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題名：國際功能分類為基礎的功能性評量在自閉症兒童應用之研究
作者：甘蜀美
作者(外文)：Gan Shu Mei
校院名稱：國立彰化師範大學
系所名稱：特殊教育學系所
指導教授：葉瓊華 老師
學位類別：博士
出版日期：2009
主題關鍵詞：國際功能分類；自閉症；功能性評量；結構方程式；功能障礙；ICF；autism；functional assessment
原始連結：連回原系統網址new window
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本研究旨在探討根據國際功能分類兒童及青少年版(International Classification of Functioning, Disability and Health－Children and Youth, ICF－CY)手冊中概念題項發展「自閉症兒童功能性問卷」的效度及測試者間信度，並進一步瞭解影響自閉症兒童參與表現的因子。本研究使用方便取樣(convenience sampling)選取來自台灣地區3－6歲自閉症兒童共162位，其中26位收取二次資料進行測試者間信度分析，另外136位收集一次資料進行影響自閉症兒童參與表現的結構方程模型分析。本研究資料以平均數、標準差、t考驗、單因子變異數分析法、相關分析和結構方程式等統計方法分析。得到下列結果：
1. 本研究所編製的「自閉症兒童功能性問卷」整體測試間信度有中度至高度(ICC > 0.50)相關。身體功能面向、活動面向及參與面向的各領域有高度相關，但環境面向各領域信度為中度相關(ICC = 0.61－0.72)。
2. 自閉症兒童在「自閉症兒童功能性問卷」中身體功能面向較活動和參與面向的障礙程度低，其中身體功能面向在心智功能領域有較大的問題，而發聲和言語功能領域次之；活動面向中以學習和應用知識領域最為困難，溝通領域次之，而動作領域的能力最好；參與面向中以交談領域需長時間協助，主要生活領域則次之。
3. 本研究發現身體功能、活動、參與三個面向之間有良好的正相關性，但與環境面向的相關性則較低。而個體面向中除就讀班級種類外，其他家庭的社經地位與各面向之間屬於低相關。
4. 結構方程式(structural equation modeling, SEM)分析顯示「自閉症兒童功能性問卷」架構有良好的信度及效度。各領域中所包含的特定題項（單一因子測量模式）可充分解釋該領域，各面向所涵蓋的領域（二階測量模式）亦可充分代表該面向，每個測量模式都有良好的效度及信度，並達到良好的適配。影響自閉症兒童參與表現的整體模式中無法達成適配，但路徑分析發現身體功能面向、環境面向的支持和人際關係與態度領域及個體面向的年齡等級與就讀班級種類等自變項，可有效解釋活動面向及參與面向的變異，整體的解釋力達72%。
The purposes of the research were (1) to investigate validity and interrater reliability of the “Functional Assessment Questionnaire for Children with Autism” which was based on the ICF－CY concepts and structure and (2) to examine the factors which influenced the participation performance of autistic children. A convenient sampling of total 162 autistic children who were aged among 3 to 6 years, during the first stage two data collector administered the questionnaire twice within 1－2 week to 26 participants to examine test-retest reliability, the second stage was a sample of 136 participants in order to construct the participation performance of complete model for autism via structural equation model analysis.
Several statistical methods were used to analyze the data in this study, including mean, standard deviation, t-test, ICC, one-way ANOVA, and SEM. The major findings are described as follows:
1. The overall interrater reliability of “Functional Assessment Questionnaire for Children with Autism” was ranged from moderate to high. The coefficient of the domains in body function, activity and participation dimensions revealed high correlation, but the domain in environment dimension was moderate (ICC = 0.61－0.72).
2. The scaling of questionnaire in autistic children revealed disability level in body function dimension was lower in activity and participation dimension. In body function dimension, there were more problems in the domain of mental domain functions where as the voice and speech function was the second worse. In activity dimension showed the domain of learning and applying knowledge was more difficult, the mobility domain had less difficulty; long duration assistance was needed in the conversation domain of participation dimension.
3. The correlation results revealed that the majority of the positive correlation existed among body function, activity, and participation dimensions, but the correlation among three dimensions and environment dimension was low. The personal dimension except the education placement and other family socioeconomic variables showed insignificant correlation.
4. The analyses of SEM for each measurement model is achieved best fit, but the complete structural model was not acceptable. The path analysis results showed that dimension of activity and participation could be significantly predicted by body function dimension, domain of support and attitude in environment dimension, and variables of age level and education placement in personal dimension. The five variables contributed to 72% variance of the participation performance for autistic children.
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