Tlf lieu tham khao ^« ^" ^ « « TONG QUAN CAC NGHIEN ClfV TREN THE GICTI VE CHirONG TRINH DAY KI NANG XA HQI CHO TRE MAM NON CO ROI LOAN PHO TlT Kf NGUY6N TH! Kli« ANH'''' TOM TAT Bdi viit trinh b[.]
Tlf lieu tham khao ^« ^" ^ « « TONG QUAN CAC NGHIEN ClfV TREN THE GICTI VE CHirONG TRINH DAY KI NANG XA HQI CHO TRE MAM NON CO ROI LOAN PHO TlT Kf NGUY6N TH! Kli« ANH' TOM TAT Bdi viit trinh bdy tdm tdt cac hoc Ihuyit tdm li cS dien vd hifn dai duac xem la nia Idng ciia day ki ndng xd hdi (KNXH) cho tri mdm non cd rdi logn tu ki vd cdc cdng Irinh nghien cuu tren thi gidi vi chuang Irinh day KNXH cho tre mdm non cd rdi logn tu M (RLPTK) TO- kllda: tre tu ki, ki ndng xd hdi, chuang trinh dgy kT ndng xd hdi ABSTRACT An overview of worldwide studies on social skills training curricula far preschoolers with ASD The article presents a summary of classical and modern psychological theories which form the foundation for teaching social skills to preschoolers with ASD and an overview of worldwide studies on social skills training curricula for preschoolers wilii ASD Keywords: Children with autism, social skills, social skills training curricula Dat v3n d£ Roi loan tu ki dang thuc su la mpt van de Ion ciia xa hpi, mot thach thirc vol cong tac nghien ciru va can thiep Viet Nam chua co thong ke ve ti le tre RLPTK, nhien theo cac bao cao tai hgi thao quoc gia ve ty ki thi so lupng tre dugc phat hien moi nam t3ng len rat nhieu Khiem khuyet ve giao tiep xa hgi thucmg dugc xem la kho khan dien hinh va gay anh huong nhiiu din tre r6i loan tu ki Muon tham gia moi trucmg hoa nhap tot, doi hoi cac tre can co kl nang (KN) tu phuc vu tot, KN ung xir phil hop, CO kha nang thiet lap cac moi quan he xa hpi vol nhimg nguoi xung quanh Chinh vi le do, giao due KNXH cho tre mjm non co RLPTK la vo ciing quan trgng Nfii dung 2.7 Tit- cdc hpc thuyit cd diin vd liiin dgi Xudt phat tir li thuyit van hoa xa hgi ciia L S Vygotsky "Vdn hda vgt chdt vd vdn hda tinh thdn Id sw kit tinh nhirng kinh nghiem xd hdi md ngudi tich luy duac qud trinh lao ddngcte chi ngu thien nhien vd cdi tgo xd hoi" Theo hgc thuyit nay, KNXH ciia tre bao ham ngi dung xS hgi - lich sii, moi trucmg xa hpi la ngu6n g6c ciia sir phat trien, sir giao due va phat triin ciia tre bao gicr ciing chiu su chi uoc ciia xa hpi Ong ciing nhan dinh, tre em sinh da dugc huong nhung gia tri ma thi he fruoc di lai, nhung TS, Tru&ng Cao ding Sir pham Trung uang TPHCM, Email: kimanh196e@yahoo.com TAP CHi KHOA HOC DHSP TPHCM Nguyen Thi Kim Anh mudn hinh nhan each cua ban than thi tre phai boat dpng tich cue, sang tao va tu l|ip dudi sir hudng din td chiic eiia ngudi ldn Ddng thdi, cac bien ph^p giao due ph£u tac dpng den "vwng^ phdt triin gdn" de kich thich tre tich cue n h ^ thuc va hoat dpng thuc tien, giiip tre dl nhay ben han tiep thu va thuc hanh cac KNXH mdi vao nhiJng hoan cdnh sdng khac