園藝課程介入對高職智能障礙學生之影響

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(1)國立高雄大學運動健康與休閒學系(所) 碩士論文. 園藝課程介入對高職智能障礙學生之影響 The effect of intervention of horticultural course on senior high school students with mental retardation. 研究生：何致惟. 撰. 指導教授：潘明珠博士. 中華民國 102 年 01 月.

(2) 誌謝我念完碩士班了！這兩年來在研究所所學，令我收穫良多。真慶幸來到這裡，我重新學了好多從未接觸過的領域，每一門課都讓我大開眼界，每一門課都讓我那麼驚奇。有趣的解剖學，讓我重新認識全身上下每一塊肌肉跟骨骼，而且竟然有幸跟著大體老師一起上課，讓我在看影集「實習醫生」之餘還能聽懂那些術語；原來旅遊醫學那麼廣泛，我認識了很多疾病，這一定讓我將來出國玩時更謹慎小心；原來休閒經濟學那麼好玩，理論結合休閒生活，讓我也能看懂大麥克指數；健身運動心理學，讓我更了解運動時應該怎麼做才有效…，還有好多有意思的專題講座，至今我都印象深刻！除了這些課程，當然，碩士班裡最重要的大事就是論文的寫作，但可以寫出一本論文，真的令我自己意外，所以，謝謝我的指導教授潘明珠老師，老師對待我們亦師亦友，對於我們的愛拖延也從不生氣，還不斷的督促我寫論文，這本論文最後能完成也是因為有潘老師的大力幫助，真的沒有潘老師，就沒有我的論文，謝謝老師。再來是孫雅彥老師，在我念研究所修老師的課其間，孫老師給了我很多啟發，不論是做學問時的嚴謹態度，或是談笑時的優雅自在，都讓我印象深刻，能跟著老師學習是一種享受。最後是口委余嬪老師，因為我的論文有不足之處，老師在口試時給了我非常多的建議，讓我的論文得以完整，謝謝老師。黃其財老師，是你帶領我接觸園藝的領域，在認識你以前我從未拿過鋤頭，但現在我竟然可以自己種出各式各樣的作物，我在你身上學習了很多農園藝的知識，也敬佩你的人生態度，謝謝你在我告訴你我想做園藝治療的研究時，一直大力的支持，我真的很感動。周育聖，有你跟我的園藝課，是我的福氣，雖然你只是助手，但是其實我在你身上重新學習了與學生相處的方式，你跟學生在一起時散發出來的光輝真的很溫暖，沒有你，我的研究不可能如此順利，謝謝你。校長，謝謝你讓我進修；老余，謝謝你幫我解決分組的問題，說真的，要不是你，我那學期的研究無法開始；老梅，感謝你給了我很多過來人的建議；其他親愛的朋友們， i.

(3) 謝謝你們的加油與打氣；所有仁特的同仁們，感謝你們在我做研究以及寫論文期間的幫助，還有我的家人，雖然感謝你們做我進修的後盾，但還是要說，我真的有在唸書啦！這本論文就是證明。最後，要感謝老方，三年前若不是你帶我去考研究所，就不會有我這自以為學很多知識的碩士生涯了！謹以此篇論文，與所有我所感謝的人一同分享。. 何致惟. 謹誌. 2013 年 2 月 18 日. ii.

(4) 園藝課程介入對高職智能障礙學生之影響指導教授：潘明珠博士國立高雄大學運動健康與休閒學系(所) 學生：何致惟國立高雄大學運動健康與休閒學系(所). 摘要. 園藝治療係運用植物和植物相關活動，提高個體的生理、心理、和社會的適應能力，從而改善其健康狀況與福祉。研究證實一個人可從和植物及庭院的互動中獲得許多利益。這對身心障礙者尤其重要，因為他們在日常生活中會遭遇許多活動的限制與障礙，因而使生活品質降低。本研究的目的在評估園藝課程對高職智能障礙學生的成效，採預實驗設計中的單組前後測設計。研究對象為就讀於高雄市立仁武特殊教育學校高職部學生，學生接受為期十四週，每週二次，每次 150 分鐘的園藝課程介入，並於課程前、課程中、及課程結束後分別進行資料收集。評估工具為園藝課程評估表。本研究量化分析採無母數法的 Wilcoxon 符號等級檢定，以分析成對樣本的分數是否有顯著性差異；質化研究則於課程結束後對每位學生的導師採深度訪談。結果顯示，園藝課程介入後，受測學生在園藝治療評估表上的「生理/知覺能力」、「社會互動能力」、「認知能力」、「情緒狀態」、「課餘興趣」等五向度的表現皆比介入前有顯著進步。. 關鍵字：治療式遊憩、休閒治療、園藝治療、園藝課程、智能障礙、高職. iii.

