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題名：家長居家介入訓練對提升自閉症幼兒共享式注意力成效之研究
作者：李惠藺
作者(外文)：Lee, Huei-lin
校院名稱：臺北市立大學
系所名稱：教育學系
指導教授：楊宗仁
蔡昆瀛
學位類別：博士
出版日期：2015
主題關鍵詞：自閉症幼兒；居家介入；家長訓練；共享式注意力；young children with autism；home-based intervention；parent training；joint attention
原始連結：連回原系統網址new window
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本研究探討在居家的情境中，教導家長以遊戲與例行性活動(例如吃飯、洗澡、換尿布等)與自閉症幼兒互動後，家長介入策略運用以及改變情形，亦探討當家長介入策略運用轉變後，對自閉症幼兒共享式注意力行為的影響。
本研究以四組生理年齡二歲一個月到三歲六個月的自閉症幼兒及家長為對象，採用單一受試之多試探設計為主，並輔以質性的分析。單一受試研究部分，針對家中親子遊戲進行資料收集，每位家長需進行三次的基線期觀察、十三或十四次的居家介入訓練，以及六個月共四次的追蹤觀察。每次居家介入擷取十分鐘親子遊戲，進行家長十四項介入策略和幼兒十項共享式注意力行為的編碼。家長十四項介入策略包括情境、情感、互動、教導與輔助等五大向度，彙整自自閉症幼兒共享式注意力發展取向與互動交流取向的介入策略；幼兒十項共享式注意力行為則整合社會性趨向的廣義性定義。在質性分析部分，研究者以文字紀錄家長親子互動歷程，包括遊戲與例行性活動時之策略運用，介入後訪談家長對居家介入訓練成效的看法。居家介入訓練過程全程錄影，提供單一受試編碼和質性分析使用，並將影片的內容轉化成文字，以利分析。
在進行量化編碼與質性資料分析後，獲得以下研究結論：
1.居家介入能增加四位受試家長與自閉症幼兒遊戲與例行活動時，介入策略的運用。
2.居家介入後家長策略的運用因應活動目標與活動內容而有不同。
3.居家介入後自閉症幼兒共享式注意力行為頻率增加，尤其是「眼神注視」、「情感交流」、「規範行為」、「社交互動」、「狹義共享式注意力」等行為都有不同程度的進步。
4.家長互動時運用策略越多，自閉症幼兒的共享式注意力行為的出現也有增加趨勢。
5.家長介入策略的改變增進了「親子關係」並提升了「幼兒學習效果」。
本研究亦針對未來的研究、早期療育居家介入和自閉幼兒療育等方面提出建議。
The present study examined changes in the practice of parental strategies during interaction with children, and also examined joint attention actions in children with autism after in the home environment after instruction to parents for interaction with autistic children through playing and routine activities (e.g. eating, bathing, changing diapers).
In the present study, subjects were grouped into four groups based on their physiologic age: autistic children ranging in age from 2 years and 1 month to 3 years and 6 months were included in the study. The present study primarily employed a single subject, multiple probe design, supplemented by qualitative analysis. In single subject design, we collected data related to parent-child playing in the home. Parental baseline observations were performed three times, 13 or 14 times of home-based parent trainings were conducted, and six-month, four times of follow-up observations were collected. During each home-based parent training, we captured 10 minutes of the parent playing with the child, and coded 14 intervention strategies for parents and 10 joint attention behaviors for children. The 14 intervention strategies for parents included five main areas, i.e., situation, affect, interaction, instruction and facilitate, which were aggregated from the joint attention of autistic children obtained by intervention strategies of developmental-response approach and transactional approach. The 10 joint attention behaviors for children were integrated as the generalized definition of social orienting. For qualitative analysis, the authors wrote down a record of the interactions between parents and children, including intervention strategies regarding play and routine activities etc., and the post-intervention opinions of parents concerning the effects of home-based parent training. The entire home-based parent training was recorded, for use in the single case design and qualitative analysis. Furthermore, the video contents were transcribed in order to facilitate analysis.
After performing quantitation coding and qualitative analysis of the data, we obtained the following conclusions from the study:
1.Home-based parent training could increase the implementation of intervention strategies when four test parents and their autistic children played or conducted routine activities.
2.The implementation of parental strategies should be different according to the goals and contents of activities after home-based parent training.
3.After home-based parent training, joint attention behaviors in children with autism increased, and unequal progress was especially noted for actions such as eye gaze, shared positive affect, behavior regulation, social interaction, and joint attention.
4.When parent interaction strategies increased, joint attention actions of children with autism also tended to increase.
5.Changes in parent intervention strategies increased the "parent-child relationship" and "learning effects in children."
The purpose of the present study was to also pave the way for future studies and propose suggestions for early parental intervention, intervention for children with autism, etc.
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