第四章 結論與討論
第五節 研究限制
國
立 政 治 大 學
‧
Na tiona
l Ch engchi University
70
論發展及缺陷已是被廣泛接受及臨床應用的議題，而本研究結果也顯示，即使 是整體智能發展及適應水準相對正常的高功能自閉症學齡兒童，甚至是智能優 異的自閉症兒童，仍可能有心智理論缺陷的問題，亦即這些兒童仍較一般兒童 容易在日常生活面臨解讀他人情緒、意圖、信念的困難，而解讀心智的困難也 以不同的方式呈現。
對於臨床從業人員來說，心智理論包含不同面向（包含：第一階錯誤信 念、第二階錯誤信念、理解諷刺、理解隱喻、辨識失態…等），提供了臨床實務 上良好的知識架構以及概念化之參考，而能輔助臨床從業人員更為了解個案面 臨的困難並提供更適合個案的介入方法。為了客觀了解個案的心智理論發展，
除了晤談資料的收集和臨床觀察，也可考量使用本研究所發展之心智理論作 業，以更完整了解個案的心智理論發展。
另外回應智能優異的議題，智能優異的高功能自閉症孩童在臨床上面臨雙 重特殊需求的難題，使得他們在教育上較難獲得適當的安置及協助。本研究中 也發現，細看這群孩子在心智理論測驗上的表現，仍容易有錯誤使用心理辯證 策略去解讀他人心理狀態的傾向；這顯示仍有必要呼籲教育和臨床人員關注到 智能優異高功能自閉症孩童的缺陷所在，並給予適當的協助。此外，本研究發 現智能優異的自閉症兒童可能較擅長透過物理線索的使用去補足容易錯誤解讀 他人的傾向，未來在臨床上也可考量以物理線索輔助的介入技巧，輔助自閉症 孩童發展心智理論能力。
第五節 研究限制
從抽樣方式來看，本研究樣本大多數來自大台北地區，這些地區的教育和 醫療資源較多，自閉症組的孩童可能接受到較多的療育，且受試者也可能來自 較高教育水準及社經地位的家庭，本研究的資料也確實顯示不論是一般發展或 整體自閉症組平均皆有中上水準的智商。上述現象可能會導致本研究的結論在 類推至教育水準及社經地位較低的家庭、或較乏教育和醫療資源的地區時出現 問題。
‧
緩（Baron-Cohen, 1989）；過去部分研究雖有嘗試探討成人自閉症的心智理論發 展（例如：Baron‐Cohen et al., 2001; Kleinman et al., 2001），然而相較於成年期 以前心智理論發展的研究，為數仍少。從性別比來看，因為信效度分析的需要‧ 國
立 政 治 大 學
‧
Na tiona
l Ch engchi University
72
言、注意力等因素的影響。針對這個限制，建議在計分方式上需要剃除未能通 過控制問題的回答，以排除其他歷程對於測驗表現的影響，確保分析結果可真 正反應心智理論能力的差異。此外，未來研究也可朝向Apperly 與 Butterfill
（2009）所提出的內隱心智理論（Implicit ToM）的概念進行探討，以及其相關 測量方式，例如：眼動工具的使用；如同Apperly 與 Butterfill 所述，內隱心智 理論相對是一個較為自動化、非意識的歷程，較不需受試者有意地投注認知、
注意力、語言等資源進行受測，也較能排除這些因素的干擾，且回應上述研究 對象的限制，這類的作業也較能同時應用在高功能及中低功能的自閉症孩童 上。
‧ 國
立 政 治 大 學
‧
Na tiona
l Ch engchi University
73
參考文獻
張正芬（2007）。亞斯柏格資優生之適性教育方案（I）研究成果報告（精簡 版）。行政院國家科學委員會專題研究成果報告（編號：NSC 95-2614-S-003-019-），未出版。
陳心怡（1999）。「簡式」魏氏兒童智力量表之建立研究-四個分測驗之組合。測 驗年刊，46(2)，13-32。
陳榮華（1997）。魏氏兒童智力量表第三版（中文版）指導手冊。臺北，中國行 為科學社。
許君翎（2007）。注意力缺陷/過動疾患兒童與高功能自閉症兒童在心智理論能 力上的差異（碩士論文）。取自臺灣碩博士論文系統。（系統編號
095FJU00071006）。
曹峰銘、蔡佩君、王加恩、呂信慧（2012）。高功能自閉症學齡兒童的心智理論 與口語敘說。中華心理學刊，54(3)，365-383。
鄒小蘭、盧台華（2015）。身心障礙資優學生支援服務系統建構之行動研究。特 殊教育研究學刊，40(2)，1-29。
鄒啟蓉（2005）。學齡前幼兒“錯誤信念”發展研究。特殊教育研究學刊，29，
25-47。
黃玉枝、黃桂君、宣崇慧（2009）。修訂學齡兒童語言障礙評量表指導手冊。教 育部特殊教育工作小組出版。
鳳華（2007）。中部地區亞斯伯格症兒童「心智理論」（Theory of Mind）的發 展現況及心智理論暨社會技巧訓練對亞斯伯格兒童介入成效之研究成果報 告（精簡版）。行政院國家科學委員會專題研究成果報告（編號：NSC-95-2413-H-018-003），未出版。
Abell, F., Happé, F., & Frith, U. (2000). Do triangles play tricks? Attribution of mental states to animated shapes in normal and abnormal development. Cognitive Development, 15(1), 1-16.
‧
Adachi, T., Koeda, T., Hirabayashi, S., Maeoka, Y., Shiota, M., Wright, E. C., &
Wada, A. (2004). The metaphor and sarcasm scenario test: A new instrument to help differentiate high functioning pervasive developmental disorder from attention deficit/hyperactivity disorder. Brain and Development, 26(5), 301-306.
