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系統識別號 U0026-2401201710532300
論文名稱(中文) 探討台南市特殊教育專業團隊中職能治療師對國小自閉症學童適應性行為的影響
論文名稱(英文) Assessing Effects of Occupational Therapists in Professional Teams on the Adaptive Functioning of Elementary School Children with Autism Spectrum Disorder in Tainan
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 105
學期 1
出版年 105
研究生(中文) 孫維黛
研究生(英文) Wei-Dai Sun
電子信箱 magicaltccc@gmail.com
學號 T76034024
學位類別 碩士
語文別 英文
論文頁數 72頁
口試委員 口試委員-黃雅淑
口試委員-黃璨珣
口試委員-郭雅雯
指導教授-林玲伊
中文關鍵字 專業團隊  自閉症  適應性行為 
英文關鍵字 Special Educational Professional Team  Autism  Adaptive Functioning 
學科別分類
中文摘要 特殊教育專業團隊屬於台灣的學校介入模式,旨在協助具特殊需求學童的學校適應與學習,此服務模式並受到特殊教育法及相關條文保障與規範。此專業團隊由眾多專業人員(如物理治療師、職能治療師、語言治療師、臨床心理師、社會工作師、特殊教育老師等)組成,並且結合學童的家長、老師等相關人員,經過個別化教育計畫會議(Individualized Education Plan Meeting)一同訂定學期目標或轉銜計畫後,即由專業人員提供老師與家長建議或實際執行介入,階段性地提升特殊需求學童的各項能力。專業團隊屬於「以學校為基礎」之介入模式,聚焦在學童在校時的實際表現及困難;同時,由於專業團隊的成員可各自提供其專業意見,並且結合班級老師、家長之實際環境觀察,相較「以臨床為基礎」的介入方式,更能為特殊需求學童的活動參與提供全面性的觀點。
對於自閉症學童來說,其自閉症症狀嚴重度以及智力表現的範圍極廣,如高功能自閉症或一般自閉症;但適應行為問題是普遍存在於自閉症族群中,無論其智力正常與否,都有可能在適應行為的各面向中出現適應問題,如溝通、社會互動、動作與一般生活技巧。故在專業團隊的職能治療師介入之下,提升自閉症學童在學校的適應表現則為不容忽略的目標。
此專業團隊服務模式在台灣推行至今已近二十年,過去文獻探討此介入模式時,多數著重於內部成員的合作現況、相互滿意度之調查,卻少深入探討專業團隊或職能治療師的介入是否有助於提升特殊需求學童的各項能力;由於缺乏實證研究的基礎,造成專業團隊介入定位不明的困境。故此研究旨在探討特殊教育專業團隊中職能治療師是否能有效提升自閉症學童在校的適應性行為能力。
此研究招募台南市 十九位國小自閉症學童,納入條件為於學校中有接受特殊教育專業團隊職能治療服務之學童,並在一般國小就學(非在家教育、機構特殊班級)。此研究分別於專業團隊介入前以及介入一至二學期後,以感覺處理能力剖析量表中文版(Sensory Profile-Chinese)、文蘭適應行為量表中文編譯版(教室版) (Vineland Adaptive Behavior Scale-Chinese, VABS-C)評估自閉症學童的感覺處理能力以及在校適應行為的變化。統計分析包含(一)以描述性統計分析學童的基本資料以及職能治療師在特殊教育專業團隊執行現況;(二)使用Wilcoxon符號排序檢定 (Wilcoxon signed rank test) 分析學童在介入前後的表現差異;(三)使用斯皮爾曼相關係數(Spearman's rank correlation coefficient)職能治療師到校執行介入的頻率、次數等現況條件和學童在校適應行為的相關性。
此研究結果顯示,自閉症學童在接受學校職能治療師服務前後,其適應性行為的變化未在文蘭適應性行為量表的各項標準分數中有顯著性差異,但學童的進步顯著呈現於目標達成量表中。在相關性分析裡,校外治療課、職能治療師到校的次數以及家長執行活動的頻率則和適應性行為的分數變化有顯著相關性,特別是職能治療師服務的次數顯著與社會互動有正相關。職能治療師在專業團隊服務中對於學童在校的適應性行為扮演重要的角色,但由於服務次數較少、治療師與家長間缺乏溝通等現況則可能導致該服務模式在學童身上的成效不彰。此研究利用多種評估工具可為特殊教育專業團隊中的職能服務提供實證基礎,進而讓臨床專業人員、老師以及家長重視其專業團隊的助益,以提升自閉症學童在校適應性行為的訓練品質。
英文摘要 Special educational professional team is a type of intervention in Taiwan, and it has been assisting students with special needs for nearly 20 years. Such the team comprises professionals, teachers, and parents is organized with the aim of providing suitable suggestions, resources, and educational goals to assist students in adapting to school. As an occupational therapist (OT), adaptive functioning is also the major concern as well.