(5) The effect of intervention of horticultural course on senior high school students with mental retardation Advisor: Dr. Ming-Chu Pan Department (Institute) of Kinesiology, Health, and Leisure Studies National University of Kaohsiung Student: Chih-Wei Ho Department (Institute) of Kinesiology, Health, and Leisure Studies National University of Kaohsiung. Abstract Horticultural therapy is a treatment method using plants and plant-related activities to improve the physical, mental, and social adjustment of an individual, thus improving his/her health and well-being. Research confirms that positive benefits accrue when people interact with plants and gardens.This is particularly important for people with disabilities because they will encounter many activity limitations and restrictions to participation in life situations caused by disabling condition, which result in a decrease in quality of life. The purpose of this study is to evaluate effects of horticultural activity on students with mental retardation. One-group pretest-posttest design was conducted with a sample of 12 senior high students with mental retardation at one of the Special Education School of Kaohsiung City. Horticultural intervention was given to students for 12 weeks, 2 sections per week, 150 minutes per section. Data were collected before, during, and immediately after a 12-week therapeutic horticulture program. The assessment instruments was revised from “Horticultural Therapy Evaluation Form” used at New York University Medical Center. Wilcoxon signed- rank test of non-parametric statistics were used to assess whether iv.

(6) significant differences exist between paired means. Results have shown that students exhibited significant differences from pre to posttest on mobility, physical/perceptual abilities, social interaction, cognitive ability, emotional status, and avocational interests of Horticultural Therapy Evaluation Scale. Keywords: therapeutic recreation, recreation therapy, horticultural therapy, horticultural program, mental retardation,senior high school. v.

(7) 目. 錄. 誌謝 ······································································································································· i 摘要 ····································································································································· iii Abstract ································································································································ iv 目錄 ································································································································· vi 表目錄 ································································································································· ix 圖目錄 ·································································································································· x 第一章緒論 ······················································································································ 1 第一節研究背景與動機 ........................................................................................... 1 第二節研究目的 ....................................................................................................... 4 第三節研究效益 ....................................................................................................... 5 第四節研究範圍與限制 ........................................................................................... 5 第二章文獻探討 ··············································································································· 6 第一節智能障礙 ....................................................................................................... 6 一、定義 ·············································································································· 6 二、障礙程度 ······································································································· 7 三、智能障礙者身心特質 ···················································································· 8 第二節治療式遊憩與遊憩治療 ................................................................................ 9 一、發展及概念 ··································································································· 9 二、治療式遊憩模式及程序（Therapeutic Recreation and Process） ················ 10 第三節園藝與園藝治療 ......................................................................................... 11 一、園藝的意義 ································································································· 11 二、人與植物關係的理論背景 ·········································································· 12 三、園藝治療的發展 ························································································· 16 四、園藝治療的定義 ························································································· 18 五、園藝治療活動的效益 ·················································································· 18 六、園藝治療針對身心障礙者的相關研究 ······················································· 21 第三章研究方法 ············································································································· 27 第一節研究流程 ..................................................................................................... 27 第二節研究架構 ..................................................................................................... 29 第三節研究假設 ..................................................................................................... 29 第四節研究對象與研究場域 .................................................................................. 30 一、研究對象 ····································································································· 30 二、研究場域 ····································································································· 30 第五節研究設計 ..................................................................................................... 32 一、研究設計 ····································································································· 32 vi.

