495-505.
7. Bruinsma, Y.,Koegel, R. L.,Koegel, L. K.(2004).Joint attention and children with autism: A review of the literature.Mental retardation and Developmental Disabilities Research Review,10,169-175.
8. Carpenter, M.,Nagell, K.,Tamasello, M.(1998).Social cognition, joint attention, and communicative competence from 9 to 15 months of age.Monograph of the Society for Research in Child Development,63(4),1-176.
9. Carpenter, M.,Pennington, B. F.,Rogers, S. J.(2002).Interrelations among social-cognitive skills in young children with autism.Journal of Autism and Developmental Disorders,32,91-106.
10. Casey, B. J.,Gordon, C. T.,Mannheim, G. B.,Rumsey, J. M.(1993).Dysfunctional attention in autistic savants.Journal of Clinical and Experimental Neuropsychology,15,933-946.
11. Charman, T.,Swettenham, J.,Baron-Cohen, S.,Cox, A.,Baird, G.,Drew, A.(1998).An experimental investigation of social-cognitive abilities in infants with autism: Clinical implications.Infant Mental Health Journal,19,260-275.
12. Charman, T.,Swettenham, J.,Baron-Cohen, S.,Cox, A.,Baird, G.,Drew, A.(1997).Infants with autism: An investigation of empathy, pretend play, joint attention, and imitation.Developmental Psychology,33,781-789.
13. Chiang, C. H.,Soong, W. T.,Lin, T. L.,Rogers, S. J.(2008).Nonverbal communication skills in young children with autism.Journal of Autism and Developmental Disorder,38,1898-1906.
14. Corkum, V.,Moore, C.,C. Moore(Eds.),P. J. Dunham(Eds.)(1995).Joint attention: It's origins and role in development.NJ:Lawrence Erlbaum Associates.
15. Courchesne, E.,Chisum, H.,Townsend, J.(1994).Neural activity-dependent brain changes in development: Implications for psychopathology.Development and Psychopathology,6,697-722.
16. Courchesne, E.,Townsend, J.,Akshoomoff, N. A.,Saitoh, O.,Yeung-Courchesne, R.,Lincolin, A. J.(1994).Impairment in shifting attention in autistic and cerebellar patients.Behavioural Neuroscience,108,848-865.
17. Dawson, G.,Meltzoff, A. N.,Osterling, J.,Rinaldi, J.,Brown, E.(1998).Children with autism fail to orient to naturally occurring social stimuli.Journal of Autism and Developmental Disorder,28,479-485.
18. Dawson, G.,Munson, J.,Estes, A.,Osterling, J.,McPartland, J.,Toth, K.(2002).Neurocognitive function and joint attention ability in young children with autism spectrum disorder versus developmental delay.Child Development,73,345-358.
19. Dawson, G.,Toth, K.,Abbott, R.,Osterling, J.,Munson, J.,Estes, A.(2004).Early social attention impairments in autism: social orienting, joint attention, and attention to distress.Developmental Psychology,40,271-283.
20. Dawson, G.,Webb, S.,Schellenberg, G. D.,Dager, S.,Friedman, S.,Aylward, E. H.(2002).Defining the broader phenotype of autism: Genetic, brain, and behavioral perspectives.Development and Psychopathology,14,581-611.
21. Delgado, C. E. F.,Mundy, P.,Crowson, M.,Markus, J.,Yale, M.,Schwartz, H.(2002).Responding to joint attention and language development: A comparison of target locations.Journal of Speech, Language, and Hearing Research,45,715-719.
22. Goldstein, G.,Johnson, C. R.,Minshew, N. J.(2001).Attentional processes in autism.Journal of Autism and Developmental Disorders,31,433-440.
23. Kanner, L.(1943).Autistic disturbances of affective contact.Nervous Child,2,217-250.
24. Landry, R.,Bryson, S. E.(2004).Impaired disengagement of attention in young children with autism.Journal of Child Psychology and Psychiatry,45,1115-1122.
25. Leekam, S. R.,López, B.,Moore, C.(2000).Attention and joint attention in preschool children with autism.Developmental Psychology,36,261-273.
26. Leekam, S. R.,Ramsden, C. A. H.(2006).Dyadic orienting and joint attention in preschool children with autism.Journal of Autism and Developmental Disorders,36,185-197.
27. Lord, C.,Risi, S.,A. M. Wetherby(Eds.),B. M. Prizant(Eds.)(2000).Autism spectrum disorders: A Transactional Developmental Perspective.Baltimore:Brookes.
28. Lord, C.,Rutter, M.,DiLavore, P. C.,Risi, S.(1999).Autism diagnostic observation schedule (ADOS).LA:WPS.
29. MacDonald, R.,Anderson, J.,Dube, W. V.,Geckeler, A.,Green, G.,Holcomb, W.(2006).Behavior assessment of joint attention: A methodological report.Research in Developmental Disabilities,27,138-150.
30. Maestro, S.,Muratori, F.,Cavallaro, M. C.,Pecini, C.,Cesari, A.,Paziente, A.(2005).How young children treat objects and people: an empirical study of the first year of life in autism.Child Psychiatry & Human Development,35,383-396.
31. Maestro, S.,Muratori, F.,Cavallaro, M. C.,Pei, F.,Stern, D.,Golse, B.(2002).Attentional skills during the first 6 months of age in autism spectrum disorder.Journal of the American Academy of Child & Adolescent Psychiatry,41,1239-1245.
