學齡前自閉症類群障礙症兒童內化性行為問題與親職壓力之關聯：兒童主動控制的調節與中介效果

Associations between Internalizing Behavior Problems and Parenting Stress in Preschool Children with Autism Spectrum Disorder: Moderating and Mediating Effects of Children's Effortful Control

10.30074/FJMH.202009_33(3).0002

郝心友(Xin-You Hao)；黃素英(Su-Ying Huang)

內化性行為問題 ； 主動控制 ； 自閉症類群障礙症 ； 親職壓力 ； 學齡前兒童 ； autism spectrum disorder ； effortful control ； internalizing behavior problems ； parenting stress ； preschoolers

中華心理衛生學刊

33卷3期（2020 / 09 / 01）

247 - 275

繁體中文

研究目的：自閉症類群障礙症兒童是伴隨內化性行為問題、自我調節問題的高危險群，其家長也承受較高親職挑戰。本研究旨在探討學齡前自閉症類群障礙症兒童內化性行為問題與親職壓力的關聯、兒童主動控制在兩者關係的調節與中介角色。研究方法：以54位4－6歲自閉症類群障礙症兒童及其家長為對象，施測兒童智力，家長以問卷評量兒童自閉症症狀、內化性行為問題、兒童主動控制及自身親職壓力。研究結果：控制兒童智力與自閉症症狀後，兒童內化性行為問題正向預測整體親職壓力、父母困擾、親子失功能互動及困難兒童親職壓力面向，且負向預測兒童主動控制；兒童主動控制在內化性行為問題與親職壓力間的調節效果不顯著，可部份中介內化性行為問題對整體親職壓力、困難兒童親職壓力的預測效果。研究結論：學齡前自閉症類群障礙症兒童的內化性行為問題與多面向親職壓力有直接關聯，不利兒童注意力與行為調節的發揮；兒童主動控制無法調節內化性行為問題與親職壓力的關聯，而是部分親職壓力面向的保護與中介因子。

Purpose: Children with autism spectrum disorder (ASD) usually have a high risk of suffering internalizing behavior problems and self-regulation difficulties. Their parents may also face formidable parenting challenges. The aim of this study is to investigate the direct effects of ASD-diagnosed preschoolers' internalizing behavior problems on multifaceted parenting stress, as well as the moderator and mediator effects of children's effortful control on the relationship between internalizing behavior problems and parenting stress. Methods: 54 Taiwanese preschoolers (4-6 year-old) with ASD and their parents participated. We assessed each child's IQ with an individualized test. Parents completed questionnaires to rate their child's internalizing behavior problems, effortful control, ASD symptom severity, as well as their own parenting stress. Results: The internalizing behavior problems had positive predicting effects on the indicators of parenting stress, including overall stress, parental distress, dysfunctional parent/child interaction, and difficult child. Internalizing behavior problems had a negative association with the child's effortful control when the child's intellectual level and ASD symptoms were controlled. Effortful control had negative effects on overall stress and difficult child parenting stress, and had mediator effects on the relationships between the internalizing behaviors and overall stress as well as difficult child parenting stress, even though there were no significant moderating effects. Conclusions: The internalizing behavior problems of preschoolers with ASD can predict parenting stress, and had an unfavorable relationship with the children's attention and behavior regulation. Children's effortful control mediated the association among internalizing behavior problems and some indicators of parenting stress, even though there were no significant moderating effects. Interventions targeting on children's internalizing behavior problems which seek to enhance children's attention and behavioral self-regulation may be helpful in releasing parenting stress for parents with preschoolers with ASD.

