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標題: | 學齡前自閉症類群障礙症兒童之活動參與多樣性:孩童因素、家庭因素之影響 Diversity of Activity participation in preschool-aged children with autism spectrum disorder- Contribution of child factors and family factors. |
作者: | Wei-Ting Chien 錢韋婷 |
指導教授: | 曾美惠(Mei-Hui Tseng) |
關鍵字: | 活動多樣性,參與,自閉症類群障礙症,學齡前兒童, activity,participation,autism spectrum disorder,preschoolers, |
出版年 : | 2017 |
學位: | 碩士 |
摘要: | 前言: 日常生活參與在學前孩童發展上扮演重要的角色,因為參與的情境能提供學習技巧、發展遊戲與各種表現的能力、建立友誼及感到滿足之機會,而「參與」也是發展遲緩兒童早期療育的終極目標。自閉症類群障礙症為參與困難的高危險群,過去研究指出多項影響參與的相關因子,包含疾病嚴重度、情緒行為問題、感覺處理功能及家庭環境,其中感覺處理失能為ASD常見的臨床問題,可能大幅度影響ASD孩童的生活參與及表現,如:適應行為、情緒行為問題、注意力及氣質。然而,過去研究中鮮少文獻探討學前ASD之參與情形,大多為混齡或僅限於學齡孩童之研究,無法代表學前ASD孩童之表現。且過去研究探討影響因子時,雖有少數文獻同時考量孩童因素及家庭因素,但於孩童因素中並未納入感覺處理功能,然而瞭解感覺處理功能異常對活動參與的影響,有助於專業人員釐清阻礙因子,以促進孩童參與表現。基於以上限制,對學前ASD孩童之日常生活參與情形之影響因子,仍無法有完整明確的了解。
目的: 本研究目的為了解3-6歲ASD孩童之日常生活參與情形,並探討個人因素(疾病嚴重度、情緒行為問題、感覺處理功能及社交技巧)及家庭因素(家庭資源暨環境)與學前ASD參與之關係。 方法: 本研究對象將為100名3-6歲之ASD孩童。收案來源轉介自北台灣之綜合醫院復健部、兒童心智科門診、復健科診所。將以描述性統計及皮爾森相關係數呈現各觀察變項。並以多元迴歸分析探討活動參與與所有潛在預測因子之關係。 結果: (一) 參與多樣性最高的為「教育」類型活動,最低的為「居家生活」活動。(二) 「社交活動」多樣性之顯著預測因子為VABS-社交技巧(β=0.404)、HOME-多變化刺激(β=0.29)及家庭收入(2萬以下)(β=-0.699),此模式可解釋35.5%的變異量;「居家生活」多樣性之顯著預測因子為HOME-語言刺激(β=1.163)、孩童年齡(β=0.056)及VABS-社交技巧(β=0.022),此模式可解釋33.4%的變異量。;「自我照顧」多樣性之顯著預測因子為孩童年齡(β=0.042),此模式可解釋16.8%的變異量;「社區移動」多樣性之顯著預測因子為Home-多變化刺激(β=0.5),此模式可解釋23.4%的變異量;「高活動量休閒」多樣性之顯著預測因子為孩童年齡(β=0.044)及VABS-社交技巧(β=0.017),此模式可解釋16.3%的變異量;「低活動量休閒」多樣性之顯著預測因子為VABS-社交技巧(β=0.027)、孩童年齡(β=0.051)及SDQ-行為問題 (β=0.186),此模式可解釋30.2%的變異量;「教育」多樣性之顯著預測因子為孩童年齡(β=0.034)、家庭收入(2萬-8萬)( (β=-1.781)、SSP-視覺/聽覺敏感(β=-1.102)、SDQ-行為問題(β=-0.131)、VABS-社交技巧(β=0.015)、SDQ-同儕相處問題(β=0.133),此模式可解釋47.9%的變異量。(三) 孩童原因為「社交活動」、「自我照顧」、「低活動量休閒」及「教育」的主因,家長原因為「居家生活」、「社區移動」及「高活動量休閒」之未參與主因。 結論: 本篇為第一篇研究探討國內3-6歲ASD 孩童於家裡、學校、社區活動參與多樣性,並以迴歸模型探討學前ASD孩童日常生活活動參與之潛在預測因子。本研究結果指出國內學齡前ASD孩童參與較少的居家活動,且各類型活動多樣性分別與不同的孩童及家庭因子相關,其中參與多樣性之相關因子包含孩童年齡、社交技巧、行為問題、視覺/聽覺敏感、家庭收入及家庭環境刺激。上述結果有助於臨床專業人員或照護者了解學齡前ASD孩童在各類型活動參與之多樣性,尤其是其中可改變的相關因子將成為未來學前ASD兒童早期治療或教育計畫的主要介入目標。此外與家庭資源有關的因子亦可作為政府擬定政策或投注資源以有效支持ASD兒童社區參與之參考。 Backgound: Daily life participation plays an important role in child development, particularly in preschool stage. By participating in daily life activities, children learn, gain sensory-motor and cognitive experiences. Children with autism spectrum disorder (ASD) are at high risk for restricted daily participation. Many factors have been proposed as influencing child’s daily participation, such as autism severity, emotion and behavior problems, sensory processing dysfunction and parent’s socio-economics status. Sensory processing dysfunction is the common clinic symptom for ASD that may influence daily participation and performance, such as adaptive behavior, emotional and behavioral problems, attention and temperament characteristics. Few studies have examined the participation of preschool children with ASD, and participants of existing studies were a mixture of preschool and school-aged children. Results of these studies are not applicable to preschool children with ASD. When examining the potential predictors of activity participation, factors from dimensions of child and family were not taken into account jointly. In addition, despite a high prevalence of sensory processing dysfunction in children with ASD, few studies include sensory processing dysfunction as the potential factor of participation. Thus, activity participation and its predictors of preschool children with ASD remain unknown. Purpose: The purpose of the study was twofold: (1) to investigate activity participation in preschool children with ASD using the Preschool Activity Card Sort, (2) to consider all the factors from dimensions of child and family as potential predictors of activity participation. Method: One hundred preschool