32. Morales, M.,Mundy, P.,Delgado, C. E. F.,Yale, M.,Messinger, D.,Neal, R.(2000).Responding to joint attention across the 6-through 24 month age period and early language acquisition.Journal of Applied Developmental Psychology,21,283-298.
33. Mullen, E.,AGS(ed.)(1995).Mullen scales of early learning.Circle Pines, MN:American Guidance Service.
34. Mundy, P.(2003).The neural basis of social impairments in autism: The role of the dorsal medial-frontal cortex and anterior cingulated system.Journal of Child Psychology and Psychiatry,44,793-809.
35. Mundy, P.,Burrette, C.,F. R. Volkmar(Eds.),R. Paul(Eds.),A. Klin(Eds.),D. Cohen(Eds.)(2005).Handbook of autism and pervasive developmental disorders.NJ:John Wiley & Sons.
36. Mundy, P.,Delgado, C.,Block, J.,Venezia, M.,Hogan, A.,Seibert, J.(2003).A manual for the abridged early social communication scales (ESCS).
37. Mundy, P.,Neal, A. R.,L. M. Glidden (Ed.)(2001).International review of research in mental retardation.San Diego:Academic Press.
38. Mundy, P.,Sigman, M.,D. Cicchetti(Eds.),D. Cohen(Eds.)(2006).Developmental Psychopathology, Volume One: Theory and Methods.NJ:John Wiley & Son.
39. Naber, F. B. A.,Bakermans-Kranenburg, M. J.,van IJzendoorn, M. H.,Dietz, C.,van Daalen, E.,Swinkels, S. H. N.(2008).Joint attention development in toddlers with autism.European Child and Adolescent Psychiatry,17,143-152.
40. Osterling, J.,Dawson, G.(1994).Early recognition of children with autism: A study of first birthday home videotapes.Journal of Autism and Developmental Disorders,24,247-257.
41. Osterling, J.,Dawson, G.,Munson, J. A.(2002).Early recognition of 1-year-old infants with autism spectrum disorder versus mental retardation.Development and Psychopathology,14,239-251.
42. Palomo, R.,Ozonoff, S.(2006).Autism and family home movies: A comprehensive review.Developmental and Behavioral Pediatrics,27,59-68.
43. Parish-Morris, J.,Hirsh-Pasek, K.,Hennon, E. A.,Golinkoff, R. M.,Tager-Flusberg, H.(2007).Children with autism illuminate the role of social intention in word learning.Child Development,78,1265-1287.
44. Robins, D. L.,Fein, D.,Barton, M. L.,Green, J. A.(2001).The modified checklist for autism in toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders.Journal of Autism and Developmental Disorders,31,131-148.
45. Rochat, P.(Ed.),Striano, T.(1997).Early social cognition: Understanding others in the first months of life.Mahwah, NJ:Erlbaum.
46. Rogers, S. J.,Hepburn, S. L.,Stackhouse, T.,Wehner, E.(2003).Imitation performance in toddlers with autism and those with other developmental disorders.Journal of Child Psychology and Psychiatry,44,763-781.
47. Rogers, S. J.,L. M. Glidden (Ed.)(2001).International Review of Research in Mental Retardation.San Diego:Academic Press.
48. Sigman, M.,Ruskin, E.(1999).Continuity and change in the social competence of children with autism, down syndrome, and developmental delays.Monograph of the Society for Research in Child Development,64(1),1-114.
49. Stone, W. L.,Ousley, O. Y.,Yoder, P. J.,Hogan, K. L.,Hepburn, S. L.(1997).Nonverbal communication in two-and three-year-old children with autism.Journal of Autism and Developmental Disorders,27,677-696.
50. Swettenham J.,Baron-Cohen, S.,Charman, T.,Cox, A.,Baird, G.,Drew, A.(1998).The frequency and distribution of spontaneous attention shifts between social and nonsocial stimuli in autistic, typically developing, and nonautistic developmentally delayed infants.Journal of Child Psychology and Psychiatry,39,747-753.
51. Wainwright-Sharp, J. A.,Bryson, S. E.(1993).Visual orienting deficits in high-functioning people with autism.Journal of Autism and Developmental Disorders,23,1-13.
52. Werner, E.,Dawson, G.,Osterling, J.,Dinno, N.(2000).Brief report: Recognition of autism spectrum disorder before one year of age: A retrospective study based on home videotapes.Journal of Autism and Developmental Disorders,30,157-162.
53. Wetherby, A. M.,Prizant, B. M.(2002).Communication and symbolic behavior scales developmental profiles.Baltimore. MD:Paul H. Brookes.
54. Wetherby, A. M.,Watt, N.,Morgan, L.,Shumway, S.(2007).Social communication profiles of children with autism spectrum disorders late in the second year of life.Journal of Autism and Developmental Disorders,37,960-975.
55. Yoder, P. J.,Warren, S. F.(2004).Early predictors of language in children with and without Down syndrome.American Journal on Mental Retardation,109,285-300.
56. 姜忠信、宋維村、國立台北師院特教中心主編(2001)。自閉症心理與教育論文集。台北市:國立台北師院特教中心。
57. 范德鑫(1988)。平均數事前比較的重要性及其統計方法。師大學報，33，163-186。

1. 呂依庭(2016)。音樂療育課程對身心障礙生 注意力影響之研究:以高職綜合職能科為例。國立臺北藝術大學藝術與人文教育研究所學位論文。2016。1-148。