1. Abidin, R. R.(1995).Parenting stress index-short form.Lutz, FL:Psychological Assessment Resources.
2. Achenbach, T. M.,Rescorla, L. A.(2000).Manual for the ASEBA preschool forms & profiles: An integrated system of multi-informant assessment; Child behavior checklist for ages 11/2-5; Language development survey; Caregiver-teacher report form.Burlington, Vt:University of Vermont.
3. American Psychiatric Association(2013).Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5.USA:American Psychiatric Association.
4. Ashford, J.,Smit. F.,Van Lier, P, A. C.,Cuijper, P.,Koot. H. M.(2008).Early risk indicators of internalizing problems in late childhood: A 9-year longitudinal study.The Journal of Child Psychology and Psychiatry,49(7),774-780.
5. Auyeung, B.,Baron-Cohen, S.,Wheelwright, S.,Allison, C.(2008).The autism spectrum quotient: Children’s version (AQ-Child).Journal of Autism and Developmental Disorders,38(7),1230-1240.
6. Baron, R. M.,Kenny, D. A.(1986).The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations.Journal of personality and social psychology,51(6),1173-1182.
7. Bayley, N.(2006).Bayley Scales of Infant and Toddler Development.San Antonio, TX.:Pearson Education, Inc.
8. Blair, C.(2002).School readiness: Integrating cognition and emotion in a neurobiological conceptualization of children’s functioning at school entry.American Psychologist,57(2),111.
9. Bonanno, G. A.(2005).Resilience in the face of potential trauma.Current Directions in Psychological Science,14,135-138.
10. Campbell, S. B.,Spieker, S.,Burchinal, M.,Poe, M. D.(2006).Trajectories of aggression from toddlerhood to age 9 predict academic and social functioning through age 12.Journal of Child Psychology and Psychiatry,47(8),791-800.
11. Choe, D. E.,Shaw, D. S.,Brennan, L. M.,Dishion, T. J.,Wilson, M. N.(2014).Inhibitory control as a mediator of bidirectional effects between early oppositional behavior and maternal depression.Development and Psychopathology,26,1129-1147.
12. Cicchetti, D.(Ed.),Cohen, D. J.(Ed.)(2015).Developmental Psychopathology.Hoboken, NJ:John Wiley & Sons.
13. Davis, N. O.,Carter, A. S.(2008).Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: associations with child characteristics.Journal of Autism and Developmental Disorders,38(7),1278-1291.
14. Dawson, G.,Rogers, S.,Munson, J.,Smith, M.,Winter, J.,Greenson, J.,Varley, J.(2010).Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model.Pediatrics,125(1),e17-e23.
15. DelCarmen-Wiggins, R.(Ed.),Carter, A.(Ed.)(2004).Handbook of infant, toddler, and preschool mental health assessment.New York, NY:Oxford University Press.
16. Eisenberg, N.(Ed.),Damon, W.(Ed.),Lerner, R. M.(Ed.)(2006).Temperament Handbook of Child Psychology: Vol. 3, Social, Emotional, and Personality Development.Hoboken, NJ:Wiley.
17. Elliot, A. J.(Ed.),Dweck, C. S.(Ed.)(2005).Handbook of Competence and Motivation.New York:Guilford Press.
18. Feldman, R.,Eidelman, A. I.,Rotenberg, N.(2004).Parenting stress, infant emotion regulation, maternal sensitivity, and the cognitive development of triplets: A model for parent and child influences in a unique ecology.Child Development,75(6),1774-1791.
19. Gartstein, M. A.,Putnam, S. P.,Rothbart, M. K.(2012).Etiology of preschool behavior problems: Contributions of temperament attributes in early childhood.Infant Mental Health Journal,33(2),197-211.
20. Giovagnoli, G.,Postorino, V.,Fatta, L. M.,Sanges, V.,De Peppo, L.,Vassena, L.,Mazzone, L.(2015).Behavioral and emotional profile and parental stress in preschool children with autism spectrum disorder.Research in Developmental Disabilities,45,411-421.
