Transcript AUTISM SPECTRUM DISORDER - 國立新竹教育大學-首頁

Interventions and Strategies for
Educating Young Children with Autism
in the Public Schools
Kathy M. Small, M.A.
1
Developmentally-Based Public School Program for Young Children
with Autism Provides:
以發展為基礎的學校方案
 Normalized educational experience 普通教育經驗
 Enjoying normal educational experience, however adapted
合適且有趣的普通教育經驗
 Opportunity for social interaction 社會互動的經驗
 Daily experience 日常經驗
 Same players 相同的玩伴
 Structured 結構化
 Broad educational approach 廣泛的教學方案
 Multiple learning experiences 多元學習經驗
 No single approach 非單一的方案
 Opportunity for spontaneous imitation 給予模仿的經驗
 Familiar environment 和善的環境
 Peers, experiences increase possibility of learning to imitate
同儕學習經驗的模仿
2
Developmentally-Based Program
以發展為主的計畫
 Opportunity to benefit from peers as models
製造從同儕中學習的機會
 Learn to respond to others 學習回應他人
 Incorporate peers into daily learning experiences
把同儕當做每日學習的經驗
 Opportunity to develop play skills
製造發展遊戲技巧的機會
 Play emphasized in developmental program
遊戲著重在發展性的計畫
 Familiar peers, relationship熟悉的同儕和關係
 Child’s interests and strengths as source of information for
program planning:設計計劃要考慮孩子的興趣及能力
 Motivation considered要考慮動機
 Consideration of child in developing curriculum/learning
experiences/daily activities
考慮孩子的發展性課程/學習經驗/每日例行活動
 Good for all children, critical for children with ASD
對每個孩子都有益，尤其是ASD兒童
3
Developmentally-Based Program
以發展為主的計畫
 Opportunity to develop and use language
製造發展和使用語言的機會
 Familiar environment with familiar peers provides
context for language
使用熟悉的環境和同儕做為語言的內容
 Daily activities reinforcing for language
利用每日例行活動可加強語言
 Parent support and advocacy
家長的支持和擁護
 Parent and educator can share knowledge, concerns,
triumphs and goals
親師可以分享新知、要事、喜悅和目標
 Supports generalized learning
家長的支持可以概括到學習
4
Specific Classroom Practices in an Early
Intervention Program for Children with
ASD
ASD兒童早期介入方案中的特別教室練習
 Evaluate communication and language abilities




評估溝通和語言能力
 Non-verbal and verbal by observation/parent
透過觀察及家長得知有無語言
 Behavior is communication行為是一種溝通
 Communication priority as core deficit/challenge
視核心缺陷/挑戰發展溝通的優先順序
Physically structure room so verbal directions are supported by
physical realities
製造結構化物理環境以利於口語發展
Defined areas in room
教室中定出固定空間
Planned areas can reduce distractions/escape
設定的區域要能降低分心/離開位子
Visual schedules 視覺化功課表
5
Specific Classroom Practices
特別教室練習
 Create environment where relationships are possible
and frequently unavoidable
製造一個經常有人際互動產生的環境
 Children in proximity鄰近的孩子
 Partners for transitions同伴的轉換
 Activities/materials/toys staged to increase shared
participation and enjoyment
多種活動/物品/玩具以增加分享的參與度和享受能力
 Support child’s desired outcomes as contingent upon
adult/peer interactions
以大人/同儕互動為條件去支持孩子想要的結果
 Set up routine and be faithful to it
設定例行活動並遵守
 Crucial in development of ability to predict and anticipate
activities/events in the day
能力的發展很重要，它可以預測一天中活動/事件的發生
6
Specific Classroom Practices
特別教室練習
 Curriculum that is meaningful and appropriate
課程是有意義且適當的
 Thematic teaching for natural context
對自然情境內容做主題式教學
 Consider child as concrete learner: objects/materials
以小孩為學習者：物體/材料
 Incidental teaching: Embedded learning experiences
(e.g. Music for motor imitation, mechanical animals
for language, rainbow ribbon for turn-taking,
participation)
附帶教學：學習經驗印象加深
 Incorporate interests and motivations
合併與趣和動機
7
Specific Classroom Practices
特別教室練習
 Incorporate other programs and approaches to provide a broad
but philosophically unified program
加入其它計劃及方法使其更廣但哲學上統一化的計劃
 Develop a clear educational philosophy for educating your
students on the autism spectrum
發展一套清楚教育哲學來教育ASD學生
 Avoid implementing methods and strategies learned in
trainings that aren’t paired with a foundation of knowledge
and educational practices for the child with ASD
避免實施那些和教育ASD學童理論相違背的方法及策略
8
Specific Classroom Practices
特別教室練習
 Individualize expectations and tailor, as much as
possible, expectations and demands for each child
儘量依個別學童訂定個別化的期待
 Each child different though share common core challenges
雖然有一樣的核心缺陷，但每個孩子都不一樣
 Understand child’s strengths/weakness to help maximize
strengths and minimize weakness
了解孩子優弱勢，幫助增加優勢減少弱勢
9
Specific Classroom Practices
特別教室練習
 Expect student to be part of class during ALL
activities