bien ddi nhiing cau tnic da cd (thay ddi nhiing hanh dpng, hanh vi, kT nang khdng phil hpp vdi chuan muc xS hpi), t^o cau true mdi (nhihig KNXH phu hpp vdi hoan canh thuc_ tien), dan den su can bang Theo J Piaget, trd chai chinh la su ddng hda thuc su vdi hoat ddng ca nhan, cung c4p cho hoat ddng ca nhan nhiing nguyen lieu can thiet va biSn ddi thuc tai tiiy theo nhu cau cua tre Van dung li thuylt nhan thiic xa hpi ciia Albert Bandura: Hpc tap cd th§ diln tren ca sd quan sat hanh vi cua nhimg ngudi khac va hau qua cua nhiing hanh vi Theo dng, "Tre khong ldm cdi md ngu&i lan noi, nhung lgi ldm cdi md chung thdy & ngu&i lan.ldm" Cd nghia la, tre hpc va phat trien qua quan sat haih vi ciia nhiing ngudi cd kinh nghiem cac hoat ddng cd y nghia va quan trpng ddi vdi tre Bang each nay, giao vien va cha me giiip tre thich ung vdi cac hoan canh mdi, giup tre cd gang de giai quyet van de va hudng dan tre nh&i trach nhiem ve nhirng hanh vi ciaa minh Thuyet hanh vi (Behaviorism) duac hinh bdi nha tam li hpc ngudi MT John B Watson nam 1913, cho rang tam Ii hpc giai thich hanh vi ciia ngudi khdng dua tren qua trinh nhan thiic dien nao hay nhtmg hanh vi khdng thay ro (covert behaviors), ma la nhihig quan sat hanh vi dupc nhan (overt behaviors) Hpc thuySt sau dd d§t dupc phat trien hai luan thuyet ndi tieng bdi Ivan Pavlov va Burrhus Frederic Skiimer Ba dac diem de phan biet tam li hpc hanh vi, dau tien la khang dinh rang khoa hpc tam li phai dupc dua tren nhiing hanh vi cd the quan sat duoc Cac nha hanh vi cue doan gidi han tdm li hpc viec nghien ciiu cac dap ling ciia sinh vat ddi vdi kich thich ciia mdi trudng; loai trir tat ca cac khac biet vl "tinh than" nhu la suy nghT, hinh anh tudng tupng, cam xiic, tri nhd bdi vi nhimg dieu khdng the quan sat dupc Nhiing nha Ii thuySt hda hoan han thi cho rSng nhihig khai niem khdng quan sat dupc bao gdm dilu kien: Nhirng thuat ngir cd the dinh nghia dupc theo each hanh vi va nhihig bao ham ciia chiing trp giiip chiing ta gap dupc c^c muc ti6u vl tien lieu va kiem soat hanh vi Cac nha Dua vao li thuyet phat trien nhan thiic cua J Piaget thi qua trinh giao due KNXH cho tre tiirc la giiip tre thich nghi vdi nhiing hoan canh sdng khac bing each thiSt lap mdi quan he can bang giiia tre vdi mdi trudng Su can bang diln qua trinh ddng hda va dilu ling Ddng hda tiic la qua trinh tre tiep nhan thdng tin tir cac kich thich ben ngo^i, biln ddi chiing, tao cai cd nghta cho ban than qua trinh thich ling vdi mdi trudng Cdn dieu iing la qua trinh thich nghi ciia co the vdi nhihig ddi hdi da dang cua mdi trudng bang each Tlf lieu thann khao tam li hpc hanh vi dua tren chung cir nghien ciiu thuc nghiem dugc thuc hien duoi nhiing diiu kien dugc kiim soat chjt che, ciing vol cac thuc nghiem frong phong thi nghiem la phuong phap li tuong Hp ciing tin ring viec co dugc, su tri, thay d6i hoac loai bo