本研究之目的在於探討以攜帶式的語音輸出溝通裝置（VOCA）之教學策略介入二名國中階段低口語自閉症學生於學校情境下之溝通行為之成效。

語言和溝通能力缺陷或遲緩是自閉症者的明顯特徵，導致他們在與他人進行溝通時產生嚴重的困難。輔助溝通（augmentative & alternative communication, AAC）可提供一個有效的管道，有助於自閉症者藉此與外界進行溝通及表達自我需求。

語音輸出溝通裝置（voice output communication aids, VOCA）是AAC 之中一種便利的電子化裝置，可產生文字圖片或聲音的輸出，讓使用者可以藉由手指點選、按壓特殊開關等操作方式與他人進行溝通。

本研究之研究對象為一名15 歲9 個月女性及一名14 歲3 個月男性，皆為低口語自閉症者，採取單一受試研究法之跨行為多基線設計，探討以攜帶式的語音輸出溝通裝置（微電腦語音溝通板）介入溝通教學後，研究對象以溝通板表達自我需求、學習互動、人際互動三類溝通行為之成效，並記錄研究對象之溝通次數與溝通熟練程度加以分析比較，整合量化資料與質性資料獲致綜合結論。

研究結果顯示：（一）研究對象使用語音溝通板進行自我需求類溝通之次數與熟練程度均增加；（二）研究對象使用語音溝通板進行學習互動類溝通次數與熟練程度均增加；（三）研究對象使用語音溝通板進行人際互動類溝通熟練程度增加，但次數則增加不多；（四）研究對象原有的以手勢進行溝通之行為次數變化不大；（五）研究對象之家長與教師等相關人士對本研究介入之成效大致感到滿意。

最後並依據研究結果，對未來採用語音輸出溝通裝置介入自閉症者溝通教學之研究者及實務工作者提供若干建議。

The purpose of this study was to evaluate the effects of using portable voice output communication aids (VOCA) to teach two low-verbal junior high school students with autism to learn communication behaviors.

People with autism have obvious delay in language and communication skills, which causing them to communicate with others in serious difficulties. Augmentative & alternative communication (AAC) provides effective ways to help people with autism to communicate with the outside world and to request their needs.

VOCA is one kind electronic device of AAC which can output words, pictures and voices for users to communicate with others by it through fingers clicking, special switch pushing, etc.

Participants in the study are both low-verbal students with autism, which are 14 years 9 months female and 13 years 4 months male. Effects of the intervention were evaluated in a multiple-baseline design across behaviors; we taught both students to learn using the portable VOCAs (communication boards) to present self-demand, learning interaction and social interaction, then analyzed the times and level of these behaviors, and integrated quantitative and qualitative data into a conclusion.

The result of study shows: (1) The number of times and level that the participants presented self-demand by VOCAs increase; (2) The number of times and level that the participants presented learning interaction by VOCAs increase; (3) The number of level that the participants presented social interaction by VOCAs increase, but the number of times does not increase much; (4) The number of times of participants’ original communication behaviors which by hands does not change much; (5) Patriarchs and teachers of participants are roughly satisfied with the effects of the intervention.

Finally, according to the research results, we provide some suggestions of VOCAs intervention for people with autism.

