一个新的社会交往干预法----关系型发展干预

lauray

有自闭倾向或阿斯伯格症的孩子与严重自闭的孩子都有一个特点，那就是社会交往落后。（尤指与同样年龄的孩子之间的交流）。ABA 只能教技能，不能满足社交训练要求。

上次，我在此翻译了一篇有关地板玩耍时光(floor time)的介绍（可从搜索中得到），这是美国较知名的用玩耍方式提高社交能力的方法。但此法家长操作起来也许有一定难度，缺乏评估方法，最好是由专业人员来做。



最近，我从网上得知一种转门由家长来做的，有详细活动方法和评估方法的社交训练办法：关系型发展干预（Relational Development Intervention---RDI）。http://www.rdiconnect.com/



这是一种新的干预方法—大概从95年起，宗合了其他的干预方法，不同于过去社交干预中机械交流的干预方法（预设脚本来达到社交特定目标），着重于培养孩子的经验分享能力（experience sharing-----这是自闭孩子普遍缺乏，而普通孩子轻易就能做到，可过去的社交培训方法没有干预到的。



普通孩子的经验分享能力发育共分6个层次：Tuning In(birth)---谐调进入（出生以后）, Learning to Dance(6 months)---学习舞蹈（6个月大）, Improvising and Co-creating(12 months)---临时准备和共同创造（12个月大时即会）, Sharing Outside worlds( 18 months)---分享外部世界（18个月）, Discovering Inside Worlds(30 months)---发现内在世界（30个月）, Binding Selves to others(48 months)----联系自身到他人.



RDI的目标：

理解并欣赏多层次的经验分享；

在共同管理的分享经验交流中成为平等伙伴；

理解并评估其他人的独特性----他们的观点，意见和感觉；

评估并努力保持持久的关系；

在社交和非社交问题的解决上，变得有适应力和灵活性；

认识他们自己的能持续成长和发展的独特性。



分为6个层次，，每个层次有4个节段。





我驻地附近就有一个家长的孩子（目前4岁半，经过一年的培训后，由原来的重症自闭，转变成边缘性的自闭倾向，据说，他预期再经半年干预，有望变成不自闭----据说是由自闭量表来测试的结果）。那个家长组织了一个做关系型发展干预的家长组织，每月都在他家聚会，探讨干预方法。这套放法是基于Dr. Steven E. Gutstein 一个心理学医生和他夫人 Rachell sheely（也是医生）研究和从医20多年来的成果所创立。他们还据此法在当地一个 学校正式推广其干预方法。据说我们这里的特教老师也很感兴趣用此法来教孩子。

据他的书中说，他治疗的自闭症患儿，有些已是十几岁的少年，很多人有了自己的好朋友，有的甚至有了男或女朋友。这其中的原因是据说孩子变得有趣，言之有物，使普通孩子愿意找他们来玩，且能保持友谊。



一般地说，贵的学习此法的途径是先到做一个测试评估（relational development assessment---RDA）可以到他们那个中心 （在美国Houston, TX ---需一周，对孩子评估，录像讨论，家长有机会见识对你孩子的实地操作。-----估计较贵----我还没得到报价）做，也可找有那个中心培训证书授权的治疗师做（目前美国的人数都不多，如果国内机构能来人培训，国内的家长就方便了），以制定针对孩子个人特点的干预方案，并实地学习如何操作。(也有家长培训班，较贵1950美元4天，但他夫妇二人亲自教)。

便宜的方法有先认真学习他的两本书：1)Autism Aspergers: Solving the Relationship Puzzle--原里部分 ; 2) Relationship Development Intervention with young Children----具体操作1-3 层次--2-8岁孩子（雅马逊上有售: www.amazon.com, 我在 www.overstock.com 买的,更便宜,），[大孩子或大人, Relationship Development Intervention with Children, Adolescents and Adults: Social and Emotional Development Activities for Asperger Syndrome, Autism]



