自閉症類群障礙應用行為分析本位早療實證實務文獻回顧初探

Literature Review on ASD ABA-based Early Intervention EBP Research

10.6933/TJLCD.202109_8.0007

曹純瓊(Chwen-Chyong Tsau)

應用行為分析本位實證實務 ； 自閉症 ； 早期療育 ； 系統文獻回顧 ； ABA-based EBP ； ASD ； early intervention ； systematic literature review

溝通障礙教育

8卷（2021 / 09 / 01）

159 - 191

繁體中文

自閉症類群障礙高發生率與及早確診促成高效可行早期療育之殷切需求。然因先天跨多元系統之神經生理學障礙使此早期學習與發展更顯複雜。面對目前尚無可完全根治核心症狀的醫學藥理治療，早期療育因此聚焦在促進自閉症類群障礙幼兒綜合領域能力發展及核心症狀改善，以期神經系統可塑性最大化效果。自Lovaas（1987）自閉症幼兒方案成效備受注目以來，應用行為分析本位療育廣泛應用至今且相關實證實務研究亦肯定有效。然面對其實證實務模式多元且評議不一，如何確保何者滿足自閉症類群障礙幼兒個人需求且具終生影響效益？本文因此採文獻探討法聚焦近十年20篇系統文獻回顧，結果顯示對幼兒溝通、智能、社會及適應行為、核心症狀嚴重度有不同程度療效，親職壓力與家長增能之消長亦是成功關鍵。本研究亦發現2012年後實證實務研究量增且多符合實證水準，系統文獻回顧亦多採Cochrane等系統檢視偏差風險，且有基於黃金標準而僅後設分析隨機分派實驗，然多數成效實證弱或不足，特別是家長媒介模式是未來研究努力方向。

The high incidence of ASD and early diagnosis have contributed to the strong demand for effective and feasible early intervention. However, this early learning and development is more complicated due to neurophysiological barriers inherent across multi-systems. Facing currently no medical pharmacological treatment completely curing ASD core symptoms, early intervention focuses on promoting comprehensive developmental abilities and improving ASD symptoms in order to maximize neuroplastic effects. Since Lovaas's Young Autistic Children Program (1987) has gained much attention, ABA-based intervention has been widely utilized, and relevant Evidenced-Based Practical research consented its effectiveness. However, facing the diverse ABA-based EBP models and disputes, it was urgent to ensure which models meet autistic young children's needs and benefits lasting for a lifetime? Hence this research adopted literature-review method focusing on 20 systematic literature reviews in the past ten years. Results showed ABA-based intervention effects were variable on communication, IQ, social/adaptive behaviors and ASD severity, the decline and growing of parent-pressure and parent-empowerment was also the key to success. The amount of EBP increased since 2012 and many met evidence-based standards; many systematic literature reviews adopted Cochrane systems to examine deviation risk and even selected only RCT for meta-analysis, most of the research quality and effectiveness evidence revealed weak or insufficient, especially parent-mediated model, which would be future research's effort direction.

