韩建忠,代志宏,刘小军,江平,黄玲,梁敏芳,崔琴
(南宁市青秀区含式幼教特教托管中心 广西南宁 530022)
[摘要]:以残健结合条件下普通小学孤独症谱系障碍(autism spectrum disorder,ASD)儿童在校园学习及生活的社交行为为背景,通过对ASD儿童在校园内社交中运用听觉专注力能力的观察,分析ASD儿童的听觉障碍的症状、与正常儿童在校园社交中听觉专注力不同的形成机理,制定针对性的ASD儿童校园社交听觉专注力的教学训练方案,获得干预及训练ASD儿童校园社交听觉专注力的一系列有效训练的方法。
[关键词]孤独症;残健结合;校园社交;听觉专注力干预训练
( 一)引言
孤独症谱系障碍(autism spectrum disorder,ASD)是一组以社交障碍、刻板行为、语言障碍为特征的行为疾病,包括孤独症、Asperger综合征以及未分类型广泛性发育障碍,其中社交问题是ASD的核心障碍。ASD的发病原因属行为症状诊断至今未明,涉及环境因素、生物因素、心理因素等,目前无特效药物治疗。社交间题同时也是终生干预的更是学龄ASD儿童进入普通小学进行有质量的同班就读的关键。ASD儿童由于听觉障碍、听觉反应弱往往充耳不闻,令ASD儿童的听觉信息、听觉感受无法转换成有价值的社交听觉策略,使得ASD儿童在校园环境中无法进行社交活动。
听觉社交是一切学习的前提,目前国内外对社交的研究大多集中在语言及融合教育,对社交听觉专注力研究尚属空白,听觉专注力是收集听觉信息的关键,目前国内外未见有效研究成果。
作者在近10年时间里,搜集已有研究成果,在普通小学对ASD 儿童的社交进行干预和训练,发现目前国内外均有采用的单纯进行语言训练、校园融合功能综合性训练很难达到预期的效果;ASD儿童无法像正常儿童一样对多感官接收的信息进行集成、综合分析再做出反馈,而针对听觉单一感官进行训练再综合训练的方法相对有效。本文介绍了多年训练总结出的一套通过听觉专注力来提升社交能力的训练方法,对3名儿童进行了为期10个月定向训练,取得了较好的成绩。
( 二)对象
本次研究的3例ASD儿童均为医院根据DSM-Ⅵ诊断标准确诊为孤独症及Asperger综合征、入读普通学校的儿童,性别男,年龄6.0~12.5岁,所有ASD儿童均接受过不同程度的学龄前的干预训练,但效果甚微。本次训练时间2016年1月始2016年11月止。
病例1:谢某,2007年生,顺产,身高150厘米,体重44千克,听力正常,2.5岁被医院确诊为孤独症,有语言,但无法维持较长的话题,喜欢玩手,普通小学入读一年级。
病例2:黄某,早产,剖腹产,2008年生,身高130厘米,体重48千克,听力正常,3.5岁被医院确诊为Asperger综合征,语言能力较强,听觉反应过度敏感,普通小学入读二年级。
病例3:欧阳某,2003年生,剖腹产,身高150厘米,体重80千克,听力正常,情绪控制能力较弱,有较强的母亲依赖,对音乐的感受性较强,3.5岁被医院确诊为Asperger综合征,普通小学入读五年级。
( 三)方法及内容
1.干预训练方法
训练者为南宁市青秀区含式幼教特教托管中心(以下简称含式中心)老师及课题组成员,以听觉专注力干预训练为核心,校园社交为主线,语言训练(表达)(language training production)、行为干预(behavioral-interventions)、自然情境教学法(natural teaching strategies)、综合应用行为分析疗法(applied-behavioral analysis,ABA)、结构化训练方法(treatment and education of autistic and related-communication handicapped children,TEACCH)为辅助干预措施。
按照该生所在学校为背景,共进行了5个阶段共10个月的干预训练,每阶段为期2个月,每月8次,每周2次,每次2小时。这5个阶段的科目是听见、听整体、听细节、听明白、记住并泛化,也包括主要养育者(家长)的培训指导,每个阶段1次,每次2小时,共5次培训。
2.干预训练的科目
听见:ASD儿童听觉反应不足,这是导致ASD儿童没有语言发育或是语言发育不足的重要原因,这是ASD儿童听觉的第一个弱点,本科目目的是让ASD儿童在获取足够的声音刺激后产生听觉反应。
听全面:ASD儿童在听觉运用的过程中,在具有了听觉反应后,往往会出现反应过度,ASD儿童会用手指或整个手掌捂住耳朵,出现拒听的现象,这是ASD儿童听觉的第二个弱点。本科目目的是让ASD儿童具有整体听觉。
