| Abstract: | 自閉症兒童相互注意協調能力（joint attention, JA）的障礙，在過去20 年來，已經被一再驗證，這項障礙能解釋自閉症兒童出現社會及溝通障礙的心理病理機制。如何改善這些兒童的JA 能力，進而促進與JA 有關的模仿、遊戲及語言能力的發展，是目前學界相當熱門的主題之一。目前已經發展幾套對自閉症兒童做JA 介入的模式，這些模式中較少針對家長訓練作深入探究，本研究將基於研究者過去在JA 介入研究的基礎，發展一套適用於2~4 歲自閉症兒童的家長訓練模式。本研究擬以三年的計畫，招募40 名年齡在2~4 歲間的自閉症兒童及其家長。本研究將採用前-後測控制組設計，比較實驗組（家長訓練組）與控制組，他們的兒童在訓練前後的改變，並據此追蹤6 個月、12 個月，瞭解其在社會溝通、遊戲、及語言能力的發展。本研究將基於研究者過去在JA 介入的研究經驗，以初編的家長訓練手冊為藍本，用一對一的方式，以每週2 次，每次一小時，連續12 週共24 小時的療程來進行訓練，使自閉症家長學習如何對他們的孩子進行JA 介入。控制組的家長將免費接受4 次完整的評估及諮詢。本研究的依變項將包括：（1）早期社會溝通量表（Early Social Communication Scales, Mundy, et al., 2003）；（2）親子自由遊戲活動中的JA 表現與遊戲表現、（3）結構式遊戲量表中的遊戲表現、（4）Reynall 語言發展量表中的語言理解與語言表達、（5）麥氏嬰幼兒溝通發展量表中文版中的詞彙量、（6）社會溝通問卷及自閉症診斷觀察量表。資料分析將採用二因子混和設計，檢視組別（實驗組與控制組），及介入前後與追蹤（介入前、介入後、6 個月追蹤、及12 個月追蹤）的兩個主要因子效果。並以回歸分析、時間序列分析等來看兩組兒童在各項社會溝通領域能力的發展。預期這項研究的發現，能深入瞭解以家長訓練的模式，如何對自閉症兒童JA 能力做介入，同時，也能對自閉症兒童接受此種訓練後，在發展JA 及有關的社會溝通能力有更多瞭解。研究者相信這種更貼近臨床取向的研究成果，將能直接應用到臨床與教育的情境中。
Young children with autism are mainly suffered by marked difficulties in social interaction and language communicative abilities. Literature has proposed that the difficulties in these two domains could be explained by joint attention (JA). Improvement of JA was believed to change itself and other collateral abilities, like imitation, symbolic play and language development in young children with autism. Different approaches of JA intervention have demonstrated that young children with autism can be taught the repertoire of joint attention. However, few approaches focused on parent training. The aim of this study is to examine the efficacy of a 12-week one-to-one parent training of JA for young children with autism and follow up these children to know the patterns of developmental trajectory of social communicative, play, and language abilities. Three years proposal are provided. Forty young children with autism will be recruited to participate in this study. Candidates will include 2- to 4- years old referred from child psychiatrists in their regular clinic. A pre-posttest control group design will be employed to examine the outcome of this intervention and be followed up 6, 12 months later. The experimental group, i.e., parent training group, which will be used the manual developed from the author’s past JA joint attention intervention experience to facilitate their children’s social communication development. The parents in the control group will get 4 time free assessments and consultation. Six sets of instruments will be used: (1) Early social communication scales (ESCS) (Mundy, et al., 2003); (2) parent-child free play scale; (3) Structural play scale; (4) Reynell Developmental Language Scales; and (5) McArthur Communicative Developmental Inventory-Chinese version; (6) Social Communication Scales (SCQ) (Rutter, et al., 2003) and Autism Diagnostic Observation Scales (ADOS) (Lord, et al, 1999). Two-way mixed design ANOVA will be preformed to compare significance of group and phases. In addition, multiple regression and time series analysis will be used for understanding the developmental pathways of various kinds of social communicative abilities in two groups. It is expected that the results will enrich our understanding of early developmental trajectory of JA in children with ASD via intensive parent training. We hope this new working experience will be used directly in the clinical and educational settings.
本研究的目的評估共享式注意力家長訓練方案的實證療效。整個研究計畫預計進行三年時間完成，目前呈現第二年進行的成果。在過去近一年的工作主要完成兩個部分，第一部份是持續追蹤本研究的控制組，並完成控制組的第四次評估；第二部分包含介入手冊的編制、治療師的招募與訓練，並進行預試及正式個案。過去一年期間，完成三次評估之人數為25名。在完成三個月及一年追蹤的26人當中，目前完成第58週評估的個案人數有19名。第二部分已編譯介入手冊，並據之編定家長訓練手冊，完成第一階段4名兒童的預試，第二階段2名兒童的預試，發展出新的介入取向，並修改訓練方案；另完成2名治療師培訓，並正進行第二梯次2名治療師培訓。已正式招募2名治療組個案接受介入。
The study was a three years project, which goal was to development the Caregiver Mediated Joint Engagement Intervention for young children with autism. The work for the second year was separated two phases. First, the research team followed the standard procedure to recruit the subjects to our lab and special clinic as established by ours in the first year. Second, the research team revised the intervention manual, trained the therapists, and finished the pilot study. In control group, 25 children with ASD finished the pre-, post-, and 3-months follow up assessment. Within 26 children who were assessed both pre- and post- visit, 19 children were finished the 1-year follow up assessment. In second part, the intervention manual and parent manual was revised. The first phase pilot study had been conducted and 4 children were recruited. Besides, the second phase pilot study had been conducted and 2 children were recruited. The new intervention approach was developed and the program was revised again. Otherwise, two therapists have passed the training program, the other 2 therapists are training now. Two children with ASD were recruited for the intervention group. |
