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研究生:廖淑廷
研究生(外文):Shu-TingLiao
論文名稱:親子遊戲介入對學齡前自閉症兒童社交互動關係之療效研究
論文名稱(外文):The Effect of Parental Play Interventions on Increasing the Social Interaction of Pre-school Age Children with Autistic Spectrum Disorder
指導教授:林玲伊林玲伊引用關係
指導教授(外文):Ling-Yi Lin
學位類別:碩士
校院名稱:國立成功大學
系所名稱:職能治療學系碩博士班
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:124
中文關鍵詞:學齡前自閉症兒童地板時間療法親子關係親職壓力
外文關鍵詞:autistic disorderfloortimeparent-child relationshipparenting stress
相關次數:
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自閉症(Autistic Spectrum Disorders)個案的主要問題為社會性互動及溝通上的障礙、刻板且侷限的活動模式、及遊戲功能上的延遲或異常等,其中又以第一項社交互動為臨床主要的治療目標及照顧者關注的重點。過去的許多研究大多著重於探索及促進此族群在同儕及手足間的一般社交能力,卻忽略了每個人與生俱來的第一個社會化環境及社交關係,也就是家庭與親子關係。良善的家庭關係不僅能夠提供自閉症個案情感上的支持,適切的親子互動模式也能提升他們和外界連結的能力,對日後的發展必然有所裨益。總體而言,了解自閉症個案的親子關係和其對應的改善策略確實值得執行進一步的探究,故本研究首先探討學齡前自閉症兒童及照顧者的各項特質與親子關係及親職壓力之間的關聯,再進一步的教導學齡前自閉症兒童的照顧者在家中執行以地板時間(floortime)為原則所設計出的親子遊戲介入策略,透過隔週諮詢的方式提供照顧者支持,於十週的介入後評估兒童在功能性情緒能力、適應性能力、行為問題,及照顧者在遊戲技巧、親子關係、親職壓力和憂鬱程度上的成效。
本研究共招募了17位三歲九個月至五歲八個月的學齡前自閉症兒童。研究結果顯示,照顧者的親子互動關係與兒童的適應性行為及行為問題有顯著的關聯,另外照顧者對親職壓力的感受也和兒童的適應性行為有關。而親子遊戲介入後的評估結果則發現,11位兒童的功能性情緒發展能力、適應性行為和整體行為問題都有顯著的進步,照顧者的遊戲技巧進步,對孩子活動的參與度也有顯著增加,另外照顧者對孩子建立有效限制的技巧也有所改善。雖然十週的介入無法造成照顧者憂鬱程度的顯著改變,但其平均憂鬱分數卻從原本的輕度憂鬱降低到正常範圍內,且發現照顧者的憂鬱程度與兒童功能性情緒能力及親子關係、親職壓力進步值上的關聯。
本研究的樣本數雖小,卻仍能夠看出此根據地板時間所設計出的親子遊戲介入策略對兒童及照顧者的幫助,介入後除了能夠發現兒童在社交適應性能力上的進步外,照顧者在親職撫養過程中的心理安適感也符合研究假設的有所改善。另外研究結果也可增進臨床專業人員對自閉症兒童親子關係的了解,進一步的作為介入的基礎,同時也驗證地板時間療法於台灣地區施行的成效。

The main problems of children with autistic spectrum disorders are their impairments of social interaction and communication, stereotyped and limited activity performances, and delayed and abnormal play function. Social impairment is the most important concern of clinical professions and caregivers. Most researchers primarily focused on exploring and facilitating autistic children’s typical social ability such as peer and sibling interaction. However, they paid less attention on the family and parent-child relationship. Well-developed family interaction can not only provide affect support for children with autistic disorder, but also enhance their ability to connect with others and benefit for the future development. Therefore, it is worthwhile to further investigate parent-child relationship and intervention strategies for children with autistic disorder. The purposes of this study were to understand the correlation of parent-child relationship and individual characteristics and to investigate the intervention strategies on increasing social interaction and parent-child relationship for children with autistic disorder and their caregivers.
We recruited 17 children and their caregivers. These children aged from 3 years 9 months to 5 years 8 months. At first, participants were instructed parental play strategies by a certificated occupational therapist who designed appropriate interaction behaviors according to the developmental, individual difference, and relationship-based approach (DIR, also called floortime) principles. Caregivers were asked to carry out these individually parental play strategies for ten weeks. They also had to record their interaction behaviors bi-weekly and interviewed by the therapist to discuss about children progress and problems regularly. After ten weeks, outcomes for 11 children and caregivers were measured to determine changes in children functional emotional ability, children social adaptive behaviors, children behavior problems, parent-child relationship, parenting stress, and caregiver depression.
Results suggest that children made significantly greater gains in functional emotional ability, social adaptive behaviors, and behavior problems. Less improvement in parent-child relationship and parenting stress were observed. And there’s no significant improvement on caregiver’s depression but still decreased on it. Finally we also found that caregivers had significant improvements in using play strategies. The results of this study would promote the understanding of parent-child relationship of clinical professions, and moreover, confirm the effectiveness of parental play interventions such as floortime approach for children with autistic disorder in Taiwan.

