注意转移策略对自闭症儿童自伤性行为干预成效的研究
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摘要
自伤性行为(self-injury)是一种危险性极大的问题行为,它会给个体带来直接的身体伤害,在特殊教育领域有自伤性行为的个体并不在少数。因此本研究旨在探讨通过注意转移策略对两名自闭症儿童自伤性行为的干预成效。
本研究的对象是两名具有自伤性行为的自闭症男童。研究方法采用访谈法、直接观察法和单一被试法之倒返实验设计。其中单一被试法之倒返实验设计包括四个阶段:基线期A1阶段,干预期B1阶段,倒返期A2阶段和再干预期B2阶段。在资料分析上,采用目视分析法及数学专业软件Matlab的线性分析函数Regress完成对趋势的预测绘制成曲线图,并对观察和访谈等资料进行结果分析。
本研究包含两方面的内容,一是功能分析。通过对个案家长、教师的访谈,填写行为动机评量表,直接观察记录,了解个案自伤性行为的功能与动机,结果显示个案自伤性行为的主要动机是获得感官刺激、逃避、引人注意和获得事物;二是根据功能分析的结果,拟定实验设计和干预计划,并对个案每种动机的自伤性行为进行干预,主要干预策略是注意转移策略,结果显示注意转移策略实施后个案自伤性行为有所减少。
综合研究结果如下:通过功能分析,能够找出个案自伤性行为的功能;运用注意转移策略对个案不同动机的自伤性行为进行干预;实施注意转移策略后能够有效地减少个案的自伤性行为,干预撤销后自伤性行为仍有继续,并没有维持干预效果,但只要干预计划设计合理,将注意转移策略合理的设置在日常生活中,仍可以减少自伤性行为的发生,行为的减少可以改善个案的生活质量。最后,对本研究的限制加以讨论,及提出未来研究的建议。
Self-injury is an extremely dangerous problematic behavior. It will lead individuals to direct injury. There are many individuals suffer from self-injury in the realm of special education. Therefore, this thesis is aimed at discussing the effectiveness of interfering two autistic children’s self-injury behavior through the strategy of attention distraction.
Two autistic children who have self-injury behavior are research subjects in this thesis. Research approaches such as visit, observation and single subject’s reversal-replication design are applied. Among these approaches, reversal-replication design contains four steps: baseline A1 phase, intervention B1 phase, withdrawal A2 phase and re-intervention B2 phase. When analyzing materials, liner analysis function regress in Mathematical software Matlab and teacher interview were adopted to predict the inclination and draw the inclination’s curve.
The research in this thesis contains two parts, one is functional evaluation. By visiting subject’s parents, teacher, filling out behavior motivation rating scale form, direct observation record, subject’s self-injury behavior’s functionality and motivation can be understood. Results showed that subject’s self-injury behavior’s primary functionality is acquiring sensuous stimulus, escape, acquisition of object and arousing awareness. The other one is stretching experiment design and intervention plan according to functional evaluation and then, interfere every subject’s self-injury behavior from various motivations. The main intervention strategy is attention distraction. Results showed that after implementing attention distraction strategy, there is an obvious decrease in number of subjects’self-injury behavior.
Comprehensive research results are showed as follows: after execution of functional evaluation, subject’s self-injury behavior’s function could be found. Self-injury behaviors from various motivations were interfered by using attention distraction strategy. Subject’s self-injury behaviors could be effectively reduced by implementing attention distraction strategy. When self-injury behavior’s intervention been removed, the intervention results could not be maintained. However, as long as experiment was reasonably designed, attention distraction strategy can be correctly cast in daily life, self-injury behavior can still be reduced, and therefore subject’s life quality can be improved. Finally, the restriction of the research in this thesis was discussed and future research advices were proposed.
