i f N G D U N G CHlTdNG T R i N H CAN T H I E P CUA CATHERINE MAURICE TRPNG CAN THIEP CHP TRt TP KJ Phdn tich hdnh vi ung dyng (ABA) Id budc tiln quan trgng frong qud frinh phdt trien frudng phdi tdm[.]
i f N G D U N G CHlTdNG T R i N H CAN THIEP CUA CATHERINE MAURICE TRPNG CAN THIEP CHP TRt TP KJ Q hdn tich hdnh vi ung dyng (ABA) Id budc tiln quan trgng frong qud frinh phdt trien frudng phdi tdm If hgc hdnh vi d the ki XX Hudng tiep cdn can thifp hdnh vi ndy dd duge Ivan Lovoos vd cdc ddng sy tgi trudng dgi hgc California d Los Angeles (UCLA) - Hoo Ki vdn dyng can thifp cho fre tu ki (TTK) Sou dd, phuong phdp duge phd bien tgi nhilu noi fren f h l gidi ABA Id eo sd phdt trien nhilu chuang frinh can thifp (CTCT) cho TTK, so cdc CTCT theo hudng tiep edn ABA ed mdt ehuong frinh dd duge phd bien tgi Vift Nam khodng 10 ndm nay, dd IdCTCTcho TTK cuo Catherine Maurice Khdi qudt v l ehuong trinh Catherine Maurice Id me cuo hoi di/o h/ ki Sou tim hiiu nhung nghien ct/u cuo tien sT Ivor Lovoos v l vdn dyng phuong phdp ABA frong can thifp eho TTK, bd thyc sy dugc khfch If tif nhifng kef qud nghien ciru ciJo dng Catherine Maurice bdt toy vdo qud frinh thifp eho eon minh vdi sy giup ciio cd Bridget Taylor - mdt chuySn gio v l ABA vd mdt sd frj lifu vien khdc Ndm 1993, Catherine Maurice dd viet cudn «Can ihlip hdnh vl eho eho TTK nhd tud'i - Tdi lieu hudng dSn ddnh cho cha me vd chuyin gla" de gidi thifu vdl cdc nhd chuyfn mdn, dde bift Id ede cho me CTCT dd duge nghifn cuu, tht/ nghifm frSn minh, tieh luy vd dieu chinh h) ede CTCT khdc Ndi dung dugc chii y nhieu nhd't Id 101 bdi dgy (do vdy ehuong trinh ndy eOng thuong dugc cdc gido vifn (GV) vd eho me ggi tdt Id chuong trinh 101 bdi dgy TTK) dugc thiet ke, sdp xip thdnh hf thd'ng d l flip edn cho mgi dd'i tugng h> chuyfn gia, GV den eho me Mdt so thdnh phdn cung rd't quon trgng dugc chuong trinh de c^p mf t cdeh ehi tiet vd hifu dyng Id cdc mau ke hogch thifp, mau ghl kit qud, luge dd theo ddi sy phdt triln Trong nghien cuu ndy, chung tdi t^p frung vdo ung dyng 101 bdi dgy TTKv&i sy kit hgp cdc d i l u kifn vd hudng ddn thifp md chuong trinh dua P Tap ehi Glao due s6 9 (u i la/aoia) TtiS NGUYEN N Q T A M A N ' Chuong trinh frong bj cho tre cdc kTndng (KN) nen tdng (chu y, bdt chude), Idm eo sd cho vife phdt frien cdc KN co bdn (ngdn ngu, fu phye vy) vd phdt frien KN cuo tre len mdt bdc coo hon, hudng den khd ndng hgc tgp d tieu hgc sou gioi dogn thifp sdm (tiln hgc thudt, hge thudt, son sdng hgc dudng, xd hgi) Cdc KN chuong trinh duge phdn bd Idm bo mifc do: ban ddu, trung binh vd cao