國小高功能泛自閉症兒童學校參與之預測因子

Predictors of School Participation in Children with High Functioning Autism Spectrum Disorder

王怡婷(Yi-Ting Wang)

指導教授 ： 曾美惠

國立臺灣大學/醫學院/職能治療研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.10263

摘要

泛自閉症障礙兒童是學校參與受限的高危險群，因為其在社交互動和溝通上的缺陷，在許多發展領域上也有障礙，會進一步影響他們在學校的參與。本研究的目的為從兒童的內在與外在因子，探討在臺灣國小高功能泛自閉症兒童學校參與之預測因子。進一步去探討兒童在下列六項學校主要活動場合參與的預測因子，包括教室、餐飲場合、灌洗如廁、校園內行走移動、上學及放學之交通工具使用與行動、和操場與其他遊戲休閒場合。
　　共有44位就讀一到六年級的高功能泛自閉症兒童參與本研究。參與者轉介自臺灣的發展中心、醫學中心的復健部、學校、醫院的復健科、早期療育中心和早期教育計畫。獨立變項包括與兒童相關的內在因子：兒童的年齡、性別、是否合併注意力缺失/過動疾患、認知功能、執行功能、動作能力、感覺處理、語言接收能力、行為問題、自閉症症狀的嚴重程度、和兒童的活動表現和外在因子：主要照顧者的教育程度、工作狀況、兒童、是否為獨生子 、一週接受療育的時間、目前的教育安置、兒童目前學業程度是否跟得上同儕、在學校是否有申請服務。兒童的學校老師根據兒童在學校參與的程度填寫「學校日常生活功能評量」 (SFA)。　
　　結果顯示兒童的年齡、獨生子、主要照顧者的工作狀況、主要照顧者的教育程度、一週接受療育的時間、執行功能、語言接收能力、目前的教育安置、學生目前的學業程度、在學校是否有接受療育和在認知/行為的活動表現和兒童的學校參與間有明顯的關係。在教室情境的主要預測因子有主要照顧者的工作狀況、兒童的執行功能、目前的學業程度、一週接受療育的時間和兒童在工作/活動行為的表現。在餐飲場合的主要預測因子有獨生子、目前的教育安置、目前的學業程度和兒童在工作/活動行為的表現。在灌洗如廁場合，主要照顧者的教育程度是重要的預測因子。在校園內行走移動情境，主要預測因子有在學校是否有申請療育、兒童在記憶及理解力和遵從大人指示及校規行為的表現。在上學及放學之交通工具使用與行動情境，主要預測因子有獨生子、執行功能和在自我安全維護行為的表現。操場與其他遊戲休閒場合，年齡、主要照顧者的工作狀況、語言接收能力和在學校是否有申請療育是主要的預測因子。
　　對兒童學校參與的了解可以幫助臨床人員和教育人員以這些預測因子來設計介入和教育計畫，以促進小學高功能泛自閉症障礙兒童的學校參與。

關鍵字

泛自閉症障礙 ； 學校參與 ； 預測因子

並列摘要

Children with Autism Spectrum Disorders (ASD) are at high risk for school participation restricted due to their deficits in social interaction and communication, as well as difficulties in several developmental domains. The aim of this study was to identify predictors of school participation in elementary school children with high functioning ASD in Taiwan from both the intrinsic characteristics of children and extrinsic factors. Furthermore, the predictors of school participation were examined in six different settings in school: Classroom, Mealtime, Bathroom, Transitions, Transportation and Playground.
　　Caregivers of total of 44 children with high functioning ASD (mean age 101.16 months, SD 20.77 months) participated in the study along with the teachers. They were recruited from developmental centers, departments of physical medicine and rehabilitation at medical centers, elementary schools, pediatric rehabilitation clinics at hospitals, early intervention center and early education program in Taiwan. The relationship between school participation and the factors related to the child (intrinsic factors) and factors related to the environment (extrinsic factors) was examined. Factors related to the child included child chronologic age, gender, co-morbidity, cognitive function, executive function, motor function, sensory processing, receptive language function, behavior problems, severity of autistic symptoms and cognitive/behavioral activity performance (e.g. Functional Communication, Memory and Understanding, Following Social Conventions, Compliance with Adult Directives and School Rules, Task Behavior/Completion, Positive Interaction, Behavior Regulation, Personal Care Awareness and Safety). Extrinsic factors were only child, caregiver’s education level, caregiver’s job status, hours of therapy services received per week, current educational placement, current academic performance, services received in school. Teachers rated their student’s school participation using the School Function Assessment.
　　Results of stepwise linear regression models showed that child chronologic age, being only child, caregiver ‘s job status, caregiver’s education level, hours of therapy services received per week, executive function, receptive language function, student currently performing academically at grade level, services received in school and activity performances of cognitive/behavioral tasks were associated with successful participation in different elementary school settings. Knowledge of predictors of school participation helps clinicians and educators to plan intervention and educational programs targeted at these predictors to improve participation in elementary school for children with high functioning ASD.

並列關鍵字

autism spectrum disorders ； school participation ； predictors ； elementary school

參考文獻

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