21. Graziano, P. A.,McNamara, J. P.,Geffken, G. R.,Reid, A.(2011).Severity of children’s ADHD symptoms and parenting stress: A multiple mediation model of self-regulation.Journal of Abnormal Child Psychology,39(7),1073.
22. Hastings, R. P.(2002).Parental stress and behaviour problems of children with developmental disability.Journal of Intellectual and Developmental Disability,27(3),149-160.
23. Hastings, R. P.,Kovshoff, H.,Ward, N. J.,Espinosa, F. D.,Brown, T.,Remington, B.(2005).Systems analysis of stress and positive perceptions in mothers and fathers of pre-school children with autism.Journal of Autism and Developmental Disorders,35(5),635.
24. Hastings. R. P.,Johnson. E.(2001).Stress in UK families conducting intensive homebased behavioral intervention for their young child with autism.Journal of Autism and Developmental Disorders,31(3),327-336.
25. Hayes, S. A.,Watson, S. L.(2013).The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder.Journal of Autism and Developmental Disorders,43(3),629-642.
26. Herring, S.,Gray, K.,Taffe, J.,Tonge, B.,Sweeney, D.,Einfeld, S.(2006).Behaviour and emotional problems in toddlers with pervasive developmental disorders and developmental delay: Associations with parental mental health and family functioning.Journal of Intellectual Disability Research,50(12),874-882.
27. Hou, Y. M.,Stewart, L.,Iao, L. S.,Wu, C. C.(2018).Parenting stress and depressive symptoms in Taiwanese mothers of young children with autism spectrum disorder: Association with children’s behavioural problems.Journal of Applied Research in Intellectual Disabilities,31(6),1113-1121.
28. Hutchison, L.,Feder, M.,Abar, B.,Winsler, A.(2016).Relations between parenting stress, parenting style, and child executive functioning for children with ADHD or autism.Journal of Child and Family Studies,25(12),3644-3656.
29. Jahromi, L. B.(2017).Self-regulation in young children with Autism Spectrum Disorder: An Interdisciplinary perspective one emotion regulation, executive function, and effortful control.International Review of Research in Developmental Disabilities,53,45-89.
30. Kanne, S. M.,Abbacchi, A. M.,Constantino, J. N.(2009).Multi-informant ratings of psychiatric symptom severity in children with autism spectrum disorders: The importance of environmental context.Journal of Autism and Developmental Disorders,39(6),856-864.
31. Kidd, T.,Hamer, M.,Steptoe, A.(2011).Examining the association between adult attachment style and cortisol responses to acute stress.Psychoneuroendocrinology,36(6),771-779.
32. Kochanska, G.,Knaack, A.(2003).Effortful control as a personality characteristic of young children: Antecedents, correlates, and consequences.Journal of Personality,71(6),1087-1112.
33. Konstantareas, M. M.,Stewart, K.(2006).Affect regulation and temperament in children with autism spectrum disorder.Journal of Autism and Developmental Disorders,36(2),143-154.
34. Lai, M.-C.,Lombardo, M. V.,Baron-Cohen, S.(2014).Autism.The Lancet,383(9920),896-910.
35. Liew, J.(2012).Effortful control, executive functions, and education: Bringing self-regulatory and social-emotional competencies to the table.Child Development Perspectives,6(2),105-111.
36. Mathis, E. T.,Bierman, K. L.(2015).Dimensions of parenting associated with child prekindergarten emotion regulation and attention control in low-income families.Social Development,24(3),601-620.
37. Mayes, S. D.,Calhoun, S. L.,Murray, M. J.,Zahid, J.(2011).Variables associated with anxiety and depression in children with autism.Journal of Developmental and Physical Disabilities,23(4),325-337.
38. Mazurek, M. O.,Kanne, S. M.(2010).Friendship and internalizing symptoms among children and adolescents with ASD.Journal of autism and developmental disorders,40(12),1512-1520.
