AUTISM SPECTRUM DISORDER (ASD) 泛自閉症障礙症候群 Kathy M. Small, M.A. Instructor, San Francisco State University Teacher and Autism Specialist, West Contra Costa Unified School District

Autism Spectrum Disorder 泛自閉症障礙症候群 Overview: Autism Spectrum Disorder Learning Characteristics of the Young Child with Autism 學習特徵 Intervention Practices for Young Children with Autism 介入 Educational Methodologies 教學方法 Working with and Supporting Families 家庭合作與支持

Overview: Autism Spectrum Disorder (ASD) 泛自閉症障礙症候群 What is autism 什麼是自閉症 Leo Kanner, 1943 Autism Spectrum Disorders include: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 Childhood Disintegrative Disorder 兒童期崩解症 Autism Core Challenge areas (Core Deficits): 自閉症主要問題(主要缺陷): Social Interaction 社會互動 Communication 溝通 Restricted Interests, Repetitive/Stereotyped Behaviors 有限的興趣,重複的行為 Diagnostic tools 診斷工具: DSM IV/ICD-10 and more

Diagnostic Criteria for ASD (DSM-IV-TR) 診斷標準 Social (2 or more) Limited eye contact, facial expressions, 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/no friends 無法建立同儕關係 Little sharing of interests with others 無法與他人分享興趣 Impaired social-emotional reciprocity 缺乏社交或情緒相互作用 Communication (1 or more) Delay in language 語言發展遲緩 Poor conversation 與他人談話的能力有明顯障礙 Idiosyncratic language (e.g. echolalia) 刻板的或重複的使用語句(例如仿說) Repetitive/Stereotyped Behaviors (1 or more) Narrow interests 侷限的興趣模式 Non-functional routines/insistence on sameness/routines 不具功能性的常規或儀式行為 Motor stereotypies 刻板而重複的身體動作 Preoccupation with part of objects 持續專注於物體的一部份 Autism Spectrum Disorders, Ozonoff, Rogers, Hendren, 2003

Overview of ASD Neurological Disorder not Psychological 神經上的失調而非生理上的 Developmental Disorder / Syndrome 發展性的症狀 Currently 1:150 Center for Disease Control (CDC) 目前大約1:150 Why is autism increasing? 為什麼自閉症在增加? Better diagnostic practices: shift from mental retardation to autism diagnosis 有較完整的診斷:從MR轉變為自閉症診斷標準 Increased recognition of mild presentations 對於自閉症認識的增加 Changes in diagnostic criteria 診斷標準的改變 Other factors possible: toxic exposure, biological predisposition and environment, vaccinations 其他可能因素:中毒、生理和環境因素、疫苗 Autism Spectrum Disorders, Ozonoff, Rogers, Hendren, 2003

Overview of ASD More boys than girls diagnosed 男生比女生多 Girls often more involved 女生的障礙上較複雜 10-15% with ASD average/above IQ 10-15%的智力在平均以上 25-35% Borderline/Mild Mental Retardation 25-35%位於輕度MR的臨界 Remainder moderate to profound Mental Retardation 其餘的大多是重度MR Helping Children with Autism Learn, Siegel 2003

Learning Characteristics of the Young Child with Autism 學習特徵 Joint Attention共同注意力 Imitation模仿 Need for Routines: Prediction/Anticipation 必須按照例行行程:可以預估且預測 Motivation動機 Motivation Means and Investment增加動機 Context-Specific/Dependent Learner依賴特別的情境 Visual Learner視覺的學習者 Theory of Mind心智理論 Literal Thinker無想像力的 Rituals儀式 Sensory Challenges感官挑戰

Sharing enjoyment, interests, and attention with others Joint Attention 共同注意力 Sharing enjoyment, interests, and attention with others 與其他人分享喜悅、興趣與注意力 Necessary in development of: 必要的發展: Cognition/learning 認知學習 Communication 溝通 Interacting with others 與他人互動 Social development 社會技能發展 Implications for Early Intervention Educators 早期介入

Imitation 模仿 Imitation as innate 直覺的模仿 Imitation as foundation of learning 學習基礎的模仿 Difficulty attending to human model Lack of interest in copying others’ actions 對於複製他人行為的興趣不足 Imitation without Imagination: The screwdriver and the pencil 模仿缺乏想像力:螺絲起子和鉛筆 Imitation challenges through the ages: action on toys to styles of fashion Implications for Early Intervention Educators 早期介入

Need for Routines: Prediction and Anticipation 必須按照例行行程:可以預估且預測 Young children rely on routines: skills increase, need decreases 依賴例行行程:增加技能、減少需求 Routines familiar/not novel 熟悉的例行行程,不是無先例的 Routine used to Predict what’s next 可預測下一個是什麼 Predicting future events important; inability sustains routines 可預測未來重要的結果;無法維持例行行程 Anticipating future events supports interest/engagement 預測 Implications for Early Intervention Educators: Pick your battles: Does it interfere or regulate? 早期介入:

