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| Title: | 臺灣自閉症類群障礙兒童之短期低密集度丹佛早療模式之縱貫研究：家長成效追蹤
A Follow-Up Study on the Implementation of a Short-Term, Low-Intensity of Early Start Denver Model for Children with Autism Spectrum Disorder in Taiwan: Parental Outcomes |
| Authors: | 張艷倩
Cheong, Im Sin |
| Contributors: | 姜忠信
Chiang, Chung-Hsin
張艷倩
Cheong, Im Sin |
| Keywords: | 自閉症類群障礙症
丹佛早療模式
親職壓力
親職效能
生活品質
學齡期自閉症資源及服務使用
縱貫研究
Autism Spectrum Disorder
Early Start Denver Model
parenting stress
parenting self-efficacy
quality of life
autism-related resourse utilization
school-aged
longitudinal study |
| Date: | 2025 |
| Issue Date: | 2025-07-01 14:12:41 (UTC+8) |
| Abstract: | 研究目的:目前針對丹佛早期介入模式(Early Start Denver Model, ESDM)對家長長期成效上的研究，無論在亞洲或全球仍相當有限。本研究旨在填補此一研究缺口，探討ESDM對臺灣自閉症類群障礙(Autism Spectrum Disorder, ASD)兒童之家長福祉之長期影響。本研究延續林姿伶(2019)之成果，進行介入後6個月與4.5年之追蹤，評估短期、低密集度ESDM介入對家長親職壓力、親職效能與生活品質的持續性影響，並進一步了解ASD兒童學齡期家庭所使用的自閉症相關資源與服務及其經濟支出，評估對家庭經濟狀況的影響。
研究方法:本研究採準實驗、縱貫設計，並整合量化與質性研究方法。研究參與 者為2至4歲曾接受ESDM個別介入、家長接受每兩週一次、每次一小時家長教育課程(ESDM介入組)，或一般早期療育介入(一般社區介入組)之兒童家長。資料蒐集於四個時間點進行:介入前(時間點一，T1)、介入後(時間點二， T2)、介入後6個月(時間點三，T3)與介入結束後4.5年(時間點四，T4)。量化資料包含追蹤兩組家長之親職壓力、親職效能與生活品質。此外，T4新增自閉症資源使用問卷-學齡版(T-RUQ-S)以探討ASD家庭過去一年自閉症資源與服務的使用情況，以及憂鬱-焦慮-壓力量表(DASS-21)以評估家長在T4時的心理狀態。質性部分透過半結構式訪談，探討家長對ESDM介入之回顧與照顧歷程中的心理變化。
研究結果:研究結果顯示，ESDM介入組家長在 T2 的親職壓力呈現下降趨勢，然而親職效能與生活品質則未見顯著提升。於T3，兩組家長在多數變項上未有明顯進展，僅親職壓力之「憂鬱」次量表呈現顯著的時間主效果，為6個月追蹤期內唯一達顯著水準之次量表。進入T4追蹤期，兩組家長在親職壓力、親職效能及生活品質的部分結果呈現顯著進展，呈現延宕性介入效果，且相較於一般社區介入組，ESDM介入組家長在部分分量表或次量表之得分改善幅度更大。此外，T4新增的DASS-21結果亦顯示，ESDM介入組家長在「憂鬱」與「焦慮」之得分顯著低於一般社區介入組。在自閉症資源與服務自費支出方面，兩組未呈現顯著差異，顯示早期ESDM介入並未直接減少ASD家庭在服務支出上的花費。然而，質性訪談結果指出，ESDM介入雖不直接降低家庭的服務支出，但有助於家長更清晰地評估子女狀況，進而更有效地安排資源與進行教養決策。
研究結論與建議:本研究為亞洲少數探討ESDM對家長長期影響之研究。研究結果顯示，儘管短期介入效果有限，介入結束4.5年後，兩組家長在親職壓力、親職效能與生活品質的部分結果有顯著提升。研究亦指出，在資源相對充裕的臺 灣北部地區，無論介入組別為何，持續參與療育之家長均能隨著時間推移而獲益。此研究結果強調，外在支持(如持續獲得高品質之服務與資源)及內在因素(如家長之動機與調適能力)皆可能促進家長之長期正向發展。未來研究建議擴大樣本範圍，納入不同區域之家庭，並結合醫療紀錄或第三方資料進行交叉驗證。此外，可透過焦點團體或深入個案研究，以及進一步探討家庭系統中其他成員之參與與影響，以更全面地理解早期介入在家庭層面之長期效益。
Objectives: Research on the long-term effects of the Early Start Denver Model (ESDM) on parents remains limited, both in Asia and globally. This study aims to address this gap by examining the long-term impact of ESDM on the well-being of parents of children with autism spectrum disorder (ASD) in Taiwan. Building upon the findings of Lin (2019), the study conducted follow-ups at 6 months and 4.5 years post- intervention to evaluate the effects of short-term, low-intensity ESDM intervention on parenting stress, parental self-efficacy, and quality of life. Additionally, it assessed the use of autism-related resources and services by families with school-aged children with ASD, as well as the associated economic costs, to better understand the impact on household financial burden.
