兩歲前自閉症類疾患嬰幼兒篩檢工具：文獻回顧

Screening Tools for Infants under Two Years Old with Autism Spectrum Disorders: A Literature Review

10.30074/FJMH.201312_26(4).0002

吳進欽(Chin-Chin Wu)；姜忠信(Chung-Hsin Chiang)；侯育銘(Yuh-Ming Hou)

自閉症類疾患嬰幼兒 ； 篩檢工具 ； 敏感度 ； 精確度 ； infants ； autism spectrum disorders ； screening tool ； sensitivity ； specificity

中華心理衛生學刊

26卷4期（2013 / 12 / 01）

549 - 568

繁體中文

研究目的：本文回顧2歲前自閉症類疾患嬰幼兒篩檢工具。研究方法：本文從回溯性研究、前瞻性研究及眼球追蹤技術的研究方法，回顧2歲前自閉症類疾患嬰幼兒早期發展障礙。之後，本文依據當代自閉症類疾患篩檢工具兩層次的分類方式，簡介目前學界2歲前自閉症類疾患篩檢工具，及不同篩檢工具的敏感度與精確度。研究結果：2歲前自閉症類疾患嬰幼兒的早期發展障礙，主要出現在六方面，分別是：視覺／感官異常、動作能力落後、遊戲行為重複性、社會溝通障礙、語言能力落後以及認知能力落後。當代2歲前自閉症類疾患的篩檢工具，主要是層次一社區樣本的篩檢工具，層次二臨床樣本的篩檢工具比較少見。研究結論：不論層次一或層次二的自閉症類疾患早期篩檢工具，多數皆具備不錯的敏感度與精確度。台灣醫療場域，不同專業領域的工作人員，應該依據工作場域性質與篩檢目的，來選擇與使用自閉症類疾患早期篩檢工具。

Purpose: This article reviews screening tools for infants under 2 years old with autism spectrum disorders (ASD). Methods: Literature focusing on retrospective and prospective studies, and the studies of eye-tracking technique were reviewed for understanding the early signs in infants with ASD. Then, based on the findings of the literature, two levels of tools for infants with ASD were developed. We report the sensitivities and specificities and application of each screening tool for infants under 2 years old with ASD. Results: The previous studies suggested that infants under 2 years old with ASD showed early developmental signs in 6 domains, including visual/sensory abnormalities, delayed motor skills, repetitive play behavior, social communication impairment, and delayed language and cognitive abilities. Most screening tools for detecting ASD in infants under 2 years old are Level 1 tools, which are used to identify high risk infants with ASD from the general population. There exist few Level 2 screening tools, which are used to distinguish ASD from other developmental disorders. Conclusions: Both the Level 1 and Level 2 screening tools have good sensitivities and specificities. Suggestions are offered for selection and use of screening tools to detect ASD in infants under 2 in clinical settings in Taiwan.

