運用園藝治療活動在亞斯伯格兒童之個案研究

A Case Study of Horticultural Activities for Children with Asperger

巫潞琳(Lu - Lin Wu)

指導教授 ： 陳惠美

國立臺灣大學/生物資源暨農學院/園藝學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.00790

摘要

亞斯伯格屬於自閉症的一種，台灣目前只有自閉症的統計資料，台灣行政院內政部統計年報顯示自閉症人數不斷上升，台灣自閉症人數從2001年2,550人到2010年成長為10,160人，十年間人數激增四倍。目前尚無治癒之藥物與療法。亞斯伯格屬於自閉症功能較好之類型，通常就讀普通班。但其社會互動、情緒、感官與精細動作、刻板與侷限興趣方面之問題造成生活困擾。目前台灣僅將園藝治療應用在自閉症，尚未應用在亞斯伯格。園藝治療具有社交、心理效益，並有五感體驗、多樣化、生活化之特性，呼應亞斯伯格問題。尚未有研究針對亞斯伯格兒童做探討，本研究希望能找出適合方案，並檢測活動效益。故本研究針對亞斯伯格兒童設計十週園藝治療活動，讓亞斯伯格兒童參與，瞭解亞斯伯格兒童對園藝治療活動之偏好、在園藝治療活動中獲得之效益，效益包含社會互動、情緒、感官與精細動作、刻板與侷限興趣等方面，並瞭解個案家長對園藝治療活動之建議，作為改進參考。研究方法採用個案研究，以錄影紀錄活動過程，於事後進行行為計次分析，另外，也採用半結構式電話訪談來訪談個案家長，並讓個案填寫園藝活動調查表。
結果顯示整體園藝治療活動對亞斯伯格兒童之吸引力為形式像遊戲、活動有正向回饋；個別活動吸引力為可食用、新奇、有香味之項目；園藝治療活動對亞斯伯格兒童之效益，主要為情緒效益、其次為社會互動效益，而在感官、侷限與刻板興趣等方面有部分改善，其中，每位個案獲得之效益不大相同；而園藝治療活動與其他輔助治療之差異，亞斯伯格兒童家長認為有多種差異，例如：具有創作特性、活動溫和、形式自然、能與同儕互動、能即時處理狀況、成就感大；最後，對於園藝治療活動之建議，大多數個案家長表示滿意園藝治療活動，沒有特別意見，有一位家長則表示，其小孩能力較差，可以視覺化圖卡輔助、讓個案上台示範，並使用獎勵制度搭配操作時間表，以提昇園藝治療活動之效益。本研究結果中可知，園藝治療活動可吸引亞斯伯格兒童參與，具有一定之效益，且有其特殊性。
而亞斯伯格治療採用多管齊下方式，園藝治療活動對亞斯伯格兒童效益以情緒效益最為明顯，且園藝治療活動具有簡便與經濟特性，室內或室外皆可實施，操作成本也較低廉，建議可將園藝治療當作改善情緒方式之一。活動設計方面，建議日後園藝治療活動設計以操作內容為主，園藝治療活動內容應新奇，並可安排重複性動作，或是嗅覺刺激或烹飪內容，並安排分享回饋之活動。若參與者之能力較差，應考慮其合併症狀之特性，調整活動內容和方式，增加輔助工具，以符合參與者之需求。本研究也提供活動帶領經驗，做為相關研究之參考。研究建議部分，建議日後研究可找與亞斯伯格社會互動能力相近，情緒控制或溝通表達已有一定的能力，但無衝動問題之對象一同參與活動，如年紀較小之一般兒童，或情緒控制或溝通表達已有一定的能力之亞斯伯格兒童，並加強社會互動方面之活動設計，檢測社會互動之效益。並建議應增加活動頻率與時間，或許可與學校、日常療養機構，或是醫療單位合作，能較頻繁且長期提供服務。另一方面，建議可加強讓個案照顧植物的部分。而關於評估方法，建議日後研究或許可在活動中與活動後安排訪談，進行後續追蹤，可嘗試訪談個案以了解效益，也可採用事件取樣或其他更能評估效益的方法進行評估。

關鍵字

園藝治療 ； 亞斯伯格 ； 輔助治療

並列摘要

Asperger is a kind of Autism. There is only autism statistics in Taiwan currently. Statistical yearbook of Ministry of the Interior shows that the population of autism is rising. The population of Autism has risen from 2,550 in 2001 to 10,160 in 2010. The population increased four times during the past decade. At present we still did not have medicine of and therapy can cure Asperger entirely. Asperger’ function is better in Autism. In this reason, children with Asperger usual took the regular class. But its social interaction problem, the mood problem, exceptional sense and movement, restricted repetitive and stereotype patterns of interest create puzzle in life. There are researches about horticultural therapy (HT) of autism, without HT of Asperger. Characteristics of HT are social benefit, psychological benefit, five sense experiences, the diversification, and the adaptation. These characteristics respond to problems of Asperger. There is no research about horticultural therapy of children with. The aim of this study is finding out appropriate activities for children with Asperger and examining the effect. Therefore, this study designed 10 weeks of HT for children with Asperger. HT let children with Asperger take part in the HT program to better understand the feasibility and effectiveness of HT for children with Asperger. Effectiveness includes social interaction problem, the mood problem, exceptional sense and movement, restricted repetitive and stereotype patterns of interest. This study used case study as study method. This study used video camera recording activities prosess, and then the researcher watched videos to count behavior times. Otherwise, in-depth interview was conducted to explore preference of children with Asperger for horticultural activity, the effectiveness of HT, as well as suggestions to HT.
The results showed that the form like game and the activity with positive feedback were the attraction of the whole HT program. The children with Asperger preferred novelty activities, activities with flavor, and activities with food. Moreover, the main benefit of HT program in program was emotional benefit, secondary benefit was social interaction. There were partial benefits at exceptional sense, and restricted repetitive and stereotype patterns of interest. HT’s benefit to each case was different. HT was distinct from other forms of alternative medicine for creation features, moderate activities, natural form, interacting with the children of the same age, immediately dealing with situation, and more accomplishment. Most parents of cases satisfied with HT program. Only one parent of case suggested we can add visual picture cards, let child demonstrate, and use reward system and operating schedule in the HT program, because her children’ function is poorer. HT program can attract children with Asperger and can provide some benefits. HT program also has the distinction.
Asperger usually use many therapies at the same time. The most apparent benefit of HT for Asperger children is emotional benefit. Then HT is convenient and cheaper. We can take HT as a method of improving emotion. About HT program, this study suggests researchers take operative activities as main activity, arrange repetitive motions, arrange flavorful or cooking content, arrange share and feedback activities, and activities should be novel. If the ability of the participants is poorer, researchers should consideratie other symptom, adjust practice the contex and form of activity, use auxiliary tools. This study suggests that future study can study deeply about exceptional sense and movement, restricted repetitive and stereotype patterns of interest in the future. This study offers experiences of activities for related studies to reference. About suggestion of this study, this study suggests that future study can find children who’s social ability is similar to case as peer, the abilities of controlling emotion and expressing is to some level, and without problem of impulse, such as younger children or children with Asperger who’s abilities of controlling emotion and expressing is to some level. This study suggests reinforcing activities design in social interaction. This study suggests increasing frequency and time, such as cooperating with school, sanatorium, or hospital. This study suggests letting case care plant by itself. About assessment, this study suggests increasing interview, interviewing case, or useing other better approach, such as event sampling.

並列關鍵字

horticultural therapy ； Asperger ； alternative medicine

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