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    題名: 臺灣自閉症類群障礙幼兒丹佛早療模式之療效研究
    The Effects of Implementing Early Start Denver Model for Young Children with Autism Spectrum Disorder in Taiwan
    作者: 林姿伶
    Lin, Tzu-Ling
    貢獻者: 姜忠信
    Chiang, Chung-Hsin
    林姿伶
    Lin, Tzu-Ling
    關鍵詞: 自閉症類群障礙
    綜合性早期療育
    丹佛早療模式
    療效
    預測指標
    Autism spectrum disorder
    Comprehensive early intervention
    Early Start Denver Model
    Predictors
    日期: 2019
    上傳時間: 2019-12-06 09:21:50 (UTC+8)
    摘要: 研究目的：本研究採用丹佛早療模式（Early Start Denver Model, ESDM），與北部兒童發展聯合評估中心合作，建立參考台灣早期療育服務系統現況之ESDM早療模式，探討針對自閉症類群障礙（Autism Spectrum Disorder, ASD）幼兒實施ESDM早療模式的介入療效及預測療效之因素。

    研究方法：本研究共招募42名 25至46個月大確診ASD或疑似ASD幼兒，採用個案控制研究設計，分為ESDM介入組21名（平均年齡33.23個月），以及配對生理年齡、整體發展商數與性別之一般介入組21名（平均年齡35.14個月）。ESDM介入組受試幼兒接受為期24週、每週平均8.27小時的個別ESDM介入及每週平均1.5小時的一般醫療院所、坊間、特幼或發展中心早療介入，一般介入組受試幼兒則接受每週平均12.3小時的一般醫療院所、坊間、特幼或發展中心早療介入。另外，ESDM介入組受試幼兒之家長在24週介入期間隔週接受1小時、共12次的ESDM介入策略家長團體教育。本研究使用穆林早期學習量表、華語嬰幼兒溝通發展量表、適應行為評量系統第二版及自閉症診斷觀察量表分別在介入前（時間一）及介入24週後（時間點二）兩個時間點測量兩組受試幼兒之認知能力、口語表達、適應行為及症狀嚴重度做為受試幼兒之療效指標，檢視兩組幼兒之介入療效；同時在時間一、二也收集家長親職效能及親職壓力資料，做為家長療效指標。此外，在時間點一測量兩組幼兒之氣質特徵、感覺處理、模仿、遊戲及社會定向反應等資料做為療效預測因素之探測。

    研究結果：研究結果顯示ESDM介入組低功能ASD幼兒的非語文認知能力、語文認知能力、整體認知能力、總詞彙量及症狀嚴重度方面有顯著優於低功能一般介入之療效，ESDM介入組ASD幼兒家長在介入後的父母親職壓力有顯著的降低，尤其是在親職角色投入的壓力有顯著降低，一般介入組ASD幼兒家長則無此療效進展。ESDM介入組ASD幼兒在時間點一具較佳的模仿及遊戲表現能預測其介入後認知能力的正向進展；時間點一具較佳的主動性共享式注意力及較低的物品探索興趣能預測介入後症狀嚴重度的降低。

    結論：本研究結果指出，參考台灣早療現況所建立之ESDM早療模式，也就是短期、中低密集度ESDM介入能夠提供ASD幼兒及其家長正向的影響。此外，本研究也發現ASD幼兒介入前之個別行為特徵表現，如模仿、遊戲及共享式注意力會影響其介入後進展表現。未來研究宜持續累積樣本，採用適當的研究控制組及研究測量，採用隨機控制研究設計以釐清影響兒童及家長進展之因素。
    Objectives: This study aimed to evaluate the outcomes and outcome predictors of implementing the Early Start Denver Model (ESDM) based on Taiwanese public health policy for young children with Autism Spectrum Disorder (ASD) in the Greater Taipei area in Taiwan.

    Methods: A case control study was conducted. A total of 42 children with a DSM­5 diagnosis of ASD or suspected ASD aged between 25 and 46 months were recruited. The ESDM intervention group (N = 21, mean age = 33.23 months) matched to the control group (N = 21, mean age = 35.14 months) on chronological age, overall development quotient (DQ) and sex. Children in ESDM intervention group received 9 hours per week of one­on­one ESDM intervention in clinical settings for 24 weeks. In addition, parents in ESDM intervention group received 12 1-hour parent education sessions. Children outcome measures were administered pre­ and post­intervention, comprising the cognitive ability, language, adaptive behaviors and symptom severity assessed by the Mullen Scales of Early Learning, Mandarin-Chinese Communicative Development Inventory (Taiwan), Adaptive Behavior Assessment System, Second Edition and Autism Diagnostic Observation Scales, respectively. Parental outcome measures were also administered pre­ and post­intervention, comprising parental self-efficacy and parenting stress. Outcome predictors measures were administered pre­intervention, comprising temperament, sensory process, imitation, play and social orientation.

    Results: The results indicated that low-functioning children in ESDM intervention showed significantly greater improvements in nonverbal cognitive ability, verbal cognitive ability, overall cognitive ability, vocabulary production, and symptom severity than low-functioning children in control group did. Parents in ESDM intervention significantly decrease more in parenting stress than parents in control group did. Children in ESDM intervention having better imitation and play performances pre-intervention can predict better improvements in cognitive ability, and having more initiating joint attention and lower object exploring can predict more decrease in symptom severity.

    Conclusions: This study provides supports on the implementation of ESDM in Taiwan. The results suggest that a short­term low­intensity ESDM intervention directly delivered by a multidisciplinary team in clinical settings may be a promising treatment for young children with ASD. In addition, the imitation, paly and initiating joint attention are outcome predictor for young children with ASD receiving ESDM intervention in Taiwan. Future studies in Taiwan are indicated, including larger sample size, and which incorporate a new ESDM design control group to conduct randomized control studies.
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    描述: 博士
    國立政治大學
    心理學系
    101752502
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