Transcript Autism
香港教育學院特殊學習需要與融合教育中心、自閉症復康網絡 自閉症兒童基金協會 及 香港自閉症聯盟 合辦 自閉症醫學康復及教育研討會 Applied Behavior Analysis (ABA) 應用行為分析密集訓練 Ms. Fiona Wan 溫文蕊女士 Autism Recovery Network 現職『自閉症復康網絡』 ABA Therapist ABA行為訓練治療師 2009年8月14日 (星期五) A developmental disorder that is characterized by impairment in social skills, communication, play, language and presence of repetitive and stereotypic behaviors. 自閉症是發展障礙，主要在社交、溝通、遊戲、語 言、重複及固定行為等方面有明顯遲緩： Misconceptions 對自閉症的誤解 They are retarded 他們是智障 They are spoiled 被縱壞的孩子 Their problem is purely mental 單純是精神方面問題 Characteristics 特徵: Qualitative impairment in social interaction 社交上的明顯障礙 Marked impairment in the use of multiple non-behaviors such as eye-toeye gaze, facial expressions, body postures and gestures to regulate social interactions 未能運用多類型非語言溝通技巧，例如：以 目視對方、面部表情、身體語言及形態去調節社交行 為； Failure to develop peer relationship appropriate to developmental level 未 能因應發展階段去建立和同儕友誼； Lack of spontaneous seeking to share enjoyment, interest or achievements with other people 達成願望。 缺乏即時調適與他人分享快樂、興趣及 Lack of social or emotional reciprocity 動 缺乏和他人社交或情感互 Characteristics 特徵: Qualitative impairment in communication 溝通上的明顯障礙 Delay in or total lack of the developmental of spoken language 語言能力 的遲緩或完全没有語言能力； marked impairment in the ability to initiate or sustain a conversation with others 無法去開展或維持與他人對話； Stereotyped and repetitive use of language or idiosyncratic language 固著 或重覆的語言運用，或以自我為中心的語言； Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level 無能力按正常發展階段，進行仿 真實式遊戲，或模擬式遊戲。 Characteristics 特徵: Restricted repetitive and stereotyped patterns of behaviors, interests and activities 有限的重覆性和固著行為、興趣及活動模式 preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or rituals 日常生活中經常進 行一或多種固著行為及興趣，該等行為的次數或儀式性是超乎常 態。 inflexible adherence to specific non-functional routines or rituals固執地 依附著某些非功能性日常生活程序或儀式 Stereotyped and repetitive motor mannerism固著及重覆性的行為表現； Persistent preoccupation with parts of objects 沈醉於把弄或持有某些 物件的部份 Prevalence 發生率 The Autism Society of America estimates that autism occurs in 1 in 150 children 美國自閉症協會估計每150位兒童中有1位是自閉症患者； 4 (boy) : 1 (girl) ratio 4 (男) : 1 (女) 比例 Global estimate: 1:147 has autism 全球估計 1:147 Incidence of autism increased rapidly in recent years 近代自閉症人數急劇增加 2.8 million autistic children in China 2.8 百萬自閉症兒童中國 25,000 registered autistic children in HK 香港25,000自閉 症兒童登記 6.8% of Japanese school children have developmental disorders 日本6.8%學童發展障礙 10,000 in Shanghai alone 10,000名 上海 1 in 57 children currently in the school system has some kind of developmental problems 每57位學童中有1位有發 展問題 由 1:10,000 in 1980s 至 1:166 in 2000 以後 Effective Treatment 有效的治療 Intensive, behaviorally based early intervention has helped children learn 密集式行為模式的早期干 預有助兒童學習溝通及社交技能。 communication and social skills. Research and studies show that early intervention of children with autism has significant improvement in their developmental delays。許多調 查及研究指出早期干預有助自閉症兒童，對發展 遲緩方面有顯著的改善。 Intensive Behavioral Treatment for Children With Autism: 4 Year Outcome and Predictors by Glen O. Sallows and Tamlynn D. Graupener (Wisconsin Early Autism Project (Madison)自閉症兒童密集式行為訓練： 4年 成果及預測因子 The findings demonstrated that many children with autism could make dramatic improvement, even achieve “normalcy” and succeeding in regular education classrooms, and many researchers now agree that intensive behavioral treatment can result in substantial gains for a large proportion of children研究顯示許多自閉症兒童有明顯 的改善，甚至回復〝正常〞及重返主流學校，許 多研究人員均同意密集式行為訓練，對治療大部 份兒童均有顯注的改善。 