自閉スペクトラム症児が学校生活において認識する作業機能障害の質的解明

Qualitative investigation of occupational dysfunction in school life as perceived by children with autism spectrum disorder

要旨：自閉スペクトラム症児（以下，児童）が学校生活にて体験した主観的な困り感を作業機能障害の観点から検討することを目的に，構造構成的質的研究法とSteps for Coding and Theorizationを用いて児童4名を分析した．その結果，〈学校規定による環境や行動制限〉と〈社会情勢による経験の剥奪〉の作業剥奪，〈作業活動時と時間感覚のバランス〉と〈作業とその意味のバランス〉の作業不均衡，〈他者と自己の経験比較による無力感〉と〈集団内での疎外感〉の作業疎外，〈交流する他者に認められない価値〉と〈マイナスな経験による自罰意識〉の作業周縁化が生成された．学校全体との協働にて児童の作業遂行を支援することが，作業療法士の役割として重要であると考えられた.

　We analyzed four children with autism spectrum disorder (hereafter referred to as “children”) using the Structural Construction Qualitative Research Method and the Steps for Coding and Theorization to examine the subjective sense of distress they experienced in their school life from the perspective of occupational dysfunction. As a result, the following occupational deprivations were generated: “environmental and behavioral restrictions due to school regulations” and “deprivation of experience due to social conditions”. Furthermore, there was occupational imbalance of both “time of work activity and sense of time” and “work and its meaning”. In addition, occupational alienations of “feeling helpless by comparing one's experience with others” and “feeling alienated in a group” were experienced. Finally, there was occupational marginalization in the form of “feeling unrecognized by others with whom they value interaction” and “sense of self-punishment due to negative experiences”. The role of occupational therapists was considered important to support children's performance of tasks in collaboration with the school as a whole.