正向行為支持有效介入特殊學生拒學問題之案例探究

近年來台灣中小學生的心理疾病中以「拒學症」增加最明顯。學齡期兒童或青少年的拒學現象是一個複雜的問題，該問題通常統括了許多內向性或外向性的行為困擾，而對家長、學校人員與臨床心理衛生工作者來說往往是相當棘手的議題。本文首先回顧了國內外文獻中有關於拒學問題定義、特徵、伴隨精神疾病診斷、相關因素、評量與介入策略的結論。之後描述兩位來自臺北市特教學生情緒行為問題專業支援團隊的個案。這兩位青少年因為嚴重拒學問題轉介至本團隊，經介入處理之後拒學行為顯著改善。他們兩位皆被診斷為自閉症。本文詳細說明在正向行為支持下，運用著重團隊合作、生態調整、正面觀點的介入模式對拒學個案的評估、介入歷程與成效。最後針對實務經驗啟示與文獻研究結論的一致性加以檢視與討論，並提出相關建議。

In last few years， among mental diseases that elementary and secondary school age students have， “school refusal” has been dramatically increasing in Taiwan. School refusal behavior， referring to a student’s refusal to attend school or difficulty remaining in classes for an entire day， in children and adolescents at school age is complicated and it includes many internal as well as external behavioral disturbances. School refusal is a challenging issue for parents， school personnel and mental health professionals. The paper first reviews the research and articles on school refusal in children and adolescents， especially focusing on the definitions， common characteristics， categorical diagnoses， relevant factors， assessment and treatment strategies. Next， two cases who were referred to “Taipei City Students with Special Needs Emotional and Behavioral Problems Intervention Team” due to their serious school refusal problems are described. They are both diagnosed as Autism Syndrome. Their referral behavioral problems were significantly improved after the intervention. The article presents the details of the assessment， intervention process and effectiveness based on the guidelines， inclusive of collaboration， environmental adjustment and positive views of behavioral problems， of the positive behavioral support approach. Finally， practical experiences and the research conclusion of references are investigated and discussed in terms of their consistency， and afterwards suggestions are addressed.