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及早識別、預防及支援懷疑受 虐待有特殊教育需要兒童

日期: 二零二一年四月二十一日(星期三)

時間: 9:00am– 12:30pm

香港教育心理服務中心 教育心理學家 熊偉權先生

(2)

Rundown

識別、

了解、

預防

• 辨識懷疑受虐待有特殊教育需要(SEN)的兒童

• 了解有SEN兒童受虐待後心理與成長的影響

• 預防有SEN的兒童受虐待

支援 策略

• 處理及介入手法

• 了解家長、教師、學校社工在支援懷疑受虐待有 SEN的兒童的角色

• 個案分享

(3)

虐待兒童的定義

• 十八歲以下

• 危害/損害兒童的身/心健康發展

• 每宗個案的情況逐一評估

• 考慮多項因素(例如兒童的年齡、虐待行為及該虐待行為對兒童 造成的影響等)

• 非單單關注事件的發生次數和性質

3

(4)

身體虐待 Physical

性侵犯 Sexual

疏忽照顧 Neglect

心理傷害

Psychological

虐待的種類

Maltreatment types

(5)

身體傷害 / 虐待 (Physical)

• 對兒童身體作出非意外的傷害

• 包括使用暴力、蓄意下毒、使之窒息或燒傷、照顧者假裝兒童生 病求醫,因而使兒童身體受傷或痛苦

保護兒童免受虐待—多專業合作程序指引 (SWD, HKSAR, 2020)

(6)

性侵犯 (Sexual)

• 讓兒童參與非法的性活動(例如:強姦或口交)

• 對兒童直接或間接的性剝削和性侵犯( 例如:製作色情物品)

• 兒童在不理解情 況下同意進行這些行為

保護兒童免受虐待—多專業合作程序指引 (SWD, HKSAR, 2020)

(7)

疏忽照顧 (Neglect)

• 嚴重或持續地忽略兒童的基本需要 (身體、醫藥、教育)

• 危害或損害兒童的健康或發展

保護兒童免受虐待—多專業合作程序指引 (SWD, HKSAR, 2020)

(8)

心理傷害 / 虐待 (Psychological)

• 對兒童施行危害或損害情緒或智力發展的重複行為和態度,或極 端事件

• 例如:拒絕、恐嚇、孤立、剝削/讓兒童學壞、不理會兒童的情 緒反應,說兒童無用、不完美、不被重視或不被愛護

保護兒童免受虐待—多專業合作程序指引 (SWD, HKSAR, 2020)

(9)

Signs of abuse

• Bruises, area of bruises, burns, clips

• “Hidden” areas

• Emotional changes (down/flat   agitated)

• Behavioural changes

• Social changes – avoiding people or places

• Toileting frequency

• Regressive behaviours

• Kid may be angry and blame self

(10)

SEN  more incidences of maltreatment?

• “…children with disabilities are more than twice as likely to be physically or sexually abused as their typically-abled peers…” (Petersilia, 2001)

• “Studies suggest that children on the [autism] spectrum are up to 2.5 to 3 times as likely as their neurotypical peers to be targets of bullying and physical or sexual abuse.” (Fisher et al., 2018; Sohn, 2020)

• “Neglect, psychological and physical abuses are significantly higher in the ADHD group.” (Hadianfard, 2014)

• “35% adults with dyslexia reported that they had experienced physical abuse as children, compared to 7% of adults who did not have dyslexia.” (Fuller-Thomson and Hooper, 2015)

Sources:

1. Petersilia (2001). Crime victims with developmental disabilities: A review essay.

2. Hadianfard (2014). Child Abuse in Group of Children with Attention Deficit-Hyperactivity Disorder in Comparison with Normal Children.

3. Sohn (2020). www.spectrumnews.org/features/deep-five/how-abuse-mars-the-lives-of-autistics-people

4. Fisher et al. (2018). A population-based examination of maltreatment referrals and substantiation for children with autism spectrum disorder.

5. Fuller-Thomson & Hooper (2014). The association between childhood physical abuse and dyslexia: Findings from a population-based study.

(11)

Adapted from:

So et al. (2018). A local review of child abuse in Hong Kong:

From the perspective of emergency physicians.

(12)

SEN Types Abbr.

1. Specific Learning Difficulties SLD

2. Autism Spectrum Disorders ASD

3. Attention Deficit / Hyperactivity Disorder ADHD

4. Intellectual Disability ID

5. Physical Disability PD

6. Visual Impairment VI

7. Hearing Impairment HI

8. Speech & Language Impairment SLI

9. Mental Illness MI

(13)

Specific Learning Difficulties

(in Reading and Writing)

讀寫障礙

(14)

Letter-sounds Word shapes & patterns Sequencing &

organization

Creative & intuitive Big picture thinker Listening & speaking

(15)

The children went to work.

