提升語音異常伴隨語言障礙兒童之語音清晰度及語言能力之成效研究

本研究旨在探討促進式情境教學加強調音韻治療法（Enhanced Milieu Teaching with Phonological Emphasis, EMT+PE）對中至重度語音異常伴隨語言障礙兒童（speech sound disorders and language disorders, SSD+LD）的構音/音韻及語言能力之成效。本研究採單一個案研究法之跨行為多基線設計，研究對象為三名中至重度SSD+LD兒童，年齡介於4歲至5歲11個月，應用EMT+PE進行共24次的介入課程，每堂課約60分鐘。研究以自編目標音之正確單詞測驗單評量目標音之單詞正確題數作為介入過程的主要依變項，並將資料紀錄於基線期、介入期與維持期，再以目視分析及效果量進行分析，此外，藉由前、後測進行相關依變項之分析，在構音/音韻能力方面，包括（1）聲母正確率；（2）語詞正確率；（3）言語清晰度百分比；（4）音韻歷程出現率；在語言能力方面，包括（1）平均語句長度；（2）詞彙多樣性；（3）修訂學前兒童語言障礙評量表之表達總分，探討EMT+PE對於中至重度SSD+LD兒童之語音及語言能力之改善成效。研究結果顯示，研究對象在接受EMT+PE後，個案一在目標音韻歷程之送氣音、擦音以及塞擦音皆具立即和維持成效，個案二在送氣音具立即和維持成效，在擦音以及塞擦音具立即成效，個案三在送氣音以及塞擦音具立即及維持成效，在擦音具立即成效。再者，三名個案於構音/音韻及語言表達能力指標均進步，語音異常嚴重度從重度分別進步至中度、輕度及正常，語言表達能力由差進步至正常範圍。本研究發現，EMT+PE在介入過程中，能夠強化兒童溝通及參與之動機，並同時提升SSD+LD兒童語音及語言之表現，研究結果可提供臨床介入及相關研究之參考。

關鍵字

促進式情境教學；音韻治療；語音異常；語言障礙；音韻歷程；兒童

並列摘要

The purpose of this study was to investigate the efficacy of the Enhanced Milieu Teaching with Phonological Emphasis(EMT+PE) to expedite speech intelligibility and language ability for children with moderate to severe speech sound disorders and language disorders(SSD+LD). A multiple baseline design across behaviors were used to examine intervention effects. Three preschoolers with moderate to severe SSD+LD at age 4;0 to 5;11 participated in the 24 hours EMT+PE sessions. The probes were administered during baseline, intervention, and follow-up phases to assess generalization and maintenance of phonological skills. Data were analyzed by visual analysis and effect size. In addition, other dependent variables, including: (1) percentages of consonants correct, (2) percentags of words correct, (3) percentages of intelligible words, and (4) percentages of phonological process occurrences ; and (1) mean length of utterances, (2) lexical diversity, and (3) expressive language scores in PLS were analyzed to compare the differences between pre- and post-intervention. The result of the study showed that participants exhibited significant improvement by the end of the intervention. In addition, other variables also exhibited significant gains. The participants’ speech abilities have improved from the rating of ‘severe’ to ratings of ‘moderate’, ‘mild’ or ‘normal’. Also, the participants’ language abilities have improved from the rating of ‘severe’ to the rating of ‘normal’.The result of this study could provide clinical and research application of the speech intervention for Mandarin-speaking children with SSD+LD.