di nhieu hanh vi a dpng vat hay nguai co thi giai thich dugc mpt each day dii va chinh xac vi cac nguyen If hpc tap (leaming principles) 2.2 Tdng quan cac nghien curu tren the gidi vi churang trinh dgy KNXH cho Ire mam non cd RLPTK 2.2.1 Nghien cihi dich te ve tre cd RLPTK Nhiing nghien cimfrongnhimg nam 60 ciia the ki XX da cho rang tu ki co dien la mpt rii loan tuong doi hiim gap: tir 46/10.000 hoac khoang 1/2.000 (theo Lotter, 1967), nhiJng phat hien frong nhitag nam tir 1999 din nam 2003 thi tu ki dugc nhin duoi goc dp "pho ciia cac rii loan" thi tu ki co ti le luu hanh nhiiu hon so vol suy nghl truoc day la 60/10.000 hoac x4p xi 1/160 (theo Chakrabarti & Fombonne, 2001) [9] Mac diu co sir cai thien frong thuc hanh chin doan va mo rgng nhQng he thing phan loai dong mot vai fro quan trpngfrongviec gia tang nay, hien mpt so nha nghien cim nhu Ozonoff & Rogers (2003) tin ring cac yiu ti mdi truong co thi dat tre nho vao nguy CO cao dii vol sy phat ttiin tu ki Phin djch ti hpc tu ki moi nhit nam 2013 (DSIVI5-APA) thi ti le tre tu ki la 1/100 [9] Nhitag nghien cim vi dich ti hpc gan day ghi nhan mg*t su gia tang vi so 134 So 4(82) nam 20U lugng cac ca nhan dugc xac dinh co r6i loan tu ki thap nien vira qua Louis F Reichardt (2015) Giam die Hgi nghien Cliu Tu ki Simons (SFARI) frong bai bao khoa hgc da cho thay cac nha nghien cuu da sir dung mgt phan tich toan diSn vf mo hinh biiu hien gen qua trinh phat trien nSo bg cua nguoi Ca hai nghien ciiru nam 2013 chi ring cac gen dugc kiem soat boi mpt si ducmg than kinh lien quan den su phatfriinsom cua vo nao va su hinh cua cac khop than kinh, cac ket noi thin kinh Nhung ket qua ggi y rang cac dot bien a cac gen c6 tac dgng ro ret nhit den chuc nang cua cac te bao than kinh kich thich san xuit glutamate din truyk than kinh Thay doi ve chirc nang ti bao than kinh cac lop be mat cua vo nao, ciing nhu nhitag duong lien ket vol cac phan khac ciia nao bp, duong nhir la quan trpng nhat cho su bieu hien ciia hanh vi dien hinh cho phi tu ki [1] Theo nguon cua Autism Speaks, mpt nghien ciiu nam 2014 fre em tir den 17 tuoi tai Hoa Ki cho thiy, ti le tu ki khoang 2% Michael Rozanov, giam doc nghien ciru cua To chirc Y te cong cpng Autism Speaks, vira cong bo ket qua cua cupc khao sat mpt ti le dang ke cac phu huynh cuafreem tir 317 tuoi cr Ml da chi ti le chan doan tre CO RLPTK la 1/45 Con si cao hon so vol so lieu thong ke chinh thirc ve sir phi bien benh tu ki ciia Trung tam Kiem soat va Phong ngira dich benh Hoa Ki B 1/68 Ti le dugc dua tren mpt phan tich ho so y ti va hi so hpc tap cua tr^ em tam nam ciia mpt vai khu vuc TAP CHl KHOA HQC OHSP TPHCM dupc lira chpn ciia Hoa Ki Dua trdn phdng vin 12.000 phu huynh ve siic khde va benh tat cua cac vien gia dinh ciia hp ket hap vdi phdng v&i nglu nhien mpt diia gia dinh va kit qua la 2% tre em MT sdng vdi benh tu ki Dir lieu dua