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理解自闭症女孩的社交行为

Understanding the Social Behaviors of Girls with ASD

戴卫·格芬医学学院
David Geffen School of Medicine
自闭症研究治疗中心
Center for Autism Research and Treatment
2015年自闭症研究进展
Advances in Autism 2015
我们有请下一位发言人
I’d like to go ahead to our next speaker,
米歇尔·迪恩发表演讲
Michelle Dean who will be speaking to us
她来自加州州立大学海峡群岛分校
from Cal State University, Channel Islands
演讲主题为理解自闭症女孩的社交行为
on understanding the social behavior of girls with ASD.
让我们热烈欢迎迪恩博士
So please join me in welcoming Dr. Dean.
感谢你的到来
Thanks for coming. [Applause]
大家好 我的题目是“掩饰的艺术:性别差异
Hi, “The Art of Camouflage Gender Differences
和自闭症儿童们的社会行为”
and the Social Behaviors of Girls and Boys With Autism”
确诊那些患有自闭症 但没有认知功能障碍的
We have a great deal of difficulty identifying and diagnosing
女孩子的症状存在一定困难
girls with autism without cognitive impairment.
此外对自闭症的认识可能还存在男性偏见
And there may be a male bias in our perception of autism.
患有自闭症女孩被描述为:
Girls with autism have been described as
能够更好地掩饰自闭症状
being better able to camouflage their symptoms of autism
并且采取一些补偿行为
and to use compensatory behaviors
来掩盖她们遇到的社交挑战
that mask their social challenges.
这种掩饰和补偿行为是指
Camouflage and compensatory behaviors refer to
她们会重复或者模仿其他孩子的社交行为
echoing or mimicking the social behaviors they see other kids do.
但是当女孩子们模仿这些行为时
But when girls reenact these behaviors,
她们看起来非常流于表面
they’re described as looking superficial,
并不理解进行社交活动的
and seem to lack understanding of the underlying motivations
深层动机
that inform our social interactions.
因此“掩饰”这个词强调了环境的重要性
So the word “camouflage” highlights the importance of environment.
了解自闭症男孩和女孩是如何融入或者
Understanding the way boys and girls with autism interact with
如何与学校自然形成的社会环境互动
or blend into the natural social landscape at school
也许能让我们更好地理解
may give us a better understanding of
为什么很难识别出女孩子中的自闭症患者
why it is difficult to detect autism in girls.
我们知道自闭症儿童
We know that children with autism
在学校交朋友会非常困难
have a great deal of difficulty in making friends at school.
我们对自闭症的性别差异 社交行为
We know less about gender differences and the social behaviors of autism,
以及患有自闭症儿童的真实经历了解太少
and the actual experiences that children with autism have.
但我们确定的是 不管有没有自闭症
But we do know that children with and without autism
学校里学生们倾向于男孩女孩分开玩
tend to segregate by gender, when they play at school.
在正常成长的人群中
And in typically developing populations,
人们普遍相信男性和女性的社交方式
it is widely accepted that there are gender differences
存在差异
in the way that boys and girls socialize.
男孩们更喜欢玩游戏
Boys are more likely to be playing games,
比如激烈的格斗类游戏
rough-and-tumble play.
女孩们更喜欢进行亲密交谈
Girls are more likely to have intimate conversations.
因而自闭症女孩
So, in order for girls with autism
为了融入学校环境
to blend into the landscape at school,
她们的社交面貌 自然会和自闭症男孩不同
their social landscape is different than boys with autism.
所以我们在研究中提出了这些问题:
So in our research, we ask the following research questions:
环境因素 比如与性别密切相关的
To what extent do environmental factors
社交活动 在帮助自闭症女孩掩饰病征时
like gender-related social behaviors and activities
能起到多大的效果?
play a role in helping girls with autism to mask their symptoms?
自闭症女孩真的更擅长“掩饰”她们的自闭症状
Are girls with autism better at ‘camouflaging’ their symptoms of autism
并会用补偿行为来缓和社交困难吗?
and using compensatory behaviors to mitigate their social difficulties?
