自閉症類群障礙症兒童之家長遠距自學方案成效：一項初步的探究

Self-Directed Telehealth Parent Learning Program for Young Children with Autism Spectrum Disorder: A Pilot Study

廖之寧(Liao Chih-Ning)

指導教授 ： 姜忠信

國立政治大學/理學院/心理學系/碩士(2022年)

https://doi.org/10.6814/NCCU202200831

摘要

研究目的：本研究結合丹佛早療模式 (Early Start Denver Model, ESDM) 及讓家長成為孩子溝通訓練的老師 (Improving Parents As Communication Teachers, ImPACT) 兩種早期療育方式，建立專屬的網站提供家長訓練方案，以檢視遠距教學模式對家長學習教學技巧的效果。
研究方法：本研究共招募51名18至54個月大確診之自閉症類群障礙症 (Autism Spectrum Disorder, ASD) 之兒童，依據ASD兒童之性別、月齡及認知發展商數分組後採用隨機控制 (randomize controlled trial, RCT) 研究設計分為對照組 (23人) 及網路課程組 (28人)。網路課程組觀看每週約20分鐘之課程影片，共十三週，對照組則在經過十三週的等待期後再開放課程影片的觀看權限。本研究在介入前後使用親職效能量表及家中親子互動影片來觀察主要照顧者之介入真確度及親職效能資料；同時亦在介入前後皆使用社會溝通檢核表、華語嬰幼兒溝通發展量表、文蘭適應行為量表第三版—中文版 (幼兒版)、阿肯巴克實證衡鑑系統—一歲半至五歲兒童行為檢核表等，來測量ASD兒童之社交溝通能力、口語表達能力、適應行為能力及問題行為之進展。
研究結果：研究結果顯示，網路課程組的主要照顧者在介入真確度上，相較於對照組，於第二次評估時有顯著的進步 (p < 0.5)，然在親職效能表現無進展。另一方面，在ASD兒童的一些領域能力上有時間效果，顯示在第二次評估時有進展，但兩組參與者進步程度未有顯著差異 (p > 0.5)。
結論：本研究結果指出，利用網路課程的學習可以有效提升主要照顧者的介入教學技巧，但本研究認為未來研究應提供對照組無關介入技巧的網路課程，以減少流失者；同時亦應持續累積樣本，以了解ASD兒童在各項能力的進展歷程與主要照顧者介入教學技巧之關係。

關鍵字

自閉症類群障礙症 ； 丹佛早療模式 ； 讓家長成為孩子溝通訓練的老師 ； 遠距家長訓練方案

並列摘要

Purpose: The study integrated two models of early intervention of children with autism spectrum disorder (ASD), Early Start Denver Model (ESDM) and Improving Parents As Communication Teachers (ImPACT), to establish a website-based parent-mediated intervention. The purpose of this study is to examine the effect of telehealth parent-mediated intervention on teaching skill improvement of caregivers.
Methods: A randomize controlled trial (RCT) was conducted. A total of 51 children with a DSM­5 diagnosis of ASD or suspected ASD aged between 18 and 54 months were recruited, and divided into control group (N=23, mean age=37.11) and telehealth group (N=28, mean age=33.96) according to their sex, age, and development equivalent (DQ). Caregivers in telehealth group had the permission to the website for watching the 20-minute classes weekly for 13 weeks, while caregivers in control group is on the waiting list. Parental outcome measures were also administered pre­ and post program, comprising parental self-efficacy and intervention skills assessed by Chinese Version of Parenting Sense of Competence Scale and ESDM Fidelity Tool. Children outcome measures were administered pre- and post-program, comprising the social communication ability, language ability, adaptive behaviors and problem behaviors assessed by Social Communication Checklist, Mandarin-Chinese Communicative Development Inventory (Taiwan), Vineland Adaptive Behavior Scales - Third Edition, and Child Behavior Checklist for Ages 1.5-5, CBCL / 1.5-5.
Results: The result indicated that parents in telehealth group also showed significantly greater improvements in fidelity than parents in control group at post-program (p < 0.5), but parental self-efficacy didn’t improve. On the other hand, some outcomes of ASD children had time effects, indicating improvement at post-program, but the degree of improvement between two groups was not significantly different (p > 0.5).
Conclusions: The result showed the effects on intervention skill improvement on parents, which indicated telehealth parent-mediated intervention had influence on parents. However, future studies are suggested to provide more resources for control group to prevent dropout. Besides, future studies are encouraged to include more samples to clarify the relationship between the progress of children abilities and the intervention skill of the caregivers.

並列關鍵字

Autism spectrum disorder ； Early Start Denver Model ； Improving Parents As Communication Teachers ； Self-directed telehealth parent learning program

參考文獻

Ingersoll, B., Wainer, A. L., Berger, N. I., Pickard, K. E., & Bonter, N. (2016). Comparison of a self-directed and therapist-assisted telehealth parent-mediated intervention for children with ASD: A pilot RCT. Journal of Autism and Developmental Disorders, 46(7), 2275-2284. https://doi.org/10.1007/s10803-016-2755-z

Vismara, L. A., McCormick, C., Young, G. S., Nadhan, A., & Monlux, K. (2013). Preliminary findings of a telehealth approach to parent training in autism. Journal of Autism and Developmental Disorders, 43(12), 2953-2969. https://doi.org/10.1007/s10803-013-1841-8

Wainer, A. L., & Ingersoll, B. R. (2015). Increasing access to an ASD imitation intervention via a telehealth parent training program. Journal of Autism and Developmental Disorders, 45(12), 3877-3890. https://doi.org/10.1007/s10803-014-2186-7

Ingersoll, B., & Dvortcsak, A.（2020a）。教導自閉症幼兒社會溝通能力：家長手冊—第二版（陳孟筳、倪子洛、陳思臻、蔡曉薇譯）。洪葉文化。（原著出版年：2019）。

Ingersoll, B., & Dvortcsak, A.（2020b）。教導自閉症幼兒社會溝通能力：教練手冊—第二版（姜忠信、陳孟筳、倪子洛、江淑蓉、陳思臻、蔡曉薇、呂幸芳譯）。洪葉文化。（原著出版年：2019）。