臺灣自閉症類群障礙幼兒丹佛早療模式之療效研究

The Effects of Implementing Early Start Denver Model for Young Children with Autism ... 適應行為評量系統第二版（ABAS–II）中文－幼兒版。

Togglenavigation 主頁 Post-Print 關於學術集成 English 正體中文 理學院學位論文Item 研究者 學系 學術產出 文章檢視/開啟 (122) 書目匯出 EndnoteRIS格式資料匯出 Bibtex格式資料匯出 GoogleScholarTM 搜尋 政大圖書館 學術資源探索系統 引文資訊 社群sharing TAIR相關學術產出 >SimpleRecord >FullRecord 欄位 名稱 題名: 臺灣自閉症類群障礙幼兒丹佛早療模式之療效研究TheEffectsofImplementingEarlyStartDenverModelforYoungChildrenwithAutismSpectrumDisorderinTaiwan作者: 林姿伶Lin,Tzu-Ling貢獻者: 姜忠信Chiang,Chung-Hsin林姿伶Lin,Tzu-Ling關鍵詞: 自閉症類群障礙綜合性早期療育丹佛早療模式療效預測指標AutismspectrumdisorderComprehensiveearlyinterventionEarlyStartDenverModelPredictors日期: 2019上傳時間: 2019-12-0609:21:50(UTC+8)描述.abstract: 研究目的：本研究採用丹佛早療模式（EarlyStartDenverModel,ESDM），與北部兒童發展聯合評估中心合作，建立參考台灣早期療育服務系統現況之ESDM早療模式，探討針對自閉症類群障礙（AutismSpectrumDisorder,ASD）幼兒實施ESDM早療模式的介入療效及預測療效之因素。

研究方法：本研究共招募42名25至46個月大確診ASD或疑似ASD幼兒，採用個案控制研究設計，分為ESDM介入組21名（平均年齡33.23個月），以及配對生理年齡、整體發展商數與性別之一般介入組21名（平均年齡35.14個月）。

ESDM介入組受試幼兒接受為期24週、每週平均8.27小時的個別ESDM介入及每週平均1.5小時的一般醫療院所、坊間、特幼或發展中心早療介入，一般介入組受試幼兒則接受每週平均12.3小時的一般醫療院所、坊間、特幼或發展中心早療介入。

另外，ESDM介入組受試幼兒之家長在24週介入期間隔週接受1小時、共12次的ESDM介入策略家長團體教育。

本研究使用穆林早期學習量表、華語嬰幼兒溝通發展量表、適應行為評量系統第二版及自閉症診斷觀察量表分別在介入前（時間一）及介入24週後（時間點二）兩個時間點測量兩組受試幼兒之認知能力、口語表達、適應行為及症狀嚴重度做為受試幼兒之療效指標，檢視兩組幼兒之介入療效；同時在時間一、二也收集家長親職效能及親職壓力資料，做為家長療效指標。

此外，在時間點一測量兩組幼兒之氣質特徵、感覺處理、模仿、遊戲及社會定向反應等資料做為療效預測因素之探測。

研究結果：研究結果顯示ESDM介入組低功能ASD幼兒的非語文認知能力、語文認知能力、整體認知能力、總詞彙量及症狀嚴重度方面有顯著優於低功能一般介入之療效，ESDM介入組ASD幼兒家長在介入後的父母親職壓力有顯著的降低，尤其是在親職角色投入的壓力有顯著降低，一般介入組ASD幼兒家長則無此療效進展。

ESDM介入組ASD幼兒在時間點一具較佳的模仿及遊戲表現能預測其介入後認知能力的正向進展；時間點一具較佳的主動性共享式注意力及較低的物品探索興趣能預測介入後症狀嚴重度的降低。