男孩自闭症患者真的更加明显 容易识别吗?
And are the symptoms of autism more obvious and easier to detect in boys?
为了了解孩子们在学校如何互动
To examine how children interact with their social environment at school,
我们调查了185名儿童的行为数据
we examined the observation data
调查对象有普通孩子 也有自闭症患者
of 185 children with and without autism.
这是一份数据的二级分析报告
In… This is a secondary analysis of data
数据源自一个大型社交行为干预的
that were collected for a large randomized control trial
变量控制实验
of a social skills intervention.
这些全部都是基线数据
All of these data were baseline data,
收集于干预实验开始之前
are collected before the start of the intervention.
最初的研究对象
And in the original study,
是24个患有高功能自闭症
there were 24 girls of high-functioning autism
或患有自闭症但没有认知障碍的女孩子
or autism without cognitive impairment.
这次研究我们仍旧以她们为对象
And so we used every girl in the study.
并且在更大范围内挑选
Boys were selected from a larger pool of boys
年龄、智力、居住环境都和这些女孩子相似
that were matched to the girls with autism
的男孩自闭症患者
by age, IQ and city of residence.
这些参与研究的孩子们住在
The kids in the study lived in
巴尔的摩 安阿伯 洛杉矶和西雅图
Baltimore, Ann Arbor, Los Angeles and Seattle.
我们用自闭症诊断观察量表检验自闭诊断
We verified the diagnosis of autism using the ADOS.
这些自闭症儿童的智力得分都超过70分
All the children with autism had an IQ over 70.
他们都在普通学校接受教育
And all children with autism were educated in the general education classroom
一天中80%的时间呆在教室里
for more than 80% of the school day.
现在为了确定操场上孩子们的社交面貌
Now to determine what the social landscape on the playground looks like,
我们也收集了正常生长发育的
we also use data from typically developing children,
69名女孩和68名男孩的数据
with 69 girls and 68 boys.
这些孩子是初始研究时挑选的
These children were selected for the original study
他们是其中一名自闭症调查者的同学
because they were classmates of one of the participants with autism.
另外 他们的常规授课老师
In addition, their teacher,
推荐他们参加这个项目
so general education teacher nominated them to participate,
因为这些孩子社交技能出色
because they had good social skills.
有积极的亲社会行为
positive prosocial behavior… behaviors.
我们依据同伴参与下的操场行为观察量表
All children were observed on the playground for 10 to 15 minutes,
对操场上的孩子进行了10到15分钟的观察
using the Playground Observation of Peer Engagement,
这个量表又称POPE
or what we call the POPE.
这里每行代表了一分钟的区间
Each line here represents a one-minute interval.
POPE表展示的是一些定量和定性的数据
The POPE here yields quantitative and qualitative data.
定量指参与状态
Quantitative data refers to engagement state,
定性是简短描述这一分钟里
and qualitative data is a short description of
孩子们在做什么
what the kids were doing during that one minute interval.
本研究关注的变量是
The variables to focus for this study are:
独处时 孩子是自己呆着 还是和大人一起
Solitary, the child is alone or with an adult.
共同合作时 孩子是积极和某个人还是某些人交往
Joint Engage, the child is actively socializing with a peer or peers.
做游戏时 孩子是遵照游戏规则
Game, the child is actively playing a game
积极地与某个人 还是某些人互动
with rules with a peer or peers.
观察员通常是研究生或者研究助理
Children were observed by graduate students or research assistants
他们经过训练 数据记录可靠性至少为0.85
who were trained to a reliability criteria of at least 0.85
并能对随机观察对象遵循同一标准
and to maintain coding consistency to coders randomly
独立编制观察报告20%的数据
and independently coded 20% of the observations.
这是一个三分钟观察的样例
So here’s an example of what three minutes looks like.
共同合作 和一个女孩一起散步交谈 开心
Joint Engage, walking and talking with one girl, happy.
共同合作 和一个女孩一起散步交谈
