自閉症幼兒的共享式參與家長訓練方案：舞蹈治療之創造性律動取向初探

Caregiver-Mediated Joint Engagement Intervention for Young Children with Autism: A Pilot Study of the Creative Movement Approach to Dance Therapy

研究目的：當代對自閉症兒童之共享式注意力（joint attention, JA）及共享式參與（joint engagement, JE）之介入方案研究證實有療效，但存有日常生活情境不易類化、不具分享性及療效結果不穩定等限制。本研究旨在以舞蹈／動作治療之創造性律動取向，以JE家長訓練方案來探討其於具分享性之JE及JA的治療效果。研究方法：採多重個案設計，於2011年9月至2013年1月期間，以3名自閉症幼童為對象（2歲9個月高功能女童、3歲10個月中功能男童、及3歲6個月低功能男童），進行每週二次、每次一小時、共計20次的一對一親子介入。以舞蹈治療之創造性律動取向對幼童介入，並訓練家長使用三大教法：跟隨模仿、建立遊戲常規及提升JE狀態。療效評估以半結構評估及標準化評估工具，由獨立評估者於介入前、介入後及介入後追蹤三個月測量，療效參考以往研究之顯著進步值來認定。研究結果：3名自閉症兒童之JE及JA進步，且伴隨之認知及語言能力進展亦可維持三個月。研究結論：以舞蹈治療之創造性律動取向之家長訓練方案可有效提升自閉症幼童具分享性之JE及JA。實際臨床運用則待更多實證證據支持。

Purpose: Joint attention (JA) interventions for children with autism have focused on improving joint engagement (JE) and JA. Although recent research has demonstrated positive JA and JE, however, these skills have been limited by poor generalization and unstable efficacy. The purpose of this study was to develop a caregiver-mediated JE intervention program based on the perspective of creative dance/movement therapy to investigate its impact on JE and JA and the collateral abilities of young children with autism. Methods: A multiple case design was used. We recruited 3 children with autism (a 33-month-old girl with high function, a 46-month-old boy with middle function, and a 46-month-old boy with low function). The program consisted of 20 sessions with one hour per session twice a week. Sessions were conducted with the target child and his/her mother. Three major strategies were applied: following and imitation, forming a play routine, and improving the JE state. The creative movement approach to dance therapy was used throughout these strategies. Intervention outcomes were collected through unstructured activities and standardized tools/tasks by independent testers both pre- and post- intervention and at 3-months post-intervention. The threshold for intervention efficacy defined by the gain scores in our measurements equaled or exceeded the values in the intervention groups in published studies. Results: Greater JE and JA improvement was identified for the children with middle and high function than for the low function child. The improvement of collateral abilities such as cognition and language persisted 3 months after intervention. Conclusions: The creative movement approach to dance therapy through caregiver-mediated joint engagement intervention can effectively enhance an autistic child’s JE state and JA sharing intention. Further empirical studies are needed for clinical application.