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系統識別號 U0026-0802201712241000
論文名稱(中文) 發展中文版心智理論量表第二版暨驗證使用於自閉症類群障礙症兒童之心理計量特性
論文名稱(英文) Development and Psychometric Evaluation of the Chinese Version of the Theory of Mind Inventory-2 (ToMI-2) in Children with Autism Spectrum Disorder
校院名稱 成功大學
系所名稱(中) 職能治療學系
系所名稱(英) Department of Occupational Therapy
學年度 105
學期 1
出版年 106
研究生(中文) 江岱蓉
研究生(英文) Dai-Rong jiang
學號 T76031026
學位類別 碩士
語文別 英文
論文頁數 109頁
口試委員 指導教授-陳官琳
口試委員-鳳華
口試委員-吳進欽
口試委員-陳承德
口試委員-李雅珍
中文關鍵字 自閉症類群障礙症  心智理論  評估工具 
英文關鍵字 autism spectrum disorder  Theory of Mind  measurement 
學科別分類
中文摘要 心智理論(theory of mind, ToM)是指個體瞭解他人與自我內心心理或情緒狀態(包含信念、欲求、意圖與想法)的社會認知能力,透過心智理論,個體能夠解釋並預測對方的行為。許多研究指出,心智理論的缺損可能是造成自閉症類群障礙症(autism spectrum disorder, ASD)孩童社會互動困難的原因,進而無法和他人建立良好的社會溝通,也影響其人際關係的發展。目前已有數種心智理論評估工具,可用以瞭解ASD孩童心智理論的發展狀況,協助臨床決策與擬定治療計畫。然而,目前評估孩童心智理論評估工具有以下三項議題待討論:(1)心智理論內容概念涵蓋不完整:心智理論包含許多概念,例如情緒辨認、觀點取替與錯誤信念(false belief),但多數任務型態的評估工具僅評估心智理論單一概念的心智理論能力,無法全面涵蓋孩童的心智理論發展階層;(2)評估工具之施測過程受限於孩童的認知或語言能力:語言或認知缺損常見於ASD孩童,而多數心智理論的評估工具,如故事型的問答型式可能無法適用於注意力短暫、語言理解或表達能力較差的ASD孩童;(3)多數評估工具情境為實驗室施測:在被控制的標準化環境下所測得的能力(capacity),未必能夠類推至真實日常情境當中的表現(performance)。
由Hutchins學者等人在2014年所發展之心智理論量表第二版(Theory of Mind Inventory-2, ToMI-2)具有以下三優點,能夠克服前述目前心智理論評估工具的三項限制:(1)測驗項目內容完整且全面,涵蓋孩童心智理論發展階層的各個概念,如初級與次級錯誤信念至辨認諷刺(sarcasm)、幽默(humor)等較複雜之心智理論能力;(2)可適用於注意力短暫或語言理解、表達能力較差的ASD孩童,有助於了解各嚴重程度ASD孩童的心智理論發展;(3)著重評測孩童於日常生活情境當中的心智理論表現。然而,本評估量表部分項目存在文化差異,無法適用於台灣兒童。陳官琳教授研究團隊與美國佛蒙特大學(University of Vermont)溝通科學與障礙研究團隊Hutchins學者等人取得授權並合作發展ToMI-2中文版(Chinese version of the Theory of Mind Inventor-2, ToMI-2-C)。因此本研究目的為編譯修訂ToMI-2-C與檢測ToMI-2-C心理計量特性(psychometric properties),以發展出適合台灣孩童的心智理論評估工具。
本研究包含二部分,第一部分為編譯修訂ToMI-2-C,包含五步驟:(1)中文翻譯;(2)反向翻譯;(3)翻譯合成;(4)專家諮詢暨內容效度;(5)前驅測試。第二部分為檢驗ToMI-2-C之心理計量特性,以ToMI-2-C、心智理論任務量表(Theory of Mind Task Battery)、兒童自閉症評量量表(Childhood Autism Rating Scale)、社會性反應量表第二版-學齡兒童(Social Responsiveness Scale-second edition-school age form)、文蘭適應行為量表(Vineland Adaptive Behavior Scale)、魏氏兒童智力量表第四版(Wechsler Intelligence Scale for Children-IV)與魏氏幼兒智力量表第四版(Wechsler Preschool and Primary Scale of Intelligence-IV)之語文理解指數(verbal comprehension index, VCI)評估孩童,並以柯隆巴赫係數(Cronbach’s α)、組內相關係數(intraclass-correlation coefficient, ICC)、皮爾森相關係數(Pearson’s r)與獨立樣本t檢定分別分析內部一致性(internal consistency)、再測信度(test retest reliability)、收斂效度(convergent validity)與區辨效度(discriminative validity)。
第一部份研究結果顯示ToMI-2-C經翻譯與跨文化調整後,項目內容與量表格式修改包含因文化差異項目內容的更改、語意字詞的調整與統一和項目敘述的補充說明,經標準翻譯程序形成具文化適用性之評估工具。經專家諮詢過程的內容效度結果顯示有76%的題目達80%同意率;前驅測試認知檢證後,參考目標族群的回饋修改量表,使ToMI-2-C較通順易讀。
第二部份研究共招募台灣地區166位3至12歲ASD孩童(平均83.45個月,標準差27.85個月)與54位一般發展孩童(平均60.07個月,標準差12.19個月)及其主要照顧者參與。結果發現ToMI-2-C使用於台灣ASD孩童具備良好之心理計量特性。信度結果包含良好的內部一致性(Cronbach’s alpha=0.965)與再測信度(ICC=0.88)。ToMI-2-C收斂效度結果呈現出ToMI-2-C與心智理論任務量表(r=0.475, p<0.01)、自閉症行為檢核表(r=-0.436, p<0.01)、社會性反應量表第二版-學齡兒童(r=-0.434, p<0.01)、文蘭適應行為量表之社會化領域(socialization)分數(r=0.588, p<0.01)和魏氏兒童與幼兒智力量表之語言理解指數(r=0.522, p<0.01)具有顯著中度相關。在區辨效度部分,以ASD族群與一般發展孩童作為VCI配對比較ToMI-2-C分數,經獨立樣本t檢定分析達顯著差異(t=8.172, p<0.01) ,可作為區辨ASD孩童與一般發展孩童心智理論表現之評估工具。
