NGHl£NCauQ UING DUNG PHirUNG P H A P TIEP CAN INREAL NHAM P H A T TRIEN GIAO TIEP VA NGON NGUT CHO TRE TIT Ki I O I t v l nd l Trl ty ki l i ddi tupng ed nhu elu die b i l t bdi mot trong dc khilm khu[.]
NGHl£NCauQ UING DUNG PHirUNG P H A P TIEP CAN INREAL NHAM P H A T TRIEN GIAO TIEP VA NGON NGUT CHO TRE TIT Ki DINH N G U Y I N TRANG THU TrUAng Dji iipc Stf piifm HI N$l I.OItvlndl Trl ty ki li ddi tupng ed nhu elu die b i l t bdi mot d c khilm khuyit ldn nhlt eda d c t r l niy l i khd khin v l ngdn ngd, din din nhdng ban ehl nhlt dinh qui trinh giao tilp Sau nim 1943 - thdi dilm dinh diu tu kl dupc chinh thde gpi t i n bdi ble si Leo Kanner de phucmg phip trj lilu ngdn ngd dinh cho t r l ty ki ndi rilng v i cie t r l khuylt t i t ndi chung da dupc quan tim nhilu ban Cie nghiln cdu d n g v l sau eing chi ring d n hd trp trl phit triln v l giao tilp trudc chd phit triln ngdn ngd Mdt d c phuong phip di theo tu tudng dd l i phuong phip tilp cin INREAL- dupc khdl ngudn tdMy vio nhdng nim 70 Trl t y kl v i dac diem v l giao tiep va ngdn ngd 2.1 Khii niimvituki U lu$n v l hdi ehdng ty kf (spectrum autistic) lln diu tiin dupe sddung bdi bic si, nhi tim thin hpc ngudi Anb Lonar Wing.Thu$t ngdrdi loan phd ty kl (autism spearum disorder - ASDs) dupe bit diu xem xit td nhdng nam 70, 80 eda t h i kf XX, bao gdm nhdng dang eo bin nbUi rdi loan ty kl (autistic disorder), rdi kian /Asperger, rdi loan bit hda nhip tudi l u tho (childhood dislntegerativedisorderCDD) v i bdi chdng Rett Tit d d c rdi loan nim phd ty ki niy diu gly nhCing khilm khuylt v l chdc nang giao tilp, x l hdi v i nang tudng tupng, nhiln cd sy khic v l mdc dd, pham vl Inh hUdng, thdi dilm khdi phit vi tiin ti-iln eda trilu ehdng theo thdi gian TRfde nhdng nim 60, ty ki dupe quan nilm nhu mdt loai eda hdi ehdng tdng hpp khie Tuy nbila td sau th^p kl 60 din 70, ngUdi ta eho ring ty kl khdng chf l i khuylt tit thin kinh m i l i mdt khuylt tit v l nao, dan din d c khilm khuylt v l ngdn ngd v i nhin thde Bin th|p kl 80, nhle tdi bdi ehdng ti; kl, ngudi ta khdng ehi nhin thly nguyin nhin khuylt t i t v l nao, dan den ele khilm khuylt vi ngdn ngd- nhin thdc m i cdn nghi tdi de khilm khuylt mdi quan h i tUong tie vcS eon ngudi Nhdng khilm khuylt niy d i dupe Lonar Wing (Wing, L & Gould, J 1979) dua li luan ve "Ba khilm khuylt" bao gdm: khilm khuylt ve ti/ong tic x l hdi, khilm khuylt v l giao tilp v i khilm khuylt vi ning tudng tUpng Td th^p kl 90 eho din nhdng nam 2000, ph^m vi djnh nghia v i d c tllu chf chin doin v l hdi chdng ty kf ngiy dng dupe md rdng Theo ddk ty kf cdng dupe pliln bi|t rd ring so vdi cie hdi chdng khic nim phd ty ki nhu hdi chdng Asperger, hdi ehdng Rett cdi k>an bit hda nhip tudi l u t h