本研究的对象是两名具有自伤性行为的自闭症男童。研究方法采用访谈法、直接观察法和单一被试法之倒返实验设计。其中单一被试法之倒返实验设计包括四个阶段:基线期A1阶段,干预期B1阶段,倒返期A2阶段和再干预期B2阶段。在资料分析上,采用目视分析法及数学专业软件Matlab的线性分析函数Regress完成对趋势的预测绘制成曲线图,并对观察和访谈等资料进行结果分析。
本研究包含两方面的内容,一是功能分析。通过对个案家长、教师的访谈,填写行为动机评量表,直接观察记录,了解个案自伤性行为的功能与动机,结果显示个案自伤性行为的主要动机是获得感官刺激、逃避、引人注意和获得事物;二是根据功能分析的结果,拟定实验设计和干预计划,并对个案每种动机的自伤性行为进行干预,主要干预策略是注意转移策略,结果显示注意转移策略实施后个案自伤性行为有所减少。
综合研究结果如下:通过功能分析,能够找出个案自伤性行为的功能;运用注意转移策略对个案不同动机的自伤性行为进行干预;实施注意转移策略后能够有效地减少个案的自伤性行为,干预撤销后自伤性行为仍有继续,并没有维持干预效果,但只要干预计划设计合理,将注意转移策略合理的设置在日常生活中,仍可以减少自伤性行为的发生,行为的减少可以改善个案的生活质量。最后,对本研究的限制加以讨论,及提出未来研究的建议。
Self-injury is an extremely dangerous problematic behavior. It will lead individuals to direct injury. There are many individuals suffer from self-injury in the realm of special education. Therefore, this thesis is aimed at discussing the effectiveness of interfering two autistic children’s self-injury behavior through the strategy of attention distraction.
Two autistic children who have self-injury behavior are research subjects in this thesis. Research approaches such as visit, observation and single subject’s reversal-replication design are applied. Among these approaches, reversal-replication design contains four steps: baseline A1 phase, intervention B1 phase, withdrawal A2 phase and re-intervention B2 phase. When analyzing materials, liner analysis function regress in Mathematical software Matlab and teacher interview were adopted to predict the inclination and draw the inclination’s curve.
The research in this thesis contains two parts, one is functional evaluation. By visiting subject’s parents, teacher, filling out behavior motivation rating scale form, direct observation record, subject’s self-injury behavior’s functionality and motivation can be understood. Results showed that subject’s self-injury behavior’s primary functionality is acquiring sensuous stimulus, escape, acquisition of object and arousing awareness. The other one is stretching experiment design and intervention plan according to functional evaluation and then, interfere every subject’s self-injury behavior from various motivations. The main intervention strategy is attention distraction. Results showed that after implementing attention distraction strategy, there is an obvious decrease in number of subjects’self-injury behavior.
Comprehensive research results are showed as follows: after execution of functional evaluation, subject’s self-injury behavior’s function could be found. Self-injury behaviors from various motivations were interfered by using attention distraction strategy. Subject’s self-injury behaviors could be effectively reduced by implementing attention distraction strategy. When self-injury behavior’s intervention been removed, the intervention results could not be maintained. However, as long as experiment was reasonably designed, attention distraction strategy can be correctly cast in daily life, self-injury behavior can still be reduced, and therefore subject’s life quality can be improved. Finally, the restriction of the research in this thesis was discussed and future research advices were proposed.
引文
[1]许家成,王勉,向友余.关于中国智障者生活质量的分析研究[J].中国特殊教育,2004, 32(8): 51-52.
[2]孙立双,韦小满.国外关于特殊儿童自伤行为的研究综述[J].中国特殊教育,2008,(4):41-45.
[3] American Psychiatric Association. Diagnostic and statistic manual of ment-al disorders.4th ed.Washington,DC:Author,1994:65-71
[4] keren.skegg.Self-harm.Lancet 2005,366:1471-1483
[5]黄伟合,儿童自闭症及其他发展性障碍的行为干预[M].北京:华东师范大学出版,2003:177
[6]周会兰,蒋晓莲.分散注意力控制疼痛的研究进展[J].中华护理杂志, 2006,41(12):1139-1141.
[7]杨阳,雷秀雅,李建平.关于自闭症儿童自伤行为的研究[J].西安文理学院学报(社会科学版),2007, 10(4):122-125.
[8]引自孙立双,韦小满.国外关于特殊儿童自伤行为的研究综述[J].中国特殊教育,2008,(4):41-45.
[9]Eric S, Gary B M. Behavioral issues in autism[M]. New York and London: Ple-num Press, 1994.