听重点:由于ASD儿童在听觉运用的过程中,往往会不听、漏听和错听,所以像鹦鹉学舌、自言自语的现象也就非常普遍。在校园社交的整个过程中,因为细节关注数量不足或细节间逻辑关联梳理不清,而无法产生有效的社交策略,这是ASD儿童听觉的第三个弱点。本科目目的是让所以本ASD儿童在全面获取社交中听觉信息的同时可以有能力提取关键信息。
听明白:在完成以上听见、听全面、听重点之后,但ASD儿童缺乏整合听觉信息的必要能力,这是第四个弱点。本科目目的是干预训练ASD儿童整合全部听觉信息的能力,使之做到有效恰当的社交回应。
记住并泛化:通过以上有效地提高ASD儿童听觉策略的步骤反复强化,达到稳定、固化,最后再通过从校园社交泛化到各个领域的社交,实现社交无碍。即校园内能用视觉信息进行完整而有效的社交后,要让ASD儿童能够记住在校园这个特定背景下,进行社交活动所必须熟练掌握的听觉专注力的流程、方法及技巧,并以此为基础泛化到生活社交、情感社交乃至于未来的职业社交等更高社交领域。
3.干预训练的内容
噪音辨别:除去语言以外的声音,如铃声、走路声、自然界声、敲门等。
语音辨别:语音(如自己、父母、老师、同学、校工作人员等的声音)。
语义辨别:社交中的辨别,起主导作用人的语言,或是阶段性主导话题人的语言。听觉信息统合是将噪音、语言及语义三部分听觉信息的内容统合处理。
4.干预训练的形式
干预训练的形式分为:辨音、抗噪音干扰对话、抗语义干扰对话及电脑游戏。
校园社交听觉专注力干预训练的阶段、时间、科目、内容、形式、目标效果之间的关系见表4-4:
表4-4 干预训练详细信息表
以上内容均由含式中心老师给ASD儿童所在学校的老师、家长及相关人员示范讲解及培训。
(四)技术路径及训练步骤
1.第一阶段干预训练:听见
(1)噪音和语音分辨
抗噪音干扰对话干预训练采集校园及其他各种类型的声音,采集语音(如训练者、ASD儿童本人、ASD儿童父母、门卫、班主任、同桌等),全程给ASD儿童眼罩蒙眼,在兼顾ASD儿童对训练内容回答正确的同时,渐进地调低播放噪音和语音的音量以及缩短播放噪音和语音的时间长度,这是整个听觉专注力训练的核心训练部分。
第一步,播放噪声(语音)以便确定音量(通过对ASD儿童面部观察,确认音量舒适度);
第二步,训练ASD儿童听见噪声时举左手,听见语音时举右手;
第三步,噪声和语音随机播放,听见噪声时举左手改右手,听见语音时举右手改左手;
第四步,相似噪音辨别(如学校的铃声和手机的铃声等);
第五步,相似语音辨别(如班主任和任课老师的声音等);
第六步,相似噪音和语音随机混合辨别;
第七步,训练者在播放噪音的同时和ASD儿童对话,具体形式是训练者问,ASD儿童答。
恰当把握音量高低、语声(噪音)播放时间、ASD儿童回答速度及回答质量,四者的配比关系,训练时的声源可根据需要在电脑播放或现场制造。
(2)听觉专注力电脑游戏训练
电脑游戏声音,如对对碰、找乐器、超级鼓手等,这些游戏可进一步提升ASD 儿童对声音的敏感度、记忆能力、辨别度(电脑游戏可穿插进行,以降低训练的枯燥提高ASD儿童的耐受度)。
(3)家长培训
完整确切的理解本阶段“听见”干预训练的内容、方法,指导家长作针对ASD儿童的特点,制定在家干预训练计划,并将训练结果反馈。
2.第二阶段干预训练:听全面
(1)语义辨别
抗噪音干扰对话干预训练不同的是:
第二阶段,训练者先设定主讲人录音,然后让ASD儿童听主讲人录音,直到准确地从若干段内容相同、录音人不同的录音及噪音中,正确分辨出设定主讲人录音,并理解其含义。
3.第三阶段干预训练:听重点
听觉信息统合、抗语义干扰对话干预训练不同的是第三阶段,训练者在播放设定主讲人语言录音、非主讲人语言录音的同时和ASD儿童对话,具体形式是训练者问,ASD儿童答。例如,问:班长对你的同桌说明天要去春游,对吗?你的同桌是怎么知道明天要去春游的?如果你同桌告诉你明天春游需要准备吃的,你觉得是谁帮你准备?等等(注意问题回答正确再往下进行)。
4.第四阶段干预训练:听明白
与前面训练不同的是第四阶段,训练者在播放噪音、设定主讲人语言录音、非主讲人语言录音的同时和ASD儿童对话,具体形式是训练者问,ASD儿童答。例如,问:你刚才听到了几个人说话?他们在谈话的时候,你是否听到了上课铃声?刚才说话的那些人中,是否有人告诉你的同桌,他想请他周末到他家来玩?他是谁?等等(注意问题回答正确再往下进行)。
