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

1. 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

2. 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

3. 想法解讀的理論基礎（ToM)

4. 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

5. 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.

6. 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?

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

8. 3. Helps shape selection of form • Listener’s proximity? • Listener’s visual perspective? • Comprehension level? • Relationship • Time constraints?

9. “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)

10. 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”.

11. Theory of MindBaron-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”

12. Mind-reading Cognitive Structures 1. Intentionality detector (ID) • A perceptual device • Activated whenever input identifies something as an potential agent of action • Interprets motion as goal-oriented behavior

13. 視線偵察……

14. Mind-reading Cognitive Structures 2. Eye direction detector (EDD) • Notices another person’s eyes • Notices direction of gaze • “I know what you see”

15. Mind-reading Cognitive Structures 3. Shared Attention Mechanism (SAM) • Builds triadic representation • “I know that you see what I see”

16. Mind-reading Cognitive Structures 4. TOM Mechanism (TOMM) • Ability to infer full range of mental states • Perceptions • Feelings • Desires • Intentions • Knowledge • Retains in memory and update information

17. The Mindreading Mechanism Moving stimulus Eye-like stimuli ID ED Follow gaze Recognize agent SAM Shared Joint Attn. Store info & use as part of the theory Infer full range of mental states TOMM

18. 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

19. 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

20. 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

21. 自閉症兒童的社交及溝通障礙

22. 自閉症兒童的特徵 • 語言及溝通 • 社交 • 假想能力 • 固執行為及狹隘的興趣

23. 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 自閉症早期之特徵……

24. 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

25. 研究結果 唐氏綜合症 兒童 發展正常 兒童 自閉症兒童 Baron-Cohen, Leslie, A. M., & Frith, U. (1985)

26. 自閉症兒童的心智解讀

27. 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

28. 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

29. ToM評估方法

30. 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

31. 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

32. ToM訓練方法

33. 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

34. 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

35. 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

36. 心智解讀 心智解讀的基礎 學習程度 ≥ 48個月 語言表達及理解程度 ≥ 42個月 學習程度 ≥ 24個月 語言表達及理解程度 ≥ 24個月

37. 掌握心智解讀的能力有何用? 改善社交關係 提升溝通能力 增加假想能力 懂得鑑貌辨色 提升EQ 懂得美麗的謊言 明白說話背後的意思 發展自省的能力

38. 食客 反應 材料 特性 烹調 方法 食客 口味 選材及 份量 心思

39. 材料 特性 心智解讀 心智解讀是什麼？

40. 食客 口味 心智解讀 適合嗎？ 透過評估了解兒童的 心智解讀發展至那一個階段

41. 按評估結果 釐定訓練目標 選擇訓練重點/比重/ 先後次序 選材及 份量 心智解讀

42. 烹調 方法 心智解讀 • 形式 (個別、小組) • 小組組合 (全部自閉症兒童/ 混合發展遲緩兒童) • 家長參與

43. 食客 反應 心智解讀 檢討兒童學習進度/掌握能力

44. 心智解讀─教導時需注意的事項 • 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

45. 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

46. 心智解讀─教導時需注意的事項 …… 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

47. 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

48. 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

49. 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……

50. 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