身心障礙者固著行為的探討與處理

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一、個人變項

有些與身心障礙者個人有關的變項,可能直接或間接 地會影響到固著行為是否容易產生。一般而言,身心障礙 者的年齡、智力、語言能力、或障礙類別等個人變項,可 能會影響固著行為的出現率。 1. 年齡:固著行為產生的比率可能與身心障礙學童的年齡 有關。例如:Thompson 與 Berkson (1985) 研究 101 位 身心障礙的學童發現,一直到青少年時期為止,隨著年 齡的增加,學童固著行為的出現比率也跟著增加。 2. 智力:學童智力的高低可能與固著行為的出現比率有

關。Berkson, Rafaeli-Mor, 以及 Tarnovsky (1999) 即指 出,智力越低的學童出現固著行為的比率則越高。換言 之,越是重度或極重度的身心障礙者,越有可能出現固 著行為。

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一、感官的正增強

(positive sensory reinforcement) 有些異常行為,像是固著行為,或自我傷害行為的產 生,可能是為了獲得感官刺激的後果所造成的 (王淑貞, 民 90; 林惠芬, 民 90; Patel, Carr, Kim, Robles, & Eastridge, 2000; Rincover, 1978; Tang et al., 2003; Vollmer, Marcus, & LeBlanc, 1994)。這些問題行為的產生,可能與工作的要 求、前導事件、及後果事件皆無關(Falcomata, Roane, Hovanetz, & Kettering, 2004)。此種自我感官刺激的假定認 為:經由反覆的固著反應,可提供個體感官的自我輸入, 而得到自我快感。個體以此固著行為來調整自我感官的輸 入,以因應外界環境刺激的改變 (Lovaas, Newsom, & Hickman, 1987)。例如:個體在獨處或缺乏刺激的情境下, 會以反覆的固著行為,來調整感官的輸入情況 (Sturmey, Carlsen, Crisp, & Newton, 1988)。又如 Falcomata 等人(2004) 使用類比的功能分析(analogue functional analysis)來研究 一位自閉症學童的固著行為發現,該學童的固著行為多半 出現於獨處的情境,與社會的增強無關,很有可能是為了 獲得感官刺激的正增強後果所造成的。

二、感官的負增強

(negative sensory reinforcement) 身心障礙者的固著行為的產生,有時是為了逃避嫌惡 的感官刺激所造成的。例如:Tang 等人 (2002) 研究一位 自閉症學童蓋耳朵的固著行為發現,該學童反覆出現的固 著行為是為了逃避環境中的噪音(即教室裡同儕的尖叫 聲)。因為使用手掌蓋住耳朵,就聽不到噪音。因此,該學 童便常以蓋耳朵的固著行為來逃避同學嫌惡的尖叫聲。

三、社會的正增強

(positive social reinforcement) 某些問題行為的產生可能與個體為了引起他人的注 意、獲得想要的東西、或接近想玩的活動有關(Durand & Carr, 1987; Carr & McDowell, 1980; Wilder, Chen, Atwell, Pritchard, & Weinstein, 2006)。有時在較少社會性刺激的環 境下,身心障礙者會使用反覆的固著行為來引起他人的注 意或關懷 (Dadds, Schwartz, Adams, & Rose, 1988; Repp et al., 1988; Thompson & Berkson, 1985)。當固著行為反覆地 發生後,都能得到照顧者或成人的關切時,個體就學會以 該異常行為來獲得照顧者的關注。 Frea 和 Hughes (1997) 的研究支持這種觀點。經過研究了兩位智能障礙學生不當 的固著行為後,他們發現:這些學生的固著行為是由於社 會性的注意所引起,而且不同性質的注意,可能引發不同 頻率的固著行為。Dadds 等人 (1988) 的研究更進一步地 釐清對行為給予不同形式的注意,會引起不同頻率的固著 行為。他們研究十二個自閉症學童也發現,團體的注意比 個別的注意更容易引起學童的固著行為。