5.第五阶段千预训练:记住并泛化
听觉信息统合、抗噪音干扰对话、抗语义干扰对话干预训练ASD儿童班级上课的录音、课间同桌和其他同学对话的录音、ASD 儿童和同桌的对话录音、ASD儿童和其他同学的对话录音、给ASD儿童听课间同桌和其他同学对话的录音,并让他说出是谁在和同桌对话。听ASD儿童和同桌的对话录音,并让他复述谈话的内容。再听ASD儿童和其他很多同学的对话录音,并让他说出每个人的姓名及说话的内容。最后指导ASD儿童谈话的内容都尽量完整的。
(五)训练效果
1.在校行为改善情况
经过对3名ASD儿童校园社交听觉专注力的干预训练,整体表现都有进步,例如看人、捂耳朵、回应同学招呼、听老师指令以及同桌对话的频次和质量进步显著,见表4-5。
2.在家行为改善情况
将3名儿童行为归纳在在家行为调查表4-6中,3例儿童家长反馈儿童在家的表现有明显的进步。见表4-6。
表4-5 在校行为调查表
表4-6 在家行为调查表
(六)研究结论与未来研究
经过对3例ASD儿童5阶段共10个月的校园社交听觉专注力的干预训练,总有效率100%,其中明显地提升了ASD儿童对社交的兴趣和信心,并较明显地改善了ASD儿童特有的听觉反应不足、听觉反应过度,对听觉的分辨力、抗干扰能力、转移和分配能力都有很大的提升。
随着国内外学者对ASD儿童推进全纳教育的深入研究,势必会在如何提升ASD儿童校园社交能力的理论及实践上不断创新,本文提供的训练方法是对当前国内外使用的行为分析结构化训练策略的有力补充,这无论是对ASD社交改善的现实需求,还是未来继续深入研究都有重要意义。
注:①本文已发表在《现代特殊教育》杂志。
②本文为广西南宁市青秀区科学研究与技术开发计划项目“残健结合模式的孤独症儿童校园社交专注力教学策略及方法研究”(编号:2016024),广西高等教育本科教学改革工程立项项目(2015JGB3632015A17)的成果。(作者单位:广西南宁市青秀区含式幼教特教托管中心,广西南宁市民族大道东段小,530022)(www.xing528.com)
Mixing Handicapped Children with Healthy Children. Auditory Concentration Teaching Method Research on Campus Interaction for Children with Autism
Han Jianzhong,Dai Zhihong,Liu Xiaojun,Jiang Ping,Huang Ling,Liang Minfang,Cui Qin
(Hanshi Preschool Education Special-Education Childcare Center,Qingxiu District,Nanning,Guangxi 530022)
[Abstract]:With study and social behaviors of autism spectrum disorder(ASD)children in regular primary schools as the background,through observation on ASD children applying auditory concentration capabilities to on-campus social interaction,analyze the syndromes of hearing disorder of ASD children,and the different formation mechanisms of auditory concentration for social interaction with normal children at school,and work out tailored training programs on auditory concentration for ASD children campus interaction thereby obtaining a series of effective methods that intervene and train ASD children on their auditory concentration in their social interaction at school.