再买盘他们3个小时的录像带（要到他的网上买 http://www.rdiconnect.com/resources/default.asp，125美金）。（据说光看书还不够，最好看看是如何操作的----我不能肯定这个录像带就够用）。而后，由家长把这套方法贯彻到生活中去（并持之以恒，养成这种生活方式），每周花时间训练孩子。

也可以买到有关如何测评进展，和如何开展活动的书或详细手册。他的网页上还有许多免费的资料，方法，和讨论区。-----个人以为国内家长可用此法来学习。

我是刚开始看他的两本书（元旦买的），只知道点皮毛，也许今年春会参加一个家长培训班，看看是如何操作的。

我最近太忙，没时间做更详细的介绍了，只是觉得应该早点让国内的朋友知道这个也许会很有帮助的方法。感兴趣且会英文的家长建议去看看。有好的文章希望能翻译介绍给大家。不知在美国的家长有无已经用上此方法的？

===========================



















<font size="1" color="darkblue">Edited by - lauray on 2004/01/16  01:08:19</font>

lauray

RDI Research Summary





17 children ages 2-10 participating with their parents in RDI, were compared to 14 children



involved in other therapies.  The two groups were administered the Autism Diagnostic



Observation Scales (ADOS) during an initial evaluation and then an average of 9 months later.  



The school placements of both groups were also examined at both intervals. The non-RDI group



averaged over 26 hours per week of therapeutic intervention, while the RDI group had less than



9 hours per week of formal intervention.  





While both groups were similar at their initial evaluation, by the time of the second evaluation,



results were dramatically different.  70% of the RDI group had improved their diagnostic



classification - from Autism to Autism Spectrum or non-Autism.  Not a single child in the



non-RDI group had improved their diagnostic classification on the ADOS.  Similarly, while



70% of the RDI group moved from a special education or home setting to a regular classroom



setting without any special support, not a single child improved school settings in the non-RDI group





This is an initial study and the research paper points out a number of reasons to limit



conclusions.  However, there is no doubt that RDI has been proven to be an extremely



powerful method of addressing the core deficits of autism spectrum conditions.





---------------------

JenJen

我也刚对这一方法感兴趣呢。也是元旦前夕从Amazon买了这两本书：Relationship

Development Intervention with Young Children, and Solving the Relationship

Puzzle, by Dr. Gutstein.



你提到的RDI 研究是Dr. Gutstein本人的研究结果。目前似乎还没有被其他研究人

员所证实(replicate). 我对RDI 感兴趣主要是看中了它的交流和玩耍活动项目。我

准备把这些活动并入ABA/VB课程里。我已经注册了Dr. Carbone 这个月底在Gwynedd

Valley, PA 的VB 讲座。一月28日全家飞到新泽西。现在正在犹豫是否参加Dr. Gutstein

的RDI 讲座。为了孩子，我发现自己比我念博士学的东西还多。主要是更有动力和

兴趣了。可喜的是儿子进步很大。现在已经能用完整的句子表达自己的需求了。我

已经从这个星期开始把他从特殊学校转到普通学校就读。



瑞雪也对RDI感兴趣。Rauray, 谢谢你对RDI 的介绍。希望能与你交流RDI 的心得。





Jen

瑞雪

感謝LAURIE的介紹和翻譯。我剛剛拿到本地一位(僅此一位)RDI醫師的報價和介紹((抱歉。這段時間一直在加班﹐實在沒辦法翻譯)﹐如下﹕





介紹

Relationship Development Intervention (RDI)



RDI is a program designed to help children who have difficulties forming successful relationships in their world. Developed by Dr. Steven Gutstein and his wife, Dr. Rachelle Sheely, RDI is a program based on the building of the developmental skills that are needed to form relationships.



