以整合式音樂治療行動方案改善一位自閉症兒童嚴重自傷行為之研究

Improving the Severe Self-Injurious Behavior of a Child with Autism Spectrum Disorder through an Integrated Music Therapy Action Program

自傷行為是自閉症兒童最嚴重的行為問題之一，不僅造成身體傷害，更影響 到全面性的教育或社會功能。近年來，針對自閉症者因感覺處理異常、經由無法 容忍不確定性和焦慮情緒之中介，引發重複動作行為和堅持同一性行為的順序關 聯性，已獲得許多研究的支持，也被認為是預測自傷行為的風險因素。本研究個 案為國小特教班教師緊急轉介的學童，患有自閉症共病智能障礙，主因為嚴重自 傷行為及情緒問題。雖然特教持續介入並有醫療用藥，但受家庭內部因素影響， 行為改善的成效有限。因個案相當喜愛音樂，教師遂主動尋求入校輔導支援。在 直接入班觀察、分析課堂行為觀察紀錄並閱讀相關文獻資料後，發現有採取混合 方法處理個案問題的必要性，故整合音樂治療和行為策略，共同解決個案和教師 的困境。本研究以協同行動研究的方式進行個案評估、介入與成效檢討，參與協 同的成員包括研究者及三位特教教師，由研究者提供每週一次、單次40 分鐘，兩 學期總共18 次的個別音樂治療，並由三位教師於課堂提供行為策略。研究結果顯 示，個案在整合方案介入後的音樂行為和互動行為提升、重複行為下降，自傷行 為幾乎不再出現，並達到長期維持成效。個案家人也因為孩子的進步，開始積極 與學校配合。整體而言，本研究藉由在實務現場解決自閉症學童自傷行為的歷程 和經驗，啟發從根源探尋解決方法的模式，也為未來的問題處理提出多元介入的 可行性。

Purpose: Self-injurious behavior is not one of the three core symptoms that define autism; however， it is one of the most severe behavioral problems observed in children with autism spectrum disorder and intellectual disability. It causes physical harm and affects education and social functioning. Sensory processing abnormalities， anxiety， and restricted and repetitive behaviors frequently co-occur in autism spectrum disorder. Recent studies support that sensory processing abnormalities， intolerance of uncertainty， and anxiety may sequentially relate to or influence the repetitive motor， sameness， and self-injury behaviors of children with autism spectrum disorder and be considered risk factors for self-injury. The student in the present case study had autism spectrum disorder and intellectual disability and exhibited self-injurious behavior and emotional problems， and was referred to the emergency support by special education teachers at the student’s elementary school. There were several complicated factors within the student’s family; therefore， the influences of education and medical intervention were limited. Because the student was fond of music， his teachers requested relevant support services from the researcher. Based on direct observation in the classroom， data analysis of the behavioral observation documents provided by the teachers， and a literature review， the researcher collaborated with three special education teachers and performed an intervention involving an integrated program of music therapy and behavioral strategies. Methods: This study was conducted using a group-based collaborative action research design to discuss the results of the evaluation， intervention， and effect. Participants included the researcher and three special education teachers. A total of 18 weekly sessions of 40 minutes of individual music therapy was provided by the researcher， namely 10 sessions in the first semester and 8 sessions in the second semester. The three teachers taught behavioral strategies in the classroom during the same period. Data were collected using a questionnaire on demographics， the scale of music therapy， and classroom observations， and analyzed through the approach of Therapeutic Narrative Analysis developed by Aldridge in 2005. Results/Findings: The student’s musical and interaction behaviors improved and his repetition behavior decreased after the intervention. His head-banging behavior in the class largely diminished and then stabilized. Family members began to actively cooperate with the teachers because of the improvement in his behaviors. Conclusions/Implications: Overall， this study developed an effective practical intervention aimed at reducing self-injurious behavior through the causes analysis in a child with autism spectrum disorder and intellectual disability. Discussions and suggestions for future problem-solving strategies and a new integrated concept are also provided.