(8) 二、實驗處理 ····································································································· 32 三、課程設計 ····································································································· 32 四、教學者 ········································································································· 34 第六節研究工具 ..................................................................................................... 35 一、量化部份 ····································································································· 35 二、質化部份 ····································································································· 37 第七節名詞解釋 ..................................................................................................... 39 一、高職智能障礙學生 ····················································································· 39 二、園藝課程 ····································································································· 39 三、生理/知覺能力 ···························································································· 39 四、社會互動能力 ····························································································· 39 五、認知能力 ····································································································· 39 六、情緒狀態 ····································································································· 39 七、課餘興趣 ····································································································· 39 第八節資料處理 ..................................................................................................... 40 一、信度分析 ····································································································· 40 二、敘述性統計分析 ························································································· 40 三、Wilcoxon 符號等級檢定(Wilcoxon Signed-rank Test) ································· 40 第四章研究結果與討論 ································································································· 41 第一節基本資料分析 ............................................................................................. 41 一、園藝課程評估表信度分析 ·········································································· 41 二、受試學生基本資料分析 ·············································································· 41 三、受試學生身心特質簡述 ·············································································· 43 四、園藝課程評估表描述性統計分析 ······························································ 45 五、個別受試學生在「園藝課程評估表」平均得分及其變化分析 ················ 47 第二節無母數統計分析 ......................................................................................... 50 一、受試學生在「園藝課程評估表」之前測與中測比較 ································ 50 二、受試學生在「園藝課程評估表」之中測與後測比較 ································ 52 三、受試學生在「園藝課程評估表」之前測與後測比較 ································ 54 第三節導師訪談結果 ............................................................................................. 56 一、導師對園藝課程的看法 ·············································································· 57 二、受測學生在班上的改變 ·············································································· 58 三、小結 ············································································································ 60 第四節綜合討論 ..................................................................................................... 61 一、受試學生在「園藝課程評估表」各分項得分 ··········································· 61 二、受試學生在「園藝課程評估表」前、中、後測結果討論 ························ 63 第五章結論與建議 ········································································································· 66 第一節研究結論 ..................................................................................................... 66 一、量化分析結論 ····························································································· 66 vii.

(9) 二、觀察及訪談結論 ························································································· 67 第二節研究限制 ..................................................................................................... 68 一、研究對象的限制 ························································································· 68 二、研究時間的限制 ························································································· 68 三、研究工具的限制 ························································································· 68 四、研究人力的限制 ························································································· 68 第三節研究建議 ..................................................................................................... 69 一、對政府機關之建議 ····················································································· 69 二、對特教師資培育機構之建議 ······································································ 69 三、對學校課程方面之建議 ·············································································· 69 四、對學生家長之建議 ····················································································· 71 五、對相關單位之建議 ····················································································· 71 六、對未來研究建議 ························································································· 71 七、對個人教學生涯省思 ·················································································· 72 參考文獻 .................................................................................................................... 73 一、中文部分 ···················································································································· 73 二、英文部分 ···················································································································· 75 附錄 ···································································································································· 81 附錄一：受試者平均分數變化 .................................................................................. 81 附錄二：美國紐約大學醫學中心發展之園藝治療評估表 ....................................... 84 附錄三：本研究發展之園藝課程評估表 .................................................................. 85. viii.

(10) 表目錄表 2-1 表 2-2 表 2-3 表 2-4 表 2-5 表 3-1 表 3-2 表 3-3 表 3-4 表 4-1 表 4-2 表 4-3 表 4-4 表 4-5 表 4-6 表 4-7. 園藝活動的應用類型 ............................................................................. 15 園藝治療的發展史 ................................................................................. 17 園藝治療的已知效益 ............................................................................. 20 園藝治療在國內的相關實證研究 .......................................................... 23 相關論文內容比較一覽表 ...................................................................... 26 實驗設計 ................................................................................................. 32 每周課程進度表 ..................................................................................... 33 園藝課程評估表 ..................................................................................... 36 訪談大綱 ................................................................................................. 38 園藝課程評估表內部一致性係數信度分析表 ....................................... 41 學生基本資料一覽表 ............................................................................. 42 學生身心特質一覽表 ............................................................................. 43 園藝課程評估表描述性統計 .................................................................. 46 園藝課程評估表前測與中測比較一覽表 ............................................... 52 園藝課程評估表中測與後測比較一覽表 ............................................... 54 園藝課程評估表前測與後測比較一覽表 ............................................... 56. ix.

(11) 圖目錄圖 3-1 研究流程 ................................................................................................. 28 圖 3-2 研究架構 ................................................................................................. 29 圖 4-1 十二位受試學生評估表總平均分數變化 ............................................... 50. x.