tren ket qua khao sat cua Trung tam Qudc gia vl Thdng kd Y tl Hoa Ki duac tiln hanh nam 2014 Nghien ciiu dich te hpc trudc dd tiln hanh tai Han Qudc cho th4y su phd biln ciia benh ty ki la 1/38, va da sd cac tre em da khdng dupc chan doan nhu vay La mpt ph4n ciia nghien ciru Han Qudc, cac nha nghiSn ciiu da din tham trudng va kiem tra cac tre em cd cac diu hieu ciia benh tu ki [1] Theo quan niem hien nay, thuat ngii "tu ki" bao gdm cac rdi loEin khae va theo qua trinh tien hoa ciia lich sir Thuat ngii tu ki dau tien duoc bac sT tam than ngudi Thuy ST Eugen Bleuler su dung vao nam 1911 Cd ngudn gdc tirHy Lap: Autos (Self: tu than) va Ismos (Condition: tinh trang), Bleuler diing thuat ngii nham md ta khai niem ve "su nit lui vao ben ciia chinh minh" va duac ap dung cho ngudi trudng bi tam than phan liet Nam 1943, Leo Kanner, bac sT tam than nhi khoa dau tien cua Hoa Ki, tai benh vien Jonhs Hopkins la nguoi dau tien sii dung thuat ngii "tu ki nhu nhi" (Infantile Autism) de md ta mpt nhdm tre cd tinh each li xa hpi, cirng nhac vl hanh vi va cd suy kem ve giao tilp D4U tien, tu ki dupc xem nhu la hau qua ciia viec nudi cham sdc kem tir cha me cho mai den nhung nam ciia thap nien I960, ghi nhan rang nhilu tre cd dpng Nguyen Thi Kim Anh kinh, va rdi loan bat d4u dupfc xem nhu la cd nin tang tir th^n kinh [12] Nam 1980, tu ki nhii nhi dau tien duac dua vao DSM-III (Sd tay ch&i doan va thdng ke cac rdi loan siic khde tam thin ciia Hiep hpi Tam thin Hoa Ki), nam phan loai cac rdi loan phat trien lan tda Ciing xay vao thdi diem la su phat triin y thiic rang tu ki theo Kanner (hay tu ki ed dien) la dang nang nhat ciia mdt nhiing rdi loan phd tu ki [1] Ngoai ra, theo ICD 10, xip cac rdi loan phat triin lan tda tir F84.0 din F84.9 da dua cac dac diem tudi khdi phat: phai trudc tudi, nhien rit khd dl cd thl' chan doan dupc tu ki trudc tudi Filipek va cdng sir (1999) liet ke nhirng quan tam cua cha me cd y nghia canh bao tu ki: Quan t^m ve xa hpi: khdng bilt cudi xa hdi, choi mot minh, rki ddc lap, giao tilp mat kem, d chinh thl gidi ciia tre, khdng hda hop, khdng quan tam den tre khac Quan tam ve giao tiep: khdng dap ling gpi ten, khdng bilt ndi vdi cha me dieu tre mudn, khdng theo hudng din, giong nhu bi diic, cd Iuc nghe nhung liic khac Iai khdng nghe, khdng bilt chi hoac vay tay chao tam biet Quan tam ve hanh vi: nhiing can ndi gian, tang ddng, khdng hop tac hoac chdng ddi, khdng biet choi vdi dd chai, lap di lap lai, di nhdn gdt, gan bd khac thudng vdi mdt sd choi, xip dd cho thang hang, qua nhay cam vdi mot sd cam giac xiic giac hoac am thanh, cd nhirng kilu van ddng ngdn tay hoac co Tu" lieu tham khao the khac la [1] 2.2.2 Nghien cuu vi KNXH cita tre mdm non cd RLPTK Din bay gio thi chiing ta diu biit la tu ki ASD la mpt phi rii loan phiic tap cua he thin kinh cr mgt so fre em dang fren da phat triin, biiu hien qua