[Key words]Autism; mixing handicapped children with healthy children,social interaction at school;auditory concentration intervention training
(一)Introduction
Autism spectrum disorder(ASD) is a group of behavioral disorders characterized by social disorder,stereotyped behaviors and language disorders,including autism,Asperger’ s syndrome,and un-categorized broad developmental disorders,major disorders are shown in three aspects,namely,language,behavior,social interaction with social interaction as the core disorder. The causes of ASD so far are still unknown,involving environmental,biological,psychological factors among others.At this stage,there are no specific medicine for curing ASD.The social interaction issue is also the key to lifetime intervention and quality same-class study in regular primary schools for school-age children. ASD children often turn a deaf ear due to hearing disorder or weak auditory response so that the auditory information and auditory perception of the ASD children can not be converted into valuable social interaction hearing strategy and the ASD children are unable to have social interaction activities at school.
Auditory social interaction is the precondition for all the studies.Currently,the majority of research home and abroad on social interaction centers on languages and inclusive education,while auditory concentration research on social interaction is still virgin land. Auditory concentration is the key to collecting auditory information. No effective research findings home and abroad have been found so far.
Over the past 10 years in collecting and searching relevant research findings,and conducting intervention and training on social interaction in regular primary schools for ASD children,the authors found it very hard to achieve the desired results by simply adopting language training and on-campus inclusive comprehensive training.ASD children are unable to collect,comprehensively analyze and give feedback to information received by multiple sensory organs as normal children,while the approach to train a single sensory organ first and then comprehensive training is relatively effective. This article introduces a set of training methods summarized through many years of training to enhance the social interaction capabilities of ASD children by way of training auditory concentration,with good results achieved after 10-month orientation training on three children.
(二) Objects
The three ASD cases in this study are all diagnosed as autism and Asperger’ s syndrome by hospitals according to the DSM - Ⅵdiagnostic criteria. The three ASD male children all study in ordinary schools,aged from 6 to 12.5,all have received different degrees of preschool intervention training starting from January 2016 until November 2016,but had little improvement in their social interaction capabilities at school.
Case 1:surname Xie,born in 2007,natural labor,height 150 cm,weight 44 kg,was diagnosed with autism at the age of 2.5 by hospital,he can speak,but was unable to keep a long topic,fond of playing with his hands,in Grade One in a regular primary school.
Case 2:surname Huang,31-week premature,cesarean birth in 2008,height 130 cm,weight 24 kg,was diagnosed with Asperger’ s syndrome at the age of 3.5 by hospital,with strong language ability. His auditory response is oversensitive,in Grade Two n a regular primary school.
Case 3:surname Ouyang,born in 2003,cesarean birth,height 150 cm,weight 40 kg,his emotional control ability is weak,he is quite dependent on his mother but has a good ear for music. He was diagnosed with Asperger’ s syndrome at the age of 3.5 by hospital,in Grade Five in a regular primary school.
(三)The methods and contents
1. Intervention training method
The trainers are the teachers and the members of the task force at Hanshi Preschool Education Special-Education Childcare Center(referred to as Hanshi Center),Qingxiu District,Nanning,Guangxi.With auditory concentration as the core,the intervention training focuses on social interaction at school,with language training production,behavioral intervention,natural teaching strategies,applied-behavioral analysis(ABA),and treatment and education of autistic and related-communication handicapped children(TEACCH)as the auxiliary intervention measures.
With the schools of the three ASD children as the background,a total of 10-month intervention training in five phases was conducted,each phase lasted two months,eight times a month,twice a week,every time lasted two hours,and gave a total of five times of training coaching for the key nurturers(parents) once in each phase,for two hours each time.