It took them a long time to pick up all the popcorn.

讀 寫 障 礙 是 特 殊 學 習 障 礙 的 一 種

言 賣 寫 障 疑是 待 殊 學阝 章 疑 勺 一 重禾

(16)

讀極都唔識,

咁蠢咖!

真係懶!

冇用呀你!

你識曬先

可以食飯!

(17)

親子關係磨 擦頻生

家長的負面 無動機

情緒

自卑

憤怒 焦慮

(18)

1. Atypical social skills

2. Atypical senses

3. Stick to routines

4. Strong interests

5. May be anxious

Social Restrictive

A utism S pectrum D isorder

自閉症譜系障礙

(19)

“DAILY TRAUMA” for people with ASD

• Some people with autism find even everyday experiences stressful because they see the world literally and may not pick up on the

nuances of what people say or do, causing them to lose their ability

to trust

when people say one thing but do something else.

• “There’s a kind of chronic potential trauma of being in a world where you understand 50 percent of what’s going on most of the time

because you’re missing all these social cues, so you’re feeling

constantly out of the loop and having chronic stress around that..”

• Maltreatment can cause lasting damage, leading to severe stress, depression, anxiety and post-traumatic stress disorder (PTSD)

Sohn (2020). How abuse mars the lives of autistic people.

https://www.spectrumnews.org/features/deep-dive/how-abuse-mars-the-lives-of-autistic-people

(20)

• 一般因素:

• 被虐待,經歷暴力、天然災害、戰爭…

• 對有自閉症人士的因素:

• 火警鐘、剪頭髮、搬家、陌生人的一句話…

Source:

Gravitz (2018). At the intersection of autism and trauma. www.spectrumnews.org/features/deep-dive/intersection-autism-trauma

PTSD (創傷後壓力症)

(21)

模仿有自閉症的經歷

• https://www.youtube.com/watch?v=DgDR_gYk_a8

(22)

Characteristics of ASD that increase risk of maltreatment

• Non-verbal / weak verbal skills

• Communication / conversational difficulties

• Emotional processing difficulties (expression, perception, understanding, response)

Source:

Edelson (2010). Sexual Abuse of Children with Autism: Factors that Increase Risk and Interfere with Recognition of Abuse.

(23)

ASD – misattributed signs

• Behaviours may be related to maltreatment but attributed to ASD, or vice versa

受虐待所 產 生的行為

自閉症所 產

? 生的行為

(24)

ASD – misattributed signs

• Behaviours may be related to maltreatment but

attributed to ASD, or vice versa

(25)

Combined

Attention-Deficit/Hyperactivity Disorder

專注力失調、過度活躍症

(26)

Inattentive Type

• Forgetful

• Disorganized

• Lose belongings

• Careless mistakes

• Poor attention control

• Struggle with long projects

(27)

Hyperactive-Impulsive Type

• Fidgets

• Talks a lot

• Quick emotional shifts

• Blurts out without thinking

(28)

What is it like to have ADHD?

https://www.youtube.com/watch?v=uDXiih5TFfY&t=191s

A Stressful Simulation of ADHD

(29)

Under COVID restrictions

• Less regular exercise

• Less outdoor time

• Increased TV time

• Increased social media use

• Increased gaming

• Increased unhappy mood

• Reduced enjoyment in usual activities

• Increase loneliness

(30)

ADHD medication changes

• Medication treatment may be irregular during

school suspension, affecting behaviour at home

(31)

Ineffective communication

& aggressive relationship

Temperament of child with

ADHD

Parents with ADHD

Limited

knowledge on mental health

Stern et al. (2018). Associations between abuse/neglect and ADHD from childhood to young adulthood: A prospective

nationally-representative twin study.

(32)

ADHD – misattributed signs

• Easy to attribute “ADHD” behaviour to ADHD only, and not think of potential abuse

受虐待所 產 生的行為

ADHD所產

? 生的行為

(33)

ADHD – misattributed signs

• Easy to attribute “ADHD” behaviour to ADHD only, and not think of potential abuse

• Besides behavioural signs, note physical signs and

behavioural changes

(34)

Intellectual Disability 智能障礙

• IQ<80

• May have limited understanding of “maltreatment”

• Children with intellectual disabilities may be viewed as

easily suggestible or untrustworthy

(35)

Speech and Language Impairment 語言障礙

• “Those with behavior disorders face greater risk of

physical abuse, whereas those with speech/language disorders are at risk for neglect.”

