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題名 自閉症類群障礙症幼童的遠距家長訓練方案:家長成效之探討
Telehealth Parent-Mediated Intervention for Young Children with Autism Spectrum Disorder: Parents` Outcomes作者 鄭可欣
Cheng, Ke-Hsin貢獻者 姜忠信
Chiang, Chung-Hsin
鄭可欣
Cheng, Ke-Hsin關鍵詞 自閉症類群障礙症
丹佛早療模式
讓家長成為孩子溝通訓練的老師
遠距醫療
家長訓練
介入執行真確度
Autism spectrum disorder
Early Start Denver Model
Improving Parents As Communication Teachers
Telehealth
Parent training
Intervention fidelity日期 2022 上傳時間 1-Aug-2022 18:11:12 (UTC+8) 摘要 研究目的:隨著更多的自閉症類群障礙症(autism spectrum disorder, ASD)幼兒及早發現及確診,早期療育服務更顯供不應求,由家長作為介入執行者的模式可能嘗試彌補此缺口,提高ASD幼兒接觸高品質療育的機會。而近年來受疫情因素影響,面對面的介入提供常被迫中斷,遠距家長訓練模式能跨越地域限制,以更彈性的方式讓家長接觸具實徵證據的介入模式。本研究以丹佛早療模式(Early Start Denver Model, ESDM)及讓家長成為孩子溝通訓練的老師(Improving Parents As Communication Teachers, ImPACT)為課程設計基礎,旨在探討台灣地區ASD幼兒之遠距家長訓練方案的可能性,並檢驗家長在接受本研究介入後,與介入相關的知識及技巧執行能力之變化,以及其對於親職壓力、親職效能及生活品質之影響。研究方法:本研究為隨機對照試驗(randomized controlled trial, RCT)設計,共納入33名生理月齡介於18至48個月之ASD幼兒及其家長,隨機分為家長自助組及治療師協助組。家長自助組家長獲得本研究設計之課程網站六個月之使用授權,治療師協助組家長除了上述網站內容以外,另外接受一週一次,一次一小時,為期13週的教練課程。兩組家長皆須於介入前、後完成紙本問卷及家中親子互動影片錄製,並前來實驗室進行幼兒評估及其他資料蒐集。在2021年5月疫情爆發後,研究參與方式改為全線上進行,現場評估內容皆替代為家長自填問卷及線上訪談。研究結果:(1)在初級指標方面,接受遠距家長訓練方案後,兩組家長之介入知識分數及介入執行真確度分數皆顯著提高。在治療師的協助下,家長的介入執行真確度分數有更顯著地提升。(2)在次級指標方面,兩組家長之親職壓力總分、親職效能總分及生活品質範疇分數皆未有顯著變化,但親職壓力量表中的親職角色投入及社會孤立次量表分數顯著提升。兩組家長在介入後皆對遠距家長訓練方案具高滿意度,大多數家長同意自己能掌握每週的主題課程,並在過程中觀察到自己與孩子的正向改變,未來也願意繼續在生活中執行介入。結論:整體而言,遠距家長訓練模式可能使家長更有機會接觸實徵介入,並在短時間內提升對介入的知識概念,但治療師的協助能讓家長更顯著提升在家中介入執行的品質。本研究建議持續蒐集更大的樣本,以釐清不同類型ASD幼兒及家長的學習歷程及困難,並深入探討介入過程中壓力感受的來源及可能的因應方式。
Objectives: With more early detection and diagnosis of young children with autism spectrum disorder (ASD), there are high levels of unmet service needs. Parent-mediated intervention (PMI) programs may fill this gap and increase access to high-quality treatment for young children with ASD. However, since the COVID-19 pandemic, face-to-face interventions have often been interrupted. The telehealth parent training model may transcend geographical restrictions, offering a promising mechanism for increasing access to evidence-based interventions in a more flexible way. Based on the Early Start Denver Model (ESDM) and the Improving Parents As Communication Teachers (ImPACT) intervention design, this study aimed to explore the effectiveness and feasibility of telehealth training programs for parents of ASD young children in Taiwan, and examined post-intervention changes in parents` intervention knowledge, implementation fidelity, parenting stress, parenting efficacy, and quality of life.Methods: A randomized controlled trial (RCT) was conducted. 33 children aged 18-48 months with ASD and their parents were randomly assigned to a self-directed or therapist-assisted program. Parents in the self-directed group received access to the website designed in this study for six months, while parents in the therapist-assisted group received the website and 13 weekly 1-hour coaching sessions. Parents of the two groups were required to complete questionnaires and record parent-child interaction at home pre- and post-intervention. An