自閉症幼兒相互注意協調能力介入效果的研究

Abstract

目的：本研究的目的在探討幼兒和學齡前自閉症患者以獨立嘗試法（DT）介入相互注意協調能力之成效。方法：研究對象為2至3歲幼兒及3至4歲學齡前自閉症患者各兩名，採用單一受試之多基線跨參與者設計，以獨立嘗試法介入相互注意協調能力。實驗設計分為基線期、介入期和維持期三階段，由獨立嘗試法所獲得的量化分析、早期社會溝通量表（ESCS）、非結構相互注意協調能力評量等方式評估介入效果。結果：研究結果發現以獨立嘗試法介入反應的相互注意協調能力和主動的相互注意協調能力都有介入效果。而類化部份與介入方法越接近的評量方式其類化越明顯，依次是獨立嘗試法評量有人的類化，其次是早期社會溝通量表有情境和刺激物的類化，最後是非結構相互注意協調能力評量的情境與刺激物的類化。研究結果也發現不同情境的維持效果有差異，只有在相似情境有維持，非結構相互注意協調能力評量很少介入和維持效果。結論：本研究結果和已發表的研究有類似的結果，都證明單獨使用DT，或DT加上軸心反應訓練，都能有效介入自閉症兒童的主動的和反應的相互注意協調能力，但主動的相互注意協調能力的介入效果不如反應的相互注意協調能力，對此結果作者予以討論並提出未來研究的建議。

Objective: The study aimed to explore the effects of joint attention intervention， using discrete trial (DT) method in toddlers and preschool children with autism. Methods : two toddler and two preschool children were recruited for intervention initiating and responding to joint attention using discrete trial (DT) method. The study used single subject multiple baseline design across participants. The intervention effects were evaluated by three measurements, including the percentage of correct response after DT, the Early Social Communication Scales (ESCS), and the unstructured joint attention assessment at baseline, immediately after intervention, and maintenance stages. Results: the results showed that intervention effects for both Responding to Joint Attention (RJA) and Initiating Joint Attention (IJA) were observed in both toddlers and preschool children. The more the relatedness between the generalized target and measurements, the greater the generalization effect was. That is, the greatest effect was found for percentage of correct response after DT when person was changed, followed by ESCS when situation and stimuli were partly changed, and the unstructured joint attention assessment which had the smallest effect when situation and stimuli were totally changed. The results also revealed that different intervention effects on maintenance stage under different situations, in which the effect at maintenance stage was significant under similar situation, while the effects at intervention and maintenance stages were not significant under unstructured joint attention assessment. Conclusions: the findings in the present study were consistent with those in the other studies that using both discrete trial only and discrete trial plus the Pivotal Responding Training which have significant intervention effects on IJA and RJA in children with autism. However, the intervention effect was smaller on IJA than that on RJA. Along with the finding discussed above, further investigation was also recommended.