Motivation 動機 Motivation is important for all learning, but crucial and necessary for students with ASD 動機對於ASD來說是重要且必須的 Motivation increases interest in task which increases possibility for learning 動機增加學習的可能性 Motivation highly individualized in students with ASD Motivation can ameliorate remoteness and support engagement 動機可以改善和支持承諾 Use idiosyncratic interests as motivators for learning 在學習時使用特別的興趣當刺激物

Motivation, Means and Investment Develop classroom experiences that are Motivating 發展學校經驗就是動機 Develop a Means by which motivating experiences can occur by: Structured activities 結構化的活動 Highly motivating materials 高度動機的材料 Relevant curriculum 相關的課程 Appropriate Learning Supports (e.g. visual, physical) 適當的學習支持（例如視覺、生理） Create a learning environment where Investment can develop by建立一個學習環境可以投資在: Repetition of highly motivating activities 反覆高動機的活動 Normalizing highly motivating activities for expanded learning opportunities and social reinforcement from others 將高動機的活動平常化來增加學習機會和社會增強 Support generalization of student’s investment at school and home 支持學生類化在學校和家裡 Kathy Small 2006 Implications for Early Intervention Educators 早期介入

Context-Specific/Dependent Learner Typical learners analyze, organize and store information and link to infinite variety of related experiences 獨特的學習分析、組織訊息來連結相關的經驗 Perceptual associations result in singular association: linking object with outing: straw bag to market, necklace to grandma’s 獨特的知覺聯想：連結事物：超市的草帽、外婆的項鍊 Generalization: Not understanding washing plates as same procedures for glasses 類化：沒辦法瞭解洗盤子的玻璃的步驟是一樣的 Learning tied to a context/experience: The boy who went to the snow 學習經驗：男孩去雪地Kathleen Quill 2000 Odd associations/contexts of acquiring information that impact learning: Eddie’s trip to IKEA; Danny’s color preferences 學習知識使用奇特的聯想；艾迪去IKEA旅行；丹尼喜歡的顏色 Water at the restaurant: Sean Barrows 餐廳裡的水： Sean Barrows There’s a Boy In Here, Barrows 1992

Visual Learner Strong, even precocious visual abilities 強烈，甚至強烈的視覺行為 Visual information static and concrete 靜止且固定的視覺訊息 Visual information circumvents core challenges (e.g. social interaction, communication, narrow interests and behavior) 主要問題（例如：社會互動、溝通、貧乏的興趣和行為） Visual information highly motivating 高動機視覺訊息 Kathleen Quill 2000

Theory of Mind (ToM): Mindblindness Limited/delayed ability to interpret other people’s mental states, 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 Blind to the mental thoughts and intentions of others 無法瞭解其他人的想法和意圖 John walks into the bedroom, walked around, and walked out: Mentalistic explanations require Theory of Mind 約翰走進臥室，繞了一圈，又走出來：心智理論說明 Mindblindness, An Essay on Autism and Theory of Mind, Simon Baron-Cohen, 1995 The boy and the chocolate candy bar: ToM 男孩和巧克力糖果 Science Magazine, Volume 300, May 2003 Have to understand boy’s intentions and beliefs, in spite of accuracy, to predict 必須瞭解男孩的意圖和行為，正確的惡意、預測

Literal Thinker 缺乏想像力的思考者 Literal Thinking: Martin and reading his mind 思考缺乏想像力：瞭解馬丁的想法 Max and the Doctor / Old Lady Who Swallowed the Fly醫生和女士吞下蒼蠅 Literal Meaning: 15 year old boy with autism: What’s the meaning of “don’t cry over spilled milk”: “If you spill milk you shouldn’t cry over it but you should pick up a rag, you should mop it up and then clean the rag and then go have some more milk.”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

Sensory Challenges 感官挑戰 Unusual responses to stimuli in the environment 在環境中對於刺激的不同反應 Visual - Sight: Side-gazing, 視覺-看:凝視 Auditory - Sound: Selective responding, Hands over ears 聽覺-聲音:選擇反應 Tactile - Touch: Intolerant or Non-discriminating 觸覺-觸摸:無法忍受或無差別的 Olfactory – Smell: Smell objects, Hands 嗅覺-聞:聞物體 Gustatory – Taste: Restricted/odd food preferences 味覺的-嚐:限制或增加喜歡的食物

Rituals 儀式 Restricted repetitive and stereotyped patterns of behavior, interests and activities: Non-functional routines 重複且老套的模仿行為、興趣和活動:無功能的 Elaborate structures; lining up objects 複雜的結構 David: teddy bears Junior: transitions in teacher’s chair 旋轉老師的椅子 Evan: “Not in your mouth”