The typical child easily knows how to seek out another human being and how to enjoy their company. The child with Autism does not readily develop the ability to understand the ever changing facial expressions and gestures of other people. Children with Autism do not "learn to run alongside their partners, share their unique perceptions, or wonder about the differences of other people's minds" (Gutstein, p. xi). Instead of wanting to engage with the people in their world, they want to make their world fit into their limited understanding of it.



Children with Autism do not develop relationships that give feelings of safety, excitement, and novelty. Rather, social encounters are stressful and confusing. It is easier for them to engage with objects, computers, videos rather than people because those are predictable.



Often we try to teach the child with Autism social skills in a scripted way. When doing this, we miss out helping them understand the reason behind wanting to engage with others. They use their social scripts without understanding if it fits within the context of what they are doing or how to adjust to make a better fit. There is "an "out-of-synch" quality to their actions - a lack if timing" (p.xii). We end up teaching the child with Autism the superficial layers of social interactions and miss helping them feel the joy of being in a relationship.



There are children on the spectrum whom we see that have a more sophisticated array of social appropriate behaviors. They can make eye contact, they may even be able to read others' emotions. But they still lack the skills for a genuine, caring friendship with another child.



It is easy to teach a child Instrumental Interactions. These are social behaviors that are used to achieve a result; they have little to do with the person on the other end of the interaction. RDI attempts to teach Experience Sharing, the pleasure of the social encounter rather than just getting what you need.



Overview of the RDI Model

RDI is based on a developmental model.

It examines a child's level of development of experience sharing and tries        to develop the areas not mastered.



It focuses on Experience Sharing. Social Skills training work within the realm of instrumental behaviors. Scripts are based upon "if/then" reasoning. Important to get by in the world, they fail in situations that demand flexibility and change.

Initial setting for intervention is purposefully artificial.

Distractions are eliminated to help focus on relationship discoveries.

Visual and auditory input is minimized.

Removing competing objects or input helps spotlight the social and emotional information we want to convey to the child.

Activities are highly structured as well as motivating to the child.

They offer emotion sharing and excitement.

They allow for gradual variation and introduction of novelty.

Parents are intensively trained to take the lead as they guide their child.

They learn to set clear limits, minimize distractions, and develop an "emotionally attuned" relationship.

Gradually, as the child is better able to assume more responsibility for maintaining the coordination of interactions, parents allow them to introduce variation and creativity into their encounters.



RDI gradually prepares children to move beyond their reliance on adults by        introducing them to carefully matched and prepared peers. First in dyads, then into groups. Setting shifts as well, from therapy area to more natural world.



RDI takes practice at home with parents and eventually in other settings.



報價

Relationship Development Intervention (RDI)



RDI is a comprehensive, developmentally based program that helps foster development of social connections. It focuses on the development of necessary fundamental skills that help motivate and encourage the child with Autism, Asperger's Syndrome or other social difficulties to want and be successful at forming friendships.



RDI is a parent based intervention program. Individual parent training is provided in according with the child's developmental needs and supported through on going supervision. Dyads and small groups are available as the child becomes more competent and successful in relationship skills. RDI offers programming appropriate throughout the child's life span, offering more complex skill development as the child develops.



Initial Assessment and Program Planning (usually completed in a 3-4 week period)

        * Review of questionnaires, rating scales, and a short video segment from home showing your child in play

        * Initial consultation with therapist and parents only

        * Autism Diagnostic Observation Schedule (ADOS) with therapist and client(this tool is used prior to beginning treatment for research and progress purposes).

        * RDA #1 (assessment) with therapist, client, and 1 parent

        * RDA #2 (Hypothesis testing session) with therapist and client

        * RDA #3 with therapist, client, and parents (used to show and teach parent(s)where and how to begin working with their child)

        * Consultation with parents and therapist only

        * Written treatment plan with recommendations for client and family to work on.