cac khiim khuyit a nhiiu miic dp tir nhe din nang frong cac linh vuc giao tiep va tuong tac xa hgi, ciing vol cac hanh vi han chi IJp di lap lai (DSM-V, 2013) Tir cu5i thi ki XX, cac tac gia Loma Wing (1996), Utah Frith (1989) va Rita Jordan (1999) la nhiing tac gia diu tien da xac dinh dugc fre tu ki co m6t cum khiem khuyet dien hinh Sau day la torn luge khiem khuySt dien hinh do: Khiem khuyet ve tuffng tac xa hgi: Tre hay chcri m6t minh, co ve tho o Ianh dam, tua nhu khong thay xung quanh minh, va khong dap iimg; fre c6 thoi quen nam tay ngucri khac dit din liy mpt vat gi cho minh thay vi hoi xin Tre thucmg hucmg vi nguoi ldn thay vi ban be ciing lira; dap ring bit chgt; co thu dpng chiu dung cac tiip xuc, tua nhu chip nhan tham gia bit cu sinh hpat nao de ra; thiiu ding cam; khong biit khen nguoi khac; khong biit tuomg tac xa hpi; nhin mpt vat hay su thi gi rit lau, ngii sat va phan ung bit chgt rii bp di; khong biit tim an ui lo Su cing thing [9] Khiem khuyit vl giao tilp: Tre co ve khong mu6n giao tilp; khong hiiu cac cir chi cua nguoi khac; co ve khong muin truyin thong diiu gi ca; noi thi noi may moc nhitag cau thupc Ipng, noi fruoc hiiu npi dung, khong cam xuc, khong hiiu dang noi vol ai; chi hiiu nghla den So 4(82) ndm 2016 khong hieu nghla bong va trim tucmg, khong hieu nhimg Icji hai huge cua nguoi khac Hanh vi va tir cihlg nhic Tre CO nhimg thoi quen choi l^p di lap lai, dong dua, quay vong hoai khong chan, dac biet liic fre muon franh ne mot kich thich nao do; ratfr£ittu, khdng mim deo va phan img manh vol nhitag thay doi nho; tre co thoi quen phai hoan tit mgt vi6c gi roi moi chuyen tiep Tre thieu nhitag hanh vi phii hop nhu nhin vao mat ai, nhan biet cac net mat ciia nguoi khac, giao tiep bang cir chi than the; khong biet tao quan he be b^ cimg lira tuoi; thieu chia se tu nhiSn nhiing niem vui va so thich - khong bi6t khoe hay chi vao'nhimg vat mafrethich; thieu bay to tinh cam vol nguoi khac, khong biet mo dau cac quan he tuong tac sao, hoac dap lai nguoi khac sao; khong biet gay chii y va chii y theo ngiroi khac; va khong biit biit nhan nhiing xiic cam cua chinh minh Cac chuyen gia khoa hgc cung da dong loat khang dinh khiim khuyet Ki^JXH la khiem khuyet nang ne nhat cOa tre tu ki (White, 2007; Romanczyljf White, & Gillis, 2005; Weiss, 2001; Weiss & Harris, 2001) [9] DSM-4: Truoc day, DSM-4 (1994) da xac dinh tu ki gim co ba ITnh vyc khiim khuyit: khiim khuyit vi tuong tac xa hgi; khiem khuyit vi truyen thong giao tiep; va cac hanh vi sir thich han che va lap di lap lai DSM-5: Trong lin duyet lai vao nam 2013, DSM-5 quy dinh lai phi tirki la mgt loai khiim khuyit vol hai Enh TAP CHI KHOA HQC OHSP TPHCM vuc: khiem khuyet giao tiep, tuong tac xa hpi; khiim khuyit cac hanh vi, sd thich, sinh hoat h ^ chi, lap di lap lai Sau day la nhimg chi tilt ma DSM5 da xac dinh: KhiSm khuyit giao tilp va tir