研究背景與目的：自 1943 年精神科醫師 Leo Kanner 將自閉症行為表現，視為兒童
期思覺失調症（childhood schizophrenia）的症狀表現，至 2013 年由美國心理學會（American Psychological Association, APA）編訂的《精神疾患診斷與統計手冊第五版》（Diagnostic and Statistical Manual of Mental Disorder, 5th; DSM-V, 2013）將自閉症與思覺失調症進行區分外，近 70 年以來，對於自閉症（autism spectrum disorder, ASD）的研究與對此疾病的認識也不斷的在推進、改變，以更切合 ASD 的病理或是臨床樣態；根據 DSM-V 列出 ASD 具兩大核心缺損，包括：社交溝通、社會互動的缺損，以及侷限、重複的行為或活動模式，其中在社交溝通與社會互動的異常可於嬰幼兒時期便被觀察到，直至成人期仍持續影響患者的社會適應，包括：語言學習、人際的發展等，可見此能力的缺損對 ASD 患者的影響終其一生；1994~2004 年間，Dawson與同事透過研究，支持 ASD 兒童的社會定向能力（social orienting），以及共享式注意力（joint attention）具顯著缺損，且此缺損在其早期發展階段便顯現，並提出社會定向與共享式注意力的缺損，為 ASD 症狀核心病理機制的假設；本研究結合眼動儀，測量ASD 兒童與典型發展兒童（typical development, TD ），觀看情緒影片以及具注意力轉移的影片時的眼動及行為表現，以驗證社會定向與共享式注意力為 ASD 核心病理機轉的假設。研究方法：本研究共納入 43 名 7~12 歲的有效樣本，包括 24 位平均年齡 9.46歲的 ASD 兒童（6 女，18 男），及 19 名平均年齡 9.39 歲的 TD 兒童（4 女，15 男），在配對兩組參與者性別、年齡，以及智力（ASD：平均語文理解 = 107.83；TD：平均語文理解=112.11）的前提下，透過眼動儀進行兩實驗，分別為：實驗一 － 臉孔情緒辨識（facial emotion recognition, FER），實驗二－ 眼神追隨作業（gazed following, GF），以蒐集兩組參與者觀看各實驗素材時，對情緒的辨識正確率、辨識情緒的反應速度，以及眼動指標。
研究結果：實驗結果發現自閉症兒童對於社會線索的觀看方式與典型發展兒童具差異，包括：在實驗一－臉孔情緒辨識實驗中，(1) ASD 組在傷心與生氣的情緒判斷上，正確率顯著低於 TD 組，(2) 畫面呈現後，兩組參與者皆對頭部其他區域具有凝視優先性（絕對第一凝視位置皆多位於頭部其他區域），但兩組參與者間的差異為 ASD組相較TD 組，對物品具有凝視優先性，但對鼻子不具凝視優先性，(3) 無論觀看何種類型的影片，ASD 組對眼睛的凝視時間（單位像素凝視時間）皆會少於 TD 組，但對嘴巴的單位像素凝視時間，則會顯著多於 TD 組，(4) 無論觀看何種類型的影片，ASD組對眼睛、鼻子的凝視次數皆會少於 TD 組；顯示自閉症兒童觀看、收集社會訊息的方式與典型發展兒童具差異，且較難正確判斷他人的負向情緒（傷心、生氣）。
實驗二發現，自閉症兒童對於由他人引發而轉移視線的能力（即反應共享式注意力）較典型發展兒童不足，包括：(1) 無論觀看何種類型的影片，ASD 組對被注視物，以及控制物的凝視時間（單位像素凝視時間），顯著較 TD 組少，且(2) 無論觀看何種類型的影片，ASD 組的「主角、被凝視物（主角看的物體）間的視線轉移次數」顯著少於TD 組。另外實驗二未發現如同過去的研究結果，複雜的情境（雙人、社交）會使兩組參與者的眼動表現差異擴大。但研究二仍顯示出自閉症兒童在反應共享式注意力，與典型兒童具有差異，尤其顯現在對目標注視物的凝視時間，以及在主角與主角指稱的物體間視線轉移的次數。
綜合兩實驗結果，本實驗支持以社會定向（social orienting）不足為自閉症類群障礙症之核心缺損的假設，自閉症患者自發性的注意到蘊含社會訊息的刺激此能力較典型發展者不足，且跟隨這些刺激轉移視線與他人共同觀看事物（即共享式注意力，本研究專指 RJA）的能力也較典型發展者弱；因此，建議與自閉症兒童互動時，可以多給予正向情緒作為回饋，除了可以增加自閉症兒童的互動自信，以及人際互動意願外，自閉症兒童也較能夠正確接收他人訊息，另外建議在引導自閉症兒童注意力時，增加訊息強度，例如：將負向情緒的表情給誇張化，在引導兒童注意力時可加入手勢作為訊號，並可從自閉症兒童凝視較久或較多次的地方，如：頭部其他區域、其他物體，引導至目標訊息（如：眼睛，或教授的課程內容），或是需要給予較多次的提醒，以增加對目標訊息的接收完整性。

