自闭症类幼儿社会注意力的探究

Social Attention in Young Children with Autism Spectrum Disorders

本研究主要目的在探讨自闭症类幼儿的社会注意力，及它与语言的关系。社会注意力包括社会定向能力和相互注意协调能力。受试者为生理年龄3岁以下的自闭症类幼儿，生理、心理年龄配对的发展迟缓幼儿和心理年龄配对的一般发展婴儿各20名。修正Dawson等人(1998)与Dawson等人(2004)的研究方法，来测量社会定向能力，并以早期社会沟通量表(Early Social Communication Scales, Mundy et al., 2003)，评估相互注意协调能力。结果发现：(1)自闭症类幼儿社会定向能力与整体注意力定向能力显着比发展迟缓幼儿及一般发展婴儿差。(2)自闭症类幼儿相互注意协调能力显着的比发展迟缓幼儿及一般发展婴儿差。(3)监别3岁以下自闭症类的幼儿，相互注意协调能力比社会定向能力是更有效的指标。(4)自闭症类幼儿整体注意力定向能力和高层次反应性相互注意协调能力显着正相关，同时，促进3岁以下自闭症类幼儿语言能力发展的关键能力是反应性相互注意协调能力。本研究结果指出自闭症类幼儿社会定向能力障碍在3岁以前便存在，反应性相互注意协调能力，在此语言发展阶段上扮演的角色，比主动性相互注意协调能力更为重要。後续的研究可以进行纵贯的探讨，以了解自闭症类幼儿早期社会能力发展路径及障碍的本质。

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.