Joint Engage, walking and talking with one girl.
共同合作 和一个女孩在攀玩架附近交谈 大笑
Joint Engage, talking with one girl on the jungle gym, laughing.
这次分析我们采用并行混合方法
For this analysis, we use concurrent mixed methods,
定性定量数据会被同时收集
in which quantitative and qualitative data were collected
并且共同分析
at the same time and analyzed concurrently.
我们的研究方案是一个考察性的个案分析
Our analytic design was an exploratory case study design
每组考察一个个案
with each group representing one case.
定量 定量分析方面 我们调查
Quantitative, for the quantitative analysis, we examine the frequency
每一组在单独活动 团队活动和玩游戏
that each group spent some time
花费特定时间的频率
in Solitary, Joint Engage or Game.
然后我们测查了不同组在不同参与状态下
Then we tested between group differences in the average amount of time
花费的平均时间量的差异
that each group spent in each engagement state.
定量 我们确定了…
Qualitatively, we identified the…
我们观察每个参与者参与的不同活动
we identified each activity
和参与状态
that each participant engaged in, in each engagement state.
然后我们找出每个组在每个状态下
And then we identified what the most popular activities
最受欢迎的活动
in each engagement state in each group.
一旦我们能够描绘出每个参与者的社交面貌
Once we’re able to develop a social profile for each participant,
我们就能够在定量数据中挑选出一个
we then went to the qualitative data to select a representative example
校园社交行为的典型样本
of what the social behaviors looked like at school.
社交面貌:正常成长的女孩子
The social landscape: typically developing girls.
这个图表展示了正常成长的女孩子
So this graph represents the proportion of typically developing girls
在每个参与状态下所花费时间的比例
that had spent some time in each engagement state.
所以对于正常成长的女孩子来说
So typically developing girls,
共同合作是最受欢迎的参与状态
the Joint Engage was the most popular engagement state.
另外 正常成长的女孩子共同合作方面
In addition, typically developing girls
平均比男孩花费更多时间
spent on average more time than boys in Joint Engage.
正常成长的女孩最喜欢的活动是聊天和跑来跑去
The most popular activities for typically developing girls were talking and flitting.
跑来跑去 我们定义为
Flitting, we called an activity as flitting
在一个观察时期内 参与者加入了三个
when a participant engaged in three or more activities
或者更多个活动
within one observation period,
并且每项活动花费的时间都差不多
and spent about at equal amounts of time in each activity.
那么正常成长的女孩看起来像这样
So what typically developing girls looks like were –
共同合作:与两个女孩一起散步 微笑并且交谈
Joint Engage: Walking with two girls. Smiling and talking.
共同合作:坐成一个圆 假装帮彼此涂指甲
Joint Engage: Sitting in a circle pretending to paint each other’s nails
她们玩这个玩了两分钟
and they did this for two minutes.
三个女孩站起来
Three girls get up.
她们手牵手 开始跑
They hold hands and they start running.
然后追赶一个男孩子 大笑着 非常开心
And then they start chasing a boy, laughing and happy.
社交面貌:正常成长的男孩
The social landscape: typically developing boys.
正常成长的男孩子 游戏是他们的最爱
Typically developing boys, Game was most popular,
紧接着是共同合作
followed pretty closely by Joint Engage.
虽然如此 男孩子们 尤其是正常成长的男孩子们
Although, on average, boys, typically developing boys
比女孩子在游戏上多花的时间非常多
spent significantly more time in game than girls.
男孩子最喜欢的活动首先是球类运动
The most popular activities for boys were
其次是交谈
first, ball games and second, talking.
所以在操场语境中 一个正常成长的男孩子
So a representative example of what it looks like
典型的例子大致是这样的:
to be a typically developing boy on the playground looks like this:
共同合作:组织一场游戏
Joint Engage: Getting a game organized.
邀请朋友们玩游戏
Going to invite kids to play the game.
玩手球
Playing handball.