children with ASD aged 3 to 6 years old were recruited from rehabilitation departments of general hospitals and pediatric rehabilitation clinics in Northern Taiwan. Descriptive analyses were conducted to characterize the basic properties of the observed variables. In multivariate analysis, multiple linear regression models were constructed to identify the predictors of the seven domains of Preschool Activity Card Sort in preschool children with ASD. Results: (1) Preschool children with ASD participated in the most diverse activities in education and in the least diversity of activities in domestic.(2) Multiple stepwise linear regression models revealed that the VABS-social skills (β=0.404), HOME- variety (β=0.29), family income(less than two million)(β=-0.699) were the significant predictors of social interaction activities in preschoolers with ASD. The model accounted for 35.5% of the variance. HOME-language stimulation (β=1.163), children’s age(β=0.056), and VABS-social skills (β=0.022) were the significant predictors of diversity of participation in domestic, accounting for 33.4% of the variance. Children’s age (β=0.042) was the only significant predictor of diversity of participation in self-care, accounting for 16.8% of the variance. HOME- variety (β=0.5) was the only significant predictor of diversity of participation in community mobility, accountaing for 23.4% of the variance. Children’s age(β=0.042) and VABS-social skills (β=0.022) were the significant predictors of diversity of participation in vigorous leisure. The model accounted for 16.3% of the variance. VABS-social skills (β=0.027), children’s age(β=0.053), and SDQ- conduct problems (β=-0.725) were the significant predictors of diversity of participation in sedentary leisure, accounting for 30.2% of the variance. Children’s age(β=0.034), family income(β=-1.781), SSP- visual or auditory sensitivity (β=-1.102), SDQ- conduct problems (β=-0.131), VABS-social skills (β=0.015), and SDQ-peer relationship problems(β=0.133) were the significant predictors of diversity of participation in education. The model accounted for 47.9% of the variance. (3) Child factors for non-participation were reported by parents most frequently in social interaction activities, self-care, sedentary leisure and education. In contrast, family reasons for non-participation were reported by parents most frequently in domestic, community mobility and vigorous leisure. Conclusion: This is the first study investigating the diversity of participation in home, school, and community activities for 3- to 6-year-old children with an ASD and using multiple regression analysis to explore the predictors of daily life participation. The results of this study indicated that the number of domestic activities which preschool-aged children with ASD participated in were fewer than other domains in Taiwan. Each dimension of participation was associated differently with the various predictors from chid and family. The crucial predictors of diversity of paticiaption were children’s age, social skills,behavior problems, visual or auditory sensitivity,family income and the stimulation of home environment.Results of this study can inform caregivers and clinicians of activity participation. Further, knowledge of the predictors of activity participation could guide clinicians’ early intervention planning and teachers’ educational plan. In particular, knowledge of the predictors in the family domain could serve as a guide for police making to improve community resources. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/68881 |
DOI: | 10.6342/NTU201703250 |
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顯示於系所單位: | 職能治療學系 |
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