a Ngoii ra, d c nghiln edu qua d c thdi k) cdng cho thly ring sd lupng t r l / ngudi mic bdi chdng ti/ kl cd xu hudng ngiy eing ting lln Nlu vio thap kl 70, ti II tri/ngudi mic hdi chdng ty kl chf la 4,5/10,000 ngUdi thi ti le niy da ting len khoing 22 ngUdi/10,000 vao nhdng nam 1980, v i tang len 30-40/10,000 ngudi vao thap kl 90 Nhu viy, sau hon 20 nim, ti le tri/ngud! mIe hdi chdng ty kl da tang lln gan 10 lln Theo sd lieu nam 2009 cda Trung tam kilm soit v i phdng ngda djch benh Hoa Ki (Centers for Disease Control and Prevention - C(X), ti ie trl mIe hdi ehdng ty ki la 1/110 t r l (tuang duang vdi tl le ban 100/10,000), v i trung binh cd 50 gia dinh tbl ed gia dinh ed trl ty ki (S Viet Nam hl|n nay, tf II trI/ngUdi mIe hdi ehdng ty ki diln hinh l i 5-6/10,000 ngUdL Khii niem tuong ddi dly dd v i phd bien nhlt bien dupe Liin Hilp qudc dUa nam 2008, ty kf dupe djnh nghia nhu sau: "Ttf ki Id m^t logi khuyit tdt triin ton tgi sudt ddt, thudng duge thi hlin ngodi ndm ddu ddL Ttfkl td mdt roi logn than kinh dnh hudng den chdc ndng hogt ddng cQa ndo bg gdy nin, chd yiu dnh hudng din tri em vd ngudi ldn d nhiiu quoc gia, khdng ptidn biit gidi tinh, diiing tdc, diiu kiin kinh ti-xd hdi £)de diim cda ndid stf khd khdn tuang tdc xa hgh ede vdn di viglao tiip bdng Idl ndi vd khdng Ijdng idl ndi, vd cd cdc hdnh vi, sd thich vd hogt ddng lap di lap lgi vd hgn hepf (http://wvvw.un.org/en/events/autismday/lndex.shtml) 2.2 Die diim vigiao tiip vi ngon ngCfcda tri tukl Tri ttfkl thudng It cd vd/khdng tri dugc dgng itfc gmo tiip Do viy, ning giao tilp eda d e em rat keoi, ngudi khic cung rat khd thilt lap giao tilp vdi trl Biy edng l i mdt die dilm khiln t r l ty kf thudng ty hay thu minh, khdng ed nhu d u giao tilp Tri ttfkl thudng It hode gdn nttu khdng ed nhu cdu giao tiip thudng xuyin Mdt nhdng diu hilu d l chin doan dau tlln ddi vdl t r l ti; kl l i cie em thudng bay thich choi mdt minh, khdng tbieb v i hau nhu khdng cd nhu d u d n giao tilp vdi ngudi khie Kl d ngudi khic chd ddng mudn giao tilp vdi trl, t r l edng thudng td thii dp thd 0, khdng quan tim, Ilng tranh va quay trd lai vdi vile tuehoi eda bin thin Tri ttf kl gdp khd khdn viic hieu vd sir dung cdc cdng cu giao tiip (bing ngdn ngd v i phi ngdn ngO) Mdt nhdng khilm khuylt eda t r l ty kl l i t r l thudng ft bilu biln xuc d m mdt cich rd nit cdng nhu It dung inh mit giao tilp Cic t r l niy thudng hay ling trinh inh nhin cda ngudi khic v i khdng bao gid hole bilm nhin vio mit ngudi ddi diln giao tilp.Trl cdng thudng thd o, lanh dam, ty thu minh t b l gidi rilng cda minh, v i ft chia si tlnb d m , d m xdc sU 13-HUM 1/2(12«27 G NGHICN CUU Tri ttfkl gdp khd khdn viic hiiu muc dleh giao 1) INREAL tilp can d c trl