社會福利署臨床心理服務科中央心理輔助服務...

社會福利署臨床心理服務科中央心理輔助服務

混合幼兒中心員工訓練工作坊自閉症兒童訓練－想法解讀

內容想法解讀 Theory of Mind (ToM) 的理論基礎自閉症兒童的社交及溝通障礙ToM 評估方法ToM 訓練方法本地教材介紹

想法解讀的理論基礎（ ToM)

ToM 理論基礎於 70 年代學者研究猿猴類動物能否理解想法而提出的理論 (Premack & Woodruffm, 1978) 80 年代其他學者將理論應用於兒童的研究上，發現它能解釋很多自閉症狀的成因 (Baron-Cohen, Lewslie & Frith, 1985) ，例如：

不會指著一些東西叫人看不能維持互動式的應對很少說出自己的想法及意念不懂辨別較複雜的感受

ToM 理論基礎定義：推測別人想法的能力（想法泛指信念、Ability to use this awareness to interpret social behavior Know different things

Have different feelings Are motivated by different things Etc.

TOM has a major influence on communication

1. Help decide when to communicate Is a listener available? What’s the listener doing? What’s the feeling of the

listener? Will s/he want to be interrupted?

2. Helps shape selection of content Is it relevant/ important to the listener? Background knowledge Shared knowledege? What information is needed How much detail?

3. Helps shape selection of form

Listener’s proximity? Listener’s visual perspective? Comprehension level? Relationship Time constraints?

“Effective conversation relies on an understanding that people know different things and that these states of knowledge can be shared.”

(Hadwin, Baron-Cohen, Howlin & Hill, 1997)

Assumptions Typical learners automatically interpret social behavior by assigning motives to the agents of action (mind-reading) TOM helps us to make sense out of seemingly disconnected utterances Mind-reading is done reflexively and the skills are part of the brain’s innate “cognitve structure”.

Theory of Mind Baron-Cohen (1995)

TOM is defined as the ability "to attribute mental state to oneself and to others and to interpret behavior in terms of mental states... mental states are unobservable entities that we use quite successfully to explain and predict behavior" In order for people to have a theory of mind mechanism (ToMM), they must also have a shared attention mechanism (SAM), which happens when two people focus their attention on the same object. The SAM uses "available information about the perceptual state of another person (or animal)… It then computes shared attentions by comparing another agent's perceptual state with the self's current perceptual state”

1. Intentionality detector (ID) A perceptual device Activated whenever input

identifies something as an potential agent of action

Interprets motion as goal-oriented behavior

Mind-reading Cognitive Structures

視線偵察……


2. Eye direction detector (EDD) Notices another person’s eyes Notices direction of gaze “I know what you see”


3. Shared Attention Mechanism (SAM)

Builds triadic representation “I know that you see what I

see”


4. TOM Mechanism (TOMM) Ability to infer full range of

mental states Perceptions Feelings Desires Intentions Knowledge

Retains in memory and update information

The Mindreading Mechanism

IDMoving

stimulus

ED

Shared Joint Attn.

Eye-like stimuli

SAM

Follow gaze

Recognize agent

TOMM

Infer full range of mental

states

Store info & use as part

of the theory

Theories about TOM and Autism

Simon Baron Cohen (1995) Learners with autism have a specific TOM deficit (i.e. mindblindness) Implies that

The cognitive wiring is absent-damaged The ability may not be teachable

Other Theories:Winner (2002) views TOM deficits on a spectrum, like ASD

MB : Mindblindness – complete lack of TOM skills EPT : emerging perspective takers – pass tasks; don’t generalize IIPT : Impairment of Interactive Perspective Taking TOM : Normal social inferencing skills

Assumes TOM skills of children in the middle can be enhanced through instruction

心智解讀是…… 明白別人擁有思想、信念、願望、動機及感覺 ( 各樣精神狀態 )

重要性 : 了解別人的動機有助我們預

測別人 ( 包括敵人 ) 的行為

自閉症兒童的社交及溝通障礙

自閉症兒童的特徵1.語言及溝通2.社交3.假想能力 4.固執行為及狹

隘的興趣

自閉症早期之特徵……目光接觸互聯注意假想遊戲對人的反應模仿力

非語言溝通模式語言社交回應 ( 微笑 ) 與友伴的關係

研究結果…… 約有八成以上的自閉症兒童並未能通過

心智解讀的測試

研究結果

自閉症兒童自閉症兒童

發展正常兒童唐氏綜合症兒童

Baron-Cohen, Leslie, A. M., & Frith, U. (1985)