A comparison of intensive behavior analytic and eclectic treatments for young children with autism by J.S. Howard et al. (Research in Developmental Disabilities)自閉症兒童 密集式行為訓練及傳統特教式訓練比較研究 The IBT group (intensive behavior analytic intervention; 1:1 adult:child ratio, 25–40 h per week) had higher mean standard scores in all skill domains than the AP (public special education classrooms; 1:1 or 1:2 ratio, 30 h per week)and GP (non-intensive public early intervention programs; small groups, 15 h per week)groups. The differences were statistically significant for all domains except motor skills. These findings are consistent with other research showing that IBT is considerably more efficacious than ‘‘eclectic’’ intervention.密集式 行為訓練(IBT) – (1對1每周25-40小時)，它在所有技巧範圍的中 位數成績均高於(AP)公立特殊教育學校的學生– ( 1對1或1對2 ， 每周30小時) ，或(GP)普通早期干預– (非密集式公立早期干預， 小組式訓練，每周15小時) 。研究結果顯示在所有範圍除大肌肉 技巧外，均有統計學認可的重要性。這項研究結果和其他研究 都一致認同 (IBT)是比較傳統特教式訓練有成效。 Effective Treatment 有效治療 Biomedical Treatment/ Intervention 生物醫學治療/干預 can help develop these areas 可以有下列功效 消減觸發因素 Stabilize condition 穩定狀況 Achieve health 改善身體健康 Eliminate triggers Ensure the child’s Maximum Learning Potential 兒童最大的學習潛能 維持 Effective Treatment 有效治療 Early Intervention (ABA) 早期干預 (ABA) Because the brain can learn to compensate and develop when it’s young 兒童腦部在早期有補償及再發展的學習能力 Increase Skills 增強技巧 Decrease Maladaptive Behaviors 減少不適應的行為 Generalize to Daily Living 類化至 (應用於) 日常生活 AUTISM RECOVERY NETWORK (ARN) 自閉症復康網絡 www.autismrec.net ARN is established, since 2005, by parents and professionals who are committed in helping kids with autism and developmental delays. ARN於 2005由一群家長及專業人士年成立，目的為幫助自閉症及 相關發展障礙兒童 ARN is the ONLY service provider of Verbal Behavior (VB) in Asia. Our program is certified by Dr. James Partington, founder of Behavior Analysts of the USA and one of the foremost experts on VB based teaching programs. All of our therapists are trained under his esteemed program.香港ARN是亞 洲區唯一提供行為語言(BV)訓練的機構，其訓練獲美國 James Partington博士認証，Partington博士是美國行為分 析訓練師學會創辦人，他亦是最早研發 行為語言(BV)訓練 課程的專家，香港ARN的治療師均有參與上述課程 Applied Behavior Analysis (ABA) 應用行為分析 • an intensive, structured teaching program密集及結構式訓練課程 • Lessons or skills to be taught are broken down into their simplest elements/ form教授的課堂或技巧細分至最基本的元素或形式 • teach language skills based on the premise that receptive language should be developed prior to expressive language教授語言技巧的原則，是先學習接 受性語言，再學習表達性語言。 • Correct responses and behaviors are rewarded with lots of positive reinforcement對正確的回應或行為表現，提供大量正面獎勵物作獎勵。 • When incorrect responses occur, they are ignored and appropriate responses are prompted and rewarded對不正確的回應，不予關注；對正確的回應 給予即時回應及獎勵。 Example of ABA ABA 的例子 child may be taught to say the word “cookie” but not necessarily when the child wants a cookie at that moment當兒童被教授〝曲奇餅〞時，他當時不一 定希望吃曲奇餅。 concept of “cookie” may be considered mastered when a child can point to a cookie and say cookie when shown a cookie當兒童能指認〝曲奇餅〞時能 說出曲奇餅，便是能掌握〝曲奇餅〞這個概念。 As the child masters the lesson, expectation are raised and primary reinforcers (like food) are replaced with social reinforcers (hugs, praise, tickles, etc.)當兒 童能掌握課堂內容，便要提升對他的祈望，用社交性獎勵物(例如：擁 抱、口頭讚賞、身體接觸等)代替原始性獎勵物(食物) Verbal Behavior (VB) 語言性行為 Focus on teaching specific components of Expressive Language (mands, receptive, imitation, echoics, tact, intraverbal, receptive identification by function/feature/class [RFFC], textual and writing)集中教授表達性語言 的重要原素(要求性、接受性、模仿性、回應性、tact 、跨 語言性、能分辨功能的接受性/特色/ RFFC ，內文式及書 寫文字) 。 