自閉症類群兒童綜合性早期療育的療效研究：文獻回顧

Comprehensive Early Intervention Research for Children with Autism Spectrum Disorder: A Narrative Overview

林姿伶(Tzu-Ling Lin) ； 姜忠信(Chung-Hsin Chiang) ； 吳欣治(Hsin-Chi Wu)

《中華心理衛生學刊》 29卷1期 (2016/03) Pp. 1-46

https://doi.org/10.30074/FJMH.201603_29(1).0001

摘要

研究目的：回顧自閉症類群兒童綜合性早期療育的療效研究。研究方法：本研究使用敘述性綜論(narrative review)方式，依據Smith等人(2007)針對自閉症類群兒童早期療育提出的四階段研究架構，回顧、檢視1987年至2015年10月國內外行為、發展及合併取向之綜合性早期療育模式療效研究現況。研究結果：各綜合性早期療育模式採用不同的療效指標進行療效研究，各顯示了不同程度的介入療效及研究階段。目前核心反應訓練(Pivotal Response Training, PRT)的療效研究工作已進入研究階段四，但仍待持續累積隨機臨床試驗(Randomized clinical trials, RCT)研究資料。早期密集行為介入(Early Intensive Behavioral Intervention, EIBI)、發展、個別差異及關係基礎模式(The Developmental Individual-Difference, Relationship-Based Model, DIR)、自閉症與溝通障礙兒童治療與教育(Treatment and Education of Autistic and Related Communicational Handicapped Children, TEACCH)、丹佛早療模式(Early Start Denver Model, ESDM)及社會溝通、情緒調節及人際支持(Social-communication, Emotional Regulation, and Transactional Support, SCERTS)等模式之療效研究進行至Smith等人所描述的第三研究階段工作，但除ESDM療效研究依照Smith等人的四階段研究進程進行系列的研究外，EIBI, DIR, TEACCH, SCERTS仍各有其不足之處。人際關係發展介入(Relationship Development Intervention, RDI)則尚未滿足研究階段一標準。研究結論：國際上已發展不同理論取向的綜合性早期療育模式，部分模式累積相當的療效研究資料，本研究針對目前國內外研究現況提出後續研究者可進一步探討之研究建議。臺灣目前未有本土發展的綜合性療育模式研究，僅有零星幾篇採取國際綜合性療育模式介入原則的個案研究報告或單一受試研究，學術及臨床領域實有急起直追的需要。

關鍵字

自閉症類群 ； 綜合性早期療育 ； 文獻回顧

並列摘要

Purpose: This article reviews intervention research of 7 comprehensive early interventions for children with autism spectrum disorder (ASD). Methods: Smith et al.’s (2007) four-step research model is used to review the current research statuses of 7 comprehensive early intervention models from 1987 through October 2015, which are Early Intensive Behavioral Intervention (EIBI); Developmental Individual-Difference, Relationship-Based Model (DIR); Relationship Development Intervention (RDI); Pivotal Response Training (PRT); Treatment and Education of Autistic and Related Communicational Handicapped Children (TEACCH); Early Start Denver Model (ESDM); and Social-communication, Emotional Regulation, and Transactional Support (SCERTS). The four-step research model was indicated in a sequence of steps, (I) formulation and systematic application of a new intervention technique, (II) developing a manual and research plan for evaluation of the intervention across sites, (III) randomized clinical trials (RCTs), and (IV) community effectiveness studies. Results: The intervention research statuses of 7 comprehensive early interventions were somehow dissimilar. Intervention research of PRT has been done in research step IV, but more research using randomized clinical trials (RCT) is needed. The research statuses in EIBI, DIR, TEACCH, ESDM, and SCERTS are all in research Step III. However, only intervention research of ESDM followed the sequence of steps, there are still some research weakness in EIBI, DIR, TEACCH and SCERTS. Intervention research of RDI has not yet met the criterion of research step I. Conclusions: We propose suggestions for future research based on our analysis of the current status of intervention research. Researchers in Taiwan still have not initiated any studies investigating the efficacy or effectiveness of comprehensive intervention models in the local context, except for a few case reports. There is an urgent need in Taiwan to match the international standard.

並列關鍵字

autism spectrum disorder ； comprehensive early intervention ； literature review

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