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題名:自閉症幼兒社會溝通能力發展之研究
作者:吳進欽 引用關係
作者(外文):Chin-chin Wu
校院名稱:國立中正大學
系所名稱:心理學所
指導教授:翁嘉英
姜忠信
學位類別:博士
出版日期:2010
主題關鍵詞:模仿相互注意協調能力自閉症遊戲AutismJoint AttentionImitationPlay
原始連結:連回原系統網址new window
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  • 被引用次數被引用次數:期刊(3) 博士論文(1) 專書(0) 專書論文(0)
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研究背景及目的:自閉症類疾患為終生、長期的發展性疾患,患者的語言及溝通能力之發展,對於未來的社會適應及預後扮演重要的角色。過去研究指出早期的非語言社會溝通能力,包括:相互注意協調能力、模仿和遊戲能力,在自閉症類患者語言及溝通動能力的發展,扮演重要的角色。然而,目前沒有研究針對三歲以下自閉症類患者,探究社會溝通能力的出現順序及關係。因此,本研究探討三歲以下自閉症類患者社會溝通能力的出現順序及關係,透過縱貫研究進行了解。時間點一的評估,是在自閉症類患者平均生理年齡30個月大時,時間點二則是在時間點一之後18個月進行。本研究的第一個目的是探究自閉症患者社會溝通能力的出現順序,比較自閉症患者與不同類型兒童的差異。第二個目的是探究自閉症類患者,相互注意協調能力、模仿能力及遊戲能力等非語言社會溝通能力,與語言能力的關係。
方法:本研究主要參考學步期自閉症篩檢工具(Screening Tool for Autism in Toddlers, STAT, Stone, Coonrod, & Ousley, 2000;Stone, Coonrod, Turner, & Pozdal, 2004),合併使用ADOS(Lord, Rutter, DiLavore, & Risi, 1999),作為測量主動性相互注意協調能力、反應性相互注意協調能力、物體模仿、動作模仿及他人/娃娃導向遊戲能力的工具。語言能力的測量,是觀察受試者在實驗過程中所出現的口語反應、照顧者所填寫的嬰幼兒溝通量表及文蘭適應量表的溝通適應領域作為指標。
結果:社會溝通能力出現順序,縱貫研究評估9-15個月大的一般發展嬰兒,結果發現一般發展嬰兒社會溝通能力出現順序為:主動性相互注意協調能力、反應性相互注意協調能力、物體模仿、動作模仿、他人/娃娃導向遊戲及語言。針對自閉症患者進行的縱貫研究,結果發現自閉症患者的社會溝通能力出現順序,和一般發展嬰兒不同,自閉症患者先出現物體模仿,語言能力在主動性相互注意協調能力前出現,自閉症患者比較早出現的三個能力為物體模仿、反應性相互注意協調能力及他人/娃娃導向遊戲。發展遲緩患者的社會溝通能力,出現順序和一般發展嬰兒雖然不盡相同,但先出現的還是主動性相互注意協調能力與反應性相互注意協調能力。
社會溝通能力的關係,結果發現30個月大的自閉症類幼兒,反應性相互注意協調能力、物體模仿及他人/娃娃導向遊戲和30個月大時的語言能力存有同時相關;30個月大時的他人/娃娃導向遊戲和48個月大時的語言能力存有顯著相關。48個月大時的動作模仿能力和48個月大時的語言能力存有顯著相關。
結論:自閉症患者社會溝通能力先出物體模仿,前三個能力為物體模仿、反應性相互注意協調能力及他人/娃娃導向遊戲,顯示語言學習與發展歷程,自閉症患者因為無法有效參照他人意圖線索,過度依賴互動者語言表達時,同時存在的突顯效果,如:手指碰觸或操作物體。這是因為自閉症患者規則基礎知識能力相對較為完整,互動者所突顯出的效果,有助於患者透過自身的優勢能力來學習。然而,這種學習策略,只能掌握規則無法正確明瞭他人意圖,導致自閉症類患者語言不適當的使用與錯誤。此外,模仿能力、反應性相互注意協調能力及他人/娃娃導向遊戲等能力與語言能力有關,在語言發展歷程扮演重大角色,對自閉症類患者早期療育的介入方向與訓練目標,提供一個思考的方向。
Background and objectives: The long-term outcome and adaptation in autism spectrum disorders (ASD) was an important issue but not really know clear. However, previous studies suggested language plays an important role. And there were a few early social-communicative skills associated with language in children with ASD. However, few researches explored the emergence sequence and relationships of social-communicative abilities in children with ASD below three years old. The purposes of the longtidutinal study were to explore eary social-communicative abilities development in young children with ASD. The first issue, we explore the sequence of emergence of the social-communicative abilities by comparing to the autism children and the non-ASD children. The second issue, we analyze the relationships of social-communicative abilities in young children with ASD, including joint attention, imitation, play, and language skills. In the current study, we conducted the first evaluation to the ASD children and the developmental delay children, whose average age were 30 months old. After eighteen months, we conducted the follow-up research to the same children.