[10]James W. Bodfish, Frank J. Symons, Dawn E. Parker, et al. Varieties of re-petitive behavior in autism: comparisons to mental retardation[J]. Journal of Autism and Developmental Disorders, 2000,30(3):237-243.
[11]韦小满,马廷慧,于文.弱智儿童不良行为的特征分析[J].心理发展与教育,1997(1):54-59.
[12]赖铭次.特殊儿童异常行为之诊断与治疗[M],台北市:心理出版社,2000.
[13]A.Baghdadli, C. Pascal, S. Grisi, et al. Risk factors for self-injurious behaviours among 222 young children with autistic disorders[J]. Journal of Inte-llectual Disability Research.2003,47:622-627.
[14]转引自杨蒉芬.自闭症学生之教育.台北:心理出版社,2005. 5 - 7 ;206
[15]Gregory P.Hanley,Brian A.Iwata,Brandon E.McCord.Functional analysis of pr-oblem behavior:a review.Journal of Applied Behavior Analysis,2003,36:147-185
[16]Carr,E.G,&Durand,V.M. Reducing behavior problems through functional commu-nication training[J].Journal of Applied Behavior Analysis,1985,18:111-126
[17]Daphne Simeon, Eric Hollander. Self-injurious be-haviors: assessment and treatment[M].Washington DC, American: Psychiatric Publishing Inc, 2001.
[18]韩玉荣.孤独症儿童行为矫正及干预措施[J].临床精神医学杂志,2001,11(6):361
[19]引自陈顺森,白学军,张日昇.自闭症谱系障碍的症状、诊断与干预[J].心理科学进展, 2011, 19( 1):60–72
[20]Victoria E.White Kress. Self-injurious behaviors: assessment and diagnosi-s[J].Journal of Counseling and Development,2003,81(4):490-496.
[21]Herbert J G. Classification in mental retardation[M].Washington, DC: Amer-ican Association on Mental De-ficiency,1983.
[22]黄伟合.关于儿童自闭症行为矫正法的几个理论问题[J].心理科学,2003,26(3):475-478
[23]李成齐.自闭症儿童的行为问题辅导——功能评估[J].中国特殊教育,2005,8(62)44-47
[24]焦公凯.鞠红珍.童孤独症自伤行为的临床分析[J].临床医学杂志.1999,9(1):15-17
[25]刘昊.正向行为支持法干预孤独症儿童问题行为的个案研究[J].中国特殊教育,2007,3(81):26-32
[26]孙立双,《自闭症儿童自伤行为的功能性行为评估及干预研究》,[D] ,北京师范大学硕士论文,2008年,万方中国学位论文全文数据库
[27]Diette GB,echtzin N,Haponik E,et al. Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy[J].Chest,2003,123(3):941-948.
[28]Touyz L Z,Lamontagne P,Smith BE. Pain and anxiety reduction using a man-ual stimulation distraction device when administering local analgesia Oro-dent-al injections: A multi-center clinical investigation[J].The Journal of Clinical Dentistry,2004,1(53):88-92.
[29]左玉琼.分散注意力在控制剖宫产产妇术后疼痛中的应用[J].家庭护士,2007,5(1)1
[30]Vessey JA,Carlson KL,McGill J. Use of distraction with children during an acute pain experience[J].Nursing Research,1994,43(6):369-372.
[31]Melissa D,Lindsey LC. Distraction for pediatric immunization pain:A cri-tical review[J].Journal of Clinical Psychology in Medical Settings,2005,1(24):281-291.
[32]徐艳艳.不同分散注意力法对住院儿童输液配合的影响[J].辽宁中医药大学学报,2010,12(7):166-167
[33]周会兰,蒋晓莲.分散注意力控制疼痛的研究进展[J].继续医学教育,2007,21(14):14
[34]章剑和.学会情绪自我调节很重要[J].读与写(初中版),2007,10:53
[35]孙国俊.教师心理健康问题的成因解读及矫正[J].河南教育(高校版),2006,8:79
[36]刘翔平.考前要“解压”[J].《时事》中学版(心理导航专栏)
[37]康夫.孕妇应怎么样摆脱消极情绪[J],家庭育儿,2002,5:34
[38]刘志宏,《初中生校园压力因果模型建构与压力疏导团体辅导研究》,[D] ,辽宁师范大学,博士学位论文,2005年,万方中国学位论文全文数据库
[39]张玉环.护士心理健康的自我调整[J].护理研究,2003,7(17):849-850
[40] JOHNSON M H.How does distraction work in the management of pain? [J].Curr Pain Headache Rep,2005,9(2):90-95.
