社交互動(social interaction)是孩童發展的基礎。根據社交互動架構(social interaction framework)，「社交」可分為二部分：社交互動的先備能力，其中心智理論(theory of mind)為重要能力之一；再者是社交互動本身，交互社交行為(reciprocal social behaviors, RSBs)及社交功能(social functioning)分別代表微觀及巨觀的社交互動。自閉症類群障礙症(autism spectrum disorder, ASD)孩童的心智理論缺損經常用以解釋其社交互動缺損。然而，過往探討ASD孩童心智理論與社交互動關係的研究結果不一致，其可能原因共有三項：(1)心智理論評估工具未完整涵蓋孩童的心智理論發展階段；(2)社交互動未同時評估交互社交行為及社交功能；(3)與心智理論相關及無關之社交功能的題目敘述不清楚，未能明確區分二類型社交功能。本研究改善此三項過往研究的限制，並考量其他可能影響ASD孩童社交互動的因子，包含社交互動風格(social interaction style)、年齡及語言能力。此外，過往文獻缺乏追蹤研究設計，心智理論與社交互動的長期關係仍不明確。因此，本研究透過二年期追蹤研究，探討ASD孩童的心智理論對社交互動（包含交互社交行為、社交功能）的預測關係。
在135位已完成第一次評估的ASD孩童當中，共106位（89位男生及17位女生）ASD孩童參與本研究的追蹤評估。在追蹤評估中，孩童平均年齡為101.03個月（標準差=20.3），平均具中等語言理解能力及輕度自閉症症狀。孩童的心智理論能力回溯第一次評估時心智理論測驗(Theory of Mind Task Battery)的分數。此次評估分別以社交技巧問卷—互動類別（家長版）(Interactive Scale of Social Skills Questionnaire-Parent Form)、交互社交行為觀察(Reciprocal Social Behaviors Observation)、互動式繪畫測驗(Interactive Drawing Test)、社交互動風格問卷(Social Interaction Style Questionnaire)評估孩童的與心智理論相關之社交功能、交互社交行為的數量、交互社交行為的品質與社交互動風格。結構方程模式(structural equation modeling)用以分析評估結果的資料。
本研究共有三項主要研究結果。第一項研究結果為ASD孩童早期的心智理論能力，顯著預測現在交互社交行為數量的組成層面(constitutive quantity of RSBs) (B = 3.53, SE = 1.86, p = .039)，以及現在心智理論相關的社交功能(B = 1.79-1.87, SE = .03-.34, p < .001)。第二項研究結果為現在淡漠型社交互動風格是現在交互社交行為數量的時序層面(temporal quantity of RSBs) (B = -111.17, SE = 20.61, p < .001)，以及交互社交行為數量的組成層面(B = -81.41, SE = 15.95, p <. 001)之顯著預測因子。現在被動型社交互動風格亦是現在交互社交行為數量的時序層面(B = -48.77, SE = 11.43, p <. 001)、交互社交行為數量的組成層面 (B = -36.30, SE = 8.86, p < .001) 之顯著預測因子。最後，本研究結果顯示ASD孩童的早期年齡顯著預測早期的語言理解能力(B = .80, SE = .11, p < .001)，早期的語言理解能力又再顯著預測早期的心智理論能力(B = .10, SE = .01, p < .001)。
本研究透過追蹤研究設計，提供ASD孩童早期心智理論對現在社交互動預測關係的整合觀點，同時考量孩童的社交互動風格、年齡及語言能力。對於ASD孩童而言，本研究不僅發現早期心智理論是現在社交互動的預測因子，亦發現淡漠型及被動型社交互動風格、語言能力可預測ASD孩童的社交互動。本研究結果可作為支持ASD孩童心智理論缺損對其社交互動缺損的因果關係之基礎。此外，臨床人員面對ASD孩童時，可依循社交互動架構，根據孩童現在的心智理論並考量其他可能影響社交互動的因子來執行整合式評估，預測其兩年後的社交互動表現。

Social interaction is the foundation of children’s development. According to the social interaction framework, “social” can be framed as two parts: prerequisite abilities of social interaction and social interaction itself. Theory of mind (ToM) is one of the important prerequisite abilities. As regards social interaction itself, reciprocal social behaviors (RSBs) and social functioning (SF) are respectively the microcosmic and macrocosmic perspectives on social interaction. ToM deficits have been suggested to explain the social interaction deficits in children with autism spectrum disorder (ASD). However, previous studies have reported inconsistent findings on the relationship between ToM and social interaction in children with ASD. Three issues may explain the inconsistencies in previous studies: (1) the measures of ToM did not cover the whole spectrum of child development in ToM; (2) RSBs and SF were not simultaneously measured for social interaction; (3) the item descriptions of ToM-related and ToM-unrelated SF were not clearly distinguished. The present study addressed these three issues and considered other variables influencing social interaction in children with ASD, including social interaction style, age, and verbal ability. In addition, no follow-up studies on ToM and social interaction have been conducted, so how ToM and social interaction are related over longer periods of time remains uncertain. Therefore, this study aimed to examine the predictive relationships of ToM to social interaction, including RSBs and ToM-related SF, in children with ASD through a two-year follow-up research design.
A total of 106 (89 boys and 17 girls) of the 135 children with ASD who completed the first evaluation participated in the follow-up evaluation in this study. These children with ASD were aged 101.03 months (SD=20.3) and on average had moderate verbal comprehension ability and mild ASD symptoms at the follow-up assessment. The children’s ToM ability, measured by the Theory of Mind Task Battery, was retrospectively obtained from the data of the first evaluation. The Interactive Scale of Social Skills Questionnaire-Parent Form, the Reciprocal Social Behaviors Observation, and the Interactive Drawing Test were used respectively to measure the children’s ToM-related SF, quantity of RSBs, and quality of RSBs. The Social Interaction Style Questionnaire was used to measure the children’s social interaction styles. Structural equation modeling was used for data analysis.
This study had three main results. First, the earlier ToM ability was a predictor of the current constitutive quantity of RSBs (B = 3.53, SE = 1.86, p = .039) and the current ToM-related SF (B = 1.79-1.87, SE = .03-.34, p < .001) in children with ASD. Second, a current aloof social interaction style was a predictor of the current temporal (B = -111.17, SE = 20.61, p < .001) and constitutive (B = -81.41, SE = 15.95, p < .001) quantity of RSBs in children with ASD. A current passive social interaction style was also a predictor of the current temporal (B = -48.77, SE = 11.43, p < .001) and constitutive (B = -36.30, SE = 8.86, p < .001) quantities of RSBs. Finally, earlier age was a predictor of earlier verbal comprehension ability (B = .80, SE = .11, p < .001), which further became a predictor of the earlier ToM (B = .10, SE = .01, p < .001) in children with ASD.
This study provided an integrated view of the predictive relationships of earlier ToM to current social interaction in children with ASD with consideration of the children’s social interaction style, age and verbal ability through a follow-up research design. This study found not only that earlier ToM is a predictor of current social interaction but also that the aloof and passive social interaction styles as well as verbal ability can predict social interaction in children with ASD. The findings of this study may support the cause-and-effect relationship between ToM deficits and social interaction deficits in children with ASD. Moreover, the findings can guide clinicians to implement an integrated evaluation of social interaction deficits and to predict the future social interaction two years later based on the current ToM of children with ASD.

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