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系統識別號 U0026-0502201816285900
論文名稱(中文) 家長訓練療程於學齡前自閉症孩童之成效探討
論文名稱(英文) The Effectiveness of a Parent-training Program for Preschool Children with Autism Spectrum Disorder
校院名稱 成功大學
系所名稱(中) 職能治療學系
系所名稱(英) Department of Occupational Therapy
學年度 106
學期 1
出版年 107
研究生(中文) 何孟欣
研究生(英文) Meng-Hsin Ho
電子信箱 t76044011@ot.ncku.edu.tw
學號 T76044011
學位類別 碩士
語文別 英文
論文頁數 78頁
口試委員 指導教授-林玲伊
口試委員-劉萌容
口試委員-蘇泓洸
中文關鍵字 自閉症類群障礙  介入  家長訓練  兒童發展  DIR模式  適應性功能 
英文關鍵字 autism spectrum disorder  intervention  parent-training  DIR model  development  adaptive functioning 
學科別分類
中文摘要 前言與文獻回顧:學齡前自閉症類群障礙兒童及其家長在日常生活面臨許多困難,包含兒童的適應性功能較差、家長的親職技巧不足及親職壓力過高,有效地介入方式對自閉症家庭極為重要。目前臨床治療人力不足,家長訓練療程將會是更具效益且在台灣可行的方式。遊戲(Play)及發展性個別差異、關係本位模式(Developmental, individual difference, and relationship-based model, DIR)不僅符合職能治療觀點,且此類型的家長訓練療程已具初步療效證據,可有效助於自閉症類群障礙兒童之發展。然而,過往研究證據層級較弱,亦較少研究探討孩童之適應性功能,且研究結果對於是否能有效改善親職技巧及降低親職壓力尚不一致。研究目的:本研究藉由相同介入時間的控制組及實驗組檢驗以遊戲及DIR為基礎的家長訓練療程對兒童適應性功能、家長親職技巧及親職壓力的療效。研究假設:實驗組家長訓練療程之兒童發展、適應性功能及家長親職技巧、親職壓力改善程度將優於控制組傳統療程。研究方法:本研究納入36位自閉症類群障礙兒童及其家長,所有受試者隨機分派至家長訓練療程組或傳統療程組。兩組皆接受為期14週的介入療程,並於療程前、後接受完整測驗。研究以功能性情緒評估量表(Functional Emotional Assessment Scale)、中文版自閉症兒童心理教育評核第三版(Psychoeducational Profile)和中文版文蘭適應行為量表(Vineland Adaptive Behavior Scales)評估兒童之發展階段及適應性功能;功能性情緒評估量表及親職壓力量表簡式版(Parenting Stress Index-Short Form)將用以評估家長的親職技巧及親職壓力。研究結果:功能性情緒評估量表分數具顯著組間差異;家長訓練療程組在功能性情緒評估量表分數、自閉症兒童心理教育評核之溝通及動作合成項目、文蘭適應行為量表之溝通、日常生活技巧及總量表具顯著組內差異;傳統療程組僅在自閉症兒童心理教育評核之溝通合成項目和文蘭適應行為量表之動作技巧具顯著組內差異。兩組家長親職壓力無顯著改善,但皆高度滿意介入療程。討論與結論:本研究結果支持以遊戲及DIR為基礎的家長訓練療程可有助於自閉症類群障礙兒童之發展、適應性功能及親職技巧。此具實證基礎的療程符合現今臨床現況,並可適用於臺灣醫療情境。
英文摘要 Introduction: Preschool children with autism spectrum disorder and their parents face many difficulties in daily lives, including children’s adaptive functioning, parenting skills, and parenting stress. Therefore, effective and economical interventions are very important to support them. With appropriate theoretical bases, a parent-training program could be effective, economical, and feasible while the clinical manpower is insufficient. Among current intervention programs, the play concept and the developmental, individual difference, and relationship-based (DIR) model match the philosophy of occupational therapy. Previous research had showed the play- and DIR-based parent-training programs would improve children’s communicative development. However, the empirical evidence was still weak due to poor research designs and little research was comprehensively investigated children’s adaptive functioning. Moreover, the results of improvement in parenting skills and reduction of parenting stress were not consistent. Aim: This study would implement a dose-matched control group and comprehensive measurements to examine if the play- and DIR-based parent-training program would improve children’s adaptive functioning and parents’ parenting skills as well as reduce parenting stress. Hypotheses: We hypothesized that the better improvements would show in the parent-training program than those in the traditional program. Method: Thirty-six preschool children with autism spectrum disorder and their parents were included and randomly assigned them to either the parent-training program group or the traditional program group after pretest phase. Both of them conducted 14-week intervention programs and were assessed after interventions. Children’s development levels and adaptive functioning were assessed by the Functional Emotional Assessment Scale (FEAS), the Chinese version of Psychoeducational Profile-Third edition (CPEP-3), and the Vineland Adaptive Behavior Scales (VABS). In addition, parents’ parenting skills were assessed by the FEAS and parenting stress was evaluated by