到外面长凳上聊天
Gets out, has a conversation on the bench,
但是仍然关注游戏
but still watching and paying attention to the game.
对于自闭症女孩来说
Girls with autism, for girls with autism,
共同合作和独处的比例相同
Joint Engage was tied with Solitary.
自闭症女孩选择共同合作或者独处
Girls with autism spent their time in Joint Engage or Solitary.
自闭症女孩最喜欢的活动也是交谈
The most popular activities for girls with autism
和正常成长的女孩类似
were talking, like typically developing girls.
她们第二喜欢的活动也一样
And their second most popular activities, so was a tie,
在一个人的游戏里不停更换
was flitting between solitary activities,
独自制定游戏规则 或者独自玩球
playing on the play structure alone or playing ball alone.
一个自闭症女孩在操场
A representative example of what a girl with autism
的典型样例是这个样子的:
looked like on the playground was:
想象操场上画了一条履带
Picture a caterpillar painted on a playground
女孩们从履带一段跳跃到另一段
and the girls were hopping from one piece of the caterpillar to the other.
团体活动:4名女孩一起玩履带游戏
So Joint Engage: Caterpillar activity with 4 girls.
远离女孩群体 走近男孩群体 没讲话
Walked away from the girls. Walked close to boys. No talking.
和一群女孩站得很近 不属于她们的一部分 但是很近
Standing near a group of girls. Not part of the group, but close.
提议女孩们一起做些别的事情
Initiates to the girls to do something else.
她们有一段简短的对话
They have a short conversation.
自闭症男孩:他们最喜欢的
Boys with autism: Solitary was the most popular
参与状态是独处
engagement state for boys with autism.
一个值得注意的互动效应表明
In fact, a significant interaction effect indicated that
自闭症男孩比其他任何一组
boys with autism spent significantly more time
在独处上花的时间都要多
being solitary than every other group.
毫不意外 男孩子们
So not surprisingly, the most popular activities
最喜欢的活动是独处
for boys were both solitary activities.
他们会和成年人一起散步聊天
And they were talking to an adult and wandering.
所以 一个有自闭症的男孩子
So, being a boy with autism,
在这个群组中呈现的典型样例
er… represented an example of what a boy with autism
的大致面貌是:
looked like in this group is:
一个人坐着 一个人吃零食
Sitting alone, eating a snack.
助手走过来和他谈话
An aide comes up to talk to him.
另一个助手走过来…走过来和第一个助手谈话
Another aide comes to talk… comes up to talk to the first aide.
男孩们站起来 走向操场
The boys gets up, walks to the playground.
低着头闲逛 独自一人
Wandering around with his head down. Alone.
我们的发现表明
So our findings suggest that
掩饰假说具备一定的证据支撑
there is some support to the “Camouflage” hypothesis.
女性社会群体的易变性看起来
The fluidity of female social groups seems
为自闭症女孩提供了一个理想的伪装环境
to provide an ideal backdrop to conceal girls with autism,
如果她徘徊于隐瞒与否的话
who tend to be hovering close by.
所以当我们考虑到操场时
So when we think about playgrounds,
成人督导在场 操场观察助理就能
an adult supervisor, a playground attendant
时刻关注操场的情况
would be scanning the playground.
但是这不足以发现
But this would be insufficient to identify
自闭症女孩会面临的社交挑战
the social challenges of girls with autism,
因为她们看起来像正常成长的女孩
because they look like typically developing girls,
除了正常成长的女孩子会不停地
except for typically developing girls are moving
在群组间来回移动
fluidly from group to group,
而自闭症女孩则是在独处和
whereas girls with autism are moving back and forth ,
团体活动之间来回转换
weaving between Joint Engage and Solitary.
团体活动阶段不时被独处阶段打断
Joint Engage periods were interrupted with Solitary periods,
这说明社交挑战可能会被
which suggests that although social challenges might be concealed
操场上的成年人隐瞒
by adults on the playground,
但并不会被同龄人隐瞒
they don’t appear to be concealed by other peers.
相反 男性社交环境似乎更容易