American Psychiatric Association (2000). Diagnostic and Statistical manual of mental disorders –Text Revision (4th ed-TR.). Washinton DC: Author.
American Psychiatric Association (2013). Diagnostic and Statistical manual of mental disorders (5th ed.). Washinton DC: Author.
Apperly, I. A., & Butterfill, S. A. (2009). Do humans have two systems to track beliefs and belief-like states?. Psychological Review, 116(4), 953.
Apperly, I. A., Samson, D., & Humphreys, G. W. (2005). Domain-specificity and theory of mind: evaluating neuropsychological evidence. Trends in cognitive sciences, 9(12), 572-577.
Assouline, S. G., Nicpon, M. F., & Dockery, L. (2012). Predicting the academic achievement of gifted students with autism spectrum disorder. Journal of autism and developmental disorders, 42(9), 1781-1789.
Astington, J. W., Hughes, C., & Zelazo, P. D. (2013). Theory of mind: Self-reflection and social understanding. In Zelazo, P. D. (Ed.), Oxford Handbook of
Developmental Psychology (pp. 398-424). USA, Oxford University Press.
Baron-Cohen, S. (1989). The autistic child’s theory of mind: A case of specific developmental delay. Journal of Child Psychology and Psychiatry, 30, 285-298.
Baron-Cohen, S. (1994). How to build a baby that can read minds: Cognitive mechanisms in mindreading. Cahiers de Psychologie Cognitive/Current Psychology of Cognition, 13, 513-552.
Baron-Cohen, S. (1995). Mindblindness: An essay on autism and theory of mind.
Cambridge, MA: MIT Press.
Baron-Cohen, S. (2001). Theory of mind and autism: A review. International Review of Research in Mental Retardation: Autism, 23, 169-184.
‧ 國
立 政 治 大 學
‧
Na tiona
l Ch engchi University
75
Baron‐Cohen, S. (2009). Autism: the empathizing–systemizing (E‐S) theory. Annals of the New York Academy of Sciences, 1156(1), 68-80.
Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a
“theory of mind”?. Cognition, 21(1), 37-46.
Baron‐Cohen, S., Leslie, A. M., & Frith, U. (1986). Mechanical, behavioural and intentional understanding of picture stories in autistic children. British Journal of Developmental Psychology, 4(2), 113-125.
Baron-Cohen, S., O'Riordan, M., Stone, V., Jones, R., & Plaisted, K. (1999).
Recognition of faux pas by normally developing children and children with Asperger syndrome or high-functioning autism. Journal of Autism and Developmental Disorders, 29(5), 407-418.