on-site child assessment and additional data collection would be administered in the laboratory. After the outbreak of the COVID-19 pandemic in May 2021, the study was adjusted to online participation. The original on-site children assessment was replaced by self-rated questionnaires and online interviews by parents.Results: (1) In terms of primary indicators, the results indicated that parents in both groups significantly improved in intervention knowledge and ESDM implementation fidelity. Parents with therapist’s assistance had greater gains in implementation fidelity. (2) In terms of secondary indicators, there were no significant changes in parenting stress, parenting efficacy and quality of life scores in both groups of parents. However, parents in both groups got significantly higher scores on attachment and isolation subscale in the Parenting Stress Index (PSI-4). Both groups of parents were highly satisfied with the telehealth parent training program. Most parents agreed that they could master the weekly courses, and observed positive changes in themselves and their young children during the process. They would like to continue implementing intervention in their daily lives in the future.Conclusions: Overall, the telehealth parent training program may suggest a potential role for parents to increase access to evidence-based interventions and improve intervention knowledge in a short period of time However, therapist assistance provided additional benefit for improving fidelity. 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國立政治大學
心理學系
107752016資料來源 http://thesis.lib.nccu.edu.tw/record/#G0107752016 資料類型 thesis dc.contributor.advisor 姜忠信 zh_TW dc.contributor.advisor Chiang, Chung-Hsin en_US dc.contributor.author (Authors) 鄭可欣 zh_TW dc.contributor.author (Authors) Cheng, Ke-Hsin en_US dc.creator (作者) 鄭可欣 zh_TW dc.creator (作者) Cheng, Ke-Hsin en_US dc.date (日期) 2022 en_US dc.date.accessioned 1-Aug-2022 18:11:12 (UTC+8) - dc.date.available 1-Aug-2022 18:11:12 (UTC+8) - dc.date.issued (上傳時間) 1-Aug-2022 18:11:12 (UTC+8) - dc.identifier (Other Identifiers) G0107752016 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/141173 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 心理學系 zh_TW dc.description (描述) 107752016 zh_TW dc.description.abstract (摘要) 研究目的:隨著更多的自閉症類群障礙症(autism spectrum disorder, ASD)幼兒及早發現及確診,早期療育服務更顯供不應求,由家長作為介入執行者的模式可能嘗試彌補此缺口,提高ASD幼兒接觸高品質療育的機會。而近年來受疫情因素影響,面對面的介入提供常被迫中斷,遠距家長訓練模式能跨越地域限制,以更彈性的方式讓家長接觸具實徵證據的介入模式。本研究以丹佛早療模式(Early Start Denver Model, ESDM)及讓家長成為孩子溝通訓練的老師(Improving Parents As Communication Teachers, ImPACT)為課程設計基礎,旨在探討台灣地區ASD幼兒之遠距家長訓練方案的可能性,並檢驗家長在接受本研究介入後,與介入相關的知識及技巧執行能力之變化,以及其對於親職壓力、親職效能及生活品質之影響。研究方法:本研究為隨機對照試驗(randomized controlled trial, RCT)設計,共納入33名生理月齡介於18至48個月之ASD幼兒及其家長,隨機分為家長自助組及治療師協助組。家長自助組家長獲得本研究設計之課程網站六個月之使用授權,治療師協助組家長除了上述網站內容以外,另外接受一週一次,一次一小時,為期13週的教練課程。兩組家長皆須於介入前、後完成紙本問卷及家中親子互動影片錄製,並前來實驗室進行幼兒評估及其他資料蒐集。在2021年5月疫情爆發後,研究參與方式改為全線上進行,現場評估內容皆替代為家長自填問卷及線上訪談。研究結果:(1)在初級指標方面,接受遠距家長訓練方案後,兩組家長之介入知識分數及介入執行真確度分數皆顯著提高。在治療師的協助下,家長的介入執行真確度分數有更顯著地提升。