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題名:運用輔助溝通系統介入對自閉症學生整體溝通成效之後設分析研究
作者:鄭媛文
作者(外文):Cheng, Yuan-Wen
校院名稱:臺北市立大學
系所名稱:教育學系
指導教授:張世彗
學位類別:博士
出版日期:2016
主題關鍵詞:輔助溝通系統自閉症學生溝通行為後設分析augmentative and alternative communicationautism spectrum disordersmeta-analysis
原始連結:連回原系統網址new window
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本研究旨在探討自閉症學生運用輔助溝通系統(AAC)之溝通成效。主要研究目的為下列幾項: 一、以後設分析探究國內自閉症學生運用AAC之整體溝通成效、口語表達之成效、與影響口語表達的關鍵因子是否與教育階段、自閉障礙程度、智力因素、口語能力有關。二、以後設分析探討國外AAC對自閉症學生之整體溝通成效、口語表達成效、及影響口語表達之關鍵因子是否與教育階段、自閉障礙程度、智力因素、口語能力有關。三、比較國內外自閉症學生運用AAC之整體溝通成效。四、瞭解自閉症學生在多管道溝通模式下對AAC模式偏好的溝通成效。
本研究以後設分析方式,搜尋1980至2015年自閉症學生運用AAC之溝通文獻、經過篩選、編碼及編碼者一致性考驗,國內適合做實證研究有27篇,國外英文文獻有40篇文獻。其次,透過後設分析「未重疊百分比」(PND)和「進步差異百分比」(IRD)計算每篇文獻之效果值,並以無母數曼-惠特尼(Mann-Whitney, U test)U檢定與克-瓦(Kruskal-Wallis test, H test)H檢定,探究研究對象之教育階段、自閉障礙程度、智力因素、有無口語仿說能力等變項對溝通成效的影響是否達到顯著。再次,透過後設分析的文獻分析方式,探究研究參與者在AAC多元溝通模式顯示其偏好之溝通成效。結果獲致下列結論:
一、 國內部份: 多數自閉症學生運用AAC介入之整體溝通成效達到非常有效程度;AAC介入對口語表達之成效,有效篇數多於無效且平均趨近中等有效程度;SGD結合情境教學的AAC模式對口語表達的成效不明確;自閉症者的仿說能力AAC是誘發口語表達之關鍵因子。
二、 國外部份:多數自閉症學生運用AAC介入之整體溝通成效,達到中等以上有效程度;AAC介入後對口語表達之成效,有效篇數多於無效且平均達到有效程度;SGD結合情境教學的AAC模式對口語表達的成效尚待強化;仿說能力是AAC介入後是誘發口語表達的關鍵因子。
三、 比較國內外自閉症學生溝通效果部份:AAC整體溝通成效,國內外皆達中等以上有效程度;AAC介入誘發自閉症口語表達成效,國內外皆達稍微有效程度;國內外皆發現仿說能力會影響口語表達。多管道溝通模式之選擇性偏好對溝通的效果,國內外皆達趨向非常有效程度;多數自閉症學生透過多管道溝通模式,依其能力選擇擅長或喜歡的溝通模式,通常能達到較佳的溝通效果。
最後,依據研究發現所提出限制與建議如下:
研究限制: 研究樣本來源的限制與研究樣本分析變項的限制。
對教學方面的建議:學生對增強物的喜好,攸關教學成敗;善用時間延宕與提示系統的教學策略;選用適性輔具前,先評估研究對象的認知程度、精細動作能力與選擇性的偏好;教導自閉症學生使用圖片溝通,進而引導拼音識字;AAC課程增加社會互動機會。對未來AAC後設分析溝通研究的建議:可擴展研究對象至其他具有嚴重溝通困難的身心障礙類別;選擇性偏好的延續追蹤;因應後設分析出版偏差問題;以質性分析為輔;建立特殊教育證據本位實務的資料庫。
The purpose of the study was to integrate and synthesize, using meta-analytic methods, the extant research literature on the effectiveness of augmentative and alternative communication (AAC) intervention in children with autism spectrum disorders (ASD). Focuses of this study are as follows:
To investigate the effectiveness of AAC on communication for students with ASD, the effectiveness of AAC on speech outcome for children with ASD, and verify whether the factors of degrees of ASD, IQ, education status, or verbal imitation are connected with speech production both in domestic and abroad, separately. Moreover, to compare the effectiveness of AAC on communication for students with ASD, and that of AAC on speech for children with ASD, and check out whether the factors of degrees of ASD, education status, IQ, or verbal imitation are correlated with speech production between domestic and abroad. Furthermore, to evaluate the effectiveness under the preference modality of AAC on communication for students with ASD in multi-model approach.
Retrieved intervention studies ranged from 1980 to May 2015, and included published articles and theses and dissertations. To be included, studies had to meet stringent criteria. A coding manual and form facilitated data extraction in terms of participant characteristics, treatment, and outcomes. Effect sizes were aggregated separately for single-subject studies for communication, speech outcomes, and preference. Twenty-seven single-subject domestic studies as well as forty abroad studies were analyzed via an effect size measure, the Percentage of Non-overlapping data (PND) and the Improvement Rate Difference (IRD) for single-subject research studies. Analysis the factors that affect speech production by analysis of variance, and explore the acquisition and preference for AAC system through systematic review.
Results indicated that AAC interventions had above average effectiveness for most participants on communication outcomes both in domestic and abroad. AAC interventions, however, do not appear to impede speech production, but the gains were rather modest. Statistical analysis reveal significant differences that verbal imitation is the predictor variable of speech outcomes in children with ASD. Last but not least, there is highly effectiveness under the preference of AAC on communication for students with ASD in multi-model approach. Limitations of the current literature were another findings as they precluded further in-depth analysis of study outcomes. Based on these findings, gaps in the existing research literature were revealed, and directions for future research were derived.
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