(12) 第一章. 緒論. 本章共分為四節，分別說明研究背景與動機、研究目的、研究效益、研究範圍與限制等四部份。. 第一節. 研究背景與動機. 休閒是人類達到個人發展及社會成就的一項重要活動。自古以來利用休閒遊憩活動達到治療目的早就存在於不同的社會文化之中。美國是在20世紀中旬後才開始受到重視，主要是因應大量退伍軍人返國後所產生生理、心理、與社交等層面的問題，經過多年發展，如今已發展為一個建構完整的「遊憩治療（recreation therapy）」或「治療式遊憩（therapeutic recreation）」的專業領域。根據世界衛生組織（World Health Organization, 1948）對健康所下的定義：「一種在生理、心智、以及社交能力上的健全狀態，而不僅是沒有疾病或沒有體弱」。相較於傳統的農業社會，現代人處於不健康的狀況已經是一個普遍的現象。一旦這個現象發生，除了藥物治療外，也可以尋求所謂之另類療法（alternative therapy），而遊憩治療即是其中之一。根據美國治療式遊憩協會（American Therapeutic Recreation Association）最新的定義，遊憩治療係指用來恢復、矯正、或恢復一個人日常生活的功能與獨立程度，以促進其健康和福祉，同時減少或消除因疾病或障礙所造成參與活動時所受到的限制及障礙的治療服務（ATRA, 2009）。遊憩治療目前在美國已廣泛應用在包括精神與心智健康、矯正及社會異常、濫用問題、自閉症、身心障礙、神經肌肉病變、認知復健、老年人照護、兒童遊戲、心臟復健、痙攣性疾病及愛滋病等復健或健康促進上，並落實於社會上各種特殊族群中，包括身心障礙者、受虐兒童或婦女、青少年犯罪、退休者、無依或體弱的老人，以及在災難中喪失親人者等（Austin, 2001）。遊憩治療在台灣仍屬新興領域，大多附屬在醫療機構之職能治療項目下，部分的醫 1.

(13) 療機構會利用遊憩治療處方來幫助精神病患進行復健；而我國職能治療師法中則明訂職能治療師業務包含遊憩治療項目，其發展進程雖遠不及美國，但近年隨著國內健保負擔日益沉重，加上國人的健康意識提高，遊憩治療也逐漸受到重視，愈來愈多的大專院校將遊憩治療課程列為系所發展的方向，而衛生署積極在各社區推動健康營造計畫，也會導入休閒遊憩活動做為健康促進的媒介。遊憩治療可以說是以休閒遊憩活動進行有目的的介入，來達到個體生活品質的提升（Iso-Ahola, 1980）。遊憩治療對身心障礙者尤其重要，因為他們在感官、知覺、動作、語言、認知、社會或情緒上的發展比較薄弱，若能導入休閒遊憩活動來幫助他們，讓這些在身體、心智或社會互動受到限制或有障礙者改善其自我處理生活的能力，進而享受生活的品質。據內政部統計通報，截至民國101年6月底止，領有身心障礙手冊者計有1110,304人，其中智能障礙者占99,165人，身心障礙人口占總人口之比率為4.77％（內政部，2012）。其中，就學生族群而言，目前我國共設有27所特殊教育學校，以滿足各類特殊需求的學生，包括視覺障礙、聽覺障礙與智能障礙等。根據教育部2012年10月的資料顯示，高級中等以下學校身心障礙學生共有103,864人，其中智能障礙類最多，有30,052人，占28.93％（教育部，2012）。普遍來說，智能障礙在認知學習、動作發展、生活技能、社交能力或者職業適應上都有困難。若能持續給予適當的特殊教育以及課程訓練，讓他們在學習的過程中加強人際關係互動、危機處理能力、提高挫折容忍度，並將所學類化至現實生活中，對於他們未來能否自力更生或者更進一步要在社會上就業有很大幫助。由於遊憩治療的媒介相當廣泛，包括藝術、音樂、戲劇、舞蹈、遊戲、園藝、運動等，因此身心障礙學生若能依照自己的個人意願與興趣進行選擇，通常會是一種相當愉悅與享受的經驗。其中，園藝治療是一項五感刺激高、植物的存在性長、對參與者而言具明顯的成就感、能讓肢體活動，能體認生命特質，又能運用勞力與知識，非常適合做為智能障礙者的職業訓練與休閒活動。國外有許多藉由園藝活動來幫助身心障礙者建立自信心及成就感，並增加其耐性的例子（如：Airhart & Tristan, 1987；Flagler, 1992；Haller, 1995；Kavanagh, 1995；Shapiro 2.

