家長回應能力的改變與自閉症幼兒發展的關聯性研究

Parental Responsiveness Change and Developmental Outcomes of Young Children with Autism

本研究目的主要在探討家長回應能力改變與自閉症幼兒發展的關係。本研究以33 位參與親子互動訓練的自閉症幼兒及其家長為研究對象，並以「家長行為量表」（Maternal Behavior Rating Scale-Revised）中的回應能力（responsiveness）的改變，將家長分為兩組，其中18 位家長的回應能力在前、後測有改變，故為改變組，另15 位家長在前、後測的回應能力無改變，即為無改變組。本研究以此兩組幼兒前測的發展能力為共變數，並以單因子多變量共變分析（MANCOVA）統計檢定比較兩組自閉症幼兒在後測與六個月後追蹤的表現。若達顯著差異者，本研究則更進一步做事後比較。研究結果發現，改變組自閉症幼兒在「口語」、「社交」、「象徵性行為」或是「關鍵性行為」發展上，都比無改變組為佳；而這差異在有些領域的發展上可維持至追蹤期，或是在後測時，兩組間有些領域的發展上差異不顯著，但在追蹤期才達顯著。本研究成果顯示家長回應能力的改變與自閉症幼兒的發展具顯著關係，家長回應能力的改變可列為自閉症幼兒早期介入服務時的重要參考因子。

Purpose: This study was originally designed to compare 2 parent-child interaction curricula in young children with autism. Results showed no reliable differences between the 2 curricula groups regarding measures of child development or parent-child interaction. We then decided to further compare the effects of both interventions combined based on whether the mother followed through with the intervention (i.e., became more responsive during intervention). Methods: Thirty-three young children with autism (M=36.61 months) were recruited from 2 child psychiatric clinics in Chung-Gung Memorial Hospital and Tao-Yuan Mental Health Center, Taiwan for 2 years. Twelve children with autism and their caregivers participated in the first year study, and 21 children with autism and their caregivers participated in the second year study. This study used the Maternal Behavior Rating Scale-Revised (Mahoney, 1999) to determine if the caregiver had become more responsive from the pretest to the posttest. One group was found to be the responsiveness-change group (N = 18), and the other group was found to be the responsiveness-no-change group (N = 15). Multivariate analysis of covariance (MANCOVA) was used in this study to examine the differences in the developmental outcomes of these 2 groups on their posttests and six month follow-ups. Communication and Symbolic Be havior Scale-Developmental Profile (CSBS-DP; Wether by & Prizant, 2002), Chinese Child Development Inventory (CCDI; Hsu, 1978), and Child Behavior Rating Scale (CBRS; Mahoney, 1999) were used in this study to measure the developmental outcomes of young children with autism. Results: The results of this study showed that there were significant differences between two groups. That is, children in the responsivenesschange group did better on cognition, communication, and social development in either their CCDI/CSBS-DP posttests or follow-ups. The results also revealed that in some areas, the significant differences between two groups were not visable in posttests but were noticeable in follow-ups. Besides, the significant differences between two groups were also found on their pivotal behavior development from CBRS. The pivotal behavior of children with autism in the responsiveness-change group were significantly lower on their pre-tests but were higher in their posttests and follow-ups when their caregivers' responsiveness changed from pre-tests to posttests. Implications: The results of this study indicated that when the mothers followed through, the effects on the children’s cognition,communication, and social functioning were significant. The effects of responsiveness appear to be related to children feeling encouraged using more pivotal behaviors that are foundational for children’s developmental learning. A change in parental responsiveness is an important factor related to the development outcomes of children with autism in early intervention.