研究背景：隨著自閉症類群障礙症（autism spectrum disorder, ASD）盛行率持續攀升，由專業醫療人員提供之早期療育已然供不應求。近年許多研究團隊以自然且具發展性的行為介入取向（naturalistic developmental behavioral intervention, NDBI）建置了自助式家長線上課程，以緩解時空與人力成本的問題，並使家長得以更彈性地安排學習與應用介入技巧的時間，提升兒童療育時數並類化其技能。然而，目前仍尚少有研究探討自助式家長線上課程的療效，且少有檢驗NDBI共通技巧、提供家長最簡要之介入技巧之研究。
研究目的：本研究旨在綜合目前主要之NDBI家長訓練方案，建置適用於台灣ASD兒童家長的線上課程，並探究自助式NDBI線上課程網站對家長之成效。
研究方法：本研究採用隨機對照試驗設計，共納入30位年齡介於18至65個月的ASD兒童家庭，隨機分派至介入組與等待組（各15人）。介入組可自行觀看本研究建置之線上課程，包含NDBI取向強調之互動共同技巧的基礎課程，以及針對特定發展領域之介入技巧的進階課程（各6至8週）；等待組則提供典型發展兒童相關衛教網站。兩組家長需於介入前、基礎課程後、介入後三個時間點，繳交親子互動影片，以及完成介入知識、親職壓力、親職效能線上問卷測量。
研究結果：初級療效方面，相較於等待組，介入組在整體執行NDBI技巧、面對面和兒童保持視線水平、跟隨兒童帶領、示範合宜的語言、直接教學頻率技巧上，隨時間有顯著療效進展，且介入後能力水準顯著高於等待組，且該些NDBI療育技巧尤於進階課程階段有顯著進展；而在正向情感和誇張化技巧、回應兒童溝通意圖、直接教學品質、誘發溝通技巧，則未有顯著進展。次級療效方面，皆未有顯著進展。
研究結論：以NDBI為基礎之自助式線上家長課程有機會提升家長療育技巧，部分調適親職壓力與效能感，且除了NDBI共通技巧的基礎課程外，針對各領域發展的進階課程也對台灣ASD學前兒童家長的學習有重要的幫助。本研究建議未來可持續蒐集更具代表性之樣本，並探討家長療效相關的中介與調節因子，以更嚴謹地驗證台灣自助式NDBI線上課程的療效。

Background: With the increasing prevalence of autism spectrum disorder (ASD), the demand for early intervention services has exceeded the available professional resources. To address challenges related to time, space, and workforce limitations, numerous research teams have developed self-directed, telehealth-based parent-mediated interventions (PMIs) grounded in the naturalistic developmental behavioral intervention (NDBI) approach. These PMIs empower parents to independently learn and apply therapeutic techniques at home, increasing the intensity of children’s interventions and promoting skill generalization. Nevertheless, research on the efficacy of such self-directed PMIs remains limited, with even fewer studies identifying the fundamental components needed to provide parents with concise and effective intervention strategies.
Objectives: This study aims to integrate fundamental elements from several NDBI-based programs into a unified self-directed PMI and evaluate its effectiveness among parents of preschoolers with ASD in Taiwan.
Methods: This study utilized a randomized controlled trial (RCT) design, enrolling 30 families of preschoolers with ASD aged 18 to 65 months and their primary caregivers. Participants were randomly assigned to either the intervention group (n = 15) or the waitlist group (n = 15). The intervention group received access to the PMI program developed for this study, which included basic courses emphasizing the core techniques of the NDBI approach, followed by advanced courses focusing on strategies for specific developmental domains (each module lasting 6 to 8 weeks). The waitlist group was provided with psycho-education websites about developmental milestones of preschoolers. Both groups were requested to submit parent-child interaction videos and complete online questionnaires assessing intervention knowledge, parental stress, and parenting efficacy at three time points: pre-intervention, post-basic course, and post-intervention.
Results: Regarding the primary outcomes, compared to the waitlist group, the intervention group demonstrated significant progress in general NDBI implementation fidelity and the Face-to-face and on the child’s level, Following the child’s lead, Modeling appropriate language, and Frequency of direct teaching episodes subskills, especially during the advanced courses. However, no significant improvements were observed for the Positive affect and animation, Responding to attempts to communicate, Using communicative temptations, and Quality of direct teaching episodes subskills or the intervention knowledge score. Similarly, regarding the secondary outcomes, no significant improvements were presented for the Chinese version of the Parental Stress Scale and the Parenting Sense of Competence Scale.
Conclusions: An NDBI-based, self-directed telehealth PMI holds the potential to facilitate parent-implemented intervention skills, reduce parenting stress, and elevate parenting efficacy. In addition to the basic courses covering common NDBI skills, advanced courses targeting specific developmental domains also offer crucial learning support for Taiwanese parents of preschoolers with ASD. This study suggests that future research should continue to recruit more representative samples and explore possible mediators or moderators of parent outcomes, thereby verifying the clinical effectiveness of the current PMI for Taiwanese families with greater rigor.

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