39. Mesman, J.,Koot, H. M.(2001).Early preschool predictors of preadolescent internalizing and externalizing DSM-IV diagnoses.Journal of the American Academy of Child & Adolescent Psychiatry,40(9),1029-1036.
40. Neece, C.,Green, S. A.,Baker, B. L.(2012).Parenting stress and child behavior problems: A transactional relationships across time.American Journal on Intellectual and Developmental Disabilities,117(1),48-66.
41. Osborne, L.A.,Reed. P.(2010).Stress and self-perceived parenting behaviors of parents of children with autistic spectrum conditions.Research in Autism Spectrum Disorders,4(3),405-414.
42. Ozsivadjian, A.,Knott, F.,Magiati, I.(2012).Parent and child perspectives on the nature of anxiety in children and young people with autism spectrum disorders: A focus group study.Autism,16(2),107-121.
43. Putnam, S. P.,Rothbart, M. K.(2006).Development of short and very short forms of the Children’s Behavior Questionnaire.Journal of Personality Assessment,87(1),102-112.
44. Reijntjes, A.,Kamphuis, J. H.,Prinzie, P.,Telch, M.(2010).Peer victimization and internalizing problems in children: A meta-analysis of longitudinal studies.Child Abuse and Neglect,34(4),244-252.
45. Rothbart, M. K.,Ahadi, S.A.,Hershey, K. L.,Fisher. P.(2001).Investigations of temperament at three to seven years: The children’s behavior questionnaire.Child Development,72,1394-1408.
46. Roza, S. J.,Hofstra, M. B.,van der Ende, J.,Verhulst, F. C.(2003).Stable prediction of mood and anxiety disorders based on behavioral and emotional problems in childhood: A 14-year follow-up during childhood, adolescence, and young adulthood.American Journal of Psychiatry,160(12),2116-2121.
47. Rueda, M. R.,Posner, M. I.,Rothbart, M. K.(2005).The development of executive attention: Contributions to the emergence of self-regulation.Developmental neuropsychology,28(2),573-594.
48. Rutherford, R. B.(Ed.),Quinn, M. M.(Ed.),Mathur, S. R.(Ed.)(2004).Handbook of Research in Emotional and Behavioral Disorders.New York, NY:Guilford Press.
49. Samyn, V.,Roeyers, H.,Bijttebier, P.(2011).Effortful control in typically developing boys and in boys with ADHD or autism spectrum disorder.Research in Developmental Disabilities,32(2),483-490.
50. Strang, J. F.,Kenworthy, L.,Daniolos, P.,Case, L.,Wills, M. C.,Martin, A.,Wallace, G. L.(2012).Depression and anxiety symptoms in children and adolescents with autism spectrum disorders without intellectual disability.Research in Autism Spectrum Disorders,6(1),406-412.
51. Tomanik, S.,Harris, G. E.,Hawkins, J.(2004).The relationship between behaviours exhibited by children with autism and maternal stress.Journal of Intellectual and Developmental Disability,29(1),16-26.
52. Valiente, C.,Lemery-Chalfant, K.,Swanson, J.(2010).Prediction of kindergartners’ academic achievement from their effortful control and emotionality: Evidence for direct and moderated relations.Journal of Educational Psychology,102(3),550-560.
53. Vohs, K. D.(Ed.),Baumeister, R. F.(Ed.)(2011).Handbook of Self-regulation: Research, theory, and applications.New York, NY:The Guilford Press.
54. Zaidman-Zait, A.,Mirenda, P.,Duku, E.,Vaillancourt, T.,Smith. I. M.,Szatmari, P.,Thompson, A.(2017).Impact of personal and social resources on parenting stress in mothers of children with autism spectrum disorder.Autism,21(2),155-166.
55. Zhou, Q.,Chen, S. H.,Main, A.(2012).Commonalities and differences in the research on children’s effortful control and executive function: A call for an integrated model of self-regulation.Child Development Perspectives,6(2),112-121.
56. 翁毓秀(2011).親職壓力量表簡式版.臺北市:心理出版社.
57. 陳心怡,陳榮華(2013).魏氏幼兒智力量表.臺北:中國行為科學社.
58. 陳怡群,黃惠玲,趙家琛(2009).阿肯巴克實證衡鑑系統.台北:心理出版社.
59. 游雯涵(2016)。高雄市，高雄醫學大學心理學研究所。

1. 鄭雅莉(2022)。以系統性文獻回顧探討臺灣特殊幼兒家庭之親職壓力及其相關因素。特殊教育季刊，164，1-11。