2. Training subjects
Heard:ASD children have inadequate auditory response,which is a major cause of no language development or inadequate language development for ASD children,and is the first weakness of ASD hearing,This purpose of this subject is to enable the ASD children to have auditory response after acquiring enough sound stimulation.
Listen comprehensively: ASD children more often than not overact after acquiring the auditory response in the process of applying hearing.They may use their fingers or the whole palm to cover ears to refuse to listen. This is the second weakness of ASD hearing. This purpose of this subject is to enable the ASD children to listen to the whole.
Listen to the key points: because ASD children often do not listen,listen partially or wrongly in the process of hearing use,parroting,talking to themselves are also very common. Because inadequate attention paid to details or unclear logic connection between details throughout on-campus social interaction process,they are unable to acquire effective social interaction strategy. This is the third weakness of ASD hearing. The purpose of this subject is to enable the ASD children to comprehensively gain auditory information from social interaction and at the same time have the ability to extract key information.
Listen with comprehension: after completion of hearing,listening comprehensively and listening to key points,but ASD kids still lack the necessary ability to integrate auditory information. This is the fourth weakness. The purpose of this subject is to train ASD kids on their ability to integrate all auditory information so that they can have effective and appropriate social interaction response.
Memorize and generalize: through repeated training of the above auditory concentration for the ASD kids to effectively strengthen,stabilize and solidify their abilities,and finally apply the strategy from campuses to every aspect of their social interaction to realize no barriers in social interaction. Namely,after they can utilize auditory information for complete and effective social interaction at school,the ASD children should be enabled to memorize the specific background of their campus,and be proficient at applying the auditory concentration processes,methods and skills to social interaction activities,and further to daily social interaction,emotional social interaction and a higher social interaction arena of workplace social interaction in the future.
3. The contents of intervention training
Noise identification:all the sounds except languages,e.g.,the bell sound,walking,sounds in nature,knocking at the door,etc.
Voice identification:voices(e.g.,his own voice,voices of his parents,teachers,classmates and school staffs,etc.).
Semantic identification:identification in social interaction,the language that plays a leading role,or a language that dominates the topic in a certain stage. Auditory information integration is integrated processing of the auditory information contents of the noise,the voice and the meanings.
4. The form of intervention training
The form of training is divided into:distinguishing the sound,anti-noise interference dialogue,anti-semantic interference dialogue and computer games.
See Table 4-4 for correlations between phases,duration,subjects,contents and forms,targets and efect of auditory attention intervention training for on-campus social interaction:
The above contents are taught/explained,trained and demonstrated by Hanshi Center teachers to the ASD school teachers,relevant staff and parents.
(四)Technical path and the training steps
1. PhaseⅠIntervention Training:heard
(1)Noise and voice identification
Anti-noise interference dialogue intervention training collects sounds at school and other various types of sound,e.g. (voices of the trainers,the ASD kids themselves,ASD kids’ parents,the security guards,the head teachers,the deskmates,etc.) The ASD children will be blindfolded throughout the process. At the same time of paying attention to the ASD children correctly answering the training contents,gradually turn down the noise and voice and shorten the playing duration. This is the core section of the entire auditory concentration training.
Step 1:play the noise(voice) in order to determine the volume(determine the comfortable volume through observing the facial expression of the ASD kid);
Step 2:train the ASD kid to raise his left hand when hearing noise,and raise his right hand when hearing voices;
Step 3:play the noise and voices randomly,this time raise his right hand when hearing noise,and raise his left hand when hearing voices;
Step 4:identify similar noises(such as the school bell and mobile phone ring tones,etc.);
Step 5:identify similar voices(e.g.,voices of the head teacher and other teacher’ s etc.);
Step 6:identify similar noises and voices mixed and played randomly;
Step 7:the trainer converses with the ASD kid while playing the noise,namely,the trainer asks questions for the ASD kid to answer.
Appropriately control the volume (high and low),voice(noise)playing duration,ASD kid answering speed and quality,the proportionate relationship between the four. At the time of training,the sound sources can be played on a computer or produced live as needed.