壹、中文部分
王大延、曹純瓊（1998）：示範、時間延宕及提示對增進自閉症學童自發語言之成效研究。臺北市立師範學院學報，29，291-315。
王姿元（2003）：可以DIY的教學法-隨機教學法之介紹與應用。2008年11月25日，取自http://r2.ntue.edu.tw/download.htm。
杜正治譯（1994）：單一受試研究法。臺北市：心理。
杜正治（2006）：單一受試研究法。臺北市：心理。
余易倩（2008）：重度智能障礙學生工作態度之AAC策略成效。臺北市第9屆教育專業創新與行動研究高職組成果集，127-144。
林欣怡（2004）：圖片兌換溝通系統對改善國小低功能自閉症自發性溝通行為類化之成效。國立臺北師範學院特殊教育學系碩士論文，未出版，臺北市。
林欣怡、楊宗仁（2005）：圖卡兌換溝通系統對改善國小低功能自閉症學生自發性溝通行為類化之成效。特殊教育研究學刊，29，199-224。
林寶貴（1994）：語言治療與矯治。臺北市：五南。
宋維村（2000）：自閉症學生輔導手冊。臺北市：教育部。
宋慧敏、孫淑柔（2003）：圖片兌換溝通系統對促進智能障礙兒童溝通能力之研究。特殊教育叢書，9201，9-28。
李宏俊（2007）：AAC應用於國小低功能無口語自閉症學童主動溝通成效之研究。國立花蓮教育大學特殊教育教學碩士論文，未出版，花蓮縣。
吳武典，王華沛（1999）：加強身心障礙者輔助科技建設。特殊教育季刊，72，1-9。
吳訓生（2003）：單一受試實驗設計資料之統計分析。載於許天威，個案實驗研究法，643-661。臺北市：五南。
吳雅萍（2006）：AAC for persons with severe communication disorders: An Introduction. 國立東華大學暑期教學碩士班講綱，未出版，花蓮縣。
倪志琳（1996）：自閉症兒童學前教育：美國方案之比較及在我國實施之建議。竹師特殊教育學報，1，83-100。
倪志琳（1997）：環境教學法在特殊兒童語言訓練之應用。特殊教育季刊，65，13-17。
施琬如、唐榮昌（2003）：低功能自閉症兒童的手勢溝通訓練。國小特殊教育，36，30-37。
教育部特殊兒童普查工作執行小組（1991）：第二次全國特殊兒童普查複查工作手冊。臺北市：教育部。
許月琴（2000）：溝通障礙者的輔助科技：輔助溝通系統簡介。特殊教育季刊，75，38-40。
許耀分（2003）：圖片兌換系統教學對增進自閉症兒童主動使用溝通行為之研究。臺北市立師範學院身心障礙教育研究所論文，未出版，臺北市。
莊妙芬（1998）：擴大性溝通系統與替代性溝通。載於曾進興（主編），語言病理學基礎（第二卷），411-431。臺北市：心理。
麥琇茹（2006）：談自閉症兒童非口語溝通行為與教學訓練。屏師特殊教育，12，46-54。
鈕文英（2001）：身心障礙者行為問題處理：正向行為支持取向。臺北市：心理。
陳麗華（2006）：圖片兌換溝通系統訓練對國中低口語自閉症學生溝通行為之成效。國立臺北教育大學特殊教育研究所碩士論文，未出版，臺北市。
黃光慧、黃榮真（2004）：教學經驗分享：溝通輔具融入智障學生實用語文之初探。國立花蓮師範學院特殊教育學系暨身心障礙與輔助科技研究所2004年度師生學術研討會，花蓮縣。
黃忠賢，王家玲、吳秉睿（2003）：淺談自閉症兒童口語及溝通障礙問題。特教園丁，18（3），43-51。
曹純瓊（1996）：自閉症兒童的語言發展過程與其語言溝通能力特徵。特殊教育季刊，58，25-32。
曾月照（2002）：視覺提示策略對國小自閉症學生生活自理學習成效之研究。國立嘉義大學教育學院碩士論文，未出版，嘉義市。
張正芬（1996）：自閉症診斷標準的演變。特殊教育季刊，59，1-9。
張正芬（1999）：自閉症兒童問題行為之探討。特殊教育研究學刊，17，253-273。
張正芬、王華沛（2000）：自閉症兒童溝通行為評量表。
董愉斐（2005）：應用圖片兌換溝通系統教學法增進自閉症兒童主動溝通行為之研究。國立屏東教育大學特殊教育係碩士論文，未出版，屏東縣。
董愉裴、羅湘敏（2005）：圖片兌換溝通系統對自閉症兒童溝通能力訓練的應用。特教園丁，20（4），31-38。
楊熾康、黃光慧（2004）：淺談輔助溝通的基本理念。國教天地，156，18-23。
廖怡欣（2004）：運用科技輔具對增進國小中低功能自閉症學生購物行為之研究。國立臺灣師大特殊教育學系在職進修碩士論文，未出版，臺北市。
蔡淑微（2004）：溝通障礙：理論與實務。臺北市：心理。
謝淑珍（2002）：發展遲緩幼兒溝通教學成效之研究。國立彰化師範大學特殊教育研究所碩士論文，未出版，彰化縣。
魏壽洪（2006）：AAC在自閉症兒童溝通行為中的應用分析。中國特殊教育，11，44-48。
羅汀琳（2004）：圖片兌換溝通系統對中度自閉症兒童溝通行為成效之研究。國立高雄師範大學特殊教育學系碩士論文，未出版，高雄市。