1. Bradshaw, J. L., Steiner, A. M., Gengoux, G. W., & Keogel, L. K. （2014）. Feasibility and effectiveness of very early intervention for infants at-risk for autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders, 45（3）, 778-794. Doi: 10.1007/s10803-014-2235-2
   連結：
2. Buescher, A. V. S., Cidav, Z., Knapp, M., & Mandell, D. S. （2014）. Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatrics, 168（8）, 721-728. Doi: 10.1001/jamapediatrics.2014.210
   連結：
3. Capes, K., Upson, S., Jones, C., Dissanayake, C., & Vivanti, G. （2019）. Delivery of group-early start Denver model in an Australian early childhood setting. Journal Focusing on Translational and Clinical Research in Pediatrics, 2. Doi: 10.21037/pm.2019.04.04
   連結：
4. Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et al. （2010）. Randomized, controlled trial of an intervention for toddlers with autism: the Early Denver Model. Pediatrics, 125, e17-23. Doi: 10.1542/ped.2009-0958
   連結：
5. Dawson, G., Jones, E. J., Merkle, K., Venema, K., Lowy, R., Faja, S., Kamara, D., Murias, M., Greenson, J., Winter, J., Smith, M., Rogers, S. J., & Webb, S. J. （2012）. Early behavioral intervention is associated with normalized brain activity in young children with autism. Journal of the American Academy of Child and Adolescent Psychiatry, 51（11）, 1150-1159. Doi: 10.1016/j.jaa.2012.08.018
   連結：
6. Eikeseth, S. （2001）. Recent critiques of the UCLA young autism project. Behavioral Interventions,16（4）, 249-264.
   連結：
7. Eapen, V., Črnčec, R., & Walter, A. （2013）. Clinical outcomes of an early intervention program for preschool children with autism spectrum disorder in a community group setting. BioMed Central Pediatrics, 13（3）,. Doi:10.1186/1471-2431-13-3
   連結：
8. French, L. & Kennedy, E. M. M. （2018）. Annual research review: Early intervention for infants and young children with, or at-risk of, autism spectrum disorder: a systematic review. Journal of Child Psychology and Psychiatry, 59（4）, 444-456. Doi: 10.1111/jcpp.12828.
   連結：
9. Fuller, E. A., Oliver, K., Vejnoska, S. F., & Rogers, S. （2020）. The effect of the early start Denver model for children with autism spectrum disorder: A Meta-Analysis. Brain Sciences, 10（6）, 368. Doi: 10.3390/10060368
   連結：
10. Grigorenko, E. L., Torres, S, Lebedeva, E. I., &Bondar, Y. A. （2018）. Evidence-based intervention for ASD: A focus on applied behavior analysis （ABA） interventions. Journal of the Higher School of Economics,15（4）, 711-727. DOI: 10.17323/1813-8919-2018-4-711-727.
    連結：
11. Lai, M-C., Lombardo, M. V., & Baron-Cohen, S. （2014）. Autism. Lancet, 383（9920）, 896-910. Doi:10.1016/S0140-6736（13）61539-1.
    連結：
12. Lai, M-C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., Szatmari, P., & Ameis, S. H. （2019）. Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis. Lancet Psychiatry, 6（10）, 819-829. Doi: 10.1016/s2215-0366（19）30289-5
    連結：
13. Landa, R. J. （2018）. Efficacy of early interventions for infants and young children with, and at risk for, autism spectrum disorders. International Review of Psychiatry, 30（1）, 25-39.
    連結：
14. Leaf, J. B., Cihon, J. H., Leaf, R., McEachin, J., Liu, N., Russell, N., Unumb, L., Shapiro, S., & Khosrowshahi, D. （2020）. Concerns about ABA-based intervention: An evaluation and recommendations. Journal of Autism and Developmental Disorders （online ahead of print）. doi:10.1007/s10803-021-05137-y
    連結：
15. Lombardo, M. V., Lai, M-C., & Baron-Cohen, S. （2019）. Big data approaches to decomposing heterogeneity across the autism spectrum. Molecular Psychiatry, 24, 1435-1450. Magán-Maganto, M. Bejarano-Martin, Á., Fernández-Alvarez, C., Narzisi, A., García-Primo,Patricia, Kawa, R., Posada, M., & Canal-Bedia, R. （2017）. Early detection and intervention of ASD: A European overview. Brain Science, 159. Doi: 10.3390/brainsci7120159.
    連結：
16. Nahmias, A. S., Pellecchia, M., Stahmer, A. C., & Mandell, D. S. （2019）. Effectiveness of ommunity-based early intervention for children with autism spectrum disorder: A meta-nalysis. Journal of Child Psychology and Psychiatry, 60（11）, 1200-1209. Doi:10.1111/jcpp.13073
    連結：