結論：本研究結果指出，參考台灣早療現況所建立之ESDM早療模式，也就是短期、中低密集度ESDM介入能夠提供ASD幼兒及其家長正向的影響。

此外，本研究也發現ASD幼兒介入前之個別行為特徵表現，如模仿、遊戲及共享式注意力會影響其介入後進展表現。

未來研究宜持續累積樣本，採用適當的研究控制組及研究測量，採用隨機控制研究設計以釐清影響兒童及家長進展之因素。

Objectives:ThisstudyaimedtoevaluatetheoutcomesandoutcomepredictorsofimplementingtheEarlyStartDenverModel(ESDM)basedonTaiwanesepublichealthpolicyforyoungchildrenwithAutismSpectrumDisorder(ASD)intheGreaterTaipeiareainTaiwan.Methods:Acasecontrolstudywasconducted.Atotalof42childrenwithaDSM­5diagnosisofASDorsuspectedASDagedbetween25and46monthswererecruited.TheESDMinterventiongroup(N=21,meanage=33.23months)matchedtothecontrolgroup(N=21,meanage=35.14months)onchronologicalage,overalldevelopmentquotient(DQ)andsex.ChildreninESDMinterventiongroupreceived9hoursperweekofone­on­oneESDMinterventioninclinicalsettingsfor24weeks.Inaddition,parentsinESDMinterventiongroupreceived121-hourparenteducationsessions.Childrenoutcomemeasureswereadministeredpre­andpost­intervention,comprisingthecognitiveability,language,adaptivebehaviorsandsymptomseverityassessedbytheMullenScalesofEarlyLearning,Mandarin-ChineseCommunicativeDevelopmentInventory(Taiwan),AdaptiveBehaviorAssessmentSystem,SecondEditionandAutismDiagnosticObservationScales,respectively.Parentaloutcomemeasureswerealsoadministeredpre­andpost­intervention,comprisingparentalself-efficacyandparentingstress.Outcomepredictorsmeasureswereadministeredpre­intervention,comprisingtemperament,sensoryprocess,imitation,playandsocialorientation.Results:Theresultsindicatedthatlow-functioningchildreninESDMinterventionshowedsignificantlygreaterimprovementsinnonverbalcognitiveability,verbalcognitiveability,overallcognitiveability,vocabularyproduction,andsymptomseveritythanlow-functioningchildrenincontrolgroupdid.ParentsinESDMinterventionsignificantlydecreasemoreinparentingstressthanparentsincontrolgroupdid.ChildreninESDMinterventionhavingbetterimitationandplayperformancespre-interventioncanpredictbetterimprovementsincognitiveability,andhavingmoreinitiatingjointattentionandlowerobjectexploringcanpredictmoredecreaseinsymptomseverity.Conclusions:ThisstudyprovidessupportsontheimplementationofESDMinTaiwan.Theresultssuggestthatashort­termlow­intensityESDMinterventiondirectlydeliveredbyamultidisciplinaryteaminclinicalsettingsmaybeapromisingtreatmentforyoungchildrenwithASD.Inaddition,theimitation,palyandinitiatingjointattentionareoutcomepredictorforyoungchildrenwithASDreceivingESDMinterventioninTaiwan.FuturestudiesinTaiwanareindicated,includinglargersamplesize,andwhichincorporateanewESDMdesigncontrolgrouptoconductrandomizedcontrolstudies.參考文獻: 王慧婷（2016）。

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DC欄位 名稱 語言 dc.contributor.advisor姜忠信zh_TWdc.contributor.advisorChiang,Chung-Hsinen_USdc.contributor.author林姿伶zh_TWdc.contributor.authorLin,Tzu-Lingen_USdc.creator(作者)林姿伶zh_TWdc.creator(作者)Lin,Tzu-Lingen_USdc.date(日期)2019en_USdc.date.accessioned2019-12-0609:21:50(UTC+8)-dc.date.available2019-12-0609:21:50(UTC+8)-dc.date.issued(上傳時間)2019-12-0609:21:50(UTC+8)-dc.identifier(其他Identifiers)G0101752502en_USdc.identifier.uri(URI)http://nccur.lib.nccu.edu.tw/handle/140.119/127729-dc.description(描述)博士zh_TWdc.description(描述)國立政治大學zh_TWdc.description(描述)心理學系zh_TWdc.description(描述)101752502zh_TWdc.description.abstract(摘要)研究目的：本研究採用丹佛早療模式（EarlyStartDenverModel,ESDM），與北部兒童發展聯合評估中心合作，建立參考台灣早期療育服務系統現況之ESDM早療模式，探討針對自閉症類群障礙（AutismSpectrumDisorder,ASD）幼兒實施ESDM早療模式的介入療效及預測療效之因素。