the Parenting Stress Index-Short Form. Results: The significant differences showed in the FEAS scores between two groups. The parent-training program had significant within-group differences in the FEAS, communication and motor composites in the CPEP-3, and communication, daily living skills, and total scales in the VABS. The traditional program only showed significant differences in the communication composite in the CPEP-3 and motor skills in the VABS. Both groups remained stable parenting stress but presented high satisfaction. Discussions/conclusion: The results suggested that the play- and DIR-based parent-training program improved children’s developmental levels, adaptive functioning, and parents’ parenting skills. Our study contributed to evidence-based practice for children with autism spectrum disorder and their parents by demonstrating a feasible and economical program in current clinics.
論文目次
CHAPTER 1 INTRODUCTION 1
CHAPTER 2 LITERATURE REVIEW 4
2.1 Autism Spectrum Disorder 4
2.1.1 Introduction 4
2.1.2 Deficits and characteristics of children with ASD 5
2.1.3 Family impacts of children with ASD 8
2.2 Interventions for children with ASD 10
2.2.1 General recommendations 10
2.2.2 Intervention means: parent-training programs 12
2.2.3 The Developmental, Individual-differences, & Relationship-based model 13
2.2.4 Perspective of occupational therapy 15
2.3 The play- and DIR-based parent-training program 18
2.3.1 Findings of previous research 18
2.3.2 Limitations 19
2.4 Summary 20
CHAPTER 3 METHODS 22
3.1 Research Design 22
3.2 Participants 22
3.3 Measurements 23
3.3.1 Demographic data and screening measures 23
3.3.2 Primary outcome measures 25
3.3.3 Secondary outcome measures 27
3.4 Intervention Program 28
3.4.1 Treatment group: Parent-training program (child-initiated activities) 28
3.4.2 Control group: Traditional program (parent-lead activities) 29
3.5 Procedures 30
3.6 Analyses 30
3.6.1 Demographic and baseline data 30
3.6.2 Primary, secondary outcome measures and intensity 31
3.6.3 Missing data 31
CHAPTER 4 RESULTS 32
4.1 Participants 32
4.2 Demographic data 32
4.3 Baseline measures 33
4.4 Intensity 33
4.5 Outcome measures 34
4.5.1 Between-group differences 34
4.5.2 Within-group differences 35
CHAPTER 5 DISCUSSIONS 36
5.1 Children’s developmental levels 36
5.2 Children’s adaptive functioning 37
5.3 Parenting skills 38
5.4 Parenting stress 39
5.5 Parents’ satisfaction and compliance 40
5.6 ITT analysis 41
5.7 Limitations 41
5.7.1 Small sample size 41
5.7.2 Outcome measures 42
5.7.3 Intensity records 42
5.7.4 Family members 43
5.7.5 Short-term design study 43
CHAPTER 6 CONCLUSION 44
References 45
參考文獻 Abidin, R. R. (1990). Parenting stress index/short form. Lutz, FL: Psychological Assessment Resources.
Amaral, D. G., Dawson, G., & Geschwind, D. H. (2011). Autism spectrum disorders. New York, NY: Oxford University Press.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorder, 4th ed., Text Revision. Washington, DC, United States: American Psychiatric Association.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorder, 5th ed. Arlington, VA: American Psychiatric Publishing.
American Occupational Therapy Association (2014). Occupational Therapy Practice Framework: Domain and Process (3rd Edition). American Journal of Occupational Therapy, 68, 1-48. doi:10.5014/ajot.2014.682006
Bader, S. H., & Barry, T. D. (2014). A longitudinal examination of the relation between parental expressed emotion and externalizing behaviors in children and adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(11), 2820-2831. doi: 10.1007/s10803-014-2142-6
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory-II. San Antonio, TX: Psychological Corporation.