In 1943, psychiatrist Leo Kanner labeled autistic behavior as a symptom of childhood schizophrenia, until the APA revised the DSM-V in 2013. New understanding about autism spectrum disorder (ASD), including the pathology and clinical states, is constantly advancing. According to DSM-V, ASD is characterized by difficulty with social communication/interaction and restricted, repetitive behaviors. Abnormalities in social interaction in childhood can have lasting impacts on ASD patients, negatively affecting language learning and interpersonal development. Dawson and colleagues’ research from 1994 to 2004 found that ASD children had deficits in social orienting and joint attention, starting at an early stage. They hypothesized that social orientating and joint attention deficits are the primary cause of ASD symptoms.

This study examines if ASD is caused by social orientating and joint attention, using an eye-tracker to observe the performance and eye movement of children with ASD and TD (typical development) when watching videos with emotional content and videos that shift attention. The study recruited 43 participants aged 7-12, including 24 with ASD and 19 with TD, matched for gender, age, and intelligence. Two experiments were conducted, Facial emotion recognition (FER) and Gazed following (GF), to assess accuracy and reaction time of emotion recognition, and eye movements of participants while viewing dynamic videos.

Experiment 1- FER found ASD children observe social cues differently than TD children. (1) The accuracy of recognition of sad and angry emotions was significantly lower in the ASD group compared to the TD group. (2) Both groups of participants had gaze priority on ‘other areas of the head’ (very first fixation location was mostly in ‘other areas of the head’). However, the ASD group had a gaze priority on objects, while the TD group had a gaze priority on the nose. (3) Regardless of the type of video watched, the ASD group had a shorter duration of gazing time (unit pixel gazing time) on the agent’s eyes, but longer on the agent’s mouth, compared to the TD group. (4) Regardless of the type of video watched, the number of times of fixation on the eyes and nose of the ASD group was less than the TD group, which shows that how ASD children observe and collect social information differs from TD children, and that ASD children are more difficult in judging others’ negative emotions (i.e., sad, angry) compared to TD children.

Experiment 2- GF found that ASD children are less able than TD children to respond to joint attention. (1) Regardless of the type of video watched, the ASD group has a shorter ‘‘unit pixel gazing time’’ than the TD group on both of the gazed object and controlled object. (2) Regardless of the type of video watched, the ASD group presented less ‘‘sight shifting between the agent and the object gazed by the agent’’, compared to the TD group. Experiment 2 also showed that the complicated situation did not make a difference between the two groups of participants in eye movement. Despite this, Experiment 2 revealed a disparity in RJA between ASD and TD, particularly in the fixation duration of the gazed object and the number of sight shifting between the agent and the gazed object.

This experiment with eye-tracking technique supports the hypothesis that social orienting is the core deficit of ASD. ASD children are less likely to notice social information spontaneously than the TD group. Besides, ASD children have weaker joint attention than the TD group. Therefore, this study suggests that, when interacting with ASD children, we could give more positive emotions as a feedback. This may boost ASD children’s confidence and their willingness to interact with people, and the accuracy of receiving social cues. Additionally, we could increase the strength of the cues when guiding the attention of ASD children. Exaggerating facial expressions of negative emotions, gestures, pointing from the area they gazed longer and more frequently (i.e. other areas of the head, or other objects) to targets (i.e. eyes or teaching material), or reminders of the social information can help to guide ASD children.

第一章 緒論　　1
一、研究背景與動機　　1
第二章 文獻探討　　5
一、自閉症定義　　5
二、社會定向（social orienting）、共享式注意力（joint attention）與社會腦（social brain）　　7
三、自閉症相關眼動研究　　10
四、本研究特點　　11
第三章 研究方法　　15
一、實驗設計與變項　　15
二、研究參與者　　16
三、實驗設備　　17
四、實驗素材與AI劃分　　18
五、實驗程序　　20
六、資料分析　　23
第四章 研究結果　　25
一、研究參與者　　25
二、實驗一- 臉孔情緒辨識實驗（facial emotion recognition, FER）　　27
三、實驗二- 眼神追隨作業（Gaze following, GF）　　38
第五章 討論與結論　　57
第八章 參考文獻　　63
中文部分　　63
外文部分　　64

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