「感官為基礎之音樂活動」提升自閉症兒童非口語溝通能力之家長訓練模式探究

Abstract

本研究旨在瞭解自閉症兒童之家長藉由家長訓練模式學習「感官為基礎之音樂活動」的介入技巧並提升其子女非口語溝通能力的歷程。在正式研究開始前，本研究透過前導研究探究「感官為基礎之音樂活動」對提升一位自閉症兒童之非口語溝通能力的成效，此前導研究採用單一受試跨行為多基線實驗設計，研究結果發現「感官為基礎之音樂方案」能有效提升一位自閉症兒童模仿、被動式相互注意力以及主動式相互注意力等非口語溝通能力。 本研究之「感官為基礎之音樂活動」家長訓練模式共分為「成人引導」、「成人回應」以及「幼兒引導」等三個階段，訓練內容分為線上資料庫與實地訓練兩種形式。線上資料庫包含「感官為基礎之音樂活動」各階段說明，以及各活動示範與說明；實地訓練為研究者至參與者家中進行親子音樂活動的觀察與討論，必要時進行訓練與示範。此介入每周兩次、每次50至90分鐘，共九週14至15次的介入。此研究採用個案研究法，共有兩對親子參與研究，此研究以質性資料為主、量化資料為輔。家長執行「感官為基礎之音樂活動」的過程全程錄影，並在每次介入結束後進行訪談，以進行資料分析與歸納。量化資料以單一受試研究中的A-B-M設計蒐集兩位家長在家長執行技巧上的資料，每次擷取十分鐘的介入以進行編碼，過程中亦蒐集幼兒的非口語溝通能力以瞭解其改變情形。 研究結果發現兩位家長皆能在九週內學會並執行三個階段的家長介入技巧。兩位家長的執行方式主要跟隨本研究三個階段的模式：（1）第一階段：提供以歌曲、教學為主的活動，主要活動來源為線上資料庫；（2）第二階段：透過音樂建構一來一往的溝通形式，並且透過音樂回應幼兒的行為；（3）第三階段：跟隨幼兒的行為後，將幼兒的行為融入音樂互動中。藉由相關係數進行探討後發現，家長的執行技巧精熟與否與幼兒非口語溝通能力的行為展現有正相關。 研究者根據以上研究結果加以討論並提出建議，以提供實務工作者、未來研究者以及自閉症兒童之家長之參考依據。The purpose of this study was to understand whether the parent of the child with autism spectrum disorder (ASD) was able to acquire the techniques of implementing the sensory-based music activities with his or her child through the parent-training model aimed to enhance nonverbal communication skills, including imitation, responding joint attention (RJA), and initiating joint attention (IJA) skills. Before the study started, a pilot study was conducted. The purpose of the pilot study was to investigate whether the sensory-based music activities were able to enhance nonverbal communication skills in a child with ASD. A “multiple probe design across behaviors of the single subject experimental design” was adopted. The result of the pilot study found that sensory-based music activities were able to enhance a child with ASD’s nonverbal communication skills. For the main study, a “case study” was adopted and two parent-child dyads participated in this study. The parent-training model included three phases: adult-guided, adult-responded, and child-guided phases. The parent-training model was delivered through two forms: an online database and direct training. The online database included the demonstration videos of each sensory-based music activity and the handouts of each activity. The direct training means that the researcher was physically present in the participants’ home setting as a trainer. This researcher observed and discussed with the parents regarding parental implementation and parent-child interaction, as well as coached and modeled the activities when needed. The intervention of parent-training model in this study took place for a 50- to 90-minute session twice per week over nine weeks for 14 to 15 sessions in total. The result found both parents obtained three-phase parental implementation techniques over nine weeks. Both parents followed the framework of three phases: (1) Phase I: provided song-based and teaching-oriented activities, and mainly followed the activities from the database; (2) Phase II: formed back and forth communications musically, and responded to their child’s behaviors musically; (3) Phase III: followed their child’s behaviors first and combined their behaviors into the music activities. The Pearson correlation coefficient between the proficiency rates of parental implementation techniques and frequency rates of NVC behaviors was computed and showed a positive correspondence, which indicated that while parents demonstrated a higher proficiency level in their parental implementation techniques, the frequency of the child’s NVC behaviors were usually enhanced. Finding from the implementation were discussed and recommendations were provided for practitioners, future researchers, and parents of children with ASD.