Methods: A modified form of the STAT (Stone et al., 2000, 2004) was used to measure the several early social-communicative abilities, including initiating joint attention (IJA), responding joint attention (RJA), object imitation, manual imitation, and doll-directed play, and also included the ADOS (Lord et al., 1999) .The language abilities were assessed by Mullen Scales of Early Learning (MSEL, Mullen, 1995), Infant Communicative Development Inventories (CDI, Liu & Tsao, 2005 ), and Vineland Adaptive Behavior Scales (Sparrow et al., 2005).
Result: In the first part of research, we collected the emergence sequence of social-communicative abilities from the nine- to fifteen-month-old typical infants to be norm and contrasted the same abilities of young children with autism. The results revealed that the typical infants in the emergence order of social-communicative abilities were IJA, RJA, object imitation, manual imitation, the other/doll directed play and language. However, the emergence sequence of social-communicative abilities in young children with autism were in opposition to the typical infants. The young autistic children emerged object imitation first, and language were developed before the IJA. Meanwhile, the first three developed social-communicative abilities in young children with autism were object imitation, RJA, and other/doll play. However, unlike the autistic children, the developmental delay children also displayed the IJA and RJA first.
In the study of the social-communicative abilities correlation, the results showed that RJA, object imitation and the other/doll directed play were current related with language abilities simultaneously in 30-month-old young children with ASD. The other/doll directed play in 30-month-old children also correlated with the language in 48-month-old children. Then, there were significant relationships between manual imitation and language abilities in 48-month-old ASD children.
Conclusion: The first three emerged social-communicative abilities in young children with autism were object imitation, RJA, and other/doll play. It indicted that the process of language development in young children with autism relied on salience effects companied by directed language of the caregivers, for example, touching and manipulating object. There is a reason that children with autism had relatively intact rule-based knowledge skill. However, the atypical learning strategy could not make them understand the intention of others, and caused the errors and inappropriate usage of language. Besides, all of RJA, imitation, and other/doll play abilities were related with language abilities in youug children with ASD. We also discussed the implication of early diagnosis, the core deficit and intervention goals in children with ASD.
一、中文部分
吳進欽、姜忠信、侯育銘、劉俊宏(2009):〈自閉症類兒童發展能力表現型態之研究〉。《中華心理衛生學刊》,22,1-25。new window
吳進欽、姜忠信、虞燕婷(2010):〈自閉症類幼兒社會注意力的探究〉。《中華心理學刊》,52,57-74。new window
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姜忠信(2008):〈台灣的自閉症研究;過去、現在與未來〉。《應用心理研究》,40,165-196。new window
姜忠信、宋維村(2002):〈學齡前自閉症兒童相互注意協調能力的發展〉。《中華心理衛生學刊》,15,29-46。new window
姜忠信、吳進欽、李季樺(2006):〈自閉症兒童的象徵遊戲能力:縱貫研究〉。《中華心理學刊》,48,255-273。new window
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