Baron‐Cohen, S., Wheelwright, S., Hill, J., Raste, Y., & Plumb, I. (2001). The
“Reading the Mind in the Eyes” test revised version: A study with normal adults, and adults with Asperger syndrome or high‐functioning autism. Journal of Child Psychology and Psychiatry, 42(2), 241-251.
Begeer, S., Gevers, C., Clifford, P., Verhoeve, M., Kat, K., Hoddenbach, E., & Boer, F. (2011). Theory of mind training in children with autism: A randomized controlled trial. Journal of Autism and Developmental Disorders, 41(8), 997-1006.
Birch, S. A., & Bloom, P. (2007). The curse of knowledge in reasoning about false beliefs. Psychological Science, 18(5), 382-386.
Brown, R., Hobson, R. P., Lee, A., & Stevenson, J. (1997). Are There “Autistic‐like”
Features in Congenitally Blind Children?. Journal of Child Psychology and Psychiatry, 38(6), 693-703.
Callenmark, B., Kjellin, L., Rönnqvist, L., & Bölte, S. (2014). Explicit versus implicit social cognition testing in autism spectrum disorder. Autism, 18(6), 684-693.
‧ 國
立 政 治 大 學
‧
Na tiona
l Ch engchi University
76
Dahlgren, S. O., & Trillingsgaard, A. (1996). Theory of mind in non‐retarded children with autism and Asperger's syndrome. A research note. Journal of Child
Psychology and Psychiatry, 37(6), 759-763.
Flavell, J. H., Miller, P. H., & Miller, S. (1993). Cognitive development. Englewood Cliffs, NJ: Prentice-Hall.
Frith, U. (1989). Autism: Explaining the enigma. Oxford: Blackwell.
Green, S., Pring, L., & Swettenham, J. (2004). An investigation of first‐order false belief understanding of children with congenital profound visual impairment.
British Journal of Developmental Psychology, 22(1), 1-17.
Happé, F. G. (1994). An advanced test of theory of mind: Understanding of story characters' thoughts and feelings by able autistic, mentally handicapped, and normal children and adults. Journal of Autism and Developmental Disorders, 24(2), 129-154.
Happé, F. G. (1995). The role of age and verbal ability in the theory of mind task performance of subjects with autism. Child Development, 66(3), 843-855.
Happé, F., Booth, R., Charlton, R., & Hughes, C. (2006). Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder:
examining profiles across domains and ages. Brain and Cognition, 61(1), 25-39.
Happé, F., & Frith, U. (2006). The weak coherence account: detail-focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders, 36(1), 5-25.
Hill, E. L. (2004). Executive dysfunction in autism. Trends in Cognitive Sciences, 8(1), 26-32.
Kleinman, J., Marciano, P. L., & Ault, R. L. (2001). Advanced theory of mind in high-functioning adults with autism. Journal of autism and developmental disorders, 31(1), 29-36.
‧ 國
立 政 治 大 學
‧
Na tiona
l Ch engchi University
77
Klin, A. (2000). Attributing social meaning to ambiguous visual stimuli in higher-functioning autism and Asperger syndrome: The social attribution task. Journal of Child Psychology and Psychiatry, 41(07), 831-846.
Klin, A., Volkmar, F. R., & Sparrow, S. S. (1992). Autistic social dysfunction: Some limitations of the theory of mind hypothesis. Journal of Child Psychology and Psychiatry, 33(5), 861-876.
Lai M-C, Lombardo MV, Chakrabarti B, Baron-Cohen S (2013) Subgrouping the Autism “Spectrum": Reflections on DSM-5. PLoS Biol 11(4): e1001544.
Lord, C., & Risi, S. (1998). Frameworks and methods in diagnosing autism spectrum disorders. Mental Retardation and Developmental Disabilities Research Reviews, 4(2), 90-96.
Lord, C., Risi, S., Lambrecht, L., Cook Jr, E. H., Leventhal, B. L., DiLavore, P. C., ...
& Rutter, M. (2000). The Autism Diagnostic Observation Schedule—Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205-223.
Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism Diagnostic Interview-Revised:
a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and
Developmental Disorders, 24(5), 659-685.
