COVID-19下音樂社會故事遠距介入提升學前自閉症類群障礙症兒童心智詞

研究背景：過去研究已知自閉症類群障礙症（Autism Spectrum Disorder, ASD）兒童之心智狀態詞能力較一般發展兒童弱，又ASD兒童常見在音樂訊息處理及音樂表現上有所優勢，目前已累積許多音樂社會故事介入相關研究。同時，身處COVID-19疫情階段，使得原先實地治療被迫暫停或轉而採取遠距醫療方式進行，然目前尚無使用音樂社會故事以遠距模式應用於提升心智狀態詞的介入。本研究目的欲探討音樂社會故事遠距介入是否能提升學前ASD兒童心智狀態詞。研究方法：本研究共納入28位5至6歲學前ASD兒童，隨機分派至實驗組「音樂社會故事組」14位（平均年齡6.07歲），以及對照組「無音樂社會故事組」14位（平均年齡5.91歲）。兩組參與兒童於介入期接受為期4週、每週1次、一次50分鐘的遠距介入課程，所教導的心智狀態詞包含：認知狀態詞「知道」，欲求狀態詞「想要」，知覺狀態詞「覺得」，以及情緒狀態詞「高興」、「難過」、「生氣」、「害怕」，又實驗組於教導情緒狀態詞時伴隨相應情感曲風音樂片段。本研究在介入四堂課程中蒐集兒童心智詞理解與表達之逐字稿語料作為第一項療效指標；另外，使用情感詞彙作業分別於前測、介入前測、介入後測及追蹤後測四個時間點量測參與兒童之基本情緒詞理解、基本情緒詞表達、複雜情緒詞理解、複雜情緒詞表達作為第二項療效指標。研究結果：結果顯示，心智詞語料分析方面，音樂社會故事組ASD兒童在重述故事中欲求狀態詞「想要」、自發經驗故事中情緒狀態詞顯著優於社會故事組。情感詞彙作業方面，音樂社會故事組ASD兒童在基本情緒表達顯著優於社會故事組。結論：本研究支持「音樂」社會故事能提升學前ASD兒童心智狀態詞表達，特別在情緒狀態詞中的基本情緒表達。並且，本研究以遠距介入模式發現此效果，可能有助於因應現階段COVID-19疫情或日後臨床遠距介入的需求。

Background: Studies have shown that the mental state term ability—knowledge of mental state terms and the ability to comprehend and express mental states—of children with autism spectrum disorder (ASD) is weaker than those of typically developed children. In addition, children with ASD are often found to possess certain advantages in music processing and music performance. At present, many studies on music social story intervention in ASD research have been published. At the same time, face-to-face treatments have been forced to be suspended or switched to tele-intervention during the COVID-19 pandemic. However, there is a lack of tele-interventions that employ a music-related social story approach to improve mental state term ability. The purpose of the current study, therefore, is to explore whether musical social story tele-intervention can improve the mental state terms of preschoolers with ASD.Methods: Participants comprised twenty-eight preschoolers with ASD aged 5–6 years, randomly assigned to the experimental “music social story group” (n = 14, Mage = 6.07 years old) and the control “social story group” (n = 14, Mage = 5.91 years old). The tele-intervention program consisted of four 50-minute weekly sessions, and the following mental state terms were taught: desire state term “want”, cognitive state term “know”, perceptual state term “feel”, and emotional state terms “happy, sad, angry, and fear”; moreover, only the experimental group listened to a corresponding emotional music excerpt while being taught emotional state terms. Children’s use of the newly learned mental state terms during the intervention was transcribed verbatim to determine their comprehension and expression of mental state terms. Further, the Affective Lexicon Task (ALT) was used to measure the participants’ ability to comprehend basic emotional terms, their ability to express basic emotional terms, their ability to comprehend sociomoral emotional terms, and their ability to express sociomoral emotional terms at four time points: pre-test, pre-intervention, post-intervention, and follow-up post-test. Results: Concerning mental state terms, preschoolers with ASD in the music social story group performed significantly better than the social story group with respect to the desire state term “want” in the retelling story and the emotional state terms in the spontaneous experience story. In addition, concerning emotional state terms, preschoolers with ASD in the music social story group performed significantly better than the social story group in expressing basic emotional terms.Conclusions: Musical social story tele-intervention led to significantly greater improvements in the expression of mental state terms in preschoolers with ASD, especially in the expression of basic emotional state terms. Moreover, the current study provides implication for tele-intervention in preschoolers with ASD, which may be a solution to intervention during the COVID-19 pandemic and a promising treatment in clinical settings in the future.