研究方法：本研究共招募42名25至46個月大確診ASD或疑似ASD幼兒，採用個案控制研究設計，分為ESDM介入組21名（平均年齡33.23個月），以及配對生理年齡、整體發展商數與性別之一般介入組21名（平均年齡35.14個月）。

ESDM介入組受試幼兒接受為期24週、每週平均8.27小時的個別ESDM介入及每週平均1.5小時的一般醫療院所、坊間、特幼或發展中心早療介入，一般介入組受試幼兒則接受每週平均12.3小時的一般醫療院所、坊間、特幼或發展中心早療介入。

另外，ESDM介入組受試幼兒之家長在24週介入期間隔週接受1小時、共12次的ESDM介入策略家長團體教育。

本研究使用穆林早期學習量表、華語嬰幼兒溝通發展量表、適應行為評量系統第二版及自閉症診斷觀察量表分別在介入前（時間一）及介入24週後（時間點二）兩個時間點測量兩組受試幼兒之認知能力、口語表達、適應行為及症狀嚴重度做為受試幼兒之療效指標，檢視兩組幼兒之介入療效；同時在時間一、二也收集家長親職效能及親職壓力資料，做為家長療效指標。

此外，在時間點一測量兩組幼兒之氣質特徵、感覺處理、模仿、遊戲及社會定向反應等資料做為療效預測因素之探測。

研究結果：研究結果顯示ESDM介入組低功能ASD幼兒的非語文認知能力、語文認知能力、整體認知能力、總詞彙量及症狀嚴重度方面有顯著優於低功能一般介入之療效，ESDM介入組ASD幼兒家長在介入後的父母親職壓力有顯著的降低，尤其是在親職角色投入的壓力有顯著降低，一般介入組ASD幼兒家長則無此療效進展。

ESDM介入組ASD幼兒在時間點一具較佳的模仿及遊戲表現能預測其介入後認知能力的正向進展；時間點一具較佳的主動性共享式注意力及較低的物品探索興趣能預測介入後症狀嚴重度的降低。