McKinnon, M. C., & Moscovitch, M. (2007). Domain-general contributions to social reasoning: Theory of mind and deontic reasoning re-explored. Cognition, 102(2), 179-218.
McLean, R. L., Harrison, A. J., Zimak, E., Joseph, R. M., & Morrow, E. M. (2014).
Executive function in probands with autism with average IQ and their unaffected first-degree relatives. Journal of the American Academy of Child & Adolescent Psychiatry, 53(9), 1001-1009.
‧ 國
立 政 治 大 學
‧
Na tiona
l Ch engchi University
78
Mesman, J., van IJzendoorn, M. H., & Bakermans-Kranenburg, M. J. (2009). The many faces of the still-face paradigm: a review and meta-analysis. Developmental Review, 29(2), 120-162.
Meltzoff, A. N. (1995). Understanding the intentions of others: re-enactment of intended acts by 18-month-old children. Developmental Psychology, 31(5), 838.
Miller, C. A. (2001). False belief understanding in children with specific language impairment. Journal of Communication Disorders, 34(1), 73-86.
Minter, M., Hobson, R. P., & Bishop, M. (1998). Congenital visual impairment and'theory of mind'. The British Journal of Developmental Psychology, 16, 183.
Muris, P., Steerneman, P., Meesters, C., Merckelbach, H., Horselenberg, R., van den Hogen, T., & van Dongen, L. (1999). The TOM test: A new instrument for assessing theory of mind in normal children and children with pervasive
developmental disorders. Journal of Autism and Developmental Disorders, 29(1), 67-80.
Nicpon, M. F., Allmon, A., Sieck, B., & Stinson, R. D. (2011). Empirical investigation of twice-exceptionality: Where have we been and where are we going?. Gifted Child Quarterly, 55(1), 3-17.
Nicpon, M. F., Doobay, A. F., & Assouline, S. G. (2010). Parent, teacher, and self perceptions of psychosocial functioning in intellectually gifted children and adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 40(8), 1028-1038.
Onishi, K. H., & Baillargeon, R. (2005). Do 15-month-old infants understand false beliefs?. Science, 308(5719), 255-258.
Ozonoff, S. (1995). Executive functions in autism. In Schopler, E., & Mesibov, G. B.
(Eds.), Learning and cognition in autism (pp. 199-219). New York, NY: Springer.
Ozonoff, S., Iosif, A. M., Baguio, F., Cook, I. C., Hill, M. M., Hutman, T., ... &
Steinfeld, M. B. (2010). A prospective study of the emergence of early behavioral
‧
signs of autism. Journal of the American Academy of Child & Adolescent Psychiatry, 49(3), 256-266.
Ozonoff, S., & Jensen, J. (1999). Brief report: Specific executive function profiles in three neurodevelopmental disorders. Journal of Autism and Developmental Disorders, 29(2), 171-177.
Pellicano, E. (2011) Psychological models of autism: An overview. In Roth, I., &
Rezaie, P. (Eds.). Researching the Autism Spectrum: Contemporary Perspectives (pp. 219-265). Cambridge University Press.
Perner, J., & Wimmer, H. (1985). “John thinks that Mary thinks that…” attribution of second-order beliefs by 5-to 10-year-old children. Journal of Experimental Child Psychology, 39(3), 437-471.
Peterson, C. C., & Siegal, M. (1995). Deafness, conversation and theory of mind.
Journal of Child Psychology and Psychiatry, 36(3), 459-474.
Peterson, C. C., & Siegal, M. (1999). Representing inner worlds: Theory of mind in autistic, deaf, and normal hearing children. Psychological Science, 10(2), 126-129.
Peterson, C. C., Wellman, H. M., & Slaughter, V. (2012). The mind behind the
message: Advancing theory‐of‐mind scales for typically developing children, and those with deafness, autism, or Asperger syndrome. Child development, 83(2), 469-485.
Pilowsky, T., Yirmiya, N., Arbelle, S., & Mozes, T. (2000). Theory of mind abilities of children with schizophrenia, children with autism, and normally developing children. Schizophrenia Research, 42(2), 145-155.