期待每個學生在所有活動中都能參與
Not negotiable不可妥協
Physical participation may precede active interest in
participation
肢體參與可以在參與時增進活動興趣
Benefits from activities cannot occur without being part of
activities
若無參與活動則無法從活動中獲益
May seem easier to let child entertain self but short term gain
with long term consequences
似乎讓孩子自己玩較容易，但短期長期結果
When child with autism not expected to participate in
classroom activities, child may be satisfied for the moment,
but has gained no internal strategies to achieve greater goal
of being part of a social environment
當ASD孩子如預期不參與活動時，他可能一時會感覺滿足，
但無法獲得社交所需的更進階的策略
10
Why Incorporate Other Programs
and Approaches into the Classroom?
為何要加入其它的計畫和方法於教室中
 Children with autism have unique ways of learning, relating and
communicating that influence their ability to learn
自閉症孩童有其獨特的學習方法及溝通方式會影響其學習能力
 Educational supports needed to accommodate core
deficits/challenges in children with ASD
需要教育的支持以適合ASD孩童的核心缺陷/挑戰
 Classroom curriculum that is enjoyed by most students may not be
appreciated by the child with autism who may retreat into selfabsorption, apathy or difficult behavior
適合大部份學生的課程不一定適合自閉症學生，他們可能會自
我刺激、表現冷淡、出現嚴重行為問題
 Individualized learning experiences (e.g. TEACCH) can
contribute to child’s educational experience
個別化學習經驗(如TEACCH)有助於孩子的學習經驗
11
Other Programs and Approaches
其它的計畫和方法
 Opportunity and proximity do not always translate into successful learning
提供機會與時常接觸並不一定會得到成功的學習
 Core challenges of ASD can make educational experiences inaccessible
without specific support
若無特殊支持，由於ASD的核心缺陷將使得教育成效難以達成
 Classroom is natural environment for introducing tools for
learning/overcoming core challenges
教室是個天然環境可供學習及克服其核心缺陷
 Integrating other programs and approaches allows the child with autism the
ability to express himself in his most idiosyncratic ways while providing
him with skills to ultimately abandon those idiosyncratic ways and replace
them with more useful and acceptable behaviors and learning strategies
在統合其它計劃和方法時,在教技巧時，允許ASD學童用他獨特方式表
達他自己，最終希望可以改掉怪異方式而以更有用且可被接受的行為
和學習策略來取代。
 Accept the student you have, understand her challenges, and develop
methods and approaches that target those challenges defined by ASD
接受你的學生、了解他困難、發掘方法去解決那些ASD的缺陷
12
The Importance of Structure and Some Forms
Structure Takes in the Classroom
結構化的重要性和在教室中可使用的結構化做法
 Map in new town新市鎮的地圖
 Student master environment 學生了解環境
 Structure through classroom routines
教室例行活動的結構化
 Vacation and new routine休假和例行活動
 Child creates own routines to create predictability
孩子自己創造例行活動以產生可預測性
 Participation as a means to create internal structure
參與是產生內在結構化的一種方式
 Classroom experiences and participation create meaning,
and help child with ASD connect and relate experiences
that lead to internal structure
教室經驗和參與可以引起有意義的、可幫助ASD連結經
驗以達到內在結構化
13
Group Time Goals for Children with
Autism Spectrum Disorder
ASD學童的團體活動目標
Joint Attention 相互注意協調能力
Joint Action 共同的行為
Social Interaction 社交互動
Social Reciprocity 社交相互對等
Shared Perspective 分享看法
Awareness of Others 覺知他人
Imitation 模仿
Anticipation 期望
Ability to Predict 預測力
Turn-Taking 輪流
Impulse Control 衝動控制
Learning concepts embedded into highly desired
material/routines
由高度興趣的例行活動中產生學習概念
 Communication 溝通