貳、英文部分
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR (4th ed., text revision). Washington DC: American Psychiatric Association.
American Speech-Language-Hearing Association (1991). American Speech-Language-Hearing Association Report: Augmentative and alternative communication. ASHA, 33 (5), 9-12.
American Speech-Language-Hearing Association (2005). Roles and responsibilities of speech-language pathologists with respect to augmentative and alternative communication: Position statement. Retrieved from http://www.asha.org/NR
American Speech-Language-Hearing Association (2009). Augmentative and Alternative Communication (AAC). Retrieved from http://www.asha.org/public/speech/disorders/AAC.htm#types_aac
American Speech-Language-Hearing Association (2009). What are the types of AAC systems? Retrieved from http://www.asha.org/public/speech/disorders/AAC.htm#what_is
Bailey, D. B. Jr. & Wolery, M. (1984). Teaching infants and preschoolers with handicaps. Columbus, OH:Merrill.
Beukelman, D. & Mirenda, P. (1998). Augmentative and alternative communication:Management of severe communication disorders in children and adults (2nd ed.). Baltimore, MD: Paul H. Brookes
Beukelman, D. & Mirenda, P. (2005). Augmentative & alternative communication: Supporting children & adults with complex communication needs (3rd ed.). Baltimore: Paul H. Brookes.
Bondy, A.S., and L. Frost. (1994). The Picture Exchange Communication System. Focus on Autistic Behavior, 9 (3), 1-19.
Bryson, S. E. (1996). Brief Report: Epidemiology of Autism. Journal of Autism and Developmental Disorders. 26(2), 165-167.
Buffington, D. M., Krantz, P. J., McClannahan, L. E. & Poulson, C. L. (1998). Procedures for teaching appropriate gestural communication skills to children with autism. Journal of Autism and Developmental Disorders, 28, 535-545.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. (2nd ed.). Hillsdale, NJ: Erlbaum.
Durand, V. M. (1999). Functional communication training using assistive devices: Recruiting natural communities of reinforcement. Journal of Applied Behavior Analysis. 32, 247-267.
Dyches, T., Davis, A., Lucido, B. & Young, J. (2002). Generalization of skills using pictographic and voice output communication devices. Augmentative and Alternative Communication, 18, 124-131.
Hagopian, L. P., Fisher W.W., Sullivan M.T., Acquisto J. & LeBlanc L.A. (1998). Effectiveness of functional communication training with and without extinction and punishment: a summary of 21 inpatient cases. Journal of Applied Behavior Analysis, 31, 211-235.
Hart, B. & Risley, T. R. (1982). How to use incidental teaching for elaborating language. Lawrence, KS: H&H Enterprises.
Jennifer , B. G. & Richard, L. S. (2004). Effects on Communicative Requesting and Speech Development of the Picture Exchange Communication System in Children with Characteristics of Autism. Journal of Autism & Developmental Disorders, 34 (4), 395-409.
Klin, A. (2006). Autism and Asperger syndrome: an overview. Rev Bras Psiquiatr, 28(1), 3-11
Koul, R. K., Schlosser, R. W. & Sancibrian, S. (2001). Effects of symbol, referent, and instructional variables on the acquisition of aided and unaided symbols by individuals with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 16, 162-169.
Kravits, T., Kamps, D., Kemmerer, K. & Potucek, J. (2002). Brief report: Increasing communication skills for an elementary-aged student with autism using the Picture Exchange Communication System. Journal of Autism and Developmental Disorders, 32, 225-230
Koegel, R. L., Firestone, P. B. & Kramme, K. W. (1974). Increasing spontaneous play by suppressing self-stimulation in autistic children. Journal of Applied Behavior Analysis, 7(4), 521-528.
