語言治療師使用手勢對發展性語言障礙學童因果句表現的影響

發展性語言障礙（Developmental Language Disorder, DLD）是指個案有明顯且持續之語言困難，但非為智能障礙、感官或神經缺損所導致。DLD兒童有明顯的複雜句理解及表達困難。文獻指出，兒童使用手勢不僅能加強或補足訊息傳遞，成人的手勢更能提供兒童理解或表達訊息的視覺支持。本研究探討共讀時，語言治療師講述因果句合併使用隱喻性手勢，能否提升發展性語言障礙學童之語言表現。本研究採非隨機實驗控制組前後測設計，共招募12位發展性語言障礙學童（均齡7;6），並分配至實驗組（手勢介入）或控制組（無手勢介入）。兩組兒童的年齡、非語言智力以及因果句表現皆無顯著差異（p值均>.05）。介入活動為八週一對一繪本共讀，每週一次三十分鐘課程。介入時，治療師給予兩組兒童之語言刺激皆大致相同。惟治療師講述因果句時，會給予實驗組「針對語句結構的隱喻性手勢」—手掌向上由左過渡至右，以表徵原因及結果兩個事件間的關聯；控制組則不接收任何手勢。研究結果顯示，介入後手勢組使用因果連接詞結合語句的表現顯著提升（p=.028），且前後測進步幅度高於無手勢組（p=.044），其成效也有短期維持效果。兩組的表達性詞彙（p=.027）及後測—追蹤故事重述語句複雜度（p=.028）皆有進步，但接收性詞彙、因果句語法正確性判斷、標準化語法測驗表現、故事重述中手勢使用率與平均句長則無顯著進步（p值均>.05）。綜上所述，本研究結果支持語言治療師在共讀時，給予針對語句結構的隱喻性手勢輔助，可有效提升發展性語言障礙學童的因果句表達表現。

Previous studies have indicated that co-speech gestures play an important role in language development, helping children supplement or complement spoken messages, as well as providing visual cues and support as children learn new concepts. We aimed to investigate during shared book reading, whether a speech-language pathologist’s gestures accompanying causal adverbial clauses affected performance of causality in children with developmental language disorder (DLD).Twelve children with DLD participated in this 8-week intervention with one session per week, evenly assigned to an experimental group or a control group. The major intervention activity was shared book reading, in which for the experimental group a metaphoric gesture was used for causal adverbial clauses, whereas no gesture was used for the control group.Our results showed that children receiving gesture stimuli not only improved on causal adverbial clauses in a sentence combining task in the posttest (p= .028), but also showed a greater gain than the control group (p=.044). Both groups’ expressive vocabulary (p=.027) and syntactic complexity in story retell (p=.028) were enhanced. However, the two groups did not differ on performances of a grammaticality judgment task, a standardized test of syntax, and MLU in story retell (p>.05). We concluded that co-speech gestures could enhance the production of causal adverbial clauses on children with DLD more effectively than just orally delivering sentences.