結論：本研究結果指出，參考台灣早療現況所建立之ESDM早療模式，也就是短期、中低密集度ESDM介入能夠提供ASD幼兒及其家長正向的影響。

此外，本研究也發現ASD幼兒介入前之個別行為特徵表現，如模仿、遊戲及共享式注意力會影響其介入後進展表現。

未來研究宜持續累積樣本，採用適當的研究控制組及研究測量，採用隨機控制研究設計以釐清影響兒童及家長進展之因素。

zh_TWdc.description.abstract(摘要)Objectives:ThisstudyaimedtoevaluatetheoutcomesandoutcomepredictorsofimplementingtheEarlyStartDenverModel(ESDM)basedonTaiwanesepublichealthpolicyforyoungchildrenwithAutismSpectrumDisorder(ASD)intheGreaterTaipeiareainTaiwan.Methods:Acasecontrolstudywasconducted.Atotalof42childrenwithaDSM­5diagnosisofASDorsuspectedASDagedbetween25and46monthswererecruited.TheESDMinterventiongroup(N=21,meanage=33.23months)matchedtothecontrolgroup(N=21,meanage=35.14months)onchronologicalage,overalldevelopmentquotient(DQ)andsex.ChildreninESDMinterventiongroupreceived9hoursperweekofone­on­oneESDMinterventioninclinicalsettingsfor24weeks.Inaddition,parentsinESDMinterventiongroupreceived121-hourparenteducationsessions.Childrenoutcomemeasureswereadministeredpre­andpost­intervention,comprisingthecognitiveability,language,adaptivebehaviorsandsymptomseverityassessedbytheMullenScalesofEarlyLearning,Mandarin-ChineseCommunicativeDevelopmentInventory(Taiwan),AdaptiveBehaviorAssessmentSystem,SecondEditionandAutismDiagnosticObservationScales,respectively.Parentaloutcomemeasureswerealsoadministeredpre­andpost­intervention,comprisingparentalself-efficacyandparentingstress.Outcomepredictorsmeasureswereadministeredpre­intervention,comprisingtemperament,sensoryprocess,imitation,playandsocialorientation.Results:Theresultsindicatedthatlow-functioningchildreninESDMinterventionshowedsignificantlygreaterimprovementsinnonverbalcognitiveability,verbalcognitiveability,overallcognitiveability,vocabularyproduction,andsymptomseveritythanlow-functioningchildrenincontrolgroupdid.ParentsinESDMinterventionsignificantlydecreasemoreinparentingstressthanparentsincontrolgroupdid.ChildreninESDMinterventionhavingbetterimitationandplayperformancespre-interventioncanpredictbetterimprovementsincognitiveability,andhavingmoreinitiatingjointattentionandlowerobjectexploringcanpredictmoredecreaseinsymptomseverity.Conclusions:ThisstudyprovidessupportsontheimplementationofESDMinTaiwan.Theresultssuggestthatashort­termlow­intensityESDMinterventiondirectlydeliveredbyamultidisciplinaryteaminclinicalsettingsmaybeapromisingtreatmentforyoungchildrenwithASD.Inaddition,theimitation,palyandinitiatingjointattentionareoutcomepredictorforyoungchildrenwithASDreceivingESDMinterventioninTaiwan.FuturestudiesinTaiwanareindicated,includinglargersamplesize,andwhichincorporateanewESDMdesigncontrolgrouptoconductrandomizedcontrolstudies.en_USdc.description.tableofcontents第一章緒論1第一節研究背景與目的1第二節文獻回顧5壹、ASD綜合性早療模式5貳、丹佛早療模式（EarlyStartDenverModel,ESDM）療效研究17參、ASD綜合性早療療效預測指標28肆、ASD綜合性早療療效研究總結39第三節研究問題與假設42第二章研究方法46第一節研究對象46第二節研究測量53壹、療效指標53貳、療效預測指標56參、其他測量指標65第三節ESDM早療模式設計66第四節資料分析69第三章研究結果71第一節ESDM介入及一般介入之療效71壹、組內介入前、後測比較71貳、組間介入後進展程度比較80第二節高、低功能ASD幼兒介入進展比較86壹、組內介入前、後測比較86貳、組間介入後進展程度比較103第三節ESDM早療模式療效預測變項122壹、ESDM介入組整體受試者之療效預測122貳、低功能ESDM介入組受試者之療效預測124第四章討論129第一節ESDM早療模式之療效129壹、兒童療效129貳、家長療效136第二節ESDM早療模式之療效預測指標139第三節本研究ESDM早療模式之發展142第四節結論與建議145參考文獻148附錄一受試者學前階段治療活動調查表166附錄二ESDM介入治療師培訓工作坊課程主題167附錄三ESDM小團體點心時間課程流程設計168zh_TWdc.format.extent4782514bytes-dc.format.mimetypeapplication/pdf-dc.source.uri(資料來源)http://thesis.lib.nccu.edu.tw/record/#G0101752502en_USdc.subject(關鍵詞)自閉症類群障礙zh_TWdc.subject(關鍵詞)綜合性早期療育zh_TWdc.subject(關鍵詞)丹佛早療模式zh_TWdc.subject(關鍵詞)療效zh_TWdc.subject(關鍵詞)預測指標zh_TWdc.subject(關鍵詞)Autismspectrumdisorderen_USdc.subject(關鍵詞)Comprehensiveearlyinterventionen_USdc.subject(關鍵詞)EarlyStartDenverModelen_USdc.subject(關鍵詞)Predictorsen_USdc.title(題名)臺灣自閉症類群障礙幼兒丹佛早療模式之療效研究zh_TWdc.title(題名)TheEffectsofImplementingEarlyStartDenverModelforYoungChildrenwithAutismSpectrumDisorderinTaiwanen_USdc.type(資料類型)thesisen_USdc.relation.reference(參考文獻)王慧婷（2016）。

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