17. Steinbrenner, J. R., Hume, K., Odom, S. L., Morin, K., L., Nowell, S. W., Tomaszewski, B., Szendrey, S., Mclntyre, N. S., Yücesoy-Özkan, Ş., & Savage, M. N. （2020）. Evidence-based practices for children, youth, and young adults with autism. National Clearinghouse on Autism Evidence and Practice. https://ncaep.fpg.unc.edu/research-resources
    連結：
18. Nevill, R. E., Lecavalier, L., & Stratis, E. A. （2018）. Meta-analysis of parent-mediated interventions for young children with autism spectrum disorder. Autism: the International Journal of Research and Practice, 22（2）, 84-98. Doi: 10.1177/1362361316677838.
    連結：
19. Pacia, C., Holloway, J., Gunning, C., & Lee, H. （2021）. Systematic review of family-mediated social communication interventions for young children with autism. Review Journal of Autism and Developmental Disorders, 1-27. Doi: 10.1007/s40489-021-00249-8.
    連結：
20. Parsons, D., Cordier, R., Vaz, S., & Lee, H. C. （2017）. Parent-mediated intervention training delivered remotely for children with autism spectrum disorder living outside of urban areas: Systematic review. Journal of Medical Internet Research, 19（8）, e198. Doi: 10.2196/jmir.6651.
    連結：
21. Reichow, B., Hume, K., Barton, E. E., & Boyd, B. A. （2018）. Early intensive behavioral intervention （EIBI） for young children with autism spectrum disorders （ASD）. The Cochrane Database of Systematic Reviews, 5（5）. Doi: 10.1002/14651858.CD009260.
    連結：
22. Rodgers, M., Marshall, D., Simmonds, M., Le Couteur, A., Biswas, M., Wright K., Rai, D., Palmer, S., Stewart, L., & Hodgson, R. （2020）. Interventions based on early intensive applied behaviour analysis for autistic children: A systematic review and cost-effectiveness analysis. Health Technology Assessment, 24（35）. Doi: 10.3310/hta24350
    連結：
23. Rodgers, M., Simmonds, M., Marshall, D., Hodgson, R., Stewart, L. A., Rai, D., Wright, K., Ben-Itzchak, E., Eikeseth, S., Eldevik, S., Kovshoff, H., Magiati, I., Osborne, L. A., Reed, P., Vivanti, G., Zachor, D., & Couteur, A. L. （2021）. Intensive behavioural interventions based on applied behaviour analysis for young children with autism: An international collaborative individual participant data meta-analysis. Autism, 25（4）, 1137-1153. Doi: 10.1177/1362361320985680
    連結：
24. Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., Guo, M., Dawson, G. （2012）. Effects of a brief early start Denver model （ESDM）-based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 51（10）, 1052-1065. Doi: 10.1016/j.jaac.2012.08.003
    連結：
25. Rogers, S. J., Estes, A., Vismara, L., Munson, J., Zierhut, C., Greenson, J., Dawson, G., Rocha, M., Sugar, C., Senturk, D., Whelan, F., & Talbott, M. （2019）. Enhancing low-intensity coaching in parent implemented early start Denver model intervention for early autism: a randomized comparison treatment trial. Journal of Autism and Developmental Disorders, 49（2）, 632-646. Doi: 10.1007/s10803-018-3740-5
    連結：
26. Rogers, S. J., Vismara, L., Wagner, A. L., McCormick, C., Young, G., & Ozonoff, S. （2014）. Autism treatment in the first year of life: A pilot study of infant start, a parent-implemented intervention for symptomatic infants. Journal of Autism and Developmental Disorders, 44（12）, 2981-2995. Doi: 10.1007/s10830-014-2202-y
    連結：
27. Rogers, S. J., Yoder, P., Estes, A., Warre, Z., McEachin, J., Munson, J., Rocha, M., Greenson, J., Wallace, L., Gardner, E., Dawson, G., Sugar, C. A., Hellemann, G., & Whelan, F. （2020）. A multisite randomized controlled trial comparing the effects of intervention intensity and intervention style on outcomes for young children with autism. Journal of the American Academy of Child and Adolescent Psychiatry, 24, 853-865. Doi:10.1016/j.jaac.2020.06.013.
    連結：
28. Rojas-Torres, L. P., Alonso-Esteban, Y., & Alcantud-Marín, F. （2020）. Early intervention with parents of children with autism spectrum disorders: A review of programs. Children, 7（12）, 294. Doi: 10.3390/children7120294.
    連結：
29. Ryberg, K. H. （2015）. Evidence for the implementation of the early start Denver model for young children with autism spectrum disorder. Journal of the American Psychiatric Nurses Association, 21（5）, 327-337. Doi: 10.3390/children7120294.
    連結：
