泛自闭症障碍症候群

AUTISMSPECTRUMDISORDER(ASD)

泛自閉症障礙症候群KathyM.Small,M.A.Instructor,SanFranciscoStateUniversityTeacherandAutismSpecialist,WestContraCostaUnifiedSchoolDistrict1AutismSpectrumDisorder

泛自閉症障礙症候群Overview:AutismSpectrumDisorder

LearningCharacteristicsoftheYoungChildwithAutism學習特徵InterventionPracticesforYoungChildrenwithAutism介入EducationalMethodologies教學方法WorkingwithandSupportingFamilies家庭合作與支持2Overview:AutismSpectrumDisorder(ASD)

泛自閉症障礙症候群Whatisautism什麼是自閉症LeoKanner,1943AutismSpectrumDisordersinclude:泛自閉症障礙症候群包括:Autism自閉症PDD-NOS未註明的廣泛性發展障礙Aspergers亞斯柏格症Retts雷特氏症ChildhoodDisintegrativeDisorder兒童期崩解症AutismCoreChallengeareas(CoreDeficits):

自閉症主要問題(主要缺陷):SocialInteraction社會互動Communication溝通RestrictedInterests,Repetitive/StereotypedBehaviors

有限的興趣,重複的行為Diagnostictools診斷工具:DSMIV/ICD-10andmore3DiagnosticCriteriaforASD

(DSM-IV-TR)

診斷標準Social(2ormore)Limitedeyecontact,facialexpressions,gestures,prosody

無法以眼對眼凝視、面部表情、身體姿勢及手勢來協助社會互動Few/nofriends無法建立同儕關係Littlesharingofinterestswithothers無法與他人分享興趣Impairedsocial-emotionalreciprocity缺乏社交或情緒相互作用Communication(1ormore)Delayinlanguage語言發展遲緩Poorconversation與他人談話的能力有明顯障礙Idiosyncraticlanguage(e.g.echolalia)刻板的或重複的使用語句(例如仿說)Repetitive/StereotypedBehaviors(1ormore)Narrowinterests侷限的興趣模式Non-functionalroutines/insistenceonsameness/routines不具功能性的常規或儀式行為Motorstereotypies刻板而重複的身體動作Preoccupationwithpartofobjects持續專注於物體的一部份AutismSpectrumDisorders,Ozonoff,Rogers,Hendren,20034OverviewofASDNeurologicalDisordernotPsychological神經上的失調而非生理上的DevelopmentalDisorder/Syndrome發展性的症狀Currently1:150

CenterforDiseaseControl(CDC)目前大約1:150Whyisautismincreasing?為什麼自閉症在增加?Betterdiagnosticpractices:shiftfrommentalretardationtoautismdiagnosis有較完整的診斷:從MR轉變為自閉症診斷標準Increasedrecognitionofmildpresentations對於自閉症認識的增加Changesindiagnosticcriteria診斷標準的改變Otherfactorspossible:toxicexposure,biologicalpredispositionandenvironment,vaccinations其他可能因素:中毒、生理和環境因素、疫苗AutismSpectrumDisorders,Ozonoff,Rogers,Hendren,20035OverviewofASDMoreboysthangirlsdiagnosed男生比女生多Girlsoftenmoreinvolved女生的障礙上較複雜10-15%withASDaverage/aboveIQ

10-15%的智力在平均以上25-35%Borderline/MildMentalRetardation

25-35%位於輕度MR的臨界RemaindermoderatetoprofoundMentalRetardation

其餘的大多是重度MR

HelpingChildrenwithAutismLearn,Siegel20036LearningCharacteristicsoftheYoungChildwithAutism

學習特徵JointAttention共同注意力Imitation模仿NeedforRoutines:Prediction/Anticipation必須按照例行行程:可以預估且預測

Motivation動機MotivationMeansandInvestment增加動機Context-Specific/DependentLearner依賴特別的情境VisualLearner視覺的學習者TheoryofMind心智理論LiteralThinker無想像力的Rituals儀式SensoryChallenges感官挑戰7JointAttention

共同注意力Sharingenjoyment,interests,andattentionwithothers

與其他人分享喜悅、興趣與注意力Necessaryindevelopmentof:

必要的發展:Cognition/learning

認知學習Communication

溝通Interactingwithothers

與他人互動Socialdevelopment

社會技能發展ImplicationsforEarlyInterventionEducators早期介入8Imitation

模仿Imitationasinnate直覺的模仿Imitationasfoundationoflearning學習基礎的模仿DifficultyattendingtohumanmodelLackofinterestincopyingothers’actions對於複製他人行為的興趣不足ImitationwithoutImagination:Thescrewdriverandthepencil模仿缺乏想像力:螺絲起子和鉛筆Imitationchallengesthroughtheages:actionontoystostylesoffashionImplicationsforEarlyInterventionEducators早期介入9NeedforRoutines:PredictionandAnticipation

必須按照例行行程:可以預估且預測

Youngchildrenrelyonroutines:skillsincrease,needdecreases依賴例行行程:增加技能、減少需求Routinesfamiliar/notnovel熟悉的例行行程,不是無先例的RoutineusedtoPredictwhat’snext可預測下一個是什麼Predictingfutureeventsimportant;inabilitysustainsroutines可預測未來重要的結果;無法維持例行行程Anticipatingfutureeventssupportsinterest/engagement預測ImplicationsforEarlyInterventionEducators:Pickyourbattles:Doesitinterfereorregulate?早期介入:10Motivation

