使用應用行為分析之低密集度家長訓練：低密集度介入於學齡前自閉症障礙類群孩童之療效

Abstract

本研究目的為，探討使用應用行為分析之低密集度短期家長訓練，對自閉症障礙類群兒童之療效，且家長介入其孩童的密集度亦為低密集度。研究設計採用的是單一受試研究法之倒反設計(within-subject reversal design)，本研究共兩位受試者，家長受訓之密集度為每週一小時，兩位家長於介入期每週介入於其孩童的時數，皆為每週0.5小時，總介入期長度為八週，家長受訓的情境為自然情境，分別在個案一的家中及個案二家長上班的地點。研究對象為兩位自閉症孩童和其母親，所採用之介入方法為應用行為分析(Applied Behavior Analysis)，主要之依變項為孩童個別化課程之目標行為表現，次要變項為受訓母親之執行個別化介入之技巧。資料分析以視覺分析為主，並佐以C統計分析。 個案一的介入目標為於用餐時間被餵食時的問題行為，分別是尖叫行為與轉頭逃避餵食的行為。研究結果顯示，介入期結束時，此家長訓練模式能有效減少個案一之尖叫行為(C=0.38，Z=2.1)，而轉頭逃避餵食的行為也有減少，但尚未達統計的顯著水準(C=0.27，Z=1.48)。 個案二的介入目標有二，一為減少其拉扯媽媽脖子以引起媽媽注意的問題行為，二為增進個案於單一動作模仿、單一動作指令、依指令拿取物品等三種不同類別課程的正確區辨行為的發生。研究結果顯示，介入期後個案的問題行為雖有減少，但尚未達到統計上的顯著水準(C=0.24，Z=1.03)；而介入期後區辨行為的增加，在單一動作模仿(C= -0.6，Z= -2.06)及依指令拿取物品(C=0.91，Z=2.94)兩個課程中，個案二之獨立的正確區辨行為有顯著的增加。但在單一指令的課程中的進步未達顯著水準(C=0.34，Z=1.19)。 整體而言兩名個案在家長訓練後的問題行為皆有減少，或觀察到特定相關能力的增加，且維持期的能力表現多與介入期沒有顯著的差異，顯示表個案的進步可維持到兩個月的期間。即本研究為低密集度家長訓練且家長為其孩童作低密集度介入之療效提供初步療效證據。 建議未來相關之研究提供更完整且詳細之相關於家長訓練各種因素的控制，且包含家長接受訓練及給與其孩童介入的密集度定義，以致能盡快找出符合經濟效益且適於長期進行的自閉症早期介入服務模式。

The purpose of this study was to explore the effectiveness of a low intensity in-home parent training which adopted applied behavior analysis (ABA) on the problem behaviors of two children with autism. The aim of parent training is to help the parents to develop specific skills of training their children, and reduce their problem behaviors. Parents have two roles in this program. They are trainees when trained by therapists and trainers when they provide treatment to their own children. In this paper, we present results of a parent training program, including parents as trainers or trainees, with relatively low intensity of training in both situations. The mothers of two different autistic children were recruited and trained by the researcher, an occupational therapist, during weekly one-hour home visits. The parents were trained to provide intervention to their children 0.5 hour weekly for 8 weeks, and all the interventions were videotaped. Both child and parent outcomes were assessed before and after intervention along with a monthly follow-up for two months. Both visual inspection and statistical analysis (C statistic) were used to analyze data. For Case 1, two feeding related behaviors were the intervention target, i.e., screaming and turning head to avoid feeding when being fed by mother. The results indicated parent training program can teach parents to effectively reduce the screaming behaviors of Case 1(C=0.38, Z=2.1). Despite no statistically significant differences, a trend of decreasing head-turning behaviors was noted during the intervention phase (C=0.27, Z=1.48) as compared to the baseline phase. For Case 2, the first target behavior was neck-pulling behavior. During the intervention phase, the frequency of the behavior was not significantly lower than that in baseline phase (C=0.24, Z=1.03). The second target is the discrimination ability of Case 2 after he received training on three different discrimination tasks, i.e., simple motor imitation, following instructions to do simple motor actions, and verbal comprehension (receptive language). Results showed that Case 2’ s discriminative ability did appear in the imitation trials (C= -0.6, Z= -2.06) and the receptive language trials (C=0.91, Z=2.94) across the baseline phase and the intervention phase, but difference of the rate of correct response did not reach the statistically significant level across the first two phases in the instruction trials (C=0.34, Z=1.19). Overall, children’s problem behaviors decreased following parent’s intervention. Parents’ fidelity in implementing ABA principles improved during the training phase, and generally the improvement was maintained at the maintenance phase. Further research on the effectiveness of intervention with different levels of intensity is warranted to provide clinicians and parents the cost-effective intervention model.