(2)Auditory Concentration Training on Computer Games
Computer game sounds include sound matching,looking for Musical Instruments,super drummer,etc.These games can further enhance the sensitivity,memorizing ability and discerning abilities of ASD children to sounds(computer games can be played alternately in order to reduce the training dullness and improve ASD children’ s tolerance).
(3)Parent training:
A complete and accurate understanding of the contents and methods of the “heard” intervention training in this phase,guide the parents to work out their personalized intervention program at home tailored to their ASD kids,and feedback the training results.
2. Phase Ⅱ Intervention Training:listen to the the whole
(1)Semantic Identification
The difference in anti-noise interference dialogue intervention training lies in :
Phase 2,the trainer first sets the featured speaker’ s audio recording,and then asks the ASD kid to listen to the speaker until he can accurately identify the audio recording of the featured speaker and understand the meaning from several paragraphs of the same contents and noises recorded by diferent speakers.
3. Phase Ⅲ Intervention Training:listen to the key points
The difference in auditory information integration antiinterference dialogue intervention training lies in the third phase.While playing the set audio recording of the featured speaker and non featured speakers,the trainer converses with the ASD kid,namely,asking questions for the ASD kid to answer,for example,Q:your class monitor said to your desk-mate you would have a spring outing tomorrow,right?And how does your desk-mate know there would be a spring outing tomorrow,if your desk-mate told you that you need to prepare something to eat for the spring outing tomorrow,whom do you think will help you prepare,etc(note:the training may only proceed only after the questions are answered correctly).
4. Phase Ⅳ Intervention Training:listening with comprehension
It is phase 4 that is different from the preceding training. While playing the noise,setting the audio recording of the featured speaker and non featured speakers,the trainer converses with the ASD kid,namely,asking questions for the ASD kid to answer,for example,Q:how many people you just heard talking? While they were speaking,did you hear the bell ring for class?Among the speakers,is there someone who told your desk-mate that he wanted to invite him to his home to play on the weekend?Who is he?etc(note:the training may only proceed only after the questions are answered correctly).
5. Phase Ⅴ Intervention Training: memorizing and generalization
Auditory information integration,anti-noise interference dialogue,anti-semantic interference dialogue intervention training.The audio recording of the ASD kid at class,the conversations between his deskmate and other students,the ASD kid and his desk-mate,and the ASD kid and other students during the break. Play the audio recording of the conversation between his desk-mate and other students,and ask the ASD kid who is conversing with his desk-mate. Play the audio recording of the conversation between the AS kid and his desk-mate,and ask the ASD kid to retell the contents of the conversation. And then listen to the audio recording of the dialogue between the ASD kid and many other classmates,and ask him to speak out the names of each classmate and the contents of the conversation. Finally,guide the ASD kid to make the contents of the conversations as complete as possible.
(五)Training efectiveness
1. Behavioral Improvement at School
Through auditory concentration interference training on the three ASD children for their on-campus social interaction,progress has been made in their overall performance. For example,obvious progress has been made in improvement in terms of looking at people,covering ears,replying classmates’ greetings,following teachers’instructions and frequency and quality of dialogues with his desk-mate,as shown in Table 4-5.
Table 4-5 School Behavior Questionnaire
2.Behavior improvement at home
Summarize the behaviors of the three children at home in Questionnaire 4-6. The parents of the three children all said the children had made obvious progress in their performance at home. See Table 4-6 for details.
Table 4-6 Behavioral Questionnaire at Home
Continued
(六) The Research Conclusion and the Future Research
After 10-month on-campus social auditory concentration intervention training in five phases for the three ASD children,the overall effective rate is 100%,with the most marked improvement in ASD kids’interest and confidence in social interaction,coupled with obvious improvement in ASD-specific auditory response inadequacy,auditory overreaction,and significant improvement in auditory identification,anti-interference,diversion and distribution abilities.
With further research by scholars at home and abroad on pushing forward inclusive education for ASD children,continuous innovation on how to improve ASD kid’ s social interaction capabilities at school can surely be expected both in theory and in practice. The training approach presented in this article is an powerful complement to the behavioral analysis-based structured training approach currently used home and abroad,and has great significance both for the realistic needs of improving ASD children’ s social interaction and future in-depth research.
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