30. Sandbank, M., Bottema-Beutel, K., Crowley, S., Cassidy, M., Dunham, K., Feldman, J., Crank, J., Albarran, S. A., Raj, W., Mahbub, P., & Woynaroski, T. G. （2020）. Project AIM: Autism intervention meta-analysis for studies of young children. Psychological Bulletin, 146（1）, 1-29. Doi: 10.1037/bul0000215
    連結：
31. Schreibman, L., Dawson, G., Stahmer, A. C., Lana, R., Rogers, S. J., McGee, G. G., Kasari, C., Ingersoll, B., Kaiser, A. P., Bruinsma, Y., McNerney, E., Wetherby, A., & Halladay, A. （2015）. Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorder, 45, 2411-2428. DOI: 10.1007/s10803-015-2407-8 [PubMed:25737021]
    連結：
32. Tachibana, Y., Miyazaki, C., Mikami, M., Ota, E., Mori, R., Hwang, Y., Terasaka, A., Kobayashi, E., & Kamio, Y. （2018）. Meta-analyses of individual versus group interventions for pre-school children with autism spectrum disorder （ASD）. PLoS One, 13（5）: e0196272. Doi: 10.1371/journal.pone.0196272
    連結：
33. Trembath, D., Gurm, M., Scheerer, N. E., Trevisan, D. A., Pynter, J., Bohadana, G., Roberts, J., & Iarocci, G. （2019）. Systematic review of factors that may influence the outcomes and generalizability of parent-mediated interventions for young children with autism spectrum disorder. Autism Research, 12（9）, 1304-1321. Doi: 10.1002/aur.2168.
    連結：
34. Vivanti, G., Dissanayake, C., Duncan, E., Feary, J., Capes, K., Upson, S., Bent, C. A., Rogers, S. J., & Hudry K. （2018）. Outcomes of children receiving group-Early Start Denver model in an inclusive versus autism-specific setting: A pilot randomized controlled trial. Autism: the International Journal of Research and Practice, 23（5）, 1165-1175. Doi: 10.1177/1362361318801341
    連結：
35. Vivanti, G., Paynter, J., Duncan, E. Fothergill, H., Dissanayake, C., & Rogers, S. J. （2014）. Effectiveness and feasibility of the Early Start Denver Model implemented in a group-based community childcare setting. Journal of Autism and Developmental Disorders, 44, 3140-3153. Doi: 10.1007/s10803-014-2168-9
    連結：
36. Warren, Z., McPheeters, M. L., Sathe, N., Foss-Feig, J. H., Glasser, A., & Veenstra- VanderWeele, J. （2011）. A systematic review of early intensive intervention for autism spectrum disorders. Pediatrics 127（5）, 1303-1311. DOI: 10.1542/peds.2011-0426.
    連結：
37. Wong, C., Odom, S. L., Hume, K., Cox, A. W., Fettig, A., Kucharczyk, S., Schultz, T. R. （2015）. Evidence-based practices for children, youth, and young adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 45, 1951-1966.
    連結：
38. Yu, Q., Li, E., Li, L., & Liang, W. （2020）. Efficacy of interventions based on applied behavior analysis for autism spectrum disorder: A meta-analysis. Psychiatry Investig, 17（5）, 432-443. Doi: 10.30773/pi.2019.0229
    連結：
39. Autism Society （2020.03.26）. CDC Report States That Prevalence Rate Increase, with 1 in 54 Children Diagnosed with Autism Spectrum Disorder. Retrieved from https://www.autism-society.org/releases/cdc-releases-new-prevalence-rates-of-people-with-autism-spectrum-disorder/
40. Granpeesheh, D., Tarbos, J., & Dixon, D. R. （2009a）. Applied behavior analytic interventions for children with autism: A description and review of treatment research. Annals of Clinical Psychiatry, 21 （3）, 162-173.
41. Granpeesheh, D., Tarbos, J., & Dixon, D. R. （2009b）. Retrospective analysis of clinical records in 38 cases of recovery from autism. Annals of Clinical Psychiatry, 21（4）, 195-204.
42. Holehan, K. M., & Zane, T. （2019）. Is there science behind that?: The early start Denver model. Science in Autism Treatment, 16（2）. https://asatonline.org/for-parents/becoming-a-savvy-consumer/is-there-science-behind-that-early-denver-model/ （Accessed June 18, ‘21）
43. Kmet, L. M., Lee, R. C., & Cook, L. S. （2004）. Standard Quality Assessment Criteria for Evaluating Primary Research Papers From a Variety of Fields. https://www.ahfmr.ab.ca/frame53.html （Accessed June 30, ,21）.
44. Vivanti, G., Vismara, L., Dawson, G., & Rogers, S.J. （2019）. Evaluations of scientific research need to be based on scientific approaches. A reply to “is there science behind that?: the Early Start Denver Model” by Holehan & Zane, 2019. Science in Autism Treatment, Newsletter. 2021.06.07 Retrieved from https://asatonline.org/evaluations-of-scientific-research/