自閉症嬰幼兒的氣質發展軌跡文獻評論

Literature Review on the Trajectories of Temperament Development in Infants with Autism Spectrum Disorder

從衛福部網站資料顯示，2021 年，0-3 歲被診斷為ASD 只有18 位，但我們都知早期療育的重要，若幼兒在3 歲之後才被診斷是ASD，再進行介入，可能都已錯過黃金療育期。國外學者早已指出ASD 幼兒在24 個月前是能被正確診斷，國內學者也提出篩選幼年早期ASD 的工具非常缺乏。在此現象下，國外研究已指出，3 歲之後被診斷為ASD 的幼兒，他們在出生的第一年，就表現出獨特的氣質發展軌跡，更指出氣質是了解ASD 在生命早期發展的重要構念和風險標記。有鑑於此，本文依上述觀點，分四部份論述，一是回顧氣質的理論取向；二是回顧國外探究ASD 嬰幼兒氣質的相關研究，並分兩主軸，主軸一是ASD 與其他類型嬰幼兒氣質的差異，主軸二是ASD 幼兒在生命早期氣質的發展軌跡；三是回顧國內ASD 嬰幼兒氣質研究；四是對國內實務面和學術面的建議。在實務面上，建議嘗試從嬰幼兒氣質評估結果介入輔導，在學術面上，建議以前瞻式長期追蹤ASD 氣質發展軌跡。總之，嬰幼兒氣質的評估不僅可以提供臨床心理師、兒童心智科醫生做為診斷ASD 幼兒重要參考資料，以及父母、老師和臨床人員做為了解和輔導幼兒的重要參考依據；另一方面，幼年早期的氣質更可協助及早發現ASD 幼兒的行為症狀，早日治療，並減輕日後家庭、社會與龐大的醫療負擔。

According to the data published on the website of the Ministry of Health and Welfare, only 18 children (age, 0–3 years) were diagnosed with autism spectrum disorder (ASD) in 2021. Despite the small number of children, early intervention is known to be crucial. Notably, if children are diagnosed with ASD after the age of 3 years and interventions are initiated thereafter, they are likely to have missed the golden period of treatment. International studies have demonstrated that children with ASD may be accurately diagnosed before 24 months of age, whereas domestic studies have reported a severe lack of screening tools for the identification of ASD in infants and young children. Based on this viewpoint, international studies have reported that children diagnosed with ASD after the age of 3 years demonstrate unique trajectories of temperament development during the first year of life. The authors of these studies further argued that temperament is an important characteristic and early risk marker for understanding the development of ASD in early childhood. Based on the abovementioned viewpoints, the discussion section can be written in 4 sections.
The first section reviews the different theoretical approaches of temperament. The second section reviews international studies on the temperament of infants and young children with ASD, particularly focusing on the following two aspects: (a) temperamental differences between infants and young children with and without ASD and (b) trajectories of temperament development in children with ASD during early childhood. The third section reviews domestic studies on the temperament of infants and young children with ASD. The fourth section proposes recommendations for practice and academic research. Regarding clinical practice, the present study suggests that interventions should be implemented based on the assessment of temperament in infants and young children. Regarding academic research, we suggest conducting prospective long-term studies of the trajectories of temperament development in children with ASD. In conclusion, the assessment of temperament in infants and young children may provide critical references to psychologists and child psychiatrists for diagnosing ASD in young children, and it can provide an essential basis for parents, teachers, and clinical professionals to understand and care for young children with ASD. Moreover, temperament can be used to facilitate the early identification of behaviors and symptoms related to ASD in young children, which, in turn, can enable early treatment, thereby reducing the heavy burden on the family, society, and healthcare system in the future.