應用以家長為中介者的介入模式及核心反應訓練策略於臺灣自閉症類群障礙幼童的早期介入計畫

Abstract

自閉症類群障礙（簡稱自閉症）兒童在西方國家的盛行率急遽上升，台灣在過去十年間的自閉症兒童人數也同樣快速增加，因此早期診斷和治療至關重要。 許多研究發現以家長為中介者的介入模式（Parent-mediated intervention，簡稱 PMI）為有效的早期療育模式，且對自閉症兒童及家庭的發展有正面的效果。 然而在台灣，此類型的介入計畫仍然不足，且較少研究結合以家長導向的目標設定方法，以及應用遠距執行方式於 PMI 中。 因此，本研究發展以 PMI 為基礎的自閉症遠距介入計畫（Telehealth Autism intervention program，簡稱 TAIP），此計畫包含遠距線上課程，讓家長學習有實證療效的核心反應訓練（Pivotal Response Treatment，PRT）策略，課程中協助家長設定自主目標，並在日常生活的自然環境中將早療策略引導孩子學習新的發展技能，並促進兒童能將所學應用至不同情境中，此介入計畫進行為期 12 週，每週一次的家長視訊課程及討論。本研究旨在探討此介入計畫的可行性和可接受性，參與研究的兒童和父母在課程前與後，以及接受一個月後的追蹤評估，整體介入計畫共 16 週完成。 本研究共有 16 名自閉症兒童（年齡中位數：47.5個月；男生佔 87.5% ) 及其父母參與。研究結果顯示，與前測期間的評估資料相比，在後測和追蹤期間，父母設定的目標達成分數、父母親職效能表現、兒童自閉症的症狀嚴重度、以及兒童的認知和動作發展能力均有顯著的進步(all p’s < 0.05)；然而，兒童的行為問題或親職壓力分數並無顯著的改變。所有參與計畫的父母均對此介入計畫具高度滿意程度。本研究結果顯示 TAIP 在台灣自閉症家庭中是可執行且接受度高的早期療育方案。 此研究成果將可以推動此遠距介入計畫在台灣家庭中的應用和發展，使得臺灣自閉症兒童之家庭獲得好的幫助。

The prevalence of autism spectrum disorder (ASD) among children has significantly risen in Western countries. Similarly, the number of Taiwanese people affected by ASD increased rapidly during the last decade that early diagnosis and intervention are crucial for Taiwanese children with ASD. Numerous studies have explored the efficacy of parent-mediated intervention (PMI) as an effective early treatment model, showing positive outcomes for Autistic children. Nevertheless, PMI-based intervention in Taiwan is insufficient that less studies have focused on integrating goal-oriented setting and telehealth methods to the PMI. Therefore, this study developed a Telehealth Autism intervention program (TAIP) based on the PMI that exposed children to therapeutic techniques of pivotal response treatment (PRT) as an online 16-week course for parents. Families have self-directed goals and exposed children to therapeutic techniques during daily activities in natural settings for facilitating the generalization of acquired skills to various contexts. The aims of this study were to investigate the feasibility and acceptability of TAIP that all the children and parents were examined for the outcome measures in the end of the courses and were conducted follow-up assessments by one month later. A total of 16 children with ASD (median of age= 47.5 months; percentage of boys= 87.5%) and their parents were enrolled into the program, with an hour online course per week. The results showed significant improvements of family-concerned goals attainment, parent efficacy and competence, autistic symptom severity and cognitive and motor developmental scores of the children at both post-test and follow-up periods comparing to the scores at pre-test period (all p’s < 0.05); whereas no significant differences on child’s behavioral problems or parenting stress scores. All parents reported high satisfaction scores for the overall intervention. This study demonstrated acceptable feasibility of TAIP for ASD families in Taiwan. These promising results could facilitate the development and application of effective telehealth intervention program for Taiwanese children with ASD and their families.