動機Motivationisimportantforalllearning,butcrucialandnecessaryforstudentswithASD動機對於ASD來說是重要且必須的Motivationincreasesinterestintaskwhichincreasespossibilityforlearning動機增加學習的可能性MotivationhighlyindividualizedinstudentswithASD

Motivationcanameliorateremotenessandsupportengagement動機可以改善和支持承諾Useidiosyncraticinterestsasmotivatorsforlearning在學習時使用特別的興趣當刺激物11Motivation,MeansandInvestmentDevelopclassroomexperiencesthatareMotivating發展學校經驗就是動機DevelopaMeans

bywhichmotivatingexperiencescanoccurby:Structuredactivities結構化的活動Highlymotivatingmaterials高度動機的材料Relevantcurriculum相關的課程AppropriateLearningSupports(e.g.visual,physical)適當的學習支持（例如視覺、生理）CreatealearningenvironmentwhereInvestmentcandevelopby建立一個學習環境可以投資在:Repetitionofhighlymotivatingactivities反覆高動機的活動Normalizinghighlymotivatingactivitiesforexpandedlearningopportunitiesandsocialreinforcementfromothers將高動機的活動平常化來增加學習機會和社會增強Supportgeneralizationofstudent’sinvestmentatschoolandhome支持學生類化在學校和家裡

KathySmall2006

ImplicationsforEarlyInterventionEducators早期介入12Context-Specific/DependentLearnerTypicallearnersanalyze,organizeandstoreinformationandlinktoinfinitevarietyofrelatedexperiences

獨特的學習分析、組織訊息來連結相關的經驗Perceptualassociationsresultinsingularassociation:linkingobjectwithouting:strawbagtomarket,necklacetograndma’s獨特的知覺聯想：連結事物：超市的草帽、外婆的項鍊Generalization:Notunderstandingwashingplatesassameproceduresforglasses

類化：沒辦法瞭解洗盤子的玻璃的步驟是一樣的Learningtiedtoacontext/experience:Theboywhowenttothesnow

學習經驗：男孩去雪地KathleenQuill2000

Oddassociations/contextsofacquiringinformationthatimpactlearning:Eddie’striptoIKEA;Danny’scolorpreferences學習知識使用奇特的聯想；艾迪去IKEA旅行；丹尼喜歡的顏色Waterattherestaurant:SeanBarrows

餐廳裡的水：SeanBarrows There’saBoyInHere,Barrows199213VisualLearnerStrong,evenprecociousvisualabilities強烈，甚至強烈的視覺行為Visualinformationstaticandconcrete靜止且固定的視覺訊息Visualinformationcircumventscorechallenges(e.g.socialinteraction,communication,narrowinterestsandbehavior)主要問題（例如：社會互動、溝通、貧乏的興趣和行為）Visualinformationhighlymotivating高動機視覺訊息

KathleenQuill200014TheoryofMind(ToM):MindblindnessLimited/delayedabilitytointerpretotherpeople’smentalstates,feelings,desires,beliefs,perspectives聯想/延遲行為去瞭解他人的心理感受、要求、行為、期望Blindtothementalthoughtsandintentionsofothers

無法瞭解其他人的想法和意圖Johnwalksintothebedroom,walkedaround,andwalkedout:MentalisticexplanationsrequireTheoryofMind約翰走進臥室，繞了一圈，又走出來：心智理論說明

Mindblindness,AnEssayonAutismandTheoryofMind,SimonBaron-Cohen,1995Theboyandthechocolatecandybar:ToM

男孩和巧克力糖果ScienceMagazine,Volume300,May2003Havetounderstandboy’sintentionsandbeliefs,inspiteofaccuracy,topredict必須瞭解男孩的意圖和行為，正確的惡意、預測15LiteralThinker

缺乏想像力的思考者LiteralThinking:Martinandreadinghismind思考缺乏想像力：瞭解馬丁的想法MaxandtheDoctor/OldLadyWhoSwallowedtheFly醫生和女士吞下蒼蠅LiteralMeaning:15yearoldboywithautism:

What’sthemeaningof“don’tcryoverspilledmilk”:“Ifyouspillmilkyoushouldn’tcryoveritbutyoushouldpickuparag,youshouldmopitupandthencleantheragandthengohavesomemoremilk.”缺乏瞭解含意的想像：十五歲自閉症什麼是不要哭超過溢出的牛奶如果你把牛奶倒到溢出來，你不應該哭而是應該拿起手帕，打掃乾淨然後把手帕洗乾淨，接著再把牛奶倒好16SensoryChallenges

感官挑戰Unusualresponsestostimuliintheenvironment在環境中對於刺激的不同反應Visual-Sight:Side-gazing,視覺-看:凝視Auditory-Sound:Selectiveresponding,Handsoverears聽覺-聲音:選擇反應Tactile-Touch:IntolerantorNon-discriminating觸覺-觸摸:無法忍受或無差別的

Olfactory–Smell:Smellobjects,Hands嗅覺-聞:聞物體Gustatory–Taste:Restricted/oddfoodpreferences味覺的-嚐:限制或增加喜歡的食物17Rituals

儀式Restrictedrepetitiveandstereotypedpatternsofbehavior,interestsandactivities:Non-functionalroutines

重複且老套的模仿行為、興趣和活動:無功能的Elaboratestructures;liningupobjects

複雜的結構David:teddybearsJunior:transitionsinteacher’schair

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