||Exploring the Performance of Self-care and Visual Perception in Preschool Children with Autism Spectrum Disorder
||Department of Occupational Therapy
autism spectrum disorder
自理能力是學齡前兒童的基礎職能活動，也是發展未來各樣職能的先備根基，而視知覺能力則是執行職能活動的表現技巧之一，亦為學齡前時期重點發展的能力。同樣的，自理能力和視知覺能力對學齡前自閉症類群障礙症(ASD)兒童也具有重要且廣泛的影響。然而，學齡前ASD兒童的自理能力和視知覺的表現，以及兩者之間的關係至今都尚未被清楚了解。先前的研究只有透過單一施測者的角度來評估兒童自我照顧的表現，視知覺也僅透過無動作(motor-free)或視動整合其中一種工具來評估。本研究著重於從兒童的表現、治療師的評估以及照顧者的觀點之多元角度來探究學齡前ASD兒童自理能力的表現，以及使用無動作和視動整合的視知覺評估工具來了解其視知覺的發展。本研究招募了132名年齡在48-83個月之間的參與者：分別是66名學齡前ASD兒童和66名典型發展學齡前兒童。研究使用動作與程序技巧評估(Assessment of Motor and Process Skills, AMPS)和中文版兒童生活功能量表(Chinese Version of Pediatric Evaluation of Disability Inventory, PEDI-C)分別從兒童表現與治療師角度以及家長的觀點來評估孩子的自理能力表現；而視知覺發展測驗第三版( Developmental Test of Visual Perception – Third Edition, DTVP-3)和視知覺技巧測驗第三版(Test of Visual-Perceptual Skills - Third Edition, TVPS-3)則分別用於評估視動整合和無動作之視知覺表現。資料透過獨立樣本t檢定分析兩組之間的表現差異，並使用Pearson相關係數了解學齡前ASD兒童的自理能力和視知覺之間的關係。結果指出，不論是由治療師直接觀察收集兒童表現之資料，抑或是家長填寫之問卷分析，兩組兒童於自理能力都存在顯著差異，且ASD兒童之平均得分低於典型發展兒童；視知覺部分，除了視覺完形(visual closure)這項能力並無顯著差異之外，所有的無動作與視動整合視知覺總分與子項目皆在兩組間有顯著差異，ASD兒童之平均得分低於典型發展兒童。在ASD孩童組中，無動作視知覺總分、視覺區辨、視覺記憶、空間關係、順序記憶和視知覺技巧測驗第三版總分、手眼協調能力與抄畫技巧得分皆與動作與程序技巧評估各項分數呈現顯著正相關；而視知覺發展測驗第三版總分、手眼協調能力和抄畫技巧得分與中文版兒童生活功能量表自我照顧之功能性能力表現得分呈現顯著正相關；無動作視知覺總分、視覺區辨得分與中文版兒童生活功能量表自理能力之照顧者協助量表得分有顯著正相關。此研究結果對目前學齡前ASD兒童的自理能力和視知覺的表現建立了更完整的認識；同時，了解學齡前ASD兒童的自我照顧和視知覺之間的關係亦能為臨床專業人員提供學齡前ASD兒童自理能力訓練與介入之參考。
Self-care is a basic occupation of preschool children as well as their foundation for the development of various occupations. Visual perception is a performance skill of performing self-care and also an important development task in preschool period. According to Gibson’s theory of affordances, children who can perform self-care tasks appropriately should perceive contexts information through visual perception correctly. It indicates that there were relationships between self-care and visual perception, and that was especially important to preschool children with autism spectrum disorder (ASD), who had been described as visual learners. However, the performance of self-care and visual perception and their relationships have not been clearly understood among preschool children with ASD. Previous studies collected information about the self-care in groups of ASD mainly from single viewpoint evaluations; visual perception had been assessed through only motor-free or visual-motor integration instruments as well. This study focused on examining the performance of self-care and visual perception in preschool children with ASD. In addition, investigating the relationships between self-care and visual perception through the performances of the child, the viewpoints of caregiver, and therapist’s evaluation was one of the research purposes. Both motor-free visual perception and visual-motor integration evaluation tools for preschool children with ASD were used. A total of 132 participants aged 48 to 83 months were recruited: 66 preschool children with ASD and 66 typically developing (TD) preschool children. The Assessment of Motor and Process Skills (AMPS) and Chinese Version of Pediatric Evaluation of Disability Inventory (PEDI-C) were used to measure the self-care performance of preschool children through the performances of the children, the viewpoints of caregivers, and therapist’s evaluation. The Developmental Test of Visual Perception – Third Edition (DTVP-3) and Test of Visual-Perceptual Skills - Third Edition (TVPS-3) were used to evaluate visual perception. Independent t-tests were used to analyze the difference of performance between the two groups. Pearson correlation coefficients were used to examine the relationship between self-care and visual perception in preschool children with ASD. Results indicated that there were significant differences between the two groups of children in AMPS, PEDI-C, TVPS-3 and DTVP-3, with the exception of visual closure. Mean scores of children with ASD were less than those of TD children. Among children with ASD, the scores of AMPS had significant positive correlations with TVPS-3 total score, discrimination, visual memory, spatial relationships, sequential memory, DTVP-3 VMI composite score, eye-hand coordination and copying. PEDI-C functional ability score was significantly associated with the scores of DTVP-3. Significant positive correlations existed between PEDI-C caregiver assistance score and TVPS-3 total score and discrimination.
Through this study, a further understanding of the self-care and visual perception among preschool children with ASD were established. Understanding the relationship between self-care and visual perception in preschool children with ASD could also provide professionals as references when providing self-care interventions for preschool children with ASD.
Chapter 1 Introduction - 1 -
Chapter 2 Literature Review - 5 -
Autism Spectrum Disorder (ASD) - 5 -
Self-care - 7 -
Visual Perception - 9 -
Relationship between Self-care and Visual Perception - 13 -
Chapter 3 Methodology - 16 -
Purposes - 16 -
Participants - 16 -
Instruments - 18 -
Standard Version of Childhood Autism Rating Scale – Second edition (CARS2-ST) - 18 -
Assessment of Motor and Process Skills (AMPS) - 18 -
Chinese Version of Pediatric Evaluation of Disability Inventory (PEDI-C) - 20 -
Test of Visual Perceptual Skills - Third Edition (TVPS-3) - 21 -
Developmental Test of Visual Perception – Third Edition (DTVP-3) - 22 -
Procedures - 23 -
Data Analysis - 23 -
Chapter 4 Results - 25 -
Demographic Information - 25 -
Performance of Self-care and Visual Perception - 25 -
Relationships between Self-care and Visual Perception in Preschool Children with ASD - 27 -
Chapter 5 Discussion - 30 -
Self-care - 30 -
Visual perception - 32 -
Relationships between Self-care and Visual Perception - 34 -
Chapter 6 Conclusion - 40 -
References - 41 -
List of Figure
Figure 1. Procedure Flowchart of the Research -54-
List of Tables
Table 1. The Developmental Milestones of Self-care in Preschool Age -55-
Table 2. The Developmental Milestones of Visual Perception -56-
Table 3. The Demographic Information -57-
Table 4. The Differences of Performance of Self-care and Visual Perception in Each Group -58-
Table 5. The Pearson Correlation Coefficient between Self-care and Visual Perception in Preschool Children with ASD -59-
Table 6. The Correlation Coefficient between Self-care and Visual Perception in TD
Preschool Children -60-
Table 7. Comparison of the Results of ASD Group with Previous Studies -61-
Table 8. Comparison of the Results of ASD Group and TD Group -62-
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