Total Cost: $850.00



        During the final consultation session, discussion of the treatment program is given which will be overseen by a certified RDI consultant. This usually consists of weekly sessions where parent(s) demonstrate how they are targeting their child's RDI objectives through the assigned activities. Assistance is offered to best facilitate the RDI objectives. Parents will be completing RDI assignment sheets which are collected prior to each session to provide insight into implementation of the program throughout the week and examine areas of strength and difficulty in implementing the program. Updated activities will be introduced by the certified RDI provider with the child during the session and then practiced with the parent(s). RDA updates will be administered within the weekly sessions every 4-6 months to track progress.

        Weekly ongoing support is available through e-mail contact.



Session Cost: $85.00/hour



On-Going Support:

        * For those families who prefer to remain in contact via the use of videotapes, the following option is available:

        * After the final consultation and the parents have begun to implement the suggested RDI program, RDI provider will view 12 consecutive videotapes sent every two weeks.

        * E-mail feedback will be given.

        * Ongoing activities will be provided as needed for that designated time period.

        * E-mail support is available as needed.



On-Going Support Cost: $85.00/video



Dyads and Small Groups:

Dyads and small groups are available as the child shows competency in relationship development. Initially, RDI is practiced with one appropriately matched peer and supervised by a certified RDI provider. As the child develops, other similar peers are included to expand and strengthen the child's relationship development and peer group.



Dyads and Small Groups: $85.00/hour



RDI Requirements

In order to do RDI, parents initially need to have a room with low stimulation to work in. You also need 4-5 beanbag chairs. Other suggestions include mounting a video camera in the corner of the designated RDI room to decrease possible distractions. A wide angle or fish-eye lens is suggested as well.





________________________________________

凡事包容，凡事相信，凡事盼望，凡事忍耐。爱是永不止息。             --哥林多前书十三章七，八节

pphhll

谢谢Lauray的介绍，这种方法太吸引人了，不知国内如何得到这些资料。

2ndwave

<img src="images/icon_smile_big.gif" border=0><img src="images/icon_smile_cool.gif" border=0><img src="images/icon_smile_tongue.gif" border=0><img src="images/icon_smile_wink.gif" border=0><img src="images/icon_smile_approve.gif" border=0><img src="images/icon_smile_disapprove.gif" border=0><img src="images/icon_smile_disapprove.gif" border=0><img src="images/icon_smile_shy.gif" border=0>好象就是用游戏来做，达到发展儿童的人际关系的功能吧。我的理解是这样！！！对否？！！！

lauray

谢谢瑞雪, Jen 的补充.



我近日在一个RDI醫師(其实她还没有拿到证书)家里看了那盘录像带, 一半是原里, 另一半录了约18个操作例子, 从第一层到第三层, 第一, 二层内容包括帮助培养孩子识别大人的面部表情, 建立和扩展活动框架, 培养孩子的情感交流, 差异装扮游戏,等. 大人各个表情及其夸张, 以各种方式(摔倒, 碰撞,大叫, 大笑等)吸引孩子注意, 并在游戏过程中加以变化, 以培养孩子适应和跟随活动中的变化, 关心其他人的活动.---都是由家长带领小孩子玩.

第三层是关于与同程度(指同样进行训练的同龄人,且同RDI训练层次的, 非普通孩子)人建立活动沟通. 有二人一同弹琴,一起协作游戏, 两个年轻人互相聊天,其中转换兴趣题目 等等.据说, 二层第8阶段以后,才能正式加入同龄人的活动.