Trong dd, ed nhirng KN dugc tiep edn d ed ba muc (nhu KN chu y, bdt chude, ngdn ngu tiep nhdn vd diin dgt) vi ddy Id ede KN nin tdng, eo sd cho sy hinh fhdnh ede KN khdc vd cung rd't khd hinh fhdnh d TTK; ed cdc KN chi cd the hinh fhdnh d mt/c cao (nhu KN ngdn ngif trifu tugng, xd hdi, sdn sdng hge dudng); sy phdt frien cdc KN tiln hgc thudt h> muc ban ddu, frung binh fhdnh KN hgc thudt d mt/c cao Mdi bdi dgy chuong frinh dirge thilt k l rd rdng, d l st/ dyng frong thifp vd theo ddi kit qud Cdc phdn chfnh gdm: KN myc tieu; - Hudng ddn thyc hifn (ede budc hudng ddn, dd diing, KN tien quylt, ggi y ho frg); - Ghl kit qud (hudng ddn ciio ngudi dgy, phdn i>ng cuo fre, ngdy hudng ddn, ngdy fhdnh thgo); - Nhgn xet Trong tirng bdi dgy, cdc kT thudt phdn tich hdnh vi I/ng dyng dugc st/ dyng khd trift de vd ed h'nh hf thd'ng, dugc vdn dyng vdo h>ng budc ht/dng ddn md ngudi dgy cdn thyc hifn vd djnh hudng cdc phdn i>ng ctJO fre fheo KN myc tieu Cdc kT thudt sou duge st/ dyng phd biln chuong frinh: kT thudt dgy hge hodn hdo (ghep ddi nhi/ng yeu edu mdi vdi hd frg cdn thiet d mifc cao nhdt de tgo ro phdn i/ng mong mud'n h> dd tgo ro mgt mdu ciing ed'cho phdn i>ng mong mud'n dd), cung ed (nhdm tdng hdnh vi tuong tu frong Idn xud't hifn sou), gidm ddn ggi y (Id mgt hogt dgng mong tinh hf thd'ng dich chuyen su hd frg frong mdt hudng ddn d ede Idn tiep theo) ' Kkoa Giiio due djc b i ^ Tiuifag Bai hfc stf pMa Ha NfI Vdi net ve thyc frgng i/ng dyng ehuong trinh CTCT cuo Catherine Maurice dd dugc dich song tieng Vift vd st/ dyng khd rgng rdi tgi cdc trung tdm can thifp, gio dinh ed TTK Tuy nhien, cOng nhu nhilu CTCT cho TTK md hifn dong dung, ehuong frinh ndy chuo dugc thfch i/ng, vife si> dyng cdn mang tinh ty phdt Dieu ndy dnh hudng tdi hifu qud eOng nhu muc tin cdy cuo cdc CTCT Tim hieu tgi mdt sd frung tdm can thifp cho TTK vd gio dinh ed TTK, chiing tdi nhgn thdy: - Chuong trinh duge nhieu GV vd cho me lyo chgn, nhien rdt if ngudi fheo dudi viec thyc hifn ehuong trinh mgt edeh trgn ven (do: da sd khdng ndm dugc kT thudt dgy nen hifu qud ehua coo tif dd trd nen sdt rudt, mudn tht/ nghiem them ede ehuong frinh khdc nifa, dirng st/ dyng ehuong trinh tre dd tien bg vd di hgc hod nhdp duge, sy fhoy ddi trung tdm thifp vd GV can thifp ); - Cdc dilu kifn thifp co bdn tgi gia dinh vd frung tdm ehua dij de thyc hien mgtCTCTchuyen biff (vl nhdn Iyc, fhdi gion, bdi cdnh, dd diing ) D l su dyng mdt chuang trinh cd tfnh chuyen sdu fheo hudng flip cdn phdn tich hdnh vi irng dyng, dilu quon frgng nhd't Id phdi ddm bdo finh hf thd'ng, nhd't qudn cua ngi