Beurkens, N. M., Hobson, J.A., & Hobson, R. P. (2013). Autism severity and qualities of parent-child relations. Journal of Autism and Developmental Disorders, 43(1), 168-178. doi: 10.1007/s10803-012-1562-4
Bonis, S. (2016). Stress and Parents of Children with Autism: A Review of Literature. Issues in Mental Health Nursing, 37(3), 153-163. doi: 10.3109/01612840.2015.1116030
Brestan, E., Jacobs, J., Rayfield, A., & Eyberg, S.M. (1999). A consumer satisfaction measure for parent-child treatments and its relationship to measures of child behavior change. Behavior Therapy, 30, 17-30.
Centers for Disease Control and Prevention (2016, March 31). Autism Spectrum Disorder (ASD): Data & Statistics [Web message]. Retrieved from http://www.cdc.gov/ncbddd/autism/data.html
Chang, J. K. (2014). The quality enhancement of occupational therapy in Taiwan. Journal of Healthcare Quality, 8(2), 12-17.
Chang, S.H., & Tseng, M. H. (2002). A Survey of Clinical Practice of Occupational Therapy and Therapists’ Self-perceived Competence in Taiwan. Formosan Journal of Medicine, 6(4), 483-494. doi:10.6320/FJM.2002.6(4).03
Chen, H. Y. (2000). Manual for the beck depression inventory-II. Taipei: Chinese Behavioral Science.
Chen, W. C., Pan, A. W., & Tseng, M. H. (2001). A Survey of Pediatric Occupational Therapy Manpower in Taiwan. Journal of Medical Education, 5, 146-155.
Christensen, D. L., Baio, J., Braun, K. V., Bilder, D., Charles, J., Constantino, J. N., …Yeargin-Allsopp, M. (2016). Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. MMWR Surveill Summ, 65(3):1–23. DOI: http://dx.doi.org/10.15585/mmwr.ss6503a1
Cohn, E. S., & Henry, A. D. (2009). Caregiving and childrearing. In E. B. Crepeau, E. S. Cohn, &B. A. B. Schell (Eds.), Willard and Spackman’s Occupational Therapy ( 11th ed., pp.579-591). Philadelphia: Lippincott Williams & Wilkins.
Couch, K. J., Deitz, J. C., & Kanny, E. M. (1998). The Role of Play in Pediatric Occupational Therapy. American Journal of Occupational Therapy, 52(2), 111-117. doi:10.5014/ajot.52.2.111
Crepeau, E. B., Schell, B. A. B., & Cohn, E. S. (2009). Contemporary occupational therapy practice in the United States. In E. B. Crepeau, E. S. Cohn, &B. A. B. Schell (Eds.), Willard and Spackman’s Occupational Therapy ( 11th ed., pp.216-221). Philadelphia: Lippincott Williams & Wilkins.
Crowe, T. K. (2009). Contemporary occupational therapy practice worldwide. In E. B. Crepeau, E. S. Cohn, &B. A. B. Schell (Eds.), Willard and Spackman’s Occupational Therapy ( 11th ed., pp.222-229). Philadelphia: Lippincott Williams & Wilkins.
Eyberg, S. M. (1974). Therapy Attitude Inventory. Unpublished instrument. Oregon Health and Sciences University. Retrieved from http://www.pcit.org
Freeman, S., & Kasari, C. (2013). Parent-child interactions in autism: characteristics of play. Autism, 17(2), 147-161. doi: 10.1177/1362361312469269
Greenspan, S.I., Degangi, G., & Wieder, S. (2001). Functional emotional assessment scale: Clinical and research applications. Bethesda, MD: Interdisciplinary Council on Developmental and Learning Disorders.
Greenspan, S. I. & Wieder, S. (1997). Developmental patterns and outcomes in infants and children with disorders in relating and communicating: A chart review of 200 cases of children with autistic spectrum diagnoses. The Journal of Developmental and Learning Disorders, 1(1).
Greenspan, S. I. & Wieder, S. (2006). Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think. Cambridge, MA: Da Capo press.