Especially for children with autism spectrum disorder (ASD), adapting to most contexts, including school, is difficult; and most people believe that professional teams could help the students with ASD to adapt to school well. However, few studies have quantified the outcomes regarding the quality of services provided by special educational professional teams. Moreover, only rare studies have investigated effects of OT in professional teams in Taiwan. Therefore, this study investigated whether the adaptive functioning of elementary school students with ASD improves after services by OT in professional teams. The researcher recruited 19 elementary school students with ASD who were serviced by OT in the professional teams across two semesters in one academic year. The adaptive functioning of the recruited students was evaluated before and after the intervention by using the Vineland Adaptive Behavioral Scale-Chinese (VABS-C) and Sensory Profile-Chinese (SP-C). The data were analyzed mainly using the Wilcoxon signed rank test to determine the extent of improvement. Additionally, the Spearman's rank correlation coefficient was used to analyze the relationships between the present situations such as frequency of services and the changes among adaptive functioning.
The results indicated that the standard scores of VABS-C did not show any significant difference, although the improvements could be observed from raw scores. In GAS, students did have significant improvements through observation by OT. In correlational analysis, extracurricular treatments, frequency of OT services, and frequency of parents’ execution were correlated with differences of VABS-C significantly. Particularly, the difference of socialization standard score was significantly correlated with frequency of OT services. However, the improvements from the students were not obvious to detect by standard assessments during this study. The reasons could be low frequency of services or poor communication. The present study established an additional evidence-based background combining with current policy of the special educational professional team and used the findings to assist clinicians in promoting the intervention confidently.
論文目次 摘要 I
Abstract III
Acknowledgement V
Table of Contents VI
List of Figures IX
List of Tables X
List of Appendix XI
Chapter 1 Introduction 1
Chapter 2 Literature Review 5
2.1 Autism Spectrum Disorder 5
2.1.1 Characteristics of autism spectrum disorder 5
2.1.2 Prevalence of autism spectrum disorder 5
2.1.3 Deficit of adaptive functioning in autism spectrum disorder 6
2.1.3.1 Language 6
2.1.3.2 Socialization 7
2.1.3.3 Daily living skills 8
2.1.3.4 Motor 9
2.1.4 Common intervention of autism spectrum 10
2.2 Special Educational Professional Team 11
2.2.1 Services 11
2.2.2 Origin 11
2.2.3 Composition and Procedures 12
2.2.4 Situations in Counties and Cities 13
2.2.5 Outcome measurements 13
Chapter 3 Materials and Methods 16
3.1 Purposes and Hypotheses 16
3.2 Research Design and Participants 16
3.3 Measurements 17
3.3.1 Basic Information Questionnaire 17
3.3.2 Vineland Adaptive Behavior Scales 17
3.3.3 Sensory Profile 18
3.3.4 Goal Attainment Scale 19
3.3.5 Parents’ Feedback questionnaire 20
3.3.6 Teachers’ Feedback Questionnaire 20
3.4 Experimental Procedure 21
3.5 Data analysis 22
Chapter 4 Results 23
4.1 Demographic Data of Participants 23
4.2 Data of Adaptive Functioning from Participants 24
4.3 The correlational analysis 27
Chapter 5 Discussion 29
5.1 Adaptive functioning of Students with Autism Spectrum Disorder 29
5.2 Sensory Processing of students with ASD 32
5.3 Special Educational Professional Team 34
5.3.1 Details of Special Educational Professional Teams 34
5.3.2 Roles of Occupational Therapists in the Team 35
5.3.3 Comparing with the models of the U.S. and Singapore 35
5.3.4 Effective Measurements for the Professional Team 37
5.4 Limitations 38
Chapter 6 Conclusion 39
References 40
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