系統性回顧：自閉症幼兒由早期療育轉銜至教育端之服務歷程、影響因子與轉銜策略之探討

Transition from Early Intervention to Preschool for Autistic Children: A Systematic Review

研究目的：本研究以系統性文獻統整自閉症幼兒由早療端轉銜至教育端之文章，探討實證研究的現況、找出影響自閉症幼兒轉銜之因子、整理轉銜策略。研究方法：研究者採用「系統性文獻回顧及統合分析之首選報告項目」（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）之步驟進行文獻搜尋及篩選。研究結果：搜尋策略初步涵蓋563篇文獻，經由篩選後納入16篇論文。主要發現：（1）過去文獻多為質性訪談及個案研究，缺乏廣泛調查自閉症幼兒轉銜現況之研究。（2）統整八類轉銜因子：幼兒園園所、幼兒園教師、家長與家庭、早期療育端、角色間的溝通協調、政策及相關支持系統、自閉症幼兒本身特質、同儕與社會文化。（3）整理轉銜前、中、後之介入計畫及教學策略。研究結論：本研究統整目前自閉症幼兒轉銜至學校之研究，發現相關文獻研究結果無法全面地反應自閉症幼兒轉銜服務現況。研究多聚焦於家長及幼兒園教師之觀點，缺乏早期療育人員於轉銜服務之角色的探討。未來研究將探究早療人員如何協助自閉症幼兒轉銜至學校、適應校園生活。

Purpose: A smooth transition to preschool is key for children in adapting to social life and the education system. Due to their limited social and communication skills, restricted interests and behavior, and hypersensitivity to contextual inputs, autistic children often have difficulty adapting to the school environment and adjusting to school routines. We aimed to (1) summarize the current literature concerning transitioning from medical-based early intervention (EI) services to school systems for autistic children, (2) identify the factors for transition success, and (3) explore intervention strategies used to facilitate this transition for autistic children. Methods: We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. First, we chose the following 4 key terms to develop the search strategy: autism spectrum disorders, transition, preschool, and early intervention. Results: We identified 563 articles using the 4 terms. After screening, we included 16 articles in our literature synthesis: 12 with a qualitative research design, 2 cross-sectional studies, 1 pre-post experimental study, and 1 mixed methods study. From these we identified 8 factors that impact autistic children’s transition outcomes: kindergarten management, school teachers, parents and family, EI professionals, communication and coordination, policy and support system, children’s characteristics, and social acceptance. Seven articles raised the issue of kindergarten management, and 7 articles concluded that school teachers are the key facilitator for children’s transitions. When teachers (1) have autism-related knowledge and skills, (2) hold positive attitudes toward autistic children, and (3) value their own work, autistic children are more likely to adjust to school life better. Eight articles identified parents and families as the key to transition success. Parents’ participation in transition meetings, making decisions in individualized education plan (IEP) meetings, and being positive about the transition all facilitate their children’s successful transition. Despite serving as a critical stakeholder in the transition process, only 4 articles described how EI services impact autistic children’s transitions. These include including providing transition readiness classes at EI centers, following up with parents on their children’s transition process, and EI staff showing respect to the family culture when providing interventions.
Policy support, communication and coordination among stakeholders, children’s characteristics, and social acceptance are also essential for autistic children to succeed in transition. Surprisingly, although autistic children are the protagonists in the transition process, most research did not investigate whether or not children’s skills and abilities impact their transition outcomes. We next summarized the transition programs and strategies based on 3 stages. In the pre-transition stage, the literature shows that providing transition readiness classes at the EI centers, home visits, and offering open house opportunities are helpful strategies for children and parents in preparing for school. During the transition, evaluation of newcomers’ needs by a multidisciplinary team, involvement of parents in the decision-making process, and increasing the school’s knowledge of the newcomer’s disabilities all facilitate appropriate treatment for autistic children. In the post-transition stage, improving classroom accessibility, providing flexible schedules and temporarily shortening school days, and making individualized education plans help autistic children adapt to school life more smoothly. However, the current evidence is inadequate to draw a firm conclusion on the effectiveness of these transition strategies due to the lack of rigorous research in transition services. Conclusions: Using PRISMA guidelines we systematically and comprehensively reviewed current studies on the transition to preschools
for autistic children. We identified 8 factors that impact autistic children’s transition outcomes, and 3 stages of programs and strategies. Our analysis may contribute insight for clinical practitioners to consider when providing transition services. We also identified the limitations of previous studies and offered directions for future investigation.