Haven, E. L., Manangan, C. N., Sparrow, J. K., & Wilson, B. J. (2014). The relation of parent-child interaction qualities to social skills in children with and without autism spectrum disorders. Autism, 18(3), 292-300. doi: 10.1177/1362361312470036
Heep Hong Society (2013). The Chinese Edition of Psychoeducational Profile - Third Edition Revised (CPEP-3). Hong Kong,
Hinojosa, J., & Kramer, P. (2008). Integrating children with disabilities into family play. In L. D. Parham & L. S. Fazio, (Eds), Play in occupational therapy for children (2nd ed., pp. 321-334). St. Louis, Mo: Mosby.
Kanne, S. M., Gerber, A. J., Quirmbach, L. M., Sparrow, S. S., Cicchetti, D. V., & Saulnier, C. A. (2011). The role of adaptive behavior in autism spectrum disorders: implications for functional outcome. 41(8), 1007-1018. doi: 10.1007/s10803-010-1126-4
Kuan, C., Hsu, S., Lin L., & Lin, J. (2013). Ambulatory healthcare utilization and medical expenditure by the child and adolescents with autism spectrum disorders. Journal of Disability Research, 11(3), 140-149.
Lai, D. C., Tseng, Y. C., Hou, Y. M, & Guo, H. R. (2012). Gender and geographic differences in the prevalence of autism spectrum disorders in children: analysis of data from the national disability registry of Taiwan. Research in Developmental Disability, 33(3), 909-915. doi: 10.1016/j.ridd.2011.12.015
Liao, S. T., Hwang, Y. S., Chen, Y. J., Lee, P., Chen, S. J., & Lin, L. Y. (2014). Home-based DIR/Floortime™ intervention program for preschool children with autism spectrum disorders: Preliminary findings. Physical & Occupational Therapy in Pediatrics, 34(4), 356-367.. doi: 10.3109/01942638.2014.918074
Lo, J. L., & Chu, T. F. (2003). Survey of the Current Situation of Occupational Therapy in Taiwan. Journal of Occupational Therapy Association, 21, 56-65.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9. doi:10.1037=0022-006x.55.1.3
Malhi, P., & Singhi, P. (2015). Adaptive Behavior Functioning in Children with Autism. Indian Journal of Pediatrics, 82(8), 677-681. doi: 10.1007/s12098-015-1692-8
Milne, S. L., McDonald, J. L., & Comino, E. J. (2013). Adaptive function in preschoolers in relation to developmental delay and diagnosis of autism spectrum disorders: insights from a clinical sample. Autism, 17(6):743-53. doi: 10.1177/1362361312453091
Ministry of Health and Welfare (2015). Statistics of persons with disabilities (according counties and age) [Data file]. Retrieved from http://www.mohw.gov.tw/cht/DOS/DisplayStatisticFile.aspx?d=31923&s=1
Accounting and Statistics, Executive Yuan (2016). Report on the survey of family income and expenditure [Data file]. Retrieved from http://win.dgbas.gov.tw/fies/doc/result/105.pdf
National Research Council (2001). Educating Children with Autism. Committee on Educational Interventions for Children with Autism. Catherine Lord and James P.McGee, eds. Division of Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.
Pajareya, K. & Nopmaneejumruslers, K. (2011). A pilot randomized controlled trial of DIR/Floortime TM parent training intervention for pre-school children with autistic spectrum disorders. Autism, 15(5), 563-577.
Pajareya, K. & Nopmaneejumruslers, K. (2012). A one-year prospective follow-up study of a DIR/FloortimeTM parent training intervention for pre-school children with autistic spectrum disorders. Journal of the Medical Association of Thailand, 95(9), 1184-1193.
Park, H. R., Lee, J. M., Moon, H. E., Lee, D. S., Kim, B. N., Kim, J., …Paek, S. H. (2016). A Short Review on the Current Understanding of Autism Spectrum Disorders. Experemental Neurobiology, 25(1), 1-13. doi: 10.5607/en.2016.25.1.1
Parham, L. D. (2008). Play and occupational therapy. In L. D. Parham & L. S. Fazio, (Eds), Play in occupational therapy for children (2nd ed., pp. 3-39). St. Louis, Mo: Mosby.
Primeau, L. A. (2009). Play and leisure. In E. B. Crepeau, E. S. Cohn, &B. A. B. Schell (Eds.), Willard and Spackman’s Occupational Therapy ( 11th ed., pp.633-648). Philadelphia: Lippincott Williams & Wilkins.