(14) & Kaplan, 1995；Stoneham, Kendle & Thoday, 1995；Strauss & Gabaldo, 1995）。而參與園藝活動可以提升人們的身心健康也受到很多學者研究的證實（如：Pothukuchi & Bickes, 2001; Rodiek, 2002; Matthew, et al., 2005; Kim, et al., 2008; M. J. Lee, 2010等）。一個人可以在照顧園藝作物的過程中經歷到植物從發芽、出葉、開花到結果等生命的變化，如果能訓練身心障礙者在園藝植物管理上一些簡單重覆的步驟，不僅可以獲得收成，而且可以從植物生長的韻律中體會到生命的現象與意義，進而增加對自我的認識與肯定。美國園藝治療協會（2008）就指出，參與園藝活動和接觸大自然可產生認知、心理、社會、實質環境等不同層面的效益。因此，從西方的經驗與成效來看，園藝治療頗值得國內推廣與應用，尤其是進行相關的實證研究，並評估其成效。然而，我國截至目前為止，若排除一般性論述，僅有二十一篇的實證研究是將園藝運用在特殊的群體上，包括亞斯伯格兒童、發展遲緩兒童、觀護少年、失智老人、受戒治人、自閉症患者、醫院輪椅病患、慢性精神病患、有壓力的大學生、教養院院生、智能障礙者與唐氏症兒童。整體而言，台灣有關園藝治療成效評估的實證研究數量明顯不足，而針對智能障礙者的研究更是屈指可數，目前僅有朱凱薇（2006）、陳國濱（2006）、高淑珍（2006）與曾兆良（2003）四篇。若要有效評估園藝治療在台灣的應用狀況，有必要累積更多有關園藝治療的本土經驗及案例，以達全民健康與提升福祉的目的。研究者本身任職於特殊教育學校高職部近6年，擔任過許多職業課程的教學工作，如園藝、餐飲、洗車等，而其中在園藝課的教學過程裡，除了感到自己對於生命的體悟有所轉變外，亦發現學生在接觸整個植物生長過程中的態度變化，從烈日下勞作的頻頻喊累到收成時的手舞足蹈，都顯示這門課程為特教學生帶來的成長與喜悅。研究者認為園藝課程對於那些特教學生的學習應該是有所幫助的，因此，為了可以更深入而具體的了解園藝課程對於特教學生的影響，並能依此以更有系統的方式將園藝課程納入特教學校在休閒教育、個案輔導與職業訓練等的教學一環，以達到特教學生的個別化教育需求，故而引發本研究的研究動機。. 3.

(15) 第二節. 研究目的. 特殊教育學校是園藝治療一個很重要的場域。根據教育部於民國八十九年頒訂實施之「特殊教育課程綱要」，高中職階段啟智學校（班）課程綱要中的課程架構乃以職業核心生活適應能力為主軸，依職業生活能力、家庭及個人生活能力、社區生活能力組成三個核心領域，透過適性的教學，期望智能障礙者達成鍛鍊身心，充實生活知能，發展健全人格，以提昇個人及家庭生活適應能力；了解環境，順應社會變遷，擴展人際關係，以培養學校及社區生活適應能力；及認識職業，培養職業道德，建立工作技能，以增進就業及社會服務能力等目標。因此，培養智能障礙者獨立自主的生活能力並加入競爭性就業市場是智障教育的最終目標（林惠芬，2005），其中園藝是智能障礙者職業訓練的課程之一，不僅可以建立工作技能，亦可培養休閒興趣。由於智能障礙者是國家社會之一份子，職場機會與休閒參與均應受到重視。有鑑於此，本研究旨在了解園藝活動對智能障礙學生的影響，期望透過園藝課程的導入，瞭解下列問題：一、. 園藝課程對高職智能障礙學生整體表現之影響。. 二、. 園藝課程對高職智能障礙學生「生理/知覺能力」之影響。. 三、. 園藝課程對高職智能障礙學生「社會互動能力」之影響。. 四、. 園藝課程對高職智能障礙學生「認知能力」之影響。. 五、. 園藝課程對高職智能障礙學生「情緒狀態」之影響。. 六、. 園藝課程對高職智能障礙學生「課餘興趣」之影響。. 4.

