訓練家長成為自閉症兒童介入方案的執行者：從現場教學到遠距教學的回顧與前瞻

A Systematic Review of Providing Parent- Mediated Intervention Training for Young Children with Autism Spectrum Disorder: From On-site Teaching to a Telehealth Model

研究目的：本研究欲系統性的回顧由專業人員訓練ASD兒童家長執行介入（parentmediated intervention, PMI）的相關研究。研究方法：以敘述性綜論的方式，回顧由專業人員訓練ASD兒童家長執行介入的相關研究，並於2020年2月，以“parent” AND “autism” AND “intervention or training” AND “distance or telehealth or videoconferencing or internet”為關鍵字於PsycINFO資料庫中搜尋，探討以遠距操作方式進行PMI的相關研究並提出未來研究方向。研究結果：PMI的介入法不僅使家長有能力執行介入方案，且可有效改善ASD兒童的社會溝通技巧，並減少兒童的問題行為。家長在被訓練的同時，也可增進家長的能力，並減少其身心壓力。PMI也可增加兒童維持技能和類化的機會。回顧遠距操作模式的PMI結果也顯示家長可以透過遠距通訊系統（例如：網路）接受訓練並搭配教練指導課程，也可獲得同樣的成效。研究結論：PMI時間成本過高，造成雙薪家庭或是位處偏遠地區的家長難以負擔，因此本研究回顧遠距照護模式，也就是家長可以透過遠距通訊系統（例如：網路）接受訓練，以利更多ASD的家庭可以獲得相關資源。

Purpose: We review the literature on parent-mediated intervention (PMI) for young children with autism spectrum disorder (ASD), and then draw implications specifically for telehealth PMI. Methods: We first conducted a narrative literature review of PMI for ASD in general. Next, we identified 12 studies on telehealth PMI published before March 2019 in the PsycINFO database using the following keywords: parent, autism, “intervention or training”, and “distance or telehealth or video conferencing or internet.” Results: The literature indicated that parents/caregivers were able to learn the intervention techniques and to implement them with high fidelity for children. Specifically, the studies reported that through PMI, children with ASD not only improved in social and communication skills, but also decreased in problem behaviors. Parents who received PMI training experienced lower stress and improved competency. Moreover, PMI was shown to help children maintain their learning skills, and the finding generalized to various situations. Finally and critically, we discovered that studies on telehealth PMI generally reported similar results to those on broader PMI. Conclusions: Both PMI and PMI training are time-consuming. Doublecareer families and families living in rural areas thus have difficulty with completing the training and implementing the intervention. However, a telehealth model may help parents/ caregivers fit PMI into their schedules, as the approach provides more flexibility than does its predecessors. Ideally, PMI through a telehealth model may allow the benefits of PMI to be more accessible for families in need.