自閉スペクトラム症の不適応行動に対する支援方略で感覚特性を評価する意義—2事例における作業療法士の臨床推論や事例の行動変容から

Assessing the sensorial properties to improve autism spectrum disorder-related behaviors: Analysis of clinical reasoning of the occupational therapist and behavior changes of two cases

要旨：本報告の目的は，自閉スペクトラム症（以下，ASD）児の不適応行動の改善を目的とした作業療法に鑑み，感覚特性を評価する意義を検証することである．発達状態や環境因子が類似し，感覚特性に相違があったASDの2事例を対象とした．作業療法（週1回の頻度で10回実施）で，作業療法士の臨床推論や介入前後の事例の行動変容を分析し，事例間で比較した．その結果，問題点の抽出で，事例Aは感覚調整機能の不全が，事例Bは感覚情報処理に対する配慮の必要性が焦点化された．これらの相違は，目標設定や介入選択の意思決定に関与していた．ASD児の不適応行動に対する支援方略を策定するうえで，感覚特性を評価する必要性が示唆された．

　This study attempts to validate the assessment of the sensorial properties in occupational therapy to improve inappropriate behaviors in children with autism spectrum disorder (ASD). Two ASD cases with similar developmental and environmental factors but presenting different sensorial properties were investigated. Occupational therapy was performed once a week for 10 weeks based on the clinical reasoning of the occupational therapist, and the changes in behavior before and after the intervention were analyzed and compared. The results showed that preliminary categorization of the causes of the inappropriate behavior was essential, since for case A, it was inadequate sensory modulation related, while for case B, it was sensory processing related. Consequently, those differences affected how to set the objectives, and the suitable interventions. This paper hints at the necessity of assessing the sensorial properties along with a well-defined strategy for supporting ASD children in improving their inappropriate behaviors.