(16) 第三節. 研究效益. 由於特殊教育學生的特殊性質，本研究希望藉由瞭解園藝課程介入後對生理/知覺能力、社會互動能力、認知能力、情緒狀態與課餘興趣之影響，據以提供家長、學校及相關單位作為休閒教育、輔導與職業訓練之參考，並為智能障礙學生的健康促進與社會適應力等提升提供一條可行之途徑。. 第四節. 研究範圍與限制. 本研究對象為仁武特殊教育學校高職部園藝組智能障礙學生，由於智能障礙學生個別差異大，因此本研究結果僅能代表本校學生之特性，無法推估一概而論，僅能做為各校/各特教工作夥伴在教學設計上的參考。. 5.

(17) 第二章. 文獻探討. 本研究的目的在以園藝課程介入，觀察對智能障礙高職學生影響。本章共分為四節，分別說明智能障礙、治療式遊憩與休閒治療、園藝治療等三部份。. 第一節. 智能障礙. 依據身心障礙者權益保障法（法務部，2012），自民國101年7月11日起推行身心障礙鑑定及需求評估新制，身心障礙的分類由原先的16類改為依據WHO所頒布的「國際健康功能與身心障礙分類系統（簡稱ICF)）」之8大分類，原本的「智能障礙者」改為「第一類：神經系統構造及精神、心智功能」，新制的精神是以醫事、社工、特殊教育與職業輔導評量等專業人員組成專業團隊進行鑑定及評估，對於合於規定者核發「身心障礙證明」。本研究仍以舊稱「智能障礙」進行闡述，主要基於以下三點：1.本研究的園藝課程介入時程在101年6月底前即已完成；2.新制分類尚在推動階段，尚並未普及全國；3. 特殊教育學生受教育所依循的法源為「特殊教育法」及其子法，而此法並未隨身心障礙者權益保障法更改分類，因此本研究仍沿用「智能障礙」一詞。一、定義何謂「智能障礙」？在教育領域裡以美國智能障礙協會（American Association on Mental Retardation，簡稱 AAMR）所界定的定義最具代表性，也最被廣為引用（Patton, Beirne-Smith & Payne, 1990；林惠芬，2005）。該協會對智能障礙的定義為「智能障礙者在智力功能和適應行為的表現有明顯的限制，且智能障礙發生於 18 歲以前。適應行為的表現是指在概念上（concept）、社交上（social）、以及實際表現上（practical）三種能力（skills）(AAMR, 2002)。」該協會於 2006 年更名為美國心智及發展協會（American Association on Intellectual and Developmental Disabilities, AAIDD），而“智能不足（Mental Retardation）”一詞也改為“心智障礙 Intellectual Disabilities” （AAIDD, 2011）。. 6.

(18) 我國教育部（教育部，民 91）的定義則更為具體：「智能障礙是指個人之智能發展較同年齡者明顯遲緩，且在學習及生活適應能力表現上有嚴重困難者，其鑑定標準如下：（一）心智功能明顯低下或個別智力測驗結果未達平均數負二個標準差（二）學生在自我照顧、動作、溝通、社會情緒或學科學習等表現上較同年齡者有顯著困難情形。二、障礙程度「智能障礙」為包括不同障礙程度的廣泛性名詞，智能障礙者不但和普通人一樣有個別差異，甚至彼此間的差異可能更大，所顯現出來的問題由輕微到嚴重的程度不一，輕者在學齡階段的學習即有明顯落後的情形，重者則連如獨立生活的社會適應都有顯著的困難。我國行政院衛生署（民 91）定義智能障礙為「成長過程中，心智的發展停滯或不完全發展，導致認知、能力和社會適應有關之智能技巧的障礙」，並分為輕度、中度、重度和極重度四個等級，分別說明如下：（一）輕度智能障礙者智商界於該智力測驗的平均值以下2個標準差至3個標準差（含）之間，或成年後心理年齡介於9歲至未滿12歲之間，在特殊教育下可部份獨立自理生活，及從事半技術性或簡單技術性工作的輕度智能不足者。（二）中度智能障礙者智商界於該智力測驗的平均值以下3個標準差至4個標準差（含）之間，或成年後心理年齡介於6歲以至未滿9歲之間，於他人監護指導下僅可部份自理簡單生活，於他人庇護下可從事非技術性的工作，但無獨立自謀生活能力的中度智能不足者。（三）重度智能障礙者智商界於該智力測驗的平均值以下4個標準差至5個標準差（含）之間，或成年後心理年齡在3歲以上至未滿6歲之間，無法獨立自我照顧，亦無自謀生活能力，須賴人長期養護的重度智能不足者。（四）極重度智能障礙者 7.