本研究奠定ToMI-2-C使用於台灣ASD孩童與應用於研究與臨床評估工具信效度之實證基礎。經標準翻譯程序完成的ToMI-2-C,符合台灣文化情境且具有良好的信度與效度,臨床與研究人員可使用ToMI-2-C評估台灣ASD孩童的心智理論於日常生活情境當中的表現,以作為治療計劃的擬定與調整之參考。
英文摘要 Theory of Mind (ToM) is a social cognitive ability to understand the mental states of oneself and others, including beliefs, desires, intentions, and thoughts, that can be used to interpret and predict others’ behavior. The core symptoms of children with autism spectrum disorder (ASD) are impairments in social communication and social interaction, which have been found to be related to specific deficits in theory of mind. Many assessments have been developed to measure ToM. However, three issues remain to be discussed about current pediatric assessments, as follows: (1) Some tasks, such as the Sally & Anne and Smarties tests, only assess a single concept of ToM and thus do not cover the whole spectrum of ToM; (2) many measures are limited to children without cognitive or language impairments; and (3) children’s capacity of ToM assessed within a standard laboratory environment may not represent children’s performance of ToM in daily contexts.
The Theory of Mind Inventory-2 (ToMI-2), developed by Hutchins et al. in 2014, may overcome the above-mentioned limitations. The ToMI-2 (1) contains concepts covering the whole spectrum of ToM comprehensively; (2) is independent of a child’s cognitive or language ability because it is completed by the child’s caregiver, and (3) focuses on performance in the child’s actual daily life instead of in a laboratory context. However, the ToMI-2 cannot be applied to children in Taiwan because of cultural differences. To measure the ToM of Taiwanese children, the development of a Chinese version of the ToMI-2 (ToMI-2-C) is warranted. Therefore, this study had two purposes: (1) to develop the ToMI-2-C; and (2) to evaluate the psychometric properties of the ToMI-2-C.
This study included two parts: development and psychometric evaluation. First, the ToMI-2-C was developed in five steps: (1) forward translation from English to Chinese, (2) back-translation from Chinese to English, (3) synthesis of the original version and back-translation, (4) expert validation and content validity, and (5) a pilot study with the caregivers. Second, to the examine the psychometric properties, the ToMI-2-C, Theory of Mind Task Battery (ToMTB), Childhood Autism Rating Scale (CARS), Social Responsiveness Scale-second edition-school age form (SRS-2), Vineland Adaptive Behavior Scale (VABS), and the verbal comprehension index (VCI) of the Wechsler Intelligence Scale for Children-IV or the Wechsler Preschool and Primary Scale of Intelligence-IV were used for measuring ToM performance, ToM capacity, symptom severity, social interaction, and verbal comprehension ability. Cronbach’s α, intra-class correlation coefficients (ICC), Pearson’s correlation coefficients (r) and independent t-tests were respectively used to examine the internal consistency, test-retest reliability, content validity, convergent validity, and discriminative validity of the ToMI-2-C.