Plaisted, K., Swettenham, J., & Rees, L. (1999). Children with autism show local precedence in a divided attention task and global precedence in a selective attention task. Journal of Child Psychology and Psychiatry, 40(05), 733-742.
Premack, D., & Woodruff, G. (1978). Does the chimpanzee have a theory of mind?.
Behavioral and brain sciences, 1(04), 515-526.
‧
Prior, M., Dahlstrom, B., & Squires, T. L. (1990). Autistic children's knowledge of thinking and feeling states in other people. Journal of Child Psychology and Psychiatry, 31(4), 587-601.
Repacholi, B. M., & Gopnik, A. (1997). Early reasoning about desires: evidence from 14-and 18-month-olds. Developmental Psychology, 33(1), 12.
Reed, T., & Peterson, C. (1990). A comparative study of autistic subjects' performance at two levels of visual and cognitive perspective taking. Journal of autism and developmental disorders, 20(4), 555-567.
Robinson, E. J., & Apperly, I. (1998). Adolescents’ and adults’ views about the evidential basis for beliefs: Relativism and determinism re‐examined.
Developmental Science, 1(2), 279-289.
Rubenstein, L. D., Schelling, N., Wilczynski, S. M., & Hooks, E. N. (2015). Lived experiences of parents of gifted students with Autism Spectrum Disorder: The struggle to find appropriate educational experiences. Gifted Child Quarterly, 59(4), 283-298.
Rumsey, J. M. (1985). Conceptual problem-solving in highly verbal, nonretarded autistic men. Journal of Autism and Developmental Disorders, 15(1), 23-36.
Russell, J. (2002). Cognitive theories of autism. In Swanwick, G. (Ed.), Cognitive deficits in brain disorders (pp. 295-323). The Royal College of Psychiatrists.
Rutter, M., Bailey, A., & Lord, C. (2003). The social communication questionnaire:
Manual. Western Psychological Services.
Schaafsma, S. M., Pfaff, D. W., Spunt, R. P., & Adolphs, R. (2015). Deconstructing and reconstructing theory of mind. Trends in cognitive sciences, 19(2), 65-72.
Scheeren, A. M., de Rosnay, M., Koot, H. M., & Begeer, S. (2013). Rethinking theory of mind in high‐functioning autism spectrum disorder. Journal of Child
Psychology and Psychiatry, 54(6), 628-635.
Shah, A., & Frith, U. (1983). An islet of ability in autistic children: A research note.
Journal of child Psychology and Psychiatry, 24(4), 613-620.
‧
Shah, A., & Frith, U. (1993). Why do autistic individuals show superior performance on the block design task?. Journal of Child Psychology and Psychiatry, 34(8), 1351-1364.
Schneider, D., Slaughter, V. P., Bayliss, A. P., & Dux, P. E. (2013). A temporally sustained implicit theory of mind deficit in autism spectrum disorders.
Cognition, 129(2), 410-417.
Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (1989). The vineland adaptive behavior scales. Major psychological assessment instruments, 2, 199-231.
Sullivan, K., Zaitchik, D., & Tager-Flusberg, H. (1994). Preschoolers can attribute second-order beliefs. Developmental Psychology, 30(3), 395.
Tager-Flusberg, H. (2001). A reexamination of the theory of mind hypothesis of autism. In Burack J. A., Charman T., Yirmiya N. & Zelazo P. R. (Eds.), The Development of Autism: Perspectives from Theory and Research (pp. 173-193).
Mahwah, NJ: Lawrence Erlbaum Associates.
Tager-Flusberg, H. (2003). Exploring the relationship between theory of mind and social-communicative functioning in children with autism. In Repacholi B. &
Slaughter V. (Eds.), Individual differences in Theory of Mind: Implications for Typical and Atypical Development (pp. 197-212). New York: Psychology Press.
Tager-Flusberg, H. (2007). Evaluating the theory-of-mind hypothesis of autism.
Current Directions in Psychological Science, 16(6), 311-315.
Tomasello, M., & Haberl, K. (2003). Understanding attention: 12-and 18-month-olds know what is new for other persons. Developmental Psychology, 39(5), 906.
Tomasello, M., & Haberl, K. (2003). Understanding attention: 12-and 18-month-olds know what is new for other persons. Developmental Psychology, 39(5), 906.