(2)在次級指標方面,兩組家長之親職壓力總分、親職效能總分及生活品質範疇分數皆未有顯著變化,但親職壓力量表中的親職角色投入及社會孤立次量表分數顯著提升。兩組家長在介入後皆對遠距家長訓練方案具高滿意度,大多數家長同意自己能掌握每週的主題課程,並在過程中觀察到自己與孩子的正向改變,未來也願意繼續在生活中執行介入。結論:整體而言,遠距家長訓練模式可能使家長更有機會接觸實徵介入,並在短時間內提升對介入的知識概念,但治療師的協助能讓家長更顯著提升在家中介入執行的品質。本研究建議持續蒐集更大的樣本,以釐清不同類型ASD幼兒及家長的學習歷程及困難,並深入探討介入過程中壓力感受的來源及可能的因應方式。 zh_TW dc.description.abstract (摘要) Objectives: With more early detection and diagnosis of young children with autism spectrum disorder (ASD), there are high levels of unmet service needs. Parent-mediated intervention (PMI) programs may fill this gap and increase access to high-quality treatment for young children with ASD. However, since the COVID-19 pandemic, face-to-face interventions have often been interrupted. The telehealth parent training model may transcend geographical restrictions, offering a promising mechanism for increasing access to evidence-based interventions in a more flexible way. Based on the Early Start Denver Model (ESDM) and the Improving Parents As Communication Teachers (ImPACT) intervention design, this study aimed to explore the effectiveness and feasibility of telehealth training programs for parents of ASD young children in Taiwan, and examined post-intervention changes in parents` intervention knowledge, implementation fidelity, parenting stress, parenting efficacy, and quality of life.Methods: A randomized controlled trial (RCT) was conducted. 33 children aged 18-48 months with ASD and their parents were randomly assigned to a self-directed or therapist-assisted program. Parents in the self-directed group received access to the website designed in this study for six months, while parents in the therapist-assisted group received the website and 13 weekly 1-hour coaching sessions. Parents of the two groups were required to complete questionnaires and record parent-child interaction at home pre- and post-intervention. An on-site child assessment and additional data collection would be administered in the laboratory. After the outbreak of the COVID-19 pandemic in May 2021, the study was adjusted to online participation. The original on-site children assessment was replaced by self-rated questionnaires and online interviews by parents.Results: (1) In terms of primary indicators, the results indicated that parents in both groups significantly improved in intervention knowledge and ESDM implementation fidelity. Parents with therapist’s assistance had greater gains in implementation fidelity. (2) In terms of secondary indicators, there were no significant changes in parenting stress, parenting efficacy and quality of life scores in both groups of parents. However, parents in both groups got significantly higher scores on attachment and isolation subscale in the Parenting Stress Index (PSI-4). Both groups of parents were highly satisfied with the telehealth parent training program. Most parents agreed that they could master the weekly courses, and observed positive changes in themselves and their young children during the process. They would like to continue implementing intervention in their daily lives in