四關鍵療法對智能障礙合併過動症少年性侵者影響之行動研究

An Action Research on the Impact of the ''Four-Key Therapy'' on Juvenile Sexual Offenders with Intellectual Disabilities combined ADHD

智能障礙伴隨過動少年性侵者之研究極少，介入方案一般以認知療法為主，成效仍待確認，而智能障礙伴隨過動性侵者之性侵害數與再犯率很高。四關鍵療法是指對過去的不舒服經驗、偏差學習模式、偏差想法、改善營養狀況，並進行輔導，即可降低再犯風險與其性偏差行為，此療法之理論基礎在於以傳統認知行為療法加入創傷知情與營養學新知，乃為跨領域之整合型方案，此方案少為人所知，而研究者以四關鍵療法進行性侵者治療已一段時日，藉此研究呈現四關鍵療法介入智能障礙伴隨過動少年性侵者的輔導過程並於輔導過程中之省思及修正。本研究以智能障礙伴隨過動少年性侵害者4個案為研究對象，4個案均有多次的性偏差行為，於「四關鍵療法」介入輔導過程反思並依據個案給予調整輔導方式。研究結果發現介入後，4位個案之再犯風險均降低，行為與人際互動之依附關係則依個案而有不同變化，個案與相關人員皆給予四關鍵療法介入後成效與治療師正向肯定，該方案中營養補充受到部分個案與其家人的肯定，個案的性偏差行為確實獲得改善。

Researches on juvenile sexual offenders with both intellectual disability and Attention Deficit Hyperactivity Disorder (ADHD) remained scarce. Existing intervention programs primarily adopt cognitive-behavioral therapy (CBT), but their effectiveness had yet to be firmly established. Notably, this population exhibited a high frequency of deviant sexual behaviors and recidivism rates. This study introduced the ''Four -Key Therapy,'' an integrated intervention model focusing on addressing past traumatic experiences, correcting maladaptive learning patterns, restructuring distorted cognitions and improving nutritional conditions. The approach was grounded in traditional CBT while incorporating trauma-informed care and nutritional science, offering a cross-disciplinary therapeutic strategy that remained relatively unknown in the field. This study involved four juvenile sexual offenders diagnosed with intellectual disability and ADHD, all of whom exhibited multiple instances of deviant sexual behavior. Through personalized intervention based on the Four-Key Therapy model, the therapeutic process included ongoing reflection and adjustment according to individual needs. Findings indicated a significant reduction in recidivism risk across all four cases. While improvements in behavior and interpersonal attachment varied by individual, all cases showed positive changes. Both the participants and their families expressed affirmative feedback regarding the intervention, with particular recognition given to the nutritional component. Notably, deviant sexual behaviors were effectively reduced. Throughout the counseling process, the therapist continually reflected upon and adapted their approach based on individual responses. These results suggested that the Four-Key Therapy, as an integrated and flexible intervention model, held promise for reducing deviant behaviors and recidivism among high-risk youth with neurodevelopmental disorders. Further application and study of this method were recommended.