14
Strategies and Benefits of Group Time for
Children with Autism Spectrum Disorder
團體時間可使用於自閉症者的策略及優勢
 Social opportunities embedded in activities/routines
活動中的社交機會
 Use appealing high-interest materials to capture
interest and maintain attention
使用可吸引高度興趣的教材來引起興趣及保持注
意力
 Exploit the need children with ASD have for routines
by maintaining them
包含ASD兒童的一些儀式化行為
 Use familiar materials and revisit materials/activities
for generalized learning
使用熟悉教材及重複活動來引導類化的學習
 Use music to teach imitation
使用音樂教導模仿能力
15
Strategies and Benefits
策略和優勢
 Avoid passive learning; involvement supports
participation
避免消極的學習並支持其活動參與
 Use most capable student as model利用能力
好的學生當作學習模範
 Don’t be intimidated to use freedom of
movement. Child’s ability to move takes
away some adult control, but has several
benefits for child
不要害怕讓學生使用〝移動的自由〞，孩
童的自由移動會減少成人的控制，但對於
他卻有多種的好處
16
Common Practices in
Education/Therapy
教育與治療中常用的實施
Behavioral 行為的
Developmental 發展的
Peer Emphasis 同儕的加強
17
The Lovaas 1987 Study:Behavioral
Lovaas1987研究：行為的
Ivar Lovaas, UCLA psychology professor Ivar Lovaas，UCLA心理學教授
1987 study of 19 young children with autism 研究19名自閉症兒童
Lovaas claimed a “recovery” rate of 47% Lovaas聲稱47％復原率
2 criteria of recovery 復原的兩個標準 :
 IQ scores IQ分數
 Classroom placement 教學安置
 No adaptive outcomes measured 沒有合適結果的測驗
 Controversy over research and methodological questions involving:
對於研究及教學問題的爭論包括以下:
 Representativeness of children: biased sample as external validity threat (replication)
孩童的典型：極端樣本的威脅
 Experimental design: children matched rather than assigned: selection bias
實驗設計：應選和式的孩童而非指定的～選擇上的偏見
 Age onset variables between control and experimental groups
控制組及實驗組的年齡變項
 Differences in pre and post tests
前後測的差別
Gresham and MacMillian, 1998
 40 hour a week Discrete Trial Training Program (DTT) (also called Intensive Behavioral
Program (IBP) and Early Intensive Behavior Program (EIB) )
每週40小時的分段測驗訓練計畫（DTT），也稱為密集行為計畫（IBP）和早期密18
集行為計畫（EIB）




SCERTS MODEL: Developmental
SCERTS模式：發展性的
 Developed by Barry Prizant, Ph.D, Amy Wetherby, Ph.D., Emily Rubin, M.S.,
Amy Laurent, OTR-L (http://depts.washington.edu/isei/iyc/iyc_previous.html)
 Comprehensive, multidisciplinary approach
綜合的、多元的方法
 Primary goal to enhance Social Communication, Emotional Regulation and
Transactional Support (SCERTS) as primary developmental dimensions for a
comprehensive program for young children with ASD
ASD孩童綜合發展課程的主要目標及基礎為增加社交溝通、情緒管理、
人際關係（SCERTS）等能力
19
SCERTS Model
 Transactional Model
人際關係模式
 SCERTS: Barry Prizant & Amy Wetherby
SC = Social Communication
社交溝通
ER = Emotional Regulation / Self and
Mutual Regulation
情緒管理/自我和相互的管理
TS = Transactional Support
Self/Education/Family
人際關係的支持～自我/教育/家庭
Prizant, et al. 2006
20
SCERTS Model
 Developed over 2 decades of empirical/clinical work