2ndwave, 没错, 这是用游戏的方法来达到增进社交的目的. 但是它有技划, 有具体框架步骤, 很结构化. (有人说它的一些活动像用菜谱一样, ---其实都可以加以变化, 是用结构化的方法来训练非结构的社会交流, 经验分享. 与ABA 不同的是不是为了达到一个现成的目的, 如某一活动只训练向人问好, 达到要求即可奖励.据Dr. Steven E. Gutstein 在书中说, 训练是希望一个孩子看见他就高兴地打招呼,而其中的原因不是为了过后从家长那里立刻就能得到奖励物, 而是因为这孩子发现他很有趣. ). 在他们网上, http://www.rdiconnect.com/ 你可能找到很多活动方法建议.



pphhll,

看来国内的人只好目前先去他的网上下载一些活动内容(免费的),英文好的家长翻译一些, 没有一开始的评估, 但从第一层,第一阶段开始做, 总没有错误.(我附近的治疗人员不能在近期给我孩子做评估, 她就建议我先从最底层开始做活动. 据说前面那个取得很大进步的 孩子, 也是从第一层做起, 经过一年左右,才到了第二层.).

在美国的家长可以把一些有用的资料介绍给大家.



与地板快乐时光比, 它是由家长引导孩子(地板快乐时光是孩子引导大人), 且据说活动时间不需要太长(一周几个小时, 而非每天几个小时).

有些美国家长将二者同和运用. 据说效果更好.

2ndwave

lauray



你可以用中文向大家讲几个操作例子吗？<img src="images/icon_smile_shock.gif" border=0><img src="images/icon_smile_shy.gif" border=0><img src="images/icon_smile.gif" border=0><img src="images/icon_smile_question.gif" border=0><img src="images/icon_smile_approve.gif" border=0><img src="images/icon_smile_kisses.gif" border=0>

lauray

我也是刚开始学着从头做一些活动。我打汉字速度不快，最近家里事情太多，只能翻译一点，供国内家长参考。



--------------------------------------------------

摘自

Relationship Development Intervention with young Children



Level 1: Novice 层次1：新手



目标---建立一个核心关系在你和孩子间。



阶段1---父母或教练的面部表情和手势要成为孩子的注意中心。目的是尽量减少提示孩子以得到他的注意。

（我加注：----此阶段是以后的基础，没有打好基础，以后容易走入死胡同。不需很多语言，好像多话的孩子还要更难做）

----------------------------------------------

活动1）我的世界是重要的。-----非特定练习，改变大人说话方式，随时随地做，直到孩子不须提示即能注意你的话。

步骤1 ---预备讲话

每个人同孩子放慢说话语速，说话时在字和句子之间加上很多预留停顿。

步骤2---平衡

第一，试着不要用比这孩子所用说话方式更多的字。

（如孩子不说话，你用最短的话；孩子说2-3个字，你也保持在这个长度）

第二，不加更多的字，直到孩子对你说的前几个字有了有意义的回应。（如果你最初的信息被忽视，不要持续重复你自己，不加更多信息。这样，你的话才有份量）

步骤3---聚光

插入‘聚光’元素到你的话中。这些是非直接（间接）但对这个孩子是有力的信号：有重要信息出现，需注意。

需试验你的说话方式的何种改变可以产生最有影响力，唤起孩子注意力的‘聚光灯’。

如：插入一个深呼吸，一个叹气，或一个‘结巴’当说到一句话的关键点。可‘停’在一个字上，重复它，如结结巴巴五秒钟。在关键性时候结巴常产生孩子凝视转移或快速增加注意力。如结巴本身不有效，可相伴着很大的音量变化。



变化：其他间接提示：变音调，语速变慢，停顿，咳嗽，清嗓子。



注，有些孩子对外界太不注意，可能不适用。

---------------------------

活动2---我说不出话来了

---开发面部表情注意，提高非-语言沟通。（此时要周围人配合，别用语言沟通）

准备好，停止对孩子的语言回应。保持一种生动活泼的，邀请的表情。要非常专注于孩子。对他的沟通尝试高度回应。用很多手指点，手势，和放大，夸张的面部表情。保持非常情绪化，生动活泼的状态。当可行时，邀请孩子交流以很兴奋的方式。但别看电视，或玩不需语言的游戏。 不要让任何人成为你的‘替代’沟通者。