VB uses language to capture a child’s motivation to develop a connection VB運用語言幫助兒 童掌握動機，並建立文字及其代表的概念。 between the value of the word and the word itself. VB approach builds on all of the ABA research but also enhances a child’s VB訓練模式建基於應用行為分 析研究結果，同時亦增強兒童學習功能性語言。 ability to learn functional language Verbal Behavior (VB) 語言性行為 Language is treated as a behavior that can be shaped and reinforced 。語言是一種行為，可以被塑造及被增 強。 It focuses in the different behavioral classification of language 。VB聚焦於語言性行為的分類。 Example of VB 語言性行為的例子 a child is first taught to ask for a “cookie” any way they can (vocally, sign language, etc.) only when they actually want a cookie. We capture that desire for a cookie and turn it into the lesson that the word (or sign) for a cookie will get you what you want 。首先教授兒童在真正想吃曲奇餅 時，以任何方式要求曲奇餅(語言、手勢等) ，我 們透過兒童希望吃曲奇餅的動機，轉化成學習課 堂，讓兒童明白曲奇餅這個字 (或符號)可以達成 他所想吃曲奇餅的事。 Behavioral Classification of Language 語言性行為的分類 Mand- asking for what you want (e.g. Ask for a cookie when it is wanted; “I want to eat chips”)要求性 -提出你的要求(例如：想吃曲奇 餅時說出你的要求 〝我想吃薯片〞 。 Imitation- copying what was observed (e.g. Repeating someone’s motor movement, such as raise arms)模仿性 -重覆觀察時所得行為(重 覆他人的大肌肉動作，例如：舉高雙手、 Echoic- vocal imitation (e.g. Repeating exactly what you hear) 鸚鵡學 舌 -重覆他人的語言 (例如：重覆他人的語句) Receptive- non-verbally following instructions or complying with the requests of others回應性 - 非語言性地服從或依照他人的要求或指示 Tact- verbally identifying objects, actions, events, etc.以語名物 -用口 語分辨不同物件、行為及事件。 Behavioral Classification of Language 語言性行為的分類 RFFC- receptively identifying specific items when given some description (features, functions, class) (e.g. Select a cookie when asked “ What has chocolate chips?” “What do you eat?” “Find the food”) RFFC -當被給予某 些描述(特色、功能及分類)並以回應性分辨物件 (例如：甚麼物件表層有 朱古力？你愛吃甚麼？能在這堆食物中找出你最愛吃的？) Intraverbal- answering questions or conversations where your words are controlled by other words (e.g. Answer questions about the cookie when it is not present)跨語言性 -在回覆或與人談話時所用的字眼受其他詞句語控 制住(例如：在沒有曲奇餅實物時回答有關曲奇餅的問題) 。 Textual- reading written words內文性 -閱讀書寫式的文字 Writing- writing and spelling words when spoken to you 書寫性 -當讀出 某字時書寫該字句。 Behavioral Classification of Language 語言性行為的分類 In addition, Natural Environment Teaching (NET) is also part of Verbal Behavior which capitalizes on the opportunities to conduct natural language training in the context of everyday activities. Many different types of language trials conducted within an activity using naturallyoccurring reinforcers. (NET)=真實環境教學是語 言性行為的其中一部份，它運用兒童日常 生活的內容，作真實環境教學，不同型式 的語言操練是運用真實的獎勵物。 ABLLS – R ABLLS - 修訂版 Assessment of Basic Language and Learning Skills – Revised基礎語 言及學習能力評估 -修訂版 is a criterion referenced assessment它的評估是依據不同標準作 參考值 important tool for analysis and identification of critical learner skills that are often easily acquired by typically developing children before they attend Kindergarten 是一項重要學習能力的評估工具，而 這些重要學習能力是一般兒童在進入幼兒園前已掌握。 ABLLS – R ABLLS - 修訂版 協 助家長及專業人員去確認兒童現時掌握的技巧或障礙。 allows parents and professionals to identify a child’s skill and skill deficit provides potential targets for instructors 提供訓練員作兒童潛能的訓 練目標 tracks a child’s progress 記錄兒童訓練進度 It has 544 specific skills and 25 repertoire/ areas 25種範疇 它有544種技巧及分屬 25 Areas 25種範疇 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 合作及獎勵物的成效 Cooperation and Reinforcer Effectiveness 視覺表現Visual Performance 回應性語言Receptive Language 模仿 Imitation 語言模仿Vocal Imitation 要求Requests 標示Labeling 跨語言性Intraverbals 即時式對話Spontaneous Vocalizations 語音及文法Syntax and Grammar 遊戲及娛樂Play and Leisure 12. 