Methods: A quasi-experimental, longitudinal design using a mixed-methods approach was employed. Participants were parents of children aged 2 to 4 years who had received either individual ESDM intervention—along with bi-weekly, one-hour parent education sessions (ESDM group)—or general early intervention services (community intervention group). Data were collected at four time points: pre-intervention (Time1, T1), post-intervention (Time2, T2), 6 months post-intervention (Time3, T3), and 4.5 years post-intervention (Time4, T4). Quantitative data included repeated assessments of parentaing stress, parental self-efficacy, and quality of life. At T4, two additional instruments were administered: the Taiwan version of the Resource Use Questionnaire for Families of School-Aged Children (T-RUQ-S) to explore autism-related service utilization in the previous year, and the Depression Anxiety Stress Scales (DASS-21) to assess parents' psychological well-being. Qualitative data were collected through semi-structured interviews, focusing on parents’ reflections on the ESDM experience and their psychological adaptation throughout the caregiving process.
Results: The study showed that parents in the ESDM group exhibited a reduction in parenting stress at T2, although no significant improvements in parental self-efficacy or quality of life were observed. At T3, little progress was detected in either group across most variables, except for a significant time effect on the “Depression” subscale of parenting stress. By T4, however, both groups demonstrated substantial improvements in certain aspects of parenting stress, parental self-efficacy, and quality of life, suggesting a delayed intervention effect. Compared to the community intervention group, parents in the ESDM group demonstrated greater improvements on several subscales or dimensions. DASS-21 scores at T4 further indicated that parents in the ESDM group reported significantly lower levels of “Depression” and “Anxiety”. No significant differences were found in out-of-pocket expenditures between the two groups, suggesting that early ESDM intervention did not directly reduce financial burden. However, qualitative findings revealed that ESDM participation helped parents gain clearer insights into their children’s needs, enabling more effective decision- making and resource allocation.
Conclusions and Recommendations: This study is among the few in Asia to explore the long-term impact of ESDM on parents. The results indicate that, despite limited short-term effects, both groups of parents exhibited some significant improvements in parenting stress, parental self-efficacy, and quality of life 4.5 years after the intervention ended. The findings also highlight that in northern Taiwan, where resources are relatively abundant, parents—regardless of intervention group—can benefit over time through continued engagement in therapeutic services. These findings underscore the importance of both external supports (e.g., sustained access to high- quality services) and internal factors (e.g., parental motivation and adaptability) in promoting long-term caregiver well-being. Future research is recommended to expand the sample to include families from diverse regions, incorporate medical records or third-party data for triangulation, and explore the roles of other family members through focus groups or in-depth case studies to gain a more comprehensive understanding of early intervention’s long-term impact at the family level. |
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| Description: | 碩士
國立政治大學
心理學系
110752025 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0110752025 |
| Data Type: | thesis |
| Appears in Collections: | [心理學系] 學位論文
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