1. 姜忠信、吳進欽、劉俊宏、侯育銘(2012)。2-3歲自閉症幼兒篩檢量表的發展：T-STAT的初究。中華心理衛生學刊，25(1)，135-154。
   連結：
2. 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)，1-10。
   連結：
3. Adrien, J. L.,Faure, M.,Perrot, A.,Hameury, L.,Garreau, B.,Barthelemy, C.,Sauvage, D.(1991).Autism and family home movies: Preliminary findings.Journal of Autism and Developmental Disorders,21(1),43-49.
4. Amaral, D. G.(Ed.),Dawson, G.(Ed.),Geschwind, D. H.(Ed.)(2011).Autism Spectrum Disorders.NY:Oxford University Press.
5. Baird, G.,Charman, T.,Baron-Cohen, S.,Cox, A.,Swettenham, J.,wheelwright, S.,Drew, A.(2000).A screening instrument for autism at 18 months of age: A 6-year follow-up study.Journal of the American Academy of Child and Adolescent Psychiatry,39,694-702.
6. Baron-Cohen, S.,Allen, J.,Gillberg, C.(1992).Can autism be detected at 18 months? The needle, the haystack, and the CHAT.British Journal of Psychiatry,161,839-843.
7. Baron-Cohen, S.,Cox. A.,Baird, G.,Swettenham, J.,Nightingale, N.,Morgan, K.,Drew, A.,Charman, T.(1996).Psychological markers in the detection of autism in infancy in a large population.British Journal of Psychiatry,168(2),158-163.
8. Barton, M. L.,Dumont-Mathieu, T.,Fein, D.(2012).Screening young children for autism spectrum disorders in primary practice.Journal of Autism and Developmental Disorders,42(6),1165-1174.
9. Bedford, R.,Elsabbagh, M.,Gliga, T.,Pickles, A.,Senju, A.,Charman, T.,Johnson, M. H.(2012).Precursors to social and communication difficulties in infants at-risk for autism: Gaze following and attentional engagement.Journal of Autism and Developmental Disorders,42(10),2208-2218.
10. Brian, J.,Bryson, S. E.,Garon, N.,Roberts, W.,Smith, I. M.,Szatmari, P.,Zwaigenbaum, L.(2008).Clinical assessment of autism in high-risk 18-month-olds.Autism,12(5),433-456.
11. Chawarska, K.,Klin, A.,Paul, R.,Macari, S.,Volkmar, F.(2009).A prospective study of toddlers with ASD: Short-term diagnostic and cognitive outcome.Journal of Child Psychology and Psychiatry,50(10),1235-1245.
12. Chiang, C. H.,Wu, C. C.,Hou, Y. M.,Chu, C. L.,Liu, J. H.,Soong, W. T.(2013).Development of T-STAT for early autism screening.Journal of Autism and Developmental Disorders,43(5),1028-1037.
13. Dawson, G.,Rogers, S.,Munson, J.,Smith, M.,Winter, J.,Greenson, J.,Donaldson, A.,Varley, J.(2010).Randomized, controlled trial of an intervention for toddlers with autism: The early start denver model.Pediatrics,125(1),e17-23.
14. Dietz, C.,Swinkels, S.,van Daalen, E.,van Engeland, H.,Buitelaar, J. K.(2006).Screening for autistic spectrum disorder in children aged 14-15 months. II : Population screening with the early screening of autistic traits questionnaire (ESAT). Design and general findings.Journal of Autism and Developmental Disorders,36,713-722.
15. Duby, J. C.,Lipkin, P. H.,Macias, M. M.,Wegner, L. M.,Duncan, P.,Hagan, J. F.,Capers, M.(2006).Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening.Pediatrics,118(1),405-420.
16. Filipek, P. A.,Accardo, P. J.,Ashwal, S.,Baranek, G. T.,Cook, E. H., Jr.,Dawson, G.,Volkmar, F. R.(2000).Practice parameter: Screening and diagnosis of autism: report of the quality standards subcommittee of the American Academy of Neurology and the Child Neurology Society.Neurology,55(4),468-479.
17. Johnson, C. P.,Myers, S. M.(2007).Identification and evaluation of children with autism spectrum disorders.Pediatrics,120(5),1183-1215.
18. Kleinman, J. M.,Robins, D. L.,Ventola, P. E.,Pandey, J.,Boorstein, H. C.,Esser, E. L.,Fein, D.(2008).The modified checklist for autism in toddlers, a follow-up study investigating the early detection of autism spectrum disorders.Journal of Autism and Developmental Disorders,38(5),827-839.
19. Kogan, M. D.,Blumberg, S. J.,Schieve, L. A.,Boyle, C. A.,Perrin, J. M.,Ghandour, R. M.,van Dyck, P. C.(2009).Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007.Pediatrics,124(5),1395-1403.
20. Lai, D. C.,Tseng, Y. C.,Guo, H. R.(2011).Gender and geographic difference in developmental delays among young children: Analysis of the data from the national registry in Taiwan.Research in Developmental Disabilities,32(1),63-69.
21. Lord, C.,Rutter, M.,DiLavore, P. C.,Risi, S.(1999).Autism Diagnostic Observation (ADOS).Los Angeles, CA:Western Psychological Services.
22. Merin, N.,Young, G. S.,Ozonoff, S.,Rogers, S. J.(2007).Visual fixation patterns during reciprocal social interaction distinguish a subgroup of 6-month-old infants at-risk autism from comparison infants.Journal of Autism and Developmental Disorders,37(1),108-121.
23. Micali, N.,Chakrabarti, S.,Fombonne, E.(2004).The broad autism phenotype: Findings from an epidemiological survey.Autism,8(1),21-37.
24. 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(3),247-257.
25. Ozonoff, S.,Iosif, A. M.,Baguio, F.,Cook, I. C.,Hill, M. M.,Hutman, T.,Young, G. S.(2010).A prospective study of the emergence of early behavioral signs of autism.Journal of the American Academy of Child and Adolescent Psychiatry,49(3),256-266.
26. Pierce, K.,Carter, C.,Weinfeld, M.,Desmond, J.,Hazin, R.,Bjork, R.,Gallagher, N.(2011).Detecting, studying, and treating autism early: The one-year well-baby checkup approach.The Journal of Pediatrics,159(3),458-465.e1-6.
27. 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(2),131-144.
28. Rogers, S. J.(2009).What are infant siblings teaching us about autism in infancy?.Autism Research,2(3),125-137.
29. Rutter, M.,LeCouteur, A.,Lord, C.(2003).Autism Diagnostic Interview-Revised (ADI-R).Los Angeles, CA:Western Psychological Services.
30. Saint-Georges, C.,Cassel, R. S.,Cohen, D.,Chetouani, M.,Laznik, M. C.,Maestro, S.,Muratori, F.(2010).What studies of family home movies can teach us about autistic infants: A literature review.Research in Autism Spectrum Disorders,4(3),355-366.
31. Siegel, B.(2004).The Pervasive Developmental Disorders Screening Test - II (PDDST-II).San Antonio:Psychological Corporation.
32. Steiner, A. M.,Goldsmith, T. R.,Snow, A. V.,Chawarska, K.(2012).Practitioner's guide to assessment of autism spectrum disorders in infants and toddlers.Journal of Autism and Developmental Disorders,42(6),1183-1196.
33. Stone, W. L.,Lee, E. B.,Adhford, L.,Brissie, J.,Hepburn, S. L.,Coonrod, E. E.,Weiss, B. H.(1999).Can autism be diagnosed accurately in children under 3 years?.Journal of Child Psychology and Psychiatry,40(2),219-226.
34. Stone, W. L.,Mcmahon, C. R.,Henderson, L. M.(2008).Use of the screening tool for autism in two-year-olds (STAT) for children under 24 months.Autism,12(5),557-573.
35. Tsai, W. C.,Soong, W. T.,Shyu, Y. I.(2012).Toddler autism screening questionnaire: development and potential clinical validity.Autism,16(4),340-349.
36. van Daalen, E.,Kemner, C.,Dietz, C.,Swinkels, S. H. N.,Buitelaar, J. K.,van Engeland, H.(2009).Inter-rater reliability and stability of diagnoses of autism spectrum disorder in children identified through screening at a very young age.European Child and Adolescent psychiatry,18(11),663-674.
37. Watson, L. R.,Baranek, G. T.,Crais, E. R.,Reznick, S.,Dykstra, J.,Perryman, T.(2007).The first year inventory: Retrospective parent response to a questionnaire designed to identify one-year-olds at risk for autism.Journal of Autism and Developmental Disorders,37(1),49-61.
38. Wetherby, A. M.,Brosnan-Maddox, S.,Peace, V.,Newton, L.(2008).Validation of the infant-toddler checklist as a broadband screener for autism spectrum disorders from 9-24 months of age.Autism,12(5),487-511.
39. Wetherby, A. M.,Prizant, B. M.(2002).Communication and symbolic behavior scales developmental profile- first normed edition.Baltimore, MD:Paul H. Brookes.
40. Wetherby, A. M.,Wood, J.,Allen, L.,Cleary, J.,Dickinson, H.,Lord, C.(2004).Early indicators of autism spectrum disorders in the second year of life.Journal of Autism and Developmental Disorders,34(5),473-493.
41. Wong, V.,Hui, L. H.,Lee, W. C.,Leung, L. S.,Ho, P. K.,Lau, W. L.,Fung, C. W.,Chung, B.(2004).A modified screening tool for autism (Checklist for autism in toddlers [CHAT-23] for Chinese children.Pediatrics,114(2),166-176.
42. Yirmiya, N.,Gamliel, I.,Pilowsky, T.,Feldman, R.,Baron-Cohen, S.,Sigman, M.(2006).The Development of siblings of children with autism at 4 and 14 months: Social engagement, communication and cognition.Journal of Child Psychology and Psychiatry,47(5),511-523.
43. Zwaigenbaum, L.,Bryson, S.,Lord, C.,Rogers, S.,Carter, A.,Carver, L.,Yirmiya, N.(2009).Clinical assessment and management of toddlers with suspected autism spectrum disorders: Insights from studies of high-risk Infants.Pediatrics,123(5),1383-1391.
44. 謝清芬、宋維村、徐澄清(1983)。自閉症：克氏行為量表的效度與研究。中華民國神經精神醫學會會刊，9(1)，17-26。