[41]张霞,杨文华,杨蓉.娱乐疗法的应用[J].神经损伤与功能重建,2006,8(1):185-186.
[42]谭雪莲,《幼儿园智力落后儿童与普通儿童同伴关系研究——以两个智力落后儿童的个案研究为例》,[D],重庆师范大学硕士学位论文,2009年,万方中国学位论文全文数据库
[43]伍新春,胡佩诚,《行为矫正》,[M].北京:高等教育出版社,2005:62
[44]http://www.iiyi.com/bbs/thread-32874-1.html
[45]沈明翠,《发展性障碍儿童行为问题功能评量及介入成效的个案研究》[D],重庆师范大学硕士学位论文,2007年,万方中国学位论文全文数据库
[46]叶平枝,《幼儿社会退缩的特征及教育干预研究》,[D],河南大学教育科学博士文丛,2007年,中国社会科学出版社
[47]昝飞、谢奥琳,自闭症儿童行为功能评估的个案分析[J],中国特殊教育,2007, 5(8):67
[48]万蓓,《积极行为支持用于智障儿童问题行为干预的研究》,[D],华东师范大学硕士学位论文,2007年,万方中国学位论文全文数据库
[49]慕雯雯,《ADHD儿童课堂干扰行为处理的个案研究》,[D],重庆师范大学硕士学位论文, 2008,万方中国学位论文全文数据库
[50]霍力嫔,《孤独症儿童人际交往训练个案研究》,[D],内蒙古师范大学硕士学位论文,2009,万方中国学位论文全文数据库
[2]孙立双,韦小满.国外关于特殊儿童自伤行为的研究综述[J].中国特殊教育,2008,(4):41-45.
[3] American Psychiatric Association. Diagnostic and statistic manual of ment-al disorders.4th ed.Washington,DC:Author,1994:65-71
[4] keren.skegg.Self-harm.Lancet 2005,366:1471-1483
[5]黄伟合,儿童自闭症及其他发展性障碍的行为干预[M].北京:华东师范大学出版,2003:177
[6]周会兰,蒋晓莲.分散注意力控制疼痛的研究进展[J].中华护理杂志, 2006,41(12):1139-1141.
[7]杨阳,雷秀雅,李建平.关于自闭症儿童自伤行为的研究[J].西安文理学院学报(社会科学版),2007, 10(4):122-125.
[8]引自孙立双,韦小满.国外关于特殊儿童自伤行为的研究综述[J].中国特殊教育,2008,(4):41-45.
[9]Eric S, Gary B M. Behavioral issues in autism[M]. New York and London: Ple-num Press, 1994.
[10]James W. Bodfish, Frank J. Symons, Dawn E. Parker, et al. Varieties of re-petitive behavior in autism: comparisons to mental retardation[J]. Journal of Autism and Developmental Disorders, 2000,30(3):237-243.
[11]韦小满,马廷慧,于文.弱智儿童不良行为的特征分析[J].心理发展与教育,1997(1):54-59.
[12]赖铭次.特殊儿童异常行为之诊断与治疗[M],台北市:心理出版社,2000.
[13]A.Baghdadli, C. Pascal, S. Grisi, et al. Risk factors for self-injurious behaviours among 222 young children with autistic disorders[J]. Journal of Inte-llectual Disability Research.2003,47:622-627.
[14]转引自杨蒉芬.自闭症学生之教育.台北:心理出版社,2005. 5 - 7 ;206
[15]Gregory P.Hanley,Brian A.Iwata,Brandon E.McCord.Functional analysis of pr-oblem behavior:a review.Journal of Applied Behavior Analysis,2003,36:147-185
[16]Carr,E.G,&Durand,V.M. Reducing behavior problems through functional commu-nication training[J].Journal of Applied Behavior Analysis,1985,18:111-126
[17]Daphne Simeon, Eric Hollander. Self-injurious be-haviors: assessment and treatment[M].Washington DC, American: Psychiatric Publishing Inc, 2001.