dung, phuong phdp ddng thdi h/dn fhtj fheo cdc hudng ddn cuo chuong frinh v l ddnh gid, lyo chgn bdi dgy, fhdi gian tieu chudn, bdi cdnh Ode bief, GV vd cho me fre cung edn dugc fdp hud'n de cd the thuc hifn td't cdc kT thudt thifp Kit qud thyc nghifm ung dyng chuong hinh 1) Dja bdn vd khdeh the thuc nghiim Thye nghifm duge tien hdnh tgi Trung tdm Khdnh Tdm (thudc Hdi ct/u trg tre em tdn tdt Viet Nam) fir thdng den thdng 12/2011 Ody Id md hinh trung tdm chuyen bift ddnh cho fre khuyet tdf, frong dd chu yeu Id TTK Trung tdm thyc hifn ba md hinh thifp: can thiip sdm (nhdm fre 2-5 tudi), tien hgc dudng (nhdm tre 5-7 fudi) vd gido dye KN sdng (nhdm fre khuyet tdf ndng fren fudi) vdn dyng kef hgp chuong trinh gido dye mdm non vd chuong frinh chuyen bift Tgi Trung tdm Khdnh Tdm, chung fdi chgn duge 34 tre frong gioi dogn eon thifp sdm (tif 2-5 tudi), ddnh gid vd phdn logi muc thifp Kef qud: ed 10/34 fre edn thifp d muc ban ddu, 24/34 fre cdn eon thifp d mifc trung binh vd ndng cao Do thdi gian vd phgm vl nghifn ci/u chiing tdi chi nndi dirng d ung dyng muc ban dau nen dd chgn 10frevdo nhdm mdu thuc nghiem (8 nam vd nif, tudi h/ 2-4) Tdt ed cdc tre dlu dugc chdn dodn d Vien Nhi qudc gia bdng thong chdn dodn h/ ki hjdi du tho (Childhood Autism Rating Scale-CARS), muc ty ki h/ nhe din ndng 2) Quy trinh thuc nghiim Tren eo sd cdc hudng ddn tif ehuong frinh, nhifng kef ludn thu dugc tif khdo sdt thuc frgng vd finh hinh thuc te tgi Trung tdm Khdnh Tdm, chiing fdi dd tien hdnh thue nghifm t/ng dyng CTCT fheo cdc budc nhu sou: Budc Xdy dyng nhdm mau thye nghiem: chiing fdi tien hdnh ddnh gid 34 TTK dang tham gia vdoCTCTsdm tgi Trung tdm Khdnh Tdm Cdng ey md chung tdi sir dyng Id Danh muc ede /CN phdn theo mifc (trich tif ehuong frinh eua Catherine Maurice) Cdng cy ddnh gid ndy khdng giiip chi ro dugc mifc phdt trien (fudi phdt trien) song thudn Igi cho viee lya chgn cdc myc tieu can thifp Sou ddnh gid 34 fre, chiing toi lyo chgn dugc 10 fre edn can thifp d mt/c ban ddu Tiep hjc khdo sdt cdc yeu fd lien quan din vife st/ dyng CTCT cuo tifng tre: nhdn lye thifp (ngodi GV tgi Trung tdm thi oi Id ngudi can thifp cho fre tgi gio dinh, kien tht/c vd KN cua nhirng ngudi thifp), thdi lugng thifp, ede dieu kifn can thifp khdc cua fre Budc Tap hud'n GV vd cha me: ndi dung fdp hud'n ehinh boo gdm KN lap ke hogch can thifp (ddnh gid, lyo chgn bdi dgy), theo ddi vd dilu chinh ke hogch thifp, cdch thirc phdi hgp giua GV vd cho me frong qud trinh can thifp, kT thudt trien khoi Kfng bdi dgy Budc Xdy dyng vd thyc hiin CTCT: sou dd fhom gio tgp hudn, dudi sy hudng