1. 陳庭筠,吳進欽,甘如晶(2018)。克氏行為量表篩檢自閉症類群障礙嬰幼兒的效度探究。臨床心理學刊，12(1/2)，35-51。
2. 陳奕臻,洪楹佳,吳進欽(2019)。修訂版學步期自閉症檢核表在不同場域篩檢自閉症類群障礙症幼兒的正確率。特殊教育研究學刊，44(3)，33-61。
3. 陳昭芬,吳進欽(2019)。台灣學齡前自閉症類群障礙兒童篩檢工具：文獻回顧。若瑟醫護雜誌，13(1)，23-37。
4. 侯育銘、李羽涵、吳進欽、朱慶琳(2015)。結合多重訊息來源篩檢3歲以下自閉症類群疾患幼兒。中華心理衛生學刊，28(4)，605-630。
5. 侯育銘、吳進欽、朱慶琳(2016)。2歲前自閉症類群障礙症早期篩檢：18個月後追蹤。中華心理衛生學刊，29(4)，327-356。
6. 姜忠信、侯育銘、林姿伶、吳進欽、朱慶琳(2014)。T-STAT評估18~24個月自閉症類嬰幼兒效度探究。中華心理衛生學刊，27(4)，621-644。
7. (2023)。聚光燈下的影子：自閉症學業成就之探討。特殊教育季刊，167，1-14。