社交互動Social Interaction 13. 小組式指導Group Instruction 14. 服從班房秩序Follow Classroom Routines 15. 類化回應Generalized Responding 16. 閱讀能力Reading Skills 17. 數學能力Math Skills 18. 書寫能力Writing Skills 19. 串字Spelling 20. 穿衣服能力Dressing Skills 21. 晉食能力Eating Skills 22. 梳洗Grooming 23. 如厠能力 Toileting Skills 23. 大肌運動Gross Motor Sills 24. 小肌運動Fine Motor Skills Our Program includes: 服務種類 Home-based therapy session: The therapy is provided in the natural environment that will allow the child the opportunity to use and master the skills acquired through therapy-helping to facilitate generalization.家居式訓 練 -兒童在日常生活中有機會應用及學會相關技巧，並應用於日常生活 中。 Each child’s therapy program is customized to address his or her specific area(s) of concern. The focus of our program, particularly in case of younger children, is on development of speech and language, conceptual and academic skills, as well as promoting play and social skills. As the child progresses, the emphasis shifts towards practical knowledge as well as adaptive skills.依照每位兒童的 不同需要訂定訓練內容，在年齡較少的兒童學習重點，是發展對話及 語言，學術及概念性能力，同時兼顧遊戲及社交能力；當兒童日漸成 長，訓練的重點轉移往實際應用知識和適應性能力。 The child’s progress is evaluated based on the data gathered by the therapist. Data collection is an integral part of an effective intervention program.治療師運用日常記錄作兒童的評 估，資料記錄是有效訓練的重要因素。 The curriculum is individualized for each child. It builds on each child’s existing skills and addresses deficits. A 6-month Individualized Education Plan (IEP) is formulated for each child based on the Assessment of Basic Language and Learning SkillsRevised (ABLLS-R) (James W. Partington, Ph.D., BCBA).每位 兒童的課程都是『度身訂造』，建基兒童現有能 力並針對其不足，運用ABLLS-R的評估數據，每 位兒童均會訂定一個半年的『個別教育方案(IEP) (James W. Partington, Ph.D., BCBA). The ABLLS-R is a criterion referenced assessment and is an important tool for analysis and identification of critical learner skills that are often easily acquired by typically developing children before they attend Kindergarten. It allows parents and professionals to identify a child’s skill and skill deficit. It also provides potential targets for instructors and for tracking of child’s progress. ABLLS-R 的評估是依據不同標準作參考值，是一 項重要學習能力的評估工具，而這些重要學習能 力是一般兒童在進入幼兒園前已掌握。協助家長 及專業人員去確認兒童現時掌握的技巧或障礙。 提供訓練員作兒童潛能的訓練目標 記錄兒童訓練 進度 Hong Kong Junior School (HKJS) Hong Kong Junior School is set up by the Autism Children Foundation (ACF), which is a non-profit making organization formed by a group of parents and professionals working with autistic children in Hong Kong. The Foundation provides funding and operational support to the school. HKJS是由『自 閉症兒童基金協會』(ACF) 設立的 自閉症學校，(ACF)是由香港一群 家長及專業人士組成的非牟利團體， ACF支援HKJS學校經濟及營運。 www.autismchildren.org.hk Hong Kong Junior School (HKJS) Use 3 of the most powerful teaching methodologies 採用3種有效教學模式 Behavior Management 行為管理 Direct Instruction 直接指導 Precision Te個aching 準確目標式教學 Learning Outcomes 學習成果 Management 管 Independent Practice個別操練 理 Instruction指導 Measurement測量 Directed Practice 直接操練 Our Humble Beginning in Sheung Wan 上環簡陋的開始 Computer Math Centre 電腦數學室 Our Humble Beginning in Sheung Wan 上環簡陋的開始 Reading Center 閱覽室 Activity Center 活動室 Language Center 語訓室 Our Humble Beginning in Sheung Wan 上環簡陋的開始 Math Counting Center 數學室 Occupational Therapy Room 職業治療室 A vigorous and systematic curriculum 一個強效及系統化的教學方案 Reading and Language 閱讀及語言 Curriculum 教學方案 Mathematics 數學科 Curriculum 教學方案 PE & Personal Development 體育及個人成長 Computer Technology 電腦科技 Questions?? 在第二節全部發言完成，發問安排。