發展超過20年以上臨床研究
Consistent with “evidence-based” practices
持續〝實證基礎〞的施行
Consistent with tenets of positive behavior support
持續正向行為支持的宗旨
Integrates visual supports 整合視覺的支持
Family-centered 以家庭為中心
Influenced by Hanen Early Language Centre Model
受到〝Hanen早期語言中心模式〞的影響
Philosophy that most children with ASD are capable of learning in natural
activities and inclusive environments
認為大多數ASD兒童能從自然的活動和其涵蓋的環境中學習
Myth that children with ASD can only learn in 1:1 instruction and that natural
environments and activities are too overly stimulating
不認同ASD兒童只能從1對1的教導中學習，也不認同自然的環境和活動是
或於刺激性的
21
SCERTS Model
 Provides information to families 提供訊息給家庭
 Shares resources with families 和家庭分享資源
 Encourages sensitivity to range of reactions family may experience in





raising child with ASD
鼓勵家庭去分類在扶養ASD兒童成長過程中可能經歷的反應
Clinicians/educators respect family priorities and family structures and
cultural factors
臨床學者/教育者應尊重家庭優先考慮的事項、家庭的結構和文化因素
Sets recommendations that are compatible with family belief systems
給予符合家庭信念系統的推薦
Helps families develop appropriate expectations and realistic, achievable
goals for child
幫助家庭發展合適的期望以及孩子實際可達成的目標
Respects parents, does not dictateHelps parents maintain hope and identify
developmentally appropriate next steps
幫助父母保持希望並認同發展合適的下一階段學習
Supports parents in celebrating small steps/positive change
22
Floor Time: Developmental
地板時間：發展性的
 Relationship-Based 以人際關係為主要基礎
 Floor Time DIR: Developmental,Individual-Difference ,
Relationship-Based: Stanley Greenspan & Serena Wieder
地板時間DIR：發展性的、個別差異、以人際關係為基礎
 Targets emotional development: child-centered focus
目標為情緒的激發：以孩童為中心
 Highly interactive 高度互動
 Teaches parents how to engage with child with outcome of
broad gains
教導父母如何對待有廣泛發展障礙的孩童
 Helps turn child’s actions into interactionsCircles of
Communication
溝通的小圈圈
 Intensive 20-30 minute sessions 6-10 times daily
密集的20-30分鐘課程，一天6-10次
Child with Special Needs
Greenspan, 1998
23
4 Floor-Time Goals Parents Help Child Attain
父母幫助孩童在地板時間所獲得的四項目標
 Encourage Attention and Intimacy 鼓勵關注和親密的行為
 Increased attention to adult 增加對成人的注意
 Maintaining mutual attention 保持相互的注意
 Enjoy presence 享受參與
 Two-Way Communication 雙向溝通
 Open and close circles of communication, non-verbally, use emotions,
body
開放及封閉的溝通圈圈，非語言的，使用情緒、身體語言
 Encouraging the Expression and Use of Feelings and Ideas
鼓勵感覺和想法的表達及應用
 Child expresses feelings/intentions in words and play
孩童使用文字和遊戲來表達感覺和意圖
 Logical Thought 邏輯的思考
 Child link ideas and feelings: understand world
孩童連結想法和感覺：瞭解世界
 Child connects thoughts in logical ways
孩童使用有邏輯的方式連結想法
The Child with Special Needs, Stanley Greenspan, M.D., Serena Wieder, Ph.D. 1998
24
Peer Emphasis
同儕間的加強
 Integrated Play Groups (IPG) (PreschoolElementary) 整合的遊戲團體: Wolfberg and Schuler
 Adult support through Guided Participation
透過引導參與來展現成人支持
 IPG occur in natural play experiences
IPG存在於自然的遊戲經驗中
 Child with ASD is “novice” player
ASD兒童為〝初級的〞遊戲者
 Typical peer is “expert” player
有代表性的同儕為〝專家級〞的遊戲者
 IPG is composed of small group of expert and novice
players organized around play activities with goal of
mutual enjoyment, and spontaneous and reciprocal play
IPG是由一小群〝專家〞和〝初級〞遊 戲者所組成，他們參與
的活動有待給彼此快樂的目標，以及自然而然、互惠的遊戲
Play & Imagination in Children with Autism, Wolfberg, 1999
25