共享式注意力多元介入方案療效研究:三名學前中高功能自閉症男童的探究
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Date
2012-07-??
Authors
江淑蓉
彭雅凌
姜忠信
林家慶
Shu-Jung Chiang
Ya-Lin Peng
Chung-Hsin Chiang
Chia-Ching Lin
Journal Title
Journal ISSN
Volume Title
Publisher
國立臺灣師範大學特殊教育學系
National Taiwan Normal University Department of Special Education
National Taiwan Normal University Department of Special Education
Abstract
共享式注意力為自閉症兒童的核心缺陷之一，旦與語言、社會互動、遊戲及模仿能力的發展有密切關係。本研究旨在探討使用合併取向，同時納入家長訓練的模式，對中高功能自閉症兒童進行lA 介入的直接與伴隨能力成效。本研究採多重個案設計，以3 名4 歲2 個月至4 歲6 個月的中高功能自閉症男章為對象，進行每週3 次、每次30-45 分鐘、為期兩個月共24 次的介入。介入採取結合區別嘗試訓練與環境教學的模式，並加入家長訓練。介入成效由獨立於介入的施測者，以標準化與半結構式工具評估能力變化，並紀錄家長自陳式報告。評量時間點分為介入前、後與介入後3 、6 個月追蹤共4 次，療效認定是將介入能力的進步程度與過去團體研究的顯著進步值相較，等阿或超過該數值時，定義為具療效。結果發現，此介入模式能有效促進受試兒童的lA 進展並達類化效果，特別是主動性lA的提升最明顯，且受試兒童的注意狀態與家長的回應性能力有正向關(系。此外，lA 介入也帶來語言理解、象徵性遊戲、制會互動能力的伴隨成效，能力進展的維持期約在3-6 個月之間。總結來說，本研究的lA 介入法確能對自|到症兒童帶來直接及伴隨能力的成效，與先前團體研究結果類似，但伴隨成效的維持期相對較短。未來研究可探討維持療效的因子，亦呵以實驗法擴大樣本並納入控制組、受試對象可以降低年齡，安排不間訓練頻率與密集度，來探究介入成效。
Purpose: Joint attention (JA) is one of the core deficits in children with autism 、aSSOClated with other developmental abilities such as language, play, social ability, and imitation.The current study uses multiple-case design with a combined approach for a JA intervention program including parent training to investigate the effects of JA and its collateral abilities for 3 children with middle-to-high functioning autism. Methods: Three 4year old boys (CA = 48-52 months, MA = 26-30 months) with middle-to-high functioning autism were diagnosed with OSM-IV-TR (APA, 2000) and AOOS (Lord et al ， 2000) by a multidisciplinary team including a psychiatrist pediatrician ， and psychologists. The children and their mothers participated in this individual program, conducted in 24 sessionsand followed up 3 and 6 months later. The program included discrete trial training (OTT) and milieu teaching method adapted from Kasari et al. (2006, 2010). Parent training sessions were also simultaneously included in the program. Each child training session was approximately 30 minutes, 3 times per week, for a total of 24 sessions. The OTT and milieu teaching approaches were used on the table time and floor time separately.The JA intervention program for parents was based on the authors' clinical experience and followed the Parent JA Intervention Manual (PJAIM). For the first half ofthe parent training from session I to 12, the interventionist used the PJAIM as a reference to explain to the parent what was going on from a one-way mirror while parents observed their child 冶training session in the playroom. From sessions 13-24, the parent was invited to the playroom to interact with the child, guided by the interventionist for 15 minutes afterthe child's training session. The intervention outcomes were collected through standardized tools/tasks, structured and unstructured activities by independent testers, and from parent reports. The threshold for intervention efficacy defined by these gain
Purpose: Joint attention (JA) is one of the core deficits in children with autism 、aSSOClated with other developmental abilities such as language, play, social ability, and imitation.The current study uses multiple-case design with a combined approach for a JA intervention program including parent training to investigate the effects of JA and its collateral abilities for 3 children with middle-to-high functioning autism. Methods: Three 4year old boys (CA = 48-52 months, MA = 26-30 months) with middle-to-high functioning autism were diagnosed with OSM-IV-TR (APA, 2000) and AOOS (Lord et al ， 2000) by a multidisciplinary team including a psychiatrist pediatrician ， and psychologists. The children and their mothers participated in this individual program, conducted in 24 sessionsand followed up 3 and 6 months later. The program included discrete trial training (OTT) and milieu teaching method adapted from Kasari et al. (2006, 2010). Parent training sessions were also simultaneously included in the program. Each child training session was approximately 30 minutes, 3 times per week, for a total of 24 sessions. The OTT and milieu teaching approaches were used on the table time and floor time separately.The JA intervention program for parents was based on the authors' clinical experience and followed the Parent JA Intervention Manual (PJAIM). For the first half ofthe parent training from session I to 12, the interventionist used the PJAIM as a reference to explain to the parent what was going on from a one-way mirror while parents observed their child 冶training session in the playroom. From sessions 13-24, the parent was invited to the playroom to interact with the child, guided by the interventionist for 15 minutes afterthe child's training session. The intervention outcomes were collected through standardized tools/tasks, structured and unstructured activities by independent testers, and from parent reports. The threshold for intervention efficacy defined by these gain