变化：可邀请孩子也假装失声（如他可理解），来与你同玩。

‘我听不见了’---你可说话，但听不见孩子的话，他必须以非语言方式沟通。你可告孩子，你能唇读，他就要找你的脸以让你‘看见’他的话。



注，对交流完全无意愿的孩子可能不适用。



--------------------

2ndwave

谢谢lauray的介绍，您可以继续呀？多介绍些，再详细！！！！！<img src="images/icon_smile_kisses.gif" border=0>

云驰爸爸

谢谢你，已经给你发短消息了，有一些事情求教，并且希望自己能够为大家共享这些信息和方法作一些工作。



<font size="1" color="darkblue">Edited by - 云驰爸爸 重新编辑於 2004/02/22  23:36:38</font>

lauray

我正在准备下周关于孩子能否取得郡里公立学校训练帮助的资格评估会议.这几周都在准备和进行孩子的相关测试, 联系我们孩子的辩护人. 我们从孩子两岁起, 就申请帮助, 两次都失败了.

我们这次准备打一次把握大一点的仗.



不是所有需要帮助的孩子在美国都能得到帮助. 我的孩子就给拖了三年. 至今还是靠自己.



所以我最近实在没有时间翻义. 抱欠.









<font size="1" color="darkblue">Edited by - lauray 重新编辑於 2004/02/26  03:15:52</font>

lauray

内容在后面有，这里删除



<font size="1" color="darkblue">Edited by - lauray 重新编辑於 2004/04/20  02:21:20</font>

2ndwave

lauray:

您好我很高兴你能在美国争取你的机会，对你的孩子和家庭很有意义，我现在也很忙于我孩子的教育，天天带他到大自然的环境里接受教育，他刚刚从机构出来，我听说好象是你从美国打来电话，我不在，没听到，以后有机会多交流！！！！

瑞雪

谢谢Lauray.很受启发。



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凡事包容，凡事相信，凡事盼望，凡事忍耐。爱是永不止息。             --哥林多前书十三章七，八节

Shandamom

I was in that 2 days work shop last weekend. Maybe I was too tied that time; I don’t think I learn anything from there. Period to that two days work shop, I took my son to see local RDI therapist, she suggested us start level 1.  I am planning to attend that 4 days parent work shop. Hope I will learn something from there.

lauray

Hi, Shandamom,



Glad to know you are also interested in RDI.

I will take the 4 days parent training in April.And we are working on my son's RDA this month from a local provider and hopfully could get some IEP goal from it(if you go to the connections center directly, the whole package will be 6600$, including 6 months follow up and re-evaluation as they told me last week). So I choose to go local provider site.



I am also trying to start the activities from the level one and the RDI life style now.I did not take the 2 days training, just watched the RDI video tape from that provider site and read the info from the internet and Dr. G's book. I heard that the 4 days training might give us more info.

In our area, I already found several other Chinese families already began their RDI activities with their children since last year. They all began from the level 1. So I think other families who could not get the RDA done, just can begin from the level one.

xiaojie

Hi Laurey,



What city are you in? You mentioned other Chinese families are doing RDI in your area. How old are those kids, how long have they been doing RDI?



Thx.

Shandamom

Hi, Lauray

Thank you for your information. I live in Seattle area. Our RDI therapist is working on set up a parent support group. I haven’t seen any Chinese family so far. I haven't started the RDI activities on my son. He just turns 3 years old. His language skill is our biggest concern. He can say Mom, dady,cow,car, ect twenty some words and can mimic some simple words. He's receptive language is much better than his expressive language. His academic skill is OK. I thought about sent him to China last year when he just get, because of Sars, we can’t go .We started a lot of services from birth to three program for him BUT his speech still not come out.. Could you share some experience about this. Most expert suggest us to speak English at home, couple says it is OK say Chinese at home, English at School.

