情感協調介入取向之社會互動療效：以低詞彙量自閉症類群障礙症幼兒為例

Social Interaction Effects of an Affect Attunement Intervention: An Example of Autism Spectrum Disorder Toddlers with Low Vocabulary

林郁涵(Yu-Han Lin)

指導教授 ： 吳進欽

高雄醫學大學/人文社會科學院/心理學系碩士班/碩士(2019年)

摘要

研究背景與目的：過去研究顯示共享式注意力（joint attention, JA）與情感互動等社會溝通行為，影響兒童的語言及認知能力發展。自閉症類群障礙（autism spectrum disorder, ASD）幼兒在JA與情感互動的障礙，不僅影響其發展，也使其難以與父母進行正向情感交流。ASD幼兒在JA與情感互動上的缺陷，能透過介入方案改善。朱慶琳等人曾以共享式參與（joint engagement, JE）家長訓練方案，合併舞蹈治療之創造性律動取向，證實該方案具JA與JE的治療效果，但仍有療效不穩定及家長在學習治療技巧上的限制。當ASD幼兒發展遲緩，語言能力有限時，家長較難聚焦在增進彼此的情感協調性，此時由治療師執行介入較為合適。本研究旨在探討以治療師為主之情感協調介入取向，對ASD幼兒社會互動的治療效果及其伴隨療效。
研究方法：本研究採用個案研究設計，受試者為三名28至30個月大之低詞彙量ASD幼兒。自閉症診斷使用DSM-5診斷準則及自閉症診斷觀察量表（Autism Diagnostic Observation Schedule, ADOS）、自閉症診斷會談量表（Autism Diagnostic Interview-Revised, ADI-R）協助臨床診斷。介入方式為治療師與幼兒一對一進行，每週二次、每次30分鐘，進行十週共20次；核心概念為治療師使用情感協調介入取向做法，加入創造性律動元素，協調幼兒的情感來促進其社會互動及其他伴隨能力。療效評估的部分以半結構、標準化評估工具及介入影片行為編碼進行分析。
研究結果：三名個案在介入後社會互動能力有一定程度的改善，且伴隨之認知及語言能力皆有進步。
結論：研究發現情感協調介入取向對於低詞彙量ASD幼兒的社會互動及其他伴隨能力有所幫助，但對於幼兒之適應行為、問題行為及母親之親職壓力的部分則改善有限。未來研究可以納入更多樣本持續探究。

關鍵字

情感協調介入取向 ； 自閉症類群障礙症幼兒 ； 社會互動能力

並列摘要

Purpose: Children’s language and cognition abilities are related to social communication behaviors such as joint attention (JA) and emotional exchange. The impairments of JA are core deficits in autism spectrum disorder (ASD). Thus, toddlers with ASD have difficulty in sharing affective experience with others. Previous study by Chu et al., a caregiver-mediated joint engagement (CMJE) intervention program that merging creative movement play was developed and could improve joint engagement (JE). Due to the CMJE program delivered by parents, it is difficult for parents to focus on the affect attunement when their children with limited language ability. An affect attunement intervention conducted by therapist is therefore suitable for these toddlers with limited language ability.
Methods: A case study design was conducted. Participants were three toddlers with ASD ages 28-30 months with low vocabulary. The diagnosis were confirmed by using DSM-V criterion combined with Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R). The program consisted of 20 sessions with 30 minutes a session and twice a week. Affect attunement intervention with creative movement play conducted by therapist, attune the toddlers’ affect to facilitate social interaction abilities. Program efficacy were collected through unstructured activities and standardized tools.
Results: Results indicated that all participants had made some improvements in social interactions and collateral abilities such as cognition and language.
Conclusion: The findings showed that the affect attunement intervention could enhance social interaction and collateral abilities, but there were no significant difference in adaptive behaviors, behavioral problems and parent stress. Further studies may recruit more participants to learn the effects of affect attunement intervention in toddlers with ASD.

並列關鍵字

affect attunement intervention ； autism spectrum disorder ； social interaction

參考文獻

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