Source:

Abuse of children with intellectual disabilities.

https://thearc.org/wp-content/uploads/forchapters/Child%20Abuse.pdf

(36)

虐待對腦部運作及神經系統的影響

虐待 多壓力 交感神經路徑

副交感神經 低壓力 安全

「攻擊或逃走」

心跳加快 血壓上升 血糖增加

「休息或安逸」

心跳變慢

血壓降低

(37)

虐待對腦部運作及神經系統的影響

•一般: 低壓力  多壓力

•SEN: 多壓力  更多壓力

(38)

虐待對兒童心理的影響

•沒有人關心我

•我沒有價值

•沒有人會在乎我

•人是不可信的

•世界是一個危險的地方

38

(39)

Childhood Trauma and the Brain

UK Trauma Council

• https://www.youtube.com/watch?v=xYBUY1kZpf8

(40)

預防策略:學習方面

•課堂、功課、測考特別安排

•安排學生放學後留在學校做功課,減少父

母跟孩子在家中衝突來源,減輕家長壓力

(41)

預防策略:了解孩子及家庭背景

•了解學生的個性特質

•問卷收集資料

•壓力程度、工作情況、健康狀況等

•識別有輔導需要的孩子及家長

(42)

預防策略:良好家校關係

•與家長建立及保持良好的溝通協 作關係

•Sunshine calls

(43)

預防策略:校方培訓

•教師培訓

•如何辨識和支援有SEN學生及家長

•如何辨識和支援具虐兒危機個案

•如何及早介入,化解危機

(44)

預防策略:親子教育

•精神健康、情緒管理教育

•提升家長管教技巧

•提升親子溝通技巧

•了解特殊教育需要

(45)

父母如何協助

子女管理情緒

(46)

孩子表達情緒的方式

1. 內斂

2. 攻擊他人 3. 自我攻擊

貼士1

(47)

如何讓孩子擁有良好心理健康

1. 察覺子女情緒

2. 從子女的不同表情、動作和行為 找出他們的情緒狀態

3. 對應的處理方法

(48)

家長講 嘢語氣稍有偏差:讚你都變鬧你

郭倩衡 (輔導心理學家)

55

38

7

(49)

孩子面對的環境與挑戰

貼士2

(50)

溝通 - 選擇合適的地點和時間

在大家感到輕鬆時

貼士3

(51)

用鼓勵分享的技巧

1. 用正面的身體語言 2. 開放式問題

貼士4

(52)

切忌

1.制止他的情緒 2.用負面的標籤 2.逃避

4.生氣 用惡言及打罵

5.威脅

(53)

1.要管行為但要接受情緒 2.給予空間及時間

3.培養孩子渲洩情緒的管道

4.培養孩子換個角度想的能力

5.培養自信:孩子看到自己的優點

適宜

(54)

教師和社工的角色

•保持與學生溝通及觀察:

•個性特質

•異樣情緒及表現

•危機程度

(55)

教師和社工的角色

•保持與家長溝通:

•了解家庭背景

•Sunshine call  信任

•情緒支援,表達慰問

•協助處理學業活動安排

(56)

教師和社工的角色

•陪同學生入院,探訪

•與訓輔組組員交流

•危機過後跟進

(57)

處理手法

•搜集基本資料 / 填《向警方舉報懷疑虐兒 個案報案表》

•確定SEN類別及嚴重程度

•Any comorbidity?

(58)

處理手法

•初步提問

•留意 SLI / ID / ASD 學生對問題的理解程度

•是否用太多 Yes/No 問題或引導性問題?  考慮是否適合繼續用提問方式

•其他方式:遊戲、畫畫

(59)

留意有自閉症學生對提問過程的感受

• Interviewed in an unfamiliar context with unfamiliar people

• Too in the present, don’t know that the discomfort of

“now” in interview or therapy will lead to better

“future” --> anxious

Edelson (2010). Sexual Abuse of Children with Autism: Factors that Increase Risk and Interfere with Recognition of Abuse

(60)

•"I am frightened to be put into a situation

where I have to explain anything to anyone….

Most of the time I just keep it to myself

because I just make too many enemies when I say something…”

- Angie, an adult with autism with very high IQ, recounts the after-effects of abuse as a child

•Prince-Hughes, D. (Ed.) (2002). Aquamarine blue: Personal stories of college students with autism.

(61)

智能障礙

•理解、溝通、專注能力

•習慣被動

•依賴性高

•「正面反應偏誤」

Baladerian (2013). Trauma and People with Intellectual or Developmental Disabilities: Recognizing Signs of Abuse and Providing Effective Symptom Relief

(62)

處理手法

•初步提問

•留意 ADHD 學生是否跟到提問過程

•如需要,重覆問題

(63)

處理手法

•即時保護兒童行動

•留意 ASD / ID 學生對入院 / 臨時住宿 的感受

•Routine change 可能引致更大打擊

•盡量保留適合的常規

參考文獻

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