比較圖卡交換轉換到語音裝置和直接使用語音裝置在建立低口語自閉症成人的溝通成效差異之研究

Abstract

溝通是人類在群體生活中非常重要的能力。有效的溝通能使人際互動產生正向之循環。無法有效溝通是自閉症族群常見之困難，特別是當溝通困難者到了成年，依然無法隨心所欲做溝通表達時，這對其身心健康有一定程度的影響，甚至會衍生出行為問題。因此，找出適合的輔助溝通系統是至關重要的。近年來有不少研究在比較圖卡交換溝通系統（PECS）和語音裝置溝通系統（SGD）在成效上的差異，但目前還未有一致性的研究結果。本研究以單一受試多基線跨受試設計結合適應性交替處理設計，來比較先使用PECS習得至PECS第四階段句子結構再轉換到SGD ，抑或直接使用SGD從PECS第一階段到第四階段，這兩種介入在成效上的差異。成效差異的評量向度包含：(一)獨立要求的次數；（二）介入期間所需的提示量；（三）通過第四階段標準所需的教學介入次數。本研究在一間獨立的房間內進行，研究對象為四位低口語自閉症成人，其中一位因疫情未能進入介入期而中止。三位研究對象中有兩位在直接使用SGD的獨立要求次數比較高。三位研究對象中有兩位在直接使用SGD所需的提示量高於PECS轉換到SGD。研究結果顯示，PECS 轉換到SGD和直接使用SGD 在達到本研究中所設定從PECS第一階段至第四階段通過標準的教學嘗試次數並無顯著差異。值得注意的是，其中兩位研究對象在AAC偏好的選擇上都有改變。研究結果顯示PECS轉換到SGD和直接使用SGD在成效上並無顯著差異。

Communication is one of the most essential elements in the social community. Effective communication creates positive interpersonal interaction with others. Communication impairment is a core feature of autism spectrum disorder (ASD). As many studies showed that facing difficulty in communication might cause challenging behavioural issues, especially adults with ASD. Therefore, having access to appropriate augmentative and alternative communication system is beneficial and of necessity. In the past decade, there were several studies comparing the efficacy of Picture Exchange Communication System (PECS) and Speech Generating Device (SGD), but the results were inconsistent. This study compared the efficacy of PECS transfer to SGD and SGD only with three adults with ASD and limited functional speech. This study combined a multiple baseline and an adapted alternating treatment design. Measurable comparable outcomes included number of independent requests, the level of prompting during intervention phase, and the number of sessions to criteria to phase four of PECS, i.e., sentence structure. The findings remained inconsistent. It showed that two participants had more independent requests as well as required higher levels of prompting in SGD only. In addition, participants of both PECS transfer to SGD and SGD only had similar number of sessions to reach PECS phase four. Interestingly, two participants had change in their AAC preference during the process.