Emotional Prosody Perception and Intervention in Preschoolers with Autism Spectrum Disorder

社交溝通困難為自閉症主要的臨床症狀，在人際溝通的情境中能夠正確解讀他人的情緒是社交溝通的核心能力之一，而情緒韻律知覺(Emotional prosody Perception)為解讀他人情緒之重要基礎能力。然而高功能自閉症患者在情緒韻律辨識上是否存在著缺陷，仍是沒有定論，而評估介入效果的研究更是稀少。研究一探索自閉症兒童從學前到學齡的情緒韻律知覺發展趨勢，以平均生理年齡7歲10個月(n = 72，範圍5~12歲)的高功能自閉症兒童與生理年齡配對的一般發展兒童(n = 70)為研究對象；其中，61位為學齡前幼兒(32位高功能自閉症組、29位正常發展組)，並採用情緒韻律辨識作業。結果顯示，與一般發展孩子相較下，學齡前高功能自閉症幼兒的開心、傷心與生氣三個情緒韻律辨識能力均有顯著困難，為情緒韻律全面性的發展遲緩。然而，隨著年齡增長，學齡自閉症兒童在傷心與生氣韻律辨識能力的表現和對照組相近，但在開心韻律的辨識上仍有顯著落後。亦即在情緒韻律辨識能力的發展歷程中，高功能自閉症與一般正常發展兒童存在差異，而知覺顯著、社會互動與焦慮情緒，為自閉症情緒韻律知覺發展的可能解釋。研究二，以應用行為功能分析與核心反應訓練為理論基礎，設計以動機為基礎情緒韻律辨識早期介入模式(Emotional Prosody Intervention Program, EPIP)，並採隨機對照實驗設計中的單盲交叉設計，採用社交遊戲團體治療形式，來評估高功能自閉症幼兒情緒韻律辨識介入的療效。自閉症幼兒(n = 12, 生理年齡73.58個月)分為介入組1和2，於不同時間點先後接受EPIP訓練。結果顯示5週的EPIP能顯著提升自閉症幼兒開心、傷心與生氣等情緒韻律的辨識表現，且有良好的類化與持續效果，且與EPIP結束三個月後的情緒韻律知覺與一般正常發展幼兒表現無異。而接受為期六個月社交遊戲團體治療課程後，高功能自閉症幼兒其焦慮、情感低落與注意力不足過動等情緒行為困擾，均有顯著減少，而社會自發、歡樂與遊戲互動行為等玩性向度均有顯著進步。本研究的EPIP介入策略與模式，為現行自閉症臨床實務介入提供新的觀點與思維。Emotional prosody perception is essential for social communication, but it is still an open issue whether children with high-function autism (HFA) exhibit any prosodic perception deficits. Further, the early intervention program for HFA preschool children with emphasis on emotional prosody perception was very rare. Study 1 investigated whether emotional prosody perception for words and sentences in HFA children (n = 72, 5–12 years of age) differed from age-matched, typically-developing children (TD, n = 70) when presented with an emotional prosody identification task. Results show that HFA preschoolers performed poorly in identifying all emotional prosody (including happy, sad and angry) from both emotionally-neutral and -relevant utterances. Additionally, the HFA school-aged children performed poorer than TD children only in perceiving happy prosody. Results of correlation analyses revealed a positive association between prosody identification, autism symptom severity, pragmatic function and social adaption. The findings indicate that preschool-aged children with HFA experience significant difficulties in recognizing happy, sad and angry, and this prosodic perception limitation is only shown to happy prosody in older HFA children. Therefore, administered an early intervention program for HFA preschoolers to facilitate their emotional prosody perception is meaningful and mandatory. Study 2 developed an “Emotional Prosody Intervention Program, EPIP” which was based on Applied Behavior Analysis (ABA) and Pivotal Response Treatment (PRT) which encouraged motivation and embedded into a social skill training group. The participants of the EPIP were preschool children with HFA (n =12, mean age = 73.58 months) and were divided in two groups. The results showed that emotional prosody perception in the intervention group (Group1) improved significantly than a control group (Group 2) after EPIP intervention. In addition, emotional prosody perception was significant increasing in both groups 1 and 2 after EPIP. Moreover, the intervention effect was generalized to perceive emotional prosody of untrained stimuli. Follow-ups at one and three months showed that the intervention benefits were preserved and the perceptual performance of HFA preschoolers was similar to that of TD children. In addition, emotion and attention problems, such as, depression, anxiety and inattention/hyperactivity, were significantly reduced in HFA children; the social spontaneity, happiness, and play interaction were significantly improved after six-month social skill training group therapy. In conclusion, the EPIP facilitated preschoolers with HFA to recognize emotional prosody. EPIP is an effective and feasible approach for conducting early intervention with HFA children