自閉症類群障礙應用行為分析本位早療實證實務文獻回顧初探

自閉症類群障礙高發生率與及早確診促成高效可行早期療育之殷切需求。然因先天跨多元系統之神經生理學障礙使此早期學習與發展更顯複雜。面對目前尚無可完全根治核心症狀的醫學藥理治療，早期療育因此聚焦在促進自閉症類群障礙幼兒綜合領域能力發展及核心症狀改善，以期神經系統可塑性最大化效果。自Lovaas（1987）自閉症幼兒方案成效備受注目以來，應用行為分析本位療育廣泛應用至今且相關實證實務研究亦肯定有效。然面對其實證實務模式多元且評議不一，如何確保何者滿足自閉症類群障礙幼兒個人需求且具終生影響效益？本文因此採文獻探討法聚焦近十年20篇系統文獻回顧，結果顯示對幼兒溝通、智能、社會及適應行為、核心症狀嚴重度有不同程度療效，親職壓力與家長增能之消長亦是成功關鍵。本研究亦發現2012年後實證實務研究量增且多符合實證水準，系統文獻回顧亦多採Cochrane等系統檢視偏差風險，且有基於黃金標準而僅後設分析隨機分派實驗，然多數成效實證弱或不足，特別是家長媒介模式是未來研究努力方向。

關鍵字

應用行為分析本位實證實務；自閉症；早期療育；系統文獻回顧

並列摘要

The high incidence of ASD and early diagnosis have contributed to the strong demand for effective and feasible early intervention. However, this early learning and development is more complicated due to neurophysiological barriers inherent across multi-systems. Facing currently no medical pharmacological treatment completely curing ASD core symptoms, early intervention focuses on promoting comprehensive developmental abilities and improving ASD symptoms in order to maximize neuroplastic effects. Since Lovaas's Young Autistic Children Program (1987) has gained much attention, ABA-based intervention has been widely utilized, and relevant Evidenced-Based Practical research consented its effectiveness. However, facing the diverse ABA-based EBP models and disputes, it was urgent to ensure which models meet autistic young children's needs and benefits lasting for a lifetime? Hence this research adopted literature-review method focusing on 20 systematic literature reviews in the past ten years. Results showed ABA-based intervention effects were variable on communication, IQ, social/adaptive behaviors and ASD severity, the decline and growing of parent-pressure and parent-empowerment was also the key to success. The amount of EBP increased since 2012 and many met evidence-based standards; many systematic literature reviews adopted Cochrane systems to examine deviation risk and even selected only RCT for meta-analysis, most of the research quality and effectiveness evidence revealed weak or insufficient, especially parent-mediated model, which would be future research's effort direction.

並列關鍵字

ABA-based EBP ； ASD ； early intervention ； systematic literature review

參考文獻

Bradshaw, J. L., Steiner, A. M., Gengoux, G. W., & Keogel, L. K. （2014）. Feasibility and effectiveness of very early intervention for infants at-risk for autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders, 45（3）, 778-794. Doi: 10.1007/s10803-014-2235-2

Buescher, A. V. S., Cidav, Z., Knapp, M., & Mandell, D. S. （2014）. Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatrics, 168（8）, 721-728. Doi: 10.1001/jamapediatrics.2014.210

Capes, K., Upson, S., Jones, C., Dissanayake, C., & Vivanti, G. （2019）. Delivery of group-early start Denver model in an Australian early childhood setting. Journal Focusing on Translational and Clinical Research in Pediatrics, 2. Doi: 10.21037/pm.2019.04.04

Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et al. （2010）. Randomized, controlled trial of an intervention for toddlers with autism: the Early Denver Model. Pediatrics, 125, e17-23. Doi: 10.1542/ped.2009-0958

Dawson, G., Jones, E. J., Merkle, K., Venema, K., Lowy, R., Faja, S., Kamara, D., Murias, M., Greenson, J., Winter, J., Smith, M., Rogers, S. J., & Webb, S. J. （2012）. Early behavioral intervention is associated with normalized brain activity in young children with autism. Journal of the American Academy of Child and Adolescent Psychiatry, 51（11）, 1150-1159. Doi: 10.1016/j.jaa.2012.08.018

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自閉症類群障礙應用行為分析本位早療實證實務文獻回顧初探

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