iPadが自閉症児の会話能力を高める
従来の治療法にコンピュータ・タブレットの使用を加えると、自閉症児の会話や交流の改善に役立つ可能性があることが、米カリフォルニア大学ロサンゼルス校セメル神経科学・人間行動学研究所のConnie Kasari氏らの研究でわかった。
5~8歳の自閉症スペクトラム障害(ASD)児61人を対象に、コンピュータ・タブレットのiPadを使用して言語・社会的コミュニケーションの治療を行ったところ、iPadを使用しない場合と比較して、この機器が治療効果を高めるのに役立つことがわかった。
被験者はいずれも、『会話能力は最も低いレベル』(話すことのできる機能語が20個以下)であり、最初の3カ月間、合計週2~3時間になる週2回のセッションを受けた。3カ月後、iPad使用群では78%近くに早期反応がみられたが、非使用群では62%にとどまった。早期反応は、発話する単語数など14の評価項目のうち半数が25%以上改善することと定義した。3カ月後、改善がみられない小児にiPadを追加したが、最初から使用した場合ほどの効果はみられなかった。
Kasari氏らは3年間の追跡調査を行った。同氏は、「全ての小児が改善したが、iPadの使用でより改善した。iPadを視覚的刺激と聴覚的フィードバックとして用いることで、会話の開始を支援することに焦点を当てた」と述べている。
Communication interventions for minimally verbal children with autism: a sequential multiple assignment randomized trial.
Connie Kasari, Ann Kaiser, Kelly Goods, Jennifer Nietfeld, Pamela Mathy, Rebecca Landa, Susan Murphy, Daniel Almirall
Journal of the American Academy of Child and Adolescent Psychiatry. 2014 Jun;53(6);635-46. doi: 10.1016/j.jaac.2014.01.019.
Abstract
OBJECTIVE :
This study tested the effect of beginning treatment with a speech-generating device (SGD) in the context of a blended, adaptive treatment design for improving spontaneous, communicative utterances in school-aged, minimally verbal children with autism.
METHOD :
A total of 61 minimally verbal children with autism, aged 5 to 8 years, were randomized to a blended developmental/behavioral intervention (JASP+EMT) with or without the augmentation of a SGD for 6 months with a 3-month follow-up. The intervention consisted of 2 stages. In stage 1, all children received 2 sessions per week for 3 months. Stage 2 intervention was adapted (by increased sessions or adding the SGD) based on the child's early response. The primary outcome was the total number of spontaneous communicative utterances; secondary measures were the total number of novel words and total comments from a natural language sample.
RESULTS :
Primary aim results found improvements in spontaneous communicative utterances, novel words, and comments that all favored the blended behavioral intervention that began by including an SGD (JASP+EMT+SGD) as opposed to spoken words alone (JASP+EMT). Secondary aim results suggest that the adaptive intervention beginning with JASP+EMT+SGD and intensifying JASP+EMT+SGD for children who were slow responders led to better posttreatment outcomes.
CONCLUSION :
Minimally verbal school-aged children can make significant and rapid gains in spoken spontaneous language with a novel, blended intervention that focuses on joint engagement and play skills and incorporates an SGD. Future studies should further explore the tailoring design used in this study to better understand children's response to treatment. Clinical trial registration information-Developmental and Augmented Intervention for Facilitating Expressive Language (CCNIA); http://clinicaltrials.gov/; NCT01013545.