the future.Conclusions: Overall, the telehealth parent training program may suggest a potential role for parents to increase access to evidence-based interventions and improve intervention knowledge in a short period of time However, therapist assistance provided additional benefit for improving fidelity. Future studies are recommended to continue collecting larger samples, for clarifying the learning process and difficulties of different parents and young children with ASD, and for further exploring the stressors and possible coping strategies during the training process. en_US dc.description.tableofcontents 摘要 iAbstract iii表次 vii圖次 viii第一章 緒論 1第一節 研究背景 1第二節 名詞釋義 4第二章 文獻回顧 6第一節 自閉症類群障礙症幼兒之介入模式 6第二節 丹佛早療模式之療效研究 12第三節 由家長執行的介入模式之療效研究 16第四節 遠距家長訓練模式的可能性 21第五節 研究問題與假設 33第三章 研究方法 35第一節 研究對象 35第二節 研究設計與流程 42第三節 研究工具 44第四節 介入設計 50第五節 分析方法 57第四章 研究結果 59第一節 前置分析 59第二節 介入前、後初級指標之進展 64第三節 介入前、後次級指標之進展 70第五章 討論 76第一節 遠距家長訓練方案對家長之成效 76第二節 治療師協助提供之額外效果 78第三節 研究限制與未來研究方向 81第四節 研究結論與臨床意義 83參考文獻 85附錄一 介入知識問卷 94附錄二 滿意度調查 97附錄三 「WHOQOL-BREF 臺灣簡明版」使用授權書 99 zh_TW dc.format.extent 1569674 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0107752016 en_US dc.subject (關鍵詞) 自閉症類群障礙症 zh_TW dc.subject (關鍵詞) 丹佛早療模式 zh_TW dc.subject (關鍵詞) 讓家長成為孩子溝通訓練的老師 zh_TW dc.subject (關鍵詞) 遠距醫療 zh_TW dc.subject (關鍵詞) 家長訓練 zh_TW dc.subject (關鍵詞) 介入執行真確度 zh_TW dc.subject (關鍵詞) Autism spectrum disorder en_US dc.subject (關鍵詞) Early Start Denver Model en_US dc.subject (關鍵詞) Improving Parents As Communication Teachers en_US dc.subject (關鍵詞) Telehealth en_US dc.subject (關鍵詞) Parent training en_US dc.subject (關鍵詞) Intervention fidelity en_US dc.title (題名) 自閉症類群障礙症幼童的遠距家長訓練方案:家長成效之探討 zh_TW dc.title (題名) Telehealth Parent-Mediated Intervention for Young Children with Autism Spectrum Disorder: Parents` Outcomes en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 吳進欽、朱慶琳、侯育銘、姚淑芬(2014)。克氏行為量表篩檢4歲以下自閉症類疾患兒童效度探究。中華心理衛生學刊,27(1),131-161。 https://doi.org/10.30074/FJMH.201403_27(1).0005林姿伶、姜忠信、吳欣治(2016)。自閉症類群兒童綜合性早期療育的療效研究:文獻回顧。中華心理衛生學刊,29(1),1-46。 https://doi.org/10.30074/FJMH.201603_29(1).0001柯慧貞、朱倍毅、陸偉明、高振傑、龔毅珊、邱郁雯、方曉喻、林木芬、胡崇元(2008)。更新學齡前兒童行為發展量表的常模。測驗學刊,55(2),313-340。 https://doi.org/10.7108/PT.200808.0313姚開屏(2002)。台灣版世界衛生組織生活品質問卷之發展與應用。台灣醫學,6(2),193-200。 https://doi.org/10.6320/FJM.2002.6(2).09翁毓秀(2019)。親職壓力量表(第四版中文版)。心理出版社。陳怡群、黃惠玲、趙家琛(2009)。阿肯巴克實證衡鑑系統。心理出版社。陳孟筳、何淑賢、吳欣治、姜忠信(2020)。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。中華心理衛生學刊,33(3),219-245。 https://doi.org/10.30074/FJMH.202009_33(3).0001張正芬、陳心怡、邱春瑜(2020)。文蘭適應行為量表第3版(中文版)。中國行為科學社。黃毅志(2008)。如何精確測量職業地位?「改良版台灣地區新職業聲望與社經地位量表」之建構。臺東大學教育學報,19(1),151-159。 https://doi.org/10.6778/NTTUERJ. 200806.0151劉惠美、曹峰銘(2010)。華語嬰幼兒溝通發展量表(台灣版)。心理出版社。衛生福利部統計處(2022)。身心障礙者人數按年齡及類別分(2022年第一季)。 https://dep.mohw.gov.tw/dos/cp-5224-62359-113.htmlIngersoll, B., & Dvortcsak, A.(2020a)。教導自閉症幼兒社會溝通能力(第二版):教練手冊(姜忠信、陳孟筳、倪子洛、江淑蓉、陳思臻、蔡曉薇、呂幸芳譯;一版)。洪葉文化。(原著出版年:2019)Ingersoll, B., & Dvortcsak, A.(2020b)。教導自閉症幼兒社會溝通能力(第二版):家長手冊(陳孟筳、倪子洛、陳思臻、蔡曉薇譯;一版)。洪葉文化。(原著出版年:2019)Rogers, S. 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