For RDI,,somehow I feel like RDI is more for high functioning kids, It may not be suitable for my son because of his langue limitation. I don't know how to start it, even though RDI theory says it apply to all level. I wonder if I can talk to you off line?

Thanks,

Sandamom

lauray

刚刚参加完4天的RDI家长培训班. 感觉有不少收获.

确实觉得它值得家长好好学习.虽说没有得到我预期的特定个人计划(实际上是小组指导大家如何组织计划和活动),令我这个等待吃鱼的人有些失望,但专而一想,至少我初步知道了一点抓鱼的办法.所以第三天起(前两天我还不能确定我得到了什么),一回家我就开始对儿子实施活动了.



训练时,我们征得了Dr. Gutstein 的夫人 Dr. Rachell sheely的同意.可以把他们网上的资料下到中国的有关网址上并翻译出来.她说已有中国家长给她们发过中文电邮件.



与他们出版的书比较,他们的方法已进化了很多.

以前,我之所以感兴趣,是我想找到一种家长能够运用的较结构化的方法来解决复杂的,灵活多变的社交问题.他们书中的菜谱式的活动方法和与之相关的层层深入的社交目标和工能吸引了我们.相比地板时光法的太灵活,使非专家不易掌握.但我也有担心,就是结构化的东西是否适用?



现在,他们进化到RDI 2.0版(书还没出).吸收了很多家长们的经验，不再鼓励照着他们过去的书按‘菜谱‘

来做活动了。但据说‘菜谱’对新手上路时还是需要的，100多个活动设计会给你不少主意。这次更多鼓励立用生活中的机会来随时随地训练， 把训练的内容变成一种生活方式 life style。我会陆续把他们的建议登出来。



这次培训中提到的重点如下：

1.        Declarative communication （宣言式交流--------说话不是为了达到直接的特定的目的，而是分享感觉，经验，如：啊，花开了。。。。天快下雨了。。。水好烫。。。）

/ Imperative communication------（命令，需要式交流----说话为达到一定的目的，如：你在学校表现好吗？。。。这是什么？。。。坐下，吃饭！）



我们发现，在日常生活中，作为家长特别是自闭孩子的家长，我们已将后者用得太多了。

理想比例要达到80：20。我们连50：50也很难。好处是，不少孩子对这种前者非功利性的交谈呼应好。但我们这几天实践的结果发现前者不如后者行动上收效快，特别是在时间紧的时候。（如，快吃，上车，。。。躺下睡觉！）因为前者弯弯绕多。但正常人交流（聊天）时据说为75：25。

Dr. G。 建议我们不能把生活搞太紧张了，要变慢，简化！他提出不是每周每天，每小时你都在巡连孩子就能达到目的。比如你这小时教了孩子说了一句话，也许下周他就忘光了。他反复提醒大家，你现在还能记住多少高中学的东西？要重质量，而非数量。当然，他也不反对其他针对有严重伴随性问题的治疗，如感统，语言，生活技能等。但他提出那些都没有触及自闭症的根本问题。（我希望他的真是：）我认为在目前自闭症原因不明的情况下，别的问题也要训练，因为你真不知哪朵云彩会下雨。）

对那些ABA, VB做了有些年头，而目前收效不大或想试着解决深层次问题的家长，我建议来做这个。Dr. G 不建议同时做VB。而认为会水到渠成。

有个语言治疗师（据有家长说是很优秀的，因为容易有家长认为新出道得才会转而求它法，以某高收入）出身的资寻师私下交谈时，就讲她过去的苦恼就是， 交会病儿说话后，他就开始旁若无人地唠唠叨叨，以致家长有要求她用什么办法让孩子少说点，且言之有物。她说，这时，她毫无办法。



2.        Frameworks（活动框架）------家长需要牢记你孩子目前的训练目标（长，短期都要有）。

按目标来组织同类型活动。如：发出---接受框架：可以是一人滚球，一人接球，循环往复；也可以用个长点的纸筒一头抬高，一头低， 从一头发个小汽车让孩子在另一头接。或干粹就是小车的推来推去。