[18]韩玉荣.孤独症儿童行为矫正及干预措施[J].临床精神医学杂志,2001,11(6):361
[19]引自陈顺森,白学军,张日昇.自闭症谱系障碍的症状、诊断与干预[J].心理科学进展, 2011, 19( 1):60–72
[20]Victoria E.White Kress. Self-injurious behaviors: assessment and diagnosi-s[J].Journal of Counseling and Development,2003,81(4):490-496.
[21]Herbert J G. Classification in mental retardation[M].Washington, DC: Amer-ican Association on Mental De-ficiency,1983.
[22]黄伟合.关于儿童自闭症行为矫正法的几个理论问题[J].心理科学,2003,26(3):475-478
[23]李成齐.自闭症儿童的行为问题辅导——功能评估[J].中国特殊教育,2005,8(62)44-47
[24]焦公凯.鞠红珍.童孤独症自伤行为的临床分析[J].临床医学杂志.1999,9(1):15-17
[25]刘昊.正向行为支持法干预孤独症儿童问题行为的个案研究[J].中国特殊教育,2007,3(81):26-32
[26]孙立双,《自闭症儿童自伤行为的功能性行为评估及干预研究》,[D] ,北京师范大学硕士论文,2008年,万方中国学位论文全文数据库
[27]Diette GB,echtzin N,Haponik E,et al. Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy[J].Chest,2003,123(3):941-948.
[28]Touyz L Z,Lamontagne P,Smith BE. Pain and anxiety reduction using a man-ual stimulation distraction device when administering local analgesia Oro-dent-al injections: A multi-center clinical investigation[J].The Journal of Clinical Dentistry,2004,1(53):88-92.
[29]左玉琼.分散注意力在控制剖宫产产妇术后疼痛中的应用[J].家庭护士,2007,5(1)1
[30]Vessey JA,Carlson KL,McGill J. Use of distraction with children during an acute pain experience[J].Nursing Research,1994,43(6):369-372.
[31]Melissa D,Lindsey LC. Distraction for pediatric immunization pain:A cri-tical review[J].Journal of Clinical Psychology in Medical Settings,2005,1(24):281-291.
[32]徐艳艳.不同分散注意力法对住院儿童输液配合的影响[J].辽宁中医药大学学报,2010,12(7):166-167
[33]周会兰,蒋晓莲.分散注意力控制疼痛的研究进展[J].继续医学教育,2007,21(14):14
[34]章剑和.学会情绪自我调节很重要[J].读与写(初中版),2007,10:53
[35]孙国俊.教师心理健康问题的成因解读及矫正[J].河南教育(高校版),2006,8:79
[36]刘翔平.考前要“解压”[J].《时事》中学版(心理导航专栏)
[37]康夫.孕妇应怎么样摆脱消极情绪[J],家庭育儿,2002,5:34
[38]刘志宏,《初中生校园压力因果模型建构与压力疏导团体辅导研究》,[D] ,辽宁师范大学,博士学位论文,2005年,万方中国学位论文全文数据库
[39]张玉环.护士心理健康的自我调整[J].护理研究,2003,7(17):849-850
[40] JOHNSON M H.How does distraction work in the management of pain? [J].Curr Pain Headache Rep,2005,9(2):90-95.
[41]张霞,杨文华,杨蓉.娱乐疗法的应用[J].神经损伤与功能重建,2006,8(1):185-186.
[42]谭雪莲,《幼儿园智力落后儿童与普通儿童同伴关系研究——以两个智力落后儿童的个案研究为例》,[D],重庆师范大学硕士学位论文,2009年,万方中国学位论文全文数据库
[43]伍新春,胡佩诚,《行为矫正》,[M].北京:高等教育出版社,2005:62
[44]http://www.iiyi.com/bbs/thread-32874-1.html
[45]沈明翠,《发展性障碍儿童行为问题功能评量及介入成效的个案研究》[D],重庆师范大学硕士学位论文,2007年,万方中国学位论文全文数据库
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