第壹章、緒論 1
第一節、研究動機與重要性 1
第二節、研究目的 3
第貳章、文獻回顧 4
第一節、自閉症兒童 4
一、簡介 4
1. 定義 4
2. 盛行率 5
二、自閉症的社交能力缺陷 6
三、自閉症的親子介入策略 8
第二節、親子互動關係 12
一、定義 12
二、自閉症兒童的親子互動關係 12
三、影響親子互動關係之照顧者與兒童特質 15
第三節、地板時間療法 16
一、簡介 16
二、理論基礎 17
三、功能性情緒發展能力 18
四、執行原則 19
五、成效研究 20
第参章、研究方法 23
第一節、前導性研究 23
第二節、研究對象 24
第三節、研究工具 26
一、基本資料表 26
二、注意力缺陷/過動障礙測驗 (Attention-Deficit/Hyperactivity Disorder Test: A Method for Identifying Individuals with ADHD, ADHDT) 26
三、萊特操作性智力測驗 (Leiter International Performance Scale, Revised, LEITER-R) 27
四、功能性情緒評估量表(Fucntional Emotional Assessment Scale, FEAS) 28
五、親子關係量表(Parent-child relationship inventory, PCRI) 29
六、親職壓力量表簡式版(Parenting Stress Index: Short Form, PSI) 31
七、文蘭適應行為量表中文編譯版(教室版) 32
八、兒童行為檢核表(Children Behavioral Checklist, CBCL) 33
九、貝克憂鬱量表第二版(The Beck Depression Inventory, 2nd edition, BDI-II) 34
十、感覺處理能力剖析量表(Sensory Profile) 34
十一、家長回饋單 36
第四節、以地板時間療法為原則的親子遊戲 37
第五節、研究流程 38
第六節、資料統計分析 41
第肆章、研究結果 43
第一節、受試者及照顧者基本資料 43
一、受試者基本資料 43
二、照顧者及家庭基本資料 44
三、受試者及照顧者評估資料 45
1. 受試者的非口語智力表現 45
2. 受試者的注意力缺陷及過動障礙 45
3. 受試者的行為問題 46
4. 受試者的感覺處理能力 46
5. 受試者的適應行為 47
6. 照顧者自評之親子互動關係及照顧者親職壓力 47
7. 照顧者的憂鬱程度 48
第二節、親子關係與其關聯因子 49
一、親子關係與受試者家庭基本資料 49
二、親子關係與受試者的適應行為和行為問題 50
三、親子關係與照顧者憂鬱程度 51
第三節、親子遊戲介入成效 52
一、學齡前自閉症兒童的進步 52
1. 功能性情緒發展能力 52
2. 適應性行為表現 53
3. 行為問題 53
二、照顧者的進步 54
1. 自評親子互動技巧 54
2. 親子關係 54
3. 親職壓力 54
4. 憂鬱程度 55
第四節、親子遊戲介入的影響因子 56
一、受試者行為問題 56
二、照顧者憂鬱程度 56
第伍章、討論 57
第一節、影響親子關係及親職壓力的相關因子 57
一、兒童與照顧者的親子關係 57
二、兒童與照顧者的親職壓力 57
三、親子關係與其關聯因子 59
1. 兒童因子 59
四、親職壓力與其關聯因子 61
1. 兒童與照顧者家庭背景 61
2. 兒童因子 62
3. 照顧者因子 64
第二節、親子遊戲介入 67
一、功能性情緒發展能力 67
二、其他變項 68
三、親子關係與親職壓力 70
第三節、親子遊戲介入的影響因子 71
一、照顧者憂鬱程度 71
二、受試者行為問題 72
三、綜合討論 72
第四節、研究限制及建議 74
一、研究對象 74
二、研究變項 74
第陸章、臨床意義及結論 76
第柒章、參考資料 78
附錄 102

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