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| Title: | 自閉症幼童的遠距家長訓練方案：兒童療效探討
Telehealth Parent-mediated Intervention for Young Children with Autism Spectrum Disorder: Children`s Outcome |
| Authors: | 陳庭萱
Chen, Ting-Hsuan |
| Contributors: | 姜忠信
陳庭萱
Chen, Ting-Hsuan |
| Keywords: | 自閉症類群障礙症
丹佛早療模式
讓家長成為孩子溝通訓練的老師
遠距醫療
由家長引導的介入
兒童療效
Autism spectrum disorder
Early Start Denver Model
Improving Parents As Communication Teachers
Telehealth
Parent-mediated intervention
Children`s outcome |
| Date: | 2023 |
| Issue Date: | 2023-07-06 16:57:50 (UTC+8) |
| Abstract: | 研究目的：本研究融合丹佛早療模式（ESDM）及讓家長成為孩子的溝通老師（ImPACT）方案，發展台灣本土自閉症類群障礙（Autism Spectrum Disorder, ASD）兒童之遠距家長訓練方案。本研究旨在探討自學網站及加入教練協助的兩種遠距家長訓練模式，針對ASD兒童之介入效果及介入後3個月的短期維持效果，並進一步探討家長學習成效與兒童療效間之關聯性。
研究方法：本研究採取隨機對照試驗（randomized controlled trial, RCT）設計，共納入28名生理年齡18-48個月大之ASD兒童及其家長，並隨機分為教練協助組及家長自助組（各14名）。介入期間共計13週，兩組家長需每週觀看本研究設計之線上課程，而教練協助組家長需額外接受每週一次、一次一小時的教練指導視訊會議。本研究於介入前（時間點一）、後（時間點二），針對兒童的社交溝通能力、適應行為及問題行為進行評估，並於時間點二後間隔三個月，再次進行時間點三評估作為追蹤。本研究原採取現場評估方式， 2021/5月後，受到台灣COVID-19疫情升溫之影響，因此將研究參與方式改為遠距形式，取消部分實驗室測量作業，並透過線上會議及問卷代替原先評估內容。
研究結果：研究結果顯示，（1）兩組受試兒童於介入後，主要在社交溝通能力有顯著正向的進展，由家長報告的社交溝通能力（社交參與、表達性語言、接受性語言及模仿/遊戲能力）、總詞彙量、平均句長，及親子互動中的溝通頻率、高層次共享式參與狀態比例，皆顯著提升。兩組受試兒童的外化行為亦明顯減少，但適應行為表現未有顯著變化。（2）追蹤時，兩組受試兒童能維持多數社交溝通之進展，但問題行為及適應行為表現相較介入前皆未有顯著變化。（3）相較於家長自助組，教練協助組家長於 ESDM介入真確度方面有更顯著之進展。然而，兩組兒童各項指標進展並未有顯著組間差異。若比較效果量及組內進展，教練協助組兒童於介入後的表達性語言、語言及非語言溝通頻率、非工具性溝通頻率，及高層次共享式參與狀態等指標之進展有優於家長自助組的趨勢。（4）整體而言，家長親子互動技巧改善幅度，與兒童表達性語言及高層次共享式參與狀態比例之進展間，相關性達顯著。
結論：研究結果初步指出遠距家長介入模式之有效性，無論是否加入額外的教練協助，皆能有效提升ASD兒童的社交溝通能力，且短期內可維持進展。本研究亦發現家長進展與兒童的表達性語言及社交互動參與進展之關聯性。未來宜持續累積更多樣本、納入一般社區介入組、加入更多客觀指標，並嘗試進一步釐清影響兒童及家長進展之各項因素。最終目標是發展兼具有效性及可及性之台灣本土遠距家長訓練方案。
Objectives: Based on the Early Start Denver Model (ESDM) and the Improving Parents As Communication Teachers (ImPACT) project, this study developed a telehealth-based parent-mediated intervention (PMI) for children with autism spectrum disorder (ASD) in Taiwan. This study aimed to examine the post-treatment and 3-month-follow-up effect of children’s outcomes between self-directed and coach-assisted group, and further explored the relationship between parents’ and children`s outcomes.
Methods: A randomized controlled trial (RCT) was conducted. A total of 28 parents and their children with ASD (aged between 18-48 months) were recruited and randomized into coach-assisted (N =14) and self-directed groups (N =14). We delivered the intervention for 13 weeks. Parents in both groups were asked to finish online courses weekly, while parents in the coach-assisted group also received an additional 1-hour coaching session through videoconference. Children outcome measures were administered pre (time 1) and postintervention (time 2), comprising social communication skills, adaptive behaviors and problem behaviors. Follow-up (time 3) evaluation also conducted, 3 months after time 2 evaluation. On-site assessment was carried out at first. However, due to the impact of the COVID-19 epidemic, we changed to a remote form after May 2021, some laboratory measurements were canceled, and online meetings and questionnaires were used to replace the original assessments.
Results: The results indicated that: (1) Children in both groups significantly improved in social communication skills, including parent-reported social engagement, expressive language, receptive language, imitation/play skills, vocabulary production and mean length of utterances, as well as the frequency of communication and higher order joint engagement during parent-child interaction. They also significantly reduced externalizing problem behaviors but showed no significant change in the adaptive behaviors. (2) During the follow-up, children in both groups were able to maintain most of the progress of social communication skills but showed no significant change in problem behaviors and adaptive behaviors. (3) Coach-assisted group had greater gains in parent fidelity; however, children’s outcomes did not significantly differ by group. If the effect size and progress within the group were considered, there’s a trend towards greater gains for the coach-assisted group in children’s expressive language, and the frequency of verbal and non-verbal communication, non-instrumental communication and higher order joint engagement. (4) We found a significant relationship between degree of change in parental interaction skill and rate of children’s improvement on expressive language and higher order joint engagement.
Conclusions: The results preliminarily suggested a potential role for both self-directed and coach-assisted programs for improving social communication skills of children with ASD, and the progress can be maintained in a short term. We also found an association between parents’ progress and children`s progress in expressive language and social engagement. In future, a larger sample size, comparing to usual community treatment group, and adding other objective indicators are needed. Also, it’s important to further exploring the factors that may affect the progress of children and parents. The ultimate goal is to develop an effective and accessible localized telehealth-based PMI for parents in Taiwan. |
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| Description: | 碩士
國立政治大學
心理學系
108752005 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0108752005 |
| Data Type: | thesis |
| Appears in Collections: | [心理學系] 學位論文
|
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