動勢擷取介入對自閉症類群障礙幼兒社會參與之療效研究

研究目的：共享式參與（joint engagement, JE）為自閉症類群障礙症（autism spectrum disorder, ASD）幼兒的核心缺陷之一，就相互主體性的發展脈絡來探究JE缺陷的心理病理機制，一般發展幼兒最先出現人-人遊戲，以身體互動來建立雙方的情感連結，並逐漸在遊戲中加入玩具而發展出JE。故本研究旨在以動勢擷取介入透過身體互動與ASD幼兒進入情感諧調，使其產生與人互動及分享的內在動機，增加自然發展出JE的機會。研究方法：本研究以3名2歲至4歲的中低功能ASD幼兒為對象，採單一受試實驗設計之多基準線跨受試設計與多探試設計，分為基線期、介入期及追蹤期三個階段。以結構身體活動評估基線期表現，介入期則進行每週2次、每次40分鐘、共17至19次介入，針對身形力度、韻律密度、感覺強度之身體動勢三面向進行擷取介入，在各階段皆以親子自由遊戲評估家長類化與維持效果。由獨立評分員觀看影片針對各項療效指標編碼，療效指標包括投入與人的互動與協調一致的共享式參與（coordinated joint engagement, CJE）合計時間、眼神注視時間、自發溝通動作及語音合計次數，並以身體動勢量表評估動勢改變歷程。研究結果：研究結果發現，主要療效指標在介入後皆有進步的趨勢，但趨勢不穩定，類化及維持效果則不明顯，而身體動勢各面向在介入後皆趨向適中範圍。總結：本研究之結果顯示動勢擷取介入對人際參與有介入效果，而趨勢不穩定與類化及維持效果不明顯之問題，仍需考慮介入強度之影響，以及療效指標與測量方式的選擇。此外，本研究指出，應留意除JE之外，單純與人互動過程中也可能出現具分享意圖的行為，並強調與ASD幼兒達到情感連結與建立關係之重要性。最後，討論本研究限制、未來研究方向及臨床應用。

關鍵字

自閉症類群障礙幼兒；舞蹈動作治療；動勢擷取介入；情感諧調；共享式參與

並列摘要

Purpose: Joint engagement (JE) is one of the core deficits in young children with autism spectrum disorder (ASD). In typical development of intersubjectivity, person-person game occurs first when caregiver interacts with their baby before 6 months. Affect connection between infant and caregiver is developed mainly through body interaction. Then, JE occurs when the toys are added to the games during caregiver-infant interaction after 6 months. The purpose of this study was to explore the effects of Dongshi movement intervention, which established affect attunement with young children with ASD through body interaction to increase their motivation to interact and share interests with others, so to develop JE naturally. Methods: Three young children aged 2-4 years with middle-to-low functioning ASD were recruited. The study used a single case design with multiple baseline design across cases and multiple probe design, including baseline, intervention and follow-up phases. The structural body assessment was used to evaluate behaviors of participants at baseline. In intervention phases, Dongshi movement intervention consisted of 17-19 sessions with 40 minutes per session and twice a week. Caregiver-child free play interaction was used to evaluate generalization in all phases. The primary outcome measures included the total time of engaging in interaction with person and coordinated joint engagement (CJE), time of eye contact, and the total times of spontaneous communication with actions and voice or language. The body Dongshi inventory was used to evaluate the changing process of body Dongshi. Results: Results showed that intervention effects for primary outcome measures of social engagement were observed in three participants, but all the trends were not stable. Effects of generalization and maintenance were not obvious. Effects of body Dongshi were observed in three participants. Conclusions: Results showed the intervention effects on social engagement. However, the trends were not stable, and effects of generalization and maintenance were not obvious. The present study found that the behaviors with motivation to interact and share interests with others not only occurred in JE, but also revealed while engaging in interaction with person even if there isn’t any toy or object. Furthermore, the present study emphasized the importance of establishing affect connection and relationship to improve their social engagement in young children with ASD. Finally, research limitations in the current study were discussed. The author also provided suggestions for the future studies and clinical practice.