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有害的社會刺激或艱難的工作所引起的(e.g., Durand & Carr, 1987; Wilder et al., 2006)。此時問題行為的功能則是 由社會的負增強所引發。通常艱難工作的本身就是一種嫌 惡刺激,過度困難的要求工作常會讓個體,特別是身心障 礙的學童逃避 ( Mace & Belfiore, 1990)。因此,若每次出 現固著行為,就可以逃避這些具有嫌惡性質的工作,久而 久之,個體就學會以此方式來逃避或躲避麻煩的工作。例 如:Durand 和 Carr(1987)對四個身心障礙的學童進行 研究。結果發現:學童拍動手臂的固著行為隨著學習工作 的難度增加而增加。此研究顯示:較困難的學習工作或高 難度的要求可能更容易引發較高頻率的行為問題。此外, Sturmey 等人 (1988) 研究也支持社會的負增強是導致固 著行為的主因。他們操弄四種情境去評估造成固著行為的 成因。結果發現三位學童的固著行為是由於教師對他們的 學業要求所引起,學童們這些固著行為的產生可能與逃避 教師對課業及作業的要求有關。以上這些研究都顯示,高 難度的工作比簡單的工作更容易引發身心障礙學童固著行 為的產生。

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一、傳統的介入方式

以往很多學者並不清楚身心障礙者固著行為的真正原 因,認為此異常行為沒有特別的功能,有時只是直覺地假 設該行為的產生,可能個體為了自我刺激 (王淑貞, 民 90; 林惠芬, 民 90; Lovaas et al., 1987)。因此,便嘗試使用各種 不同的行為改變技術來處理,以減少此行為 (王淑貞, 民 90; LaGrow & Repp, 1984)。例如:使用與特殊兒童固著行 為不兩立 (incompatible) 的行為來制衡該行為,以減低其 固著行為的次數,即利用不兩立行為與固著行為具有不同 的形態(topographies)。當特殊兒童表現不兩立的正向行為 時,就無法再產生固著行為。有些研究則以過度矯正 (overcorrection)的介入方式來消減固著行為(Barrett, Matson, Shapiro, & Ollendick, 1981)。也有研究者以隔離 (time-out) 的方式來減少固著行為的頻率(e.g., Pendergrass, 1972)。例如:以隔離的方式來阻絕引起固著行為的前導事 件(antecedent),進而消減固著行為的頻率。有些研究則 以區別增強 (differential reinforcement) 的方式來減少固著 行為發生的機率,即試圖以增強 (reinforce) 適當的行為及 忽略 (ignore) 固著行為的策略,來降低固著行為產生的次 數(Dyer, 1987; Mulhern & Baumeister, 1969)。由於這些研 究並未找出固著行為的功能,再就固著行為的功能去發展 適當的介入策略。因此對固著行為的介入不是沒有效果, 就是效果有限且不一致(即同一介入策略有時有效,有時

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Runcoet al., 1986) 誠如 Repp 等人 (1988) 的研究即指 出,根據固著行為的功能去發展介入方案,的確能很有效 地減少此行為發生的機率。

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增強的策略,雙管齊下來減少固著行為;相對地,若固著 行為的產生是逃避工作要求的社會負增強所造成的,則可 採行負增強消弱,或使用功能溝通的訓練 (FCT)來教導個 案請求協助的技巧,以取代不當的固著行為。因此,能根 據個案不同固著行為的差異以及不同固著行為的功能,採 用妥適相應對 的處理策略,才能有效地消減固著行為的頻 率,並能確保身心障礙學童的受教權,提高其學習的效率 與品質。

參考書目

中文部分

王淑貞(民 90)。應用增強相剋行為方案改善國小啟智班 學生自我刺激行為成效之研究。國立嘉義大學國民教 育研究所未出版之碩士論文。 林惠芬(民 90)。功能行性評量對智能障礙學生固著行為 介入處理成效之研究。特殊教育學報,15,85-105。

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The Exploration and Treatment of

Stereotypical Behavior in

Individuals with Developmental Disabilities

Jung-Chang Tang

National Chiayi University

Abstract

People with developmental disabilities often exhibited lots of stereotypical behavior. There existed a relationship between stereotypical behavior and individual variables, such as age, intellectual ability, language ability, and disability degrees. Additionally, environmental variables, such as impoverished, noisy, and novel settings also executed their impacts on stereotypical behavior in individual with developmental disability. Previous studies usually adopted behavioral modification techniques to reduce stereotypy directly. However, the treatment effects of these studies were inconsistent. Recently, researchers employed functional analyses to assess the possible causes in stereotypy, and then developed appropriate interventional strategies. They found that stereotypical behavior may be maintained by positive sensory reinforcement, negative sensory reinforcement, positive social reinforcement, negative social reinforcement, or multiply determined reinforcement. The studies conducted intervention derived from functional analyses could effectively eliminate or reduce such aberrant behavior.

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