丹佛早療模式和相關因子於自閉症類群障礙幼童之療效：文獻回顧

Effectiveness of Early Start Denver Model and Relevant Factors for Young Children With Autism Spectrum Disorder: A Systematic Review

徐卉昀(Hui-Yun Hsu) ； 黃湘涵(Hsiang-Han Huang) ； 蕭右欣(Yu-Hsin Hsiao) ； 蔡宜芳(Yi-Fang Tsai) ； 陳怡妤(Yi-Yu Chen)

《職能治療學會雜誌》 40卷2期 (2022/12) Pp. 243-273

https://doi.org/10.6594/JTOTA.202212_40(2).0004

摘要

研究背景：近年來以應用行為分析為基礎所發展出的丹佛早療模式，廣泛應用於1－4歲自閉症孩童族群；其聚焦在調整孩童之個人及環境因子並以遊戲和提升動機為依據。目的：本篇研究旨在更新並提供近六年關於丹佛早療模式療效討論的系統性文獻回顧。方法：藉由關鍵字和標題搜尋電子資料庫PubMed、Scopus、Springer Link、Google Scholar、華藝圖書館和手動尋找2015～2021間的中文和英文文獻，結果依照實證層級和品質、個案特徵、評估工具、介入療效、執行度、和治療劑量呈現。果：此篇回顧收錄17篇近六年已發表與丹佛早療模式有關的文章，其中少數屬於高研究層級研究且研究品質已有提升。共有644位年齡大多介於12～48個月的自閉症孩童收錄在此回顧中，無論是家長或治療師作為介入者，孩童在語言能力和溝通技巧上多能有顯著進步，而症狀嚴重程度和適應性行為則無定論。結論：提供每週訓練時間至少2.6小時且持續3個月以上的丹佛早療模式介入可增進學齡前自閉症孩童的語言溝通技巧，未來研究可根據劑量多寡探討症狀嚴重度及適應性行為的成效，並提供更多嚴謹、高實證層級的研究。

關鍵字

丹佛早療模式 ； 學齡前自閉症孩童 ； 語言及溝通 ； 症狀嚴重度 ； 適應性行為

並列摘要

Introduction: Based on Applied Behavior Analysis, Early Start Denver Model (ESDM) is widely applied in 1-4 year-old children with Autism Spectrum Disorder (ASD) in recent years. It focuses on modifying a child's personal and environmental factors based on play activities and enhanced motivation. Purpose: To provide guidelines for future intervention in young children with ASD, this study aims to update and provide the discussion on ESDM-related evidence in the recent 6 years through systematic review. Method: Keyword and title search were conducted on electronic databases (PubMed, Scopus, Springer Link, Google Scholar, Airiti Library, and manual searches) between 2015~2020, including both Chinese and English literature. The results were presented based on level of evidence, research quality, participants' characteristics, assessment tools, intervention effectiveness, fidelity, and training dosages. Results: This review includes 17 ESDM-related articles published in these 6 years. Few studies with high level of evidence and the research quality had increased. 644 children with ASD mainly aged from 12 to 48 months old were included. Children had significant improvements on language development and communication skills whether ESDM was implemented by the therapists or caregivers. However, severity of symptoms and adaptative behaviors were inconclusive. Conclusion: Providing at least 2.6-hour training of ESDM each week for at least 3 months can improve language and communication skills in preschool children with ASD. Future studies should focus on dose-response of ESDM on severity of symptoms and adaptative behaviors and increase the level of evidence.

並列關鍵字

Early Start Denver Model ； Preschoolers with Autism Spectrum Disorder ； Language and Communication ； Severity of Symptom ； Adaptive Behavior