Pugliese, C. E., Anthony, L. G., Strang, J. F., Dudley, K., Wallace, G. L., Naiman, D. Q., & Kenworthy, L. (2016). Longitudinal Examination of Adaptive Behavior in Autism Spectrum Disorders: Influence of Executive Function. Journal of Autism and Developmental Disorders, 46(2), 467-77. doi: 10.1007/s10803-015-2584-5
Rivard, M., Terroux, A., Parent-Boursier, C., & Mercier, C. (2014). Determinants of stress in parents of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(7), 1609-1620. doi: 10.1007/s10803-013-2028-z
Schopler, E., Bourgondien, M. E. V., Wellman, G. T., & Love, S. R. (2010). Childhood Autism Rating Scale, Second Edition. Los Angeles, CA: Western Psychological Services.
Schopler, E., Lansing, M. D., Reichler, R. J., & Marcus, L. M. (2005). Psychoeducational Profile: TEACCH Individualized Psychoeducational Assessment for Children with Autistic Spectrum Disorders—Third Edition (PEP-3). Austin, TX: PRO-ED.
Shyu, Y. I., Tsai, J., & Tsai, W. (2010). Explaining and selecting treatments for autism: parental explanatory models in Taiwan. Journal of Autism and Developmental Disorders, 40(11), 1323-1331. doi: 10.1007/s10803-010-0991-1
Smith, T. & Iadarola, S. (2015). Evidence Base Update for Autism Spectrum Disorder, Journal of Clinical Child & Adolescent Psychology, 44:6, 897-922. doi:10.1080/15374416.2015.1077448
Sparrow, S.S., Cicchetti, D. V., & Balla, D. A. (1984). Vineland Adaptive Behavior Scales Classroom edition. Circle Pines, Minnesota: American Guidance Service.
Sparrow, S.S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales, Second Edition (Vineland-II). San Antonio, TX: Pearson
Solomon R., Egeren, L. A. V., Mahoney, G., Huber, M. S. Q., & Zimmerman, P. (2014). PLAY project home consultation intervention program for young children with autism spectrum disorders: A randomized controlled trial. Journal of Developmental and Behavioral Pediatrics, 35, 475-485.
Solomon R., Necheles, J., Ferch, C., & Bruckman, D. (2007). Pilot study of a parent training program for young children with autism. Autism, 11(3), 205-224.
Tanta, K. J., & Knox, S. H. (2015). Play. In J. Case-Smith & J. C. O’Brien (Eds.), Occupational therapy for children and adolescents (7th ed., pp. 483-497). St. Louis: Mosby.
Tint, A., & Weiss, J. A. (2015). Family wellbeing of individuals with autism spectrum disorder: A scoping review. Autism. doi:10.1177/1362361315580442
Tsai, Y. J., & Chu, T. F. (2014). The status and future development trend of occupational therapists in Taiwan and abroad. Journal of Healthcare Quality, 8(2), 18-22.
Valicenti-McDermott, M., Lawson, K., Hottinger, K., Seijo, R., Schechtman, M., Shulman, L., & Shinnar, S. (2015). Parental Stress in Families of Children With Autism and Other Developmental Disabilities. Journal of Child Neurology, 30(13), 1728-1735. doi: 10.1177/0883073815579705
Weitlauf, A. S., Vehorn, A. C., Taylor, J. L., & Warren, Z. E. (2012). Relationship satisfaction, parenting stress, and depression in mothers of children with autism. Autism, 18(2), 194-198. doi:10.1177/1362361312458039
Wong, Y. S. (2011). The Chinese version of Parenting stress index/short form. Taipei.
World Health Organization (2013). How to use the ICF: A practical manual for using the International Classification of Functioning, Disability and Health (ICF). Exposure draft for comment. Geneva: WHO
Wu, W. T., Chang, C. F., Lu, T. H., & Chiu, S. C. (2004). Vineland Adaptive Behavior Scale – Chinese edition. Taipei, Taiwan: Psychological Publishing
Zwaigenbaum, L., Bauman, M. L., Choueiri, R., Kasari, C., Carter, A., Granpeesheh, D., et al. (2015). Early intervention for children with autism spectrum disorder under 3 years of age: recommendations for practice and research. Pediatrics, 136, 1-9.
Zwaigenbaum, L., Bauman M. L., Stone, W. L., Yirmiya, N., Estes, A., Hansen, E. L., …Wetherby, A. (2015). Early Identification of Autism Spectrum Disorder: Recommendations for Practice and Research. Pediatrics, 136, 10-40.
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