The ToMI-2-C was developed with culturally-adapted content to fit the Taiwanese cultural context. The modifications included changes in content based on cultural differences, the modification of characters or sentence patterns, and the addition of examples to items. Through the standard translation process, the culturally-fit ToMI-2-C was established. The content validity was also established based on expert consultation. In the cognitive debriefing of the pilot study, the ToMI-2-C was modified to be understandable based on feedback from the target population.
A total of 166 children with ASD (mean=83.45 months, SD=27.85 months) and 54 children with typical development (mean= 63.07 months, SD=12.19 months) of 3 to 12 years of age were recruited in this study. The ToMI-2-C was found to have good psychometric properties in children with ASD in Taiwan. The results of Cronbach’s α of the ToMI-2- C showed high internal consistency (Cronbach’s α=0.965). For the test-retest reliability, 30 children in the ASD group completed the test and retest assessments of the ToMI-2-C with a 2-week interval. The test-retest reliability of the ToMI-2-C total score was appropriate (ICC=0.88).
The results of convergent validity of the ToMI-2-C showed that the scores of the ToMI-2-C had significantly moderate correlation with the scores of the ToMTB (r=0.475, p<0.01), the scores of the CARS (r=-0.436, p<0.01), the SRS-2 (r=-0.434, p<0.01), the socialization scores of the VABS (r=0.588, p<0.01), and the scores of the VCI (r=0.522, p<0.01). For discriminative validity, the ToMI-2-C could discriminate ToM performance from VCI-matched children with ASD and TD (t=8.172, p<0.01).
The present study developed the ToMI-2-C and established empirical evidence for implementation in research and clinical settings. The ToMI-2-C was culturally-adapted so that the content of the ToMI-2-C would fit the Taiwanese cultural context. In addition, the completed ToMI-2-C was found to have good psychometric properties, including internal consistency, test retest reliability, content validity, convergent validity and discriminative validity. The ToMI-2-C could be a useful measure to help clinicians and researchers to evaluate the ToM performance of Taiwanese children with ASD accurately, without cultural barriers.
論文目次 中文摘要 I
ABSTRACT IV
TABLE OF CONTENTS VIII
LIST OF TABLES XI
LIST OF FIGURES XII
LIST OF APPENDICES XIII
Chapter 1 Introduction 1
Chapter 2 Literature review 3
2.1. Theory of mind 3
2.1.1. Definition and importance 3
2.1.2. Child development of theory of mind 4
2.1.3. Theory of mind in children with autism spectrum disorder 4
2.2. Autism Spectrum Disorder 6
2.2.1. Diagnosis 6
2.2.2. Prevalence 7
2.2.3. Functional prognosis 8
2.3. Measures of Theory of Mind 9
2.3.1. The forms of presentation 13
2.3.2. The levels of the measures 13
2.3.3. The levels of functioning 14
2.3.4. Limitations of current measures of Theory of Mind 14
2.4 Theory of Mind Inventory 16
2.5. Purposes 17
Chapter 3 Methods 18
3.1 Study 1: Development of the Chinese version of the ToMI-2 (ToMI-2-C) 18
3.1.1 Theory of Mind Inventory-2 18
3.1.2. Procedures 20
3.2. Study 2- Evaluation of the psychometric properties of the Chinese version of the Theory of Mind Inventory 22
3.2.1. Participants 23
3.2.2. Measures 24
3.2.3. Procedures 28
3.2.4. Data analysis 30
Chapter 4 Results 31
4.1.1. Forward translation 31
4.1.2. Back-translation 32
4.1.3. Synthesis 32
4.1.4. Expert validation 34
4.1.5. Pilot study 35
4.2 Study 2 - Evaluation of the psychometric properties 37
4.2.1. Descriptive Statistics 37
4.2.2. Reliability 41
4.2.3. Validity 42
Chapter 5 Discussion 43
5.1. The development of the ToMI-2-C and the content validity 44
5.2. Reliability 46
5.3. Validity 46
5.3.1. Convergent validity 46
5.3.2. Discriminative validity 49
5.4. Limitations 50
5.5. Implications 51
5.6. Conclusions 51
References 52
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