In contrast, the male landscape seems to make it easier
发现自闭症男孩的社交挑战
to detect the social challenges of boys with autism.
男孩基本上都玩游戏
Boys primarily played games.
当你思考游戏 游戏的框架
And when you think about games, the structure of games,
存在一个群体 他们在整个休息期间
there’s one large group, playing a game
都在玩一种游戏
for almost all the entire duration of recess.
所以发现自闭症男孩非常容易
So it’d be very easy to detect the boy with autism,
因为他不玩游戏
because he wasn’t playing the game.
所以简单地观察操场环境
So, simply scanning the playground environment
足以发现男孩的社交挑战
would be sufficient to identify the social challenges of boys.
因此我们的发现能够支持掩饰假说
So our findings do support the camouflage hypothesis.
它们也表明 在我们对自闭症的认知中
And they also suggest that there may be
可能存在男性偏见
a male bias in our perception of autism.
如果教育从业者或者一般从业者
If school practitioners or practitioners in general
想通过社交隔离来发现
are looking for social isolation
校园中的社交挑战
to detect social challenges at school,
那么自闭症女孩就无法被识别出 而被忽视
then girls with autism will remain unidentified and overlooked.
社交挑战存在于自闭症男孩和女孩之中
Social challenges exist in girls and boys with autism,
但是在女性人群中
but withdrawal and exclusion may be
孤僻和排斥的差别更明显 表现更隐蔽
more nuanced and less obvious in female populations.
所以关于未来的研究方向
So, for future directions,
当我们计划对校园中的孩子
we need to weigh the social landscape,
进行社交干预时 我们要考虑不同的社交面貌
when designing social interventions for kids with autism at school.
对此项研究中的自闭症男孩
For the boys with autism in this study,
对他们的干预目标是
they would need an intervention that targets…
当他们处于独处状态时
they’re being in a solitary state…
我们要帮助他们从独处进入团体活动
to help them move from solitary into joint engagement.
我们也确实需要想到 男性社交环境
We also really need to consider that the male social landscape is
在体格方面比女性社交环境有更多要求
way more physically demanding than the female social landscape.
对于女孩 我们想要承认
For girls, we would want to acknowledge
她们已经是共同合作状态
that they’re already in Joint Engage,
但是需要增加她们处于这个状态的时长
but increased the duration of time that they’re in Joint Engage.
我们应该怎样让她们保持共同合作呢?
How do we help them stay in Joint Engage?
这可能取决于互动的质量
And that may be due to a quality of their interactions.
因此我们或许要在
So perhaps we need to work on
社会交往方面着力 提高它的质量
social interactions and improving the quality.
我们确实需要做更多的工作
And more work really needs to be done
来调查亲密的社会间互动
to examine an intimate inter-social interaction,
这样才能明白问题在哪里
so we can understand where the breakdown occurs,
才能在干预时更加有效
and be even more specific in our interventions.
最终 我们可能没有充分借助同龄人
Finally, perhaps we have underutilized
作为校内儿童社交挑战
peers as a source of information
信息来源
about the social challenges of kids at school.
未来的研究可能会考虑从同龄人方面
And future research may wanna consider the peer perspective
帮助我们理解
to help us gain more understanding
患有自闭症的男孩女孩们面临的社交挑战
about the social challenges of girls with autism, and boys with autism.
同时也要感谢康妮·卡萨瑞
So, also thank you, Connie Kasari,
和卫生资源和服管理局对本研究的资金支持
and Health Resources and Services Administration for funding the study,
以及研究助理 凯特·赖德尔 玛尔塔·威咖
and research assistants, Kate Reidel and Marta Wirga.
[掌声]
[Applause]

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视频概述

通过实验来观察自闭症女孩的社交行为与掩饰行为之间以及自闭症男孩之间的差异

听录译者

jm

翻译译者

王随意

审核员

审核员 GK

视频来源

https://www.youtube.com/watch?v=KFqPvbDIsYE

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