研究目的：隨著自閉症（Autism Spectrum Disorder, ASD）診斷人數逐年增加，醫療量能不足和可及性等問題讓自閉症學前兒童無法得到充足的早療介入，以遠距（Telehealth）方式教導家長學習介入技巧（Parent-mediated Intervention）為一項可行的方法，讓ASD兒童在日常生活中獲得更多學習機會。本研究欲以自然且具發展原則之行為介入取向（NDBIs）為基礎建立線上課程網站，讓ASD兒童家長透過非同步遠距形式之線上課程學習NDBIs的介入策略，探討透過線上課程的介入能否提升ASD的社交溝通表現、適應行為和口語表達能力，並進一步探討家長成效與兒童療效間的關聯性。
研究方法：本研究採取隨機對照試驗（randomized controlled trial, RCT），共納入 30名ASD兒童及其家長，兒童生理年齡介於20至65個月，經隨機分派至網站介入組與等待組（各15名）。網站介入組家長自行觀看NDBI線上課程，課程分為基礎課程與進階課程（各6至8週）；等待組則提供典型發展兒童相關衛教網站。兩組皆於介入前、基礎課程結束後及介入後進行測量。兒童主要療效指標包含親子互動影片編碼所得之早期溝通指標、溝通功能、共享式參與狀態，以及家長填寫之社交溝通檢核表；次級療效指標包含適應行為與語言表達能力。家長互動技巧則以NDBI-Fi評估。資料分析以混合設計重複量數共變數分析檢驗兒童療效，並控制兒童發展商數；另以偏相關分析檢驗家長技巧進展與兒童主要療效指標進展之關聯。
研究結果：在主要療效指標方面，網站介入組兒童於完整介入結束後，其親子互動中的共享式參與狀態較介入前顯著提升，顯示兒童在完成完整網站課程後，較常出現高層次或協調一致的共享參與片段。然而，網站介入組於介入後之共享式參與狀態未顯著高於等待組。其他主要療效指標，包括整體溝通、自發溝通、非語言溝通、語言溝通、溝通功能種類、工具性溝通、非工具性溝通及家長報告之社交溝通表現，皆未呈現穩定顯著變化。次級療效指標方面，兩組兒童於適應行為、總詞彙量及平均句長之變化亦未達顯著差異。進一步相關分析之未校正結果初步顯示，家長技巧進展與兒童主要療效之關聯可能具有技巧特定性[CHC1] [林祐謙2] 與階段性。其中，「示範合適的語言」與兒童多項溝通及共享式參與指標呈正向關聯；介入早期之面對面、跟隨兒童帶領、回應溝通意圖及誘發溝通等技巧，則主要與兒童工具性溝通及共享式參與狀態之進展有關。然而，相關分析經 Benjamini-Hochberg FDR 方法校正後，各項相關皆未維持 q < .05 之顯著水準，故相關結果宜視為探索性發現。
研究結論：本研究結果顯示，NDBI網站自學課程對 ASD兒童具有初步介入效果，主要反映於親子互動中共享式參與狀態的提升。此結果支持網站自學型家長介入可能有助於促進兒童在自然親子互動中共同投入活動、維持互動連結與共享注意焦點。然而，本研究尚未觀察到兒童整體溝通、自發溝通、語言表達、溝通功能及適應行為等較廣泛發展能力之穩定改善，顯示共享式參與狀態可能是較早出現的近端改變，而較遠端之溝通、語言與適應功能進展，可能需要更長時間、較高介入劑量或更個別化的治療師支持。此外，此外，未校正相關結果初步顯示，不同 NDBI 核心技巧之提升與兒童療效進展間的關聯並非全面一致，可能反映不同 NDBI技巧在介入歷程中扮演不同角色；惟此結果於多重比較校正後未維持顯著，仍需保守解釋。未來若欲進一步提升網站自學型NDBI課程之效果，可考慮於進階課程階段加入治療師教練、影片回饋或個別化支持，以協助家長將互動技巧更穩定地融入日常親子互動，並促進兒童更廣泛的社交溝通與發展進展。

Objectives: Given the increasing number of children diagnosed with autism spectrum disorder (ASD) and limited access to early intervention services, telehealth-based parent-mediated intervention may provide additional learning opportunities for children in daily routines. This study developed an asynchronous online course based on Naturalistic Developmental Behavioral Interventions (NDBIs) and examined its effects on children’s social communication, adaptive behavior, and expressive language, as well as associations between parent skill gains and child outcomes.
Method: This randomized controlled trial included 30 children with ASD aged 20 to 65 months and their parents, who were assigned to a website intervention group or a waitlist control group, with 15 participants in each group. Parents in the intervention group completed an online NDBI course consisting of basic and advanced modules, whereas the waitlist group received access to a psychoeducational website on typical child development. Assessments were conducted at pre-intervention, after the basic module, and post-intervention. Primary outcomes included early communication indicators, communication functions, joint engagement states coded from parent-child interaction videos, and parent-reported social communication. Secondary outcomes included adaptive behavior and expressive language. Parent skills were assessed using the NDBI-Fi. Data were analyzed using mixed-design repeated-measures ANCOVA controlling for developmental quotient, and partial correlations were conducted to examine associations between parent skill gains and child outcomes.
Results: Children in the website intervention group showed a significant increase in joint engagement after completing the intervention, but their post-intervention scores did not significantly exceed those of the waitlist group. No stable significant changes were found in other primary or secondary outcomes. Uncorrected correlational analyses suggested skill-specific and stage-dependent associations between parent skill gains and child outcomes: Modeling Appropriate Language was positively associated with several communication and joint engagement indicators, whereas early gains in Face-to-face and On the Child’s Level, Following the Child’s Lead, Responding to Attempts to Communicate, and Using Communicative Temptations were mainly associated with instrumental communication and joint engagement. However, none of the correlations remained significant after Benjamini-Hochberg FDR correction.
Conclusions: The NDBI online self-learning course showed preliminary effects for children with ASD, primarily reflected in improved joint engagement during parent-child interactions. However, broader improvements in communication, language, and adaptive functioning were not observed. These findings suggest that joint engagement may be an earlier proximal change, whereas more distal outcomes may require longer intervention, higher dosage, or individualized therapist support. Future programs may benefit from incorporating therapist coaching, video feedback, or individualized support during advanced modules.

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