用夸张的动作，语言， 变速度等引到孩子一同兴奋，大叫，大小（同时会产生目光对视）就是为了社交分享目标(emotion sharing)。如果下一阶段， 大人拿着球迟疑不发，等着孩子用目光从你脸上疑惑地搜寻答案，就是为了训练社交参照的目标(social referencing)。 如果两人一人一球，大人喊：1，2，3。 2人同向一同滚出，就是为了第三阶段的‘共同行动(coordinating actions)’。

建立活动框架，使家长可以从同一类活动中为不同的目标而训练---‘从相同到不同’。

而从几个不同的活动框架中，你又可针对（聚光）你所要的主要目标来做。 如把东西藏在房间里的什么地方，让孩子来找（藏和找框架），找不到时，孩子也许会看你的面部表情或身体语言或手指的方向来确定下一步到哪里找，-----这也是训练社交参照(social referencing)。与别的框架中的活动连起来做（如上述的发出---接受框架：）可收到‘从不同到相同’的校果。



我就是在第三天的培训中，理解了如何制定活动框架， 才算找到了‘北‘。

开始真正有信心给儿子做活动了。



3．Dr. Gutstein试图解释自闭症的症结所在。 认为自闭的孩子是对周围世界最感到疑惑的孩子。他们无法理解复杂的动态的世界，所以才胆小，退缩到自己的世界里。我们想把他们拉出来，只能一点点来，先把基础打好，逐渐引入新的变量。他把正常孩子社会性发展过程细化成很多小的部周，要求先打好基础，再往前走。

4．Episodic Memory（事件记忆）

他认为并引用别人的研究成果（主要2000年以来），认为事件记忆的缺损是自闭孩子的核心问题。这就是我们的孩子很难记住过去发生的社交情景（仅管他们其他记忆力可能很好）。他的方法很简单，就是设计，记录正性的社交情感分享，用相机照下来（1，2张即可）作成记忆书，经常给孩子定期回顾他们，以后孩子还可以给别人讲故事。



他曾自己做过RDI有效性的研究（样本不多），其中30%无效的孩子，对家长的质询，他的答复是完全没有事件记忆的能力。为何会这样，答曰，原因不详。



培训中穿插不少较成功儿童的录像。他最得意的是一个从18个月到目前10岁的儿童。他一开始也是语言能力很差，现在已变得很好了。据说三年前已摘掉自闭症的帽子（跟据ADOS量表----一种从交流和沟通方面来度量自闭症的办法）。 在画面上那孩子看上去很灵活，乐于对同伴提供帮助，共同完成工作。

还有个4岁半的孩子家长也参加了培训。这孩子现已成为RDI家长中的名人，不知你们可否看到他的相关联结：

http://www.myimpactengine.com/personal/view/show.asp?ai=10032003152041280228&id=18

因为住得近，最后一天孩子也来玩了一会。面对屋内好几个认识或不认识的大人，他表现得很大方，依次用目光扫视，回答不同人提的问题， 还跟Dr. Gutstein聊了一会儿天。屏幕上，他能拿着记忆书给对面两岁的妹妹讲故事时，照片的上下位置对妹妹是正合适。（我儿子让我看他的书时，从不顾及我的位置，老上下颠倒地给我，显示他不能从别人的角度看问题）。妹妹叫妈妈， 但妈妈没听见，这孩子能专门跑到妈妈面前告诉她。。。。

据说这些也是近期才有的进步。 那孩子在第二层次。（不过，据说他的基础好，初步评估时，已达到第一层次的第3阶段，但也是从第一阶段训练起，至今已一年半了）。







以上是我的一点培训所得，与大家分享。















<font size="1" color="darkblue">Edited by - lauray 重新编辑於 2004/04/22  11:30:10</font>