| Summary: | 博士 === 國立臺灣大學 === 職能治療研究所 === 100 === Background: Autism Spectrum Disorders (ASD) is characterized by qualitative impairments in communication and social interaction, along with restricted interests and repetitive behaviors. Besides the core symptoms, children with ASD often have various co-occurring problems such as deficits in motor skill and sensory processing, which may greatly hamper their participation and play skill acquisition. Participation in everyday occupations is essential to a child’s development, health, and well-being. Preschoolers’ participation mainly involves home situations. In addition, play is one of preschoolers’ primary occupations, through which they learn skills and develop competence. Because of the complex nature of problems in children with ASD, it is essential to use a framework to identify children’s functioning and disability from a holistic perspective and to examine the environmental barriers or facilitators to child’s functioning. The World Health Organization (WHO) advocates an uniform framework and terminology, the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), for the description of health and health-related states. The ICF-CY is a holistic conceptual framework that not only focuses on disability but also on function and takes into account the interrelations of disease, function, person, and environment. To date, studies examining the factors influencing home participation and play skill acquisition in children with ASD only included factors from one to three specific dimensions of the ICF-CY without considering possible factors from all dimensions of the health condition, body function and structures, activities, person and environments simultaneously. In addition, no studies examined the playfulness and the predictors of playfulness in children with ASD. Thus, a study using the ICF-CY framework to investigate the predictors of home participation, play skills and playfulness in children with ASD is warranted. Moreover, the diagnosis subtypes of the participants in the previous studies were not considered, and the age of the participants expanded across a wide range, from preschoolers to adolescents. Therefore, this study was aimed at children with ASD at preschool age, and the subtypes of ASD were taken into account in data analysis.
Purposes: The purpose of this study was to investigate the factors influencing home participation in life situations involving communication, daily living activities, socialization, motor activities, along with play skills and playfulness in preschoolers with ASD. Furthermore, possible factors from the entire scope of the ICF-CY, i.e., the dimensions of health condition, body function and structures, activities and participation, person and environments were taken into account.
Method: A total of 93 preschoolers with ASD (mean age= 54.15 months) recruited from developmental centers, pediatric rehabilitation clinics, and child psychiatry and rehabilitation departments of general hospitals in the greater Taipei area and Taoyuan city participated in this study. The inclusion criteria included: (1) children were diagnosed with autistic disorder, Asperger disorder, or PDD-NOS by child psychiatrists based on the criteria in the DSM-IV-TR, (2) children’s age was 3- to 5- year-old, and (3) children’s parents or primary caregivers agreed to participate and provided the informed consent. Furthermore, children who had sensory or severe motor limitations or whose primary caregivers could not communicate in Mandarin or Taiwanese were excluded. The child with parental informed consent received a one-to-one assessment using the Chinese Psychoeducational Profile-third edition (CPEP-3). At the same time, another researcher rated the child’s behaviors using the Childhood Autism Rating Scale (CARS) and the Pediatric Volitional Questionnaire-Chinese version (PVQ-C). Meanwhile, the parent or primary caregiver was interviewed by a third researcher using the Vineland Adaptive Behavior Scale-Chinese classroom edition (VABS-C). After completing the CPEP-3, the child was observed both in free play by herself/himself and played with one researcher or the child’s sibling for 15 to 20 minutes. Meanwhile, another researcher observed the child’s playfulness using the Test of Playfulness (ToP). Afterwards, a package of questionnaires including a basic information questionnaire, the Child Behavior Checklist for Ages 1.5-5-Chinese version (CBCL-C/1.5-5), the Behavior Style Questionnaire-Chinese version (BSQ-C), the Short Sensory Profile-Chinese version (SSP-C), the Parenting Stress Index-Chinese Short Form (PSI-CSF), the Positive Affect Index (PAI) and the Family Quality of Life Questionnaire for Young Children with Special Needs (FQoLQ-YCSN) was given to parents who were asked to return questionnaires in two weeks.
Statistical analysis: Descriptive analysis and Pearson Product Moment Correlation analysis were performed for the observed variables in health condition, body function and structures, activity and participation, environmental and personal dimensions of the ICF-CY. Multiple linear regression models were fitted to identify the significant predictors of home participation, play skills and playfulness in children with ASD. The dependent variables included the Communication, Daily Living Skills, Socialization and Motor Skills domains, and the Play and Leisure Time subdomain of the VABS-C as well as the ToP. The independent variables included all the observed variables in health condition, body function and structures, activity and participation, environmental and personal dimensions of the ICF-CY.
Results: Multiple stepwise linear regression models revealed that the CPEP-3 Expressive Language (β=1.16, p<0.001), SSP-C Auditory Filtering (β=1.36, p<0.001) and Underresponsive/Seeks Sensation (β=-1.02, p=0.009), children’s age (β=-0.62, p=0.001) and the number of children in the family (β=-4.67, p=0.038) were the significant predictors of home participation in communication (VABS-C Communication) in preschoolers with ASD. The model accounted for 60.3% of the variance. Children’s PVQ-C (β=0.75, p<0.001), SSP-C Auditory Filtering (β=1.05, p=0.002) and Underresponsive/Seek Sensation (β=-0.94, p=0.005) were the significant predictors of their participation in daily living activities (VABS-C Daily Living Skills). The model explained 32.4% of the variance. Children’s CPEP-3 Affective Expression (β=1.18, p<0.001), SSP-C Auditory Filtering (β=1.04, p<0.001), BSQ-C Persistence (β=0.57, p=0.013) and Approachability (β=0.49, p=0.011) and their parental socioeconomic status in lower class (β=-14.00, p=0.048) were the significant predictors of their participation in socialization (VABS-C Socialization). The model accounted for 47.5% of the variance. Children’s CPEP-3 Fine Motor (β=1.86, p<0.001), BSQ-C Mood (β=-1.15, p=0.003) and Adaptability (β=0.71, p=0.005), children’s age (β=-0.86, p<0.001) and having seizure (β=-18.68, p=0.031) were the significant predictors of their participation in motor activities (VABS-C Motor Skills). The model explained 39.5% of the variance. With regard to play skills (VABS-C Play and Leisure Time), children’s CPEP-3 Cognitive Verbal/ Preverbal (β=0.15, p<0.001), VABS-C Daily Living Skills (β=0.08, p=0.007), BSQ-C Persistence (β=0.18, p=0.016), and parental PSI (β=-0.09, p=0.005) were the significant predictors. The model accounted for 56.2% of the variance. Children’s CARS (β=-0.08, p<0.001), PVQ-C (β=0.03, p=0.001), VABS-C Communication (β=0.01, p=0.006), children’s age (β=0.02, p=0.002) and their parental socioeconomic status in lower middle class (β=0.34, p=0.030) were the significant predictors of their playfulness (ToP). The model explained 80.5% of the variance.
Conclusions: This study is the first one to examine the factors influencing home participation in life situations involving communication, daily living activities, socialization, motor activities, as well as play skills and playfulness in preschoolers with ASD using the ICF-CY framework by considering the possible factors from all dimensions of the ICF-CY. Results of this study can benefit professionals when setting appropriate treatment goals and designing effective interventions, and serves as a guide for the government to make appropriate policies for preschool children with ASD.
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