chim ngdn ngd vdi tU tiip vd cdc nguyin tdc giao tiip Nhdng kho khan dch la de ti-| khilm khuyet ve giao tilp; diln hinh cda t r l la: khd thuc hiln luin phien giao 2) INREAL tilp can giao tilp vdi trl bing nhilu tilp, khdng bilt ehd dpi d i d i n lupt minh, khdng bilt dch khic nhau, ngdn ngd va el phi ngdn ngd nhu; anh tri cudc hdi thoai, khd doin biet npi dung d e cudc hpi m i t bilu hien xde cim, cd chl, dieu bp; thoai, khd hoac khdng hilu d e d u ndi da nghia hoic ciu 3) INREAL nudi dudng eae nang eo bin vi ndi bdng biy, nhilu him y Do do, d trUdng hop Idng ham mudn giao tilp cda trl; nhCing trl ty ki ed nang giao tilp th) npi dung cie 4) INREAL ludn danh gia va hudng din ngdn ngd cudc bdi thoai cda de em thudng dan giin, nghIo nan, cho t r l nhdng vin cinh va dia diem phd hpp; lip di lap lai, v i vdi nhdng mlu ciu diln hinh 5) Trong INREAL, ngudi ta se quay bang video dl kiem tra va phin tieh d c vin de llln quan den deh sd Tri ttfkl thudng giao tiip theo cdeh riing cda minh, ddi rdtkIcue.Ttk thudng thu minh vio t b l gidi rilng, nin dung ngdn ngdeda ngudi Idn vdi trl ngudi Idn thudng rlt khd khan vile hieu v i thim 3.2 Ong dung phuang phdp tiip ein INRE/U trin nhip vio t b l gidi cda trl Ngoii ra, die dilm khd tuin tri tukl theo cic quy tic giao tilp eung nhu hilu ve muc dfch Dya tren cic die diem vi ngon ngd v i giao tiep cCia giao tilp nin ti-l ty ki thudng ty dat de cich thdc giao trl ty ki, d l thye hien ddng li tUdng eda INREAL eung nhu tilp cda rilng minh, dilu niy giy khd hilu cho ngudi cd the dng dung phudng phip niy vile phit trien giao tilp va ngdn ngd hieu qui eho trl, ngudi Idn - ddi khie v i khd giao tilp vdi trl Phuong phap tiep cin INREAL va dng dung tic giao tiep vdi t r l - d n phii thyc hiln dung cic ndi dung cda phUOng phip nhUsau trentrltuki Thtf nhdt, ngudi Idn phii tuan theo nguyin tic 3.1 Phuong phip tiip cin INREAL giao tilp CO bin sau: Phu hop vdi trinh dp eda trl; giao 3.1.1 Lich sif hinh thdnh INREAL dupc khdi ngudn d My td nhdng nim 70 v i quyin ehd dao trd choi va giao tilp cho trl; chd dpi da lam thay ddi cie quan diem nghiln cdu phit Si t r l cd thdi gian bit diu; phu hpp vdl nhjp dilu cda trl; triln v l ngdn ngd thdi biy gid Nam 1974,tiensIWeiss,R thye hiln luan philn (eho - nhan) v i tao khdng giao v i Heublein, E eda Tnfdng Bai hpe Colorado (My) da dua tilp vui v l (theo Griee, H.P (1975) trin d e nghien edu eda minh v i dua INREAL - mdt Ngoii ra, giao tiep, ngudi ldn d n dim bio cic dch tilp cin dupc dinh gii l i cd bleu qui giio due nguyin tic v l luong (cung elp cic thdng tin d n thilt t r l chim phit trien ngdn ngd vda dd), d e nguyin tic v l chit (thdng tin de sy vile eo Ban diu, INREAL li td vilt t i t cda cum td ln-