自閉症兒童的心智解讀能力一般幼兒自閉症幼兒

留意別人的視線來了解別人的目的九至十八個月三至七歲

錯誤信念四歲八至十四歲

心智解讀是……自閉症兒童因心智解讀能力較弱

不能解讀別人的心智不能鑑貌辨色不能預知別人下一步的行動

心智解讀是…… 以為自己看到的 ( 視線 ) ，別人也能看到不能投入假想遊戲不能分辨想像與真實的世界不能理解說話中比喻及諷刺的真正意思

ToM 評估方法

Sixteen Frequently Used Measures

Tests of mental-physical distinction Brain functions tests The appearance-reality distinction First-order false-belief tasks See leads to knowing tasks Tests of recognizing mental-state

words Spontaneous use of mental state

words Tests of the production of

spontaneous pretend play

Sixteen Frequently Used Measures

Tests of understanding more complex causes of emotion

Tests of inferring thought/intent from gaze direction

Tests of being able to monitor one’s own intentions

Tests of deception Tests of understanding metaphor, sarcasm &

irony Tests of pragmatics Measures of correlation with real-life social

skills Second order false-belief (FB) tests

ToM 訓練方法

Intervention Research ASD learners can be taught to pass FB tasks Many don’t generalize knowledge in vivo Some generalise direct experience FB task to traditional task ( picture-based) Some studies found no different interaction following training on FB task

But training took place over short time Maybe ASD learners need more intense practice Maybe they need to be taught generalization

Intervention Research One study found correlation between Vineland scores and TOM skills

Vineland was adapted to include more Qs about perspective taking Correlations varied by strength of TOM (higher for ASD who could pass FB tasks, lower for those just learned to pass them)

Some teaching strategies looked more promising than others (e.g. teaching “thoughts are like pictures in your head”) If ASD have problem with overselection,

Teach them what to attend to Teach them what to ignore

Intervention Research Cognitive science has been helpful in

Showing that ASD do poorly on FB tasks Showing that FB tasks can be learned Identifying some prosthetics that can be used to teach it

Cognitive science has not shown How to identify overselection in vivo How to teach ASD to look for relevant cures How to teach to ASD to make inferences from cues

心智解讀的基礎心智解讀

學習程度 ≥ 24個月語言表達及理解程度 ≥ 24個月

學習程度 ≥ 48個月

語言表達及理解程度 ≥ 42個月

掌握心智解讀的能力有何用 ?

懂得鑑貌辨色增加假想能力提升 EQ

明白說話背後的意思

改善社交關係

懂得美麗的謊言發展自省的能力

提升溝通能力

心思材料材料特性特性

食客食客口味口味

烹調烹調方法方法選材及選材及

份量份量

食客食客反應反應

心智解讀材料材料特性特性

心智解讀是什麼？心智解讀是什麼？

心智解讀

食客食客口味口味

適合嗎？適合嗎？透過評估了解兒童的透過評估了解兒童的心智解讀發展至那一個階段心智解讀發展至那一個階段

心智解讀

選材及選材及份量份量

按評估結果按評估結果

釐定訓練目標釐定訓練目標

選擇訓練重點選擇訓練重點 // 比比重重 //

先後次序先後次序

心智解讀

烹調烹調方法方法

• 形式形式 (( 個別、小組個別、小組 ))

• 小組組合小組組合 (( 全部自閉症兒童全部自閉症兒童/ / 混合發展遲緩兒童混合發展遲緩兒童 ))

• 家長參與家長參與

心智解讀食客食客反應反應

檢討兒童學習進度檢討兒童學習進度 // 掌掌握能力握能力

心智解讀─教導時需注意的事項1. 訂立明確的訓練目標2. 分拆成細項來教導，可能需較長的時間來掌握3. 在自然環境下教導，增強類化4. 選取兒童喜愛的事物作教材，增強學習動機

心智解讀─教導時需注意的事項 ……5. 配合不同的媒介及方法媒介：遊戲、圖片、電腦方法：手偶故事、角色扮演、漫畫故事、卡通片6. 給予清晰及有系統的指示7. 配合視覺策略8. 「金句」帶出每項活動背後的原則及總結活動重點

9. 捉緊每一刻10. 其他人作示範，從別人身上學習 (A. Bandura, 1986)

11. 從經驗中學習12. 即時教導，重覆學習13. 輕鬆氣氛、時常獎勵

心智解讀─教導時需注意的事項 ……

14. 螺旋式學習、進展式學習15. 個別化學習

心智解讀─教導時需注意的事項 ……

其他訓練活動破冰遊戲身體語言語氣背後的意思調節情緒

如何應用？A. 中心

課堂：社交、玩技、唱遊、語言溝通、圖工堂、體能活動…… 環境：情緒角、分組學習、吊飾…… 日常流程：食飯時間、點名時間……

如何應用？……B. 家居

把握日常生活的每一刻安排親子時段 ( 玩玩具、一起製作食物、重溫生活照片 )一起觀看卡通片撰寫情緒日記備註： 1. 訓練重點 2. 家人參與 / 中介人 3. 學習氣氛

本地教材介紹

社會福利署 臨床心理服務科 中央心理輔助服務...

Documents

社會福利署臨床心理服務科中央心理輔助服務...