Kuder, S. J. (1997). Teaching students with language and communication disabilities. Boston, MA: Allyn & Bacon.
Lloyd, L. L. & Fuller, D. R. (1986). Toward an augementative and alternative communication stmbol taxonomy: A proposed superordinate claccification. Augement and Alternative Communication, 2, 165-171.
Lloyd, L. L., Fuller, D. R. & Arvidson, H. H.(1997). Augmentative and Alternative Communication: A Handbook of Principles and Practices. Boston: Allyn and Bacon.
Lord, C. & Paul, R. (1997). Language and communication in Autism. In D. J. Cohen & F. R. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (2nd). New York: John Wiley & Sons.
Lovaas, O. I. (1977). The autistic child: Language development through behavior modification. New York: Irvington.
Mancil, G.R., Conroy, M.A., Alter, P.J. & Nakao, T. (2006) Functional Communication Training in the natural environment: A pilot investigation with a young child with autism spectrum disorder. Education and Treatment of Children, 29, 615-634.
Martin, C. A., Drasgow, E., Halle, J. W. & Brucker, J. M. (2005). Teaching a child with autism and severe language delays to reject: Direct and indirect effects of functional communication training. Educational Psychology, 25, 287-304.
Mechling, L. C., ＆ Gast, D. L.(1997). Combination audio/visual self-prompting system for teaching chained tasks to students with intellectual disabilities. Education and Training in Mental Retardation and Developmental Disabilities, 32(2), 138-153.
Mesibov, G. & Howley, M. (2003). Accessing the curriculum for pupils with autism spectrum disorders: Using the TEACCH Program to help inclusion. London, England: David Fulton.
Mirenda, P. (2003). Toward functional augmentative and alternative communication for students with autism: Manual signs, graphic symbols, and voice output communication aids. Language, speech, ＆ Hearing Services in Schools, 34(3), 203-216.
Lord, C. & McGee, J.P. (Eds.). (2001). Educating Children With Autism. Committee on Educational Interventions for Children With Autism, Division of Behavioral and Social Sciences and Education, National Research Council. Washington DC: National Academy.
Nunes, D. (2008). AAC Interventions for Autism: A Research Summary. International Journal for Autism, 23(2), 17-26.
Olive, M., de la Cruz, B., Davis, T. N., Chan, J. M., Lang, R. B., O’Reilly, M. F. & Dickson, S. M. (2007). The effects of enhanced milieu teaching and a voice output communication aid on the requesting of three children with autism. Journal of Autism and Developmental Disorders, 37, 1505-1513.
Parette, H.P., Brotherson, M.J. & Huer, M.B. (2000). Give families a voice in augmentative and alternative communication decision-making. Education and Training in Menta Reardation and Developmental Disabilities, 35(2), 177-190.
Prizant, B. M. & Bailey, D. (1992). Facilitating the acquisition and use of communication skill. In Bailey, D. B. Jr. & Wolery, M. (Eds.), Teaching infants and preschoolers with disabilities. Columbus, OH:Merrill.
Rogers-Warren, A. K. & Warren, S. F.(1980). Mands for verbalization: Facilitating the display of newly trained language in children. Behavior Modification,4, 361-382.
Romski, M. A. & Sevcik, R. A. (1993). Language learning through augmented means: The process and its products. In Steven F. Warren & Joe Reichle (Eds.), Enhancing children's communication: Vol 2. Communication and language intervention series. Baltimore: Paul H. Brookes.
Romski, M.A. & Sevcik R. A. (1996). Breaking the speech barrier: language development through augmented means. Baltimore: Paul H. Brookes.
Schepis, M. M., Reid, D. H., Behrmann, M. M. & Sutton, K. A.(1998). Increasing communicative interaction of young children with autism using a