ddn cuo nhdm nghien cuu, GV vd eho me cung tien hdnh xdy dyng vd thyc hifnCTCT.Sou st/ dyng Danh myc cdc KN phdn theo muc d l ddnh gid fre (xde djnh nhung KN md tre dd thye hifn duge vd nhirng KN edn dgy), GV vd cho me eiing thdo lugn cdc ylu td CO bdn trude lyo chgn KN myc tieu eho fre nhu: phii hgp vdl fudi cuo tre; glup gidm thieu nhi/ng vd'n de hdnh vi cuo tre; Idm nin tdng eho ede KN khde; fre cd co hdi thye hdnh KN dd; KN cd cdn thiet vdi gia dinh tre; KN dd ed dugc fre su dyng hdng ngdy Hdng fhdng, GV vd cha me ciing ddnh gid ket qud thifp dgt dugc vd lap ke hogch thifp cho thdng tiip theo Tap chi Glao due s6 9 (ki i • la/aoia) Tre dugc thifp tgi Trung tdm thdng qua hinh fht/c can fhifp ed nhdn vd fheo nhdm nhd, dugc thifp them d nhd bdi cha me vd/hode gio su ngdy/fudn Thdi gian trf dugc thifp tgi Trung tdm theo nhdm/ldp Id gid/ngdy (24 gid/fudn), fheo hinh fhirc thifp cd nhdn Id -1,5 gid/ngdy (6-9 gid/fudn) Neu thifp tgi nhd gid/fudn tre se duge can fhifp cd nhdn gid/fudn tgi frung tdm, neu can fhifp tgi nhd gid/fudn fre se dugc fhifp gid/fudn tgi trung tdm, nhu vdy ddm bdo fhdi gian thifp ed nhdn Id 12 gid/fudn vd fhifp theo nhdm/ Idp Id 24 gid/fudn Tdng thdi gian thiep fheo ke hogch Id 36 gid/fudn (tieu chudn ciio ehuong trinh Id 35-40 gid/tudn) Tuy bdi dgy vd muc dgt duge KN d l ngudi can thifp Iua chgn dgy hgc thdng quo ede fhij nghifm rieng bift (Discrete Trial Teaching - DTT), dgy hgc fhdng qua thu nghifm fdp trung (Intensive Trial Teaching ITT) hodc dgy hgc ngdu nhien (Incidenfiol Teaching - IT) Hinh thuc fhifp theo nhdm/ Idp vd tgi nhd duge nhdm nghien ct/u khuyen khich st/ dyng dgy hgc ngdu nhien (IT) vi ddy Id CO hgi quon frgng d l tre cd the thuc hdnh KN, tdng cudng sy tuong fdc Budc 4: Ddnh gid ki't qud thye nghiim KN cua trf dgt duge sou thuc nghifm duge ddnh gid fheo muc do: «Dgf": trf thyc hifn dung 8/10 Idn hudng ddn, khdng cdn hd frg; «Dgt ed ho trg": fre thye hifn diing fir / Idn hudng ddn, cd ho frg mdt phdn; «Khdng dgt": tre thuc hifn diing dudi 5/10 Idn hudng ddn, hd frg gdn nhu hodn todn 3) Ki't qua thyc nghiim Do thdi gion nghien cuu ed hgn, chung tdi chi mdi thye nghifm t/ng dyng chuang frinh frong fhdng Kef qud thue nghifm eho thdy, ti If KN md tre dd «Dgt' coo nhd't (trung binh dgt dugc 50,2%) Chi cdn 22,1 % KN mye tieu «Khdng dgt" Trong sd cdc tre thuc nghifm cd mdt tre (N.G.B) ed kit qud can thifp ehua td't (52% KN khdng dgt) Phdn tich trudng hgp ndy chung tdi dugc biet fre thudng xuyen nghi hgc dm, qud trinh thifp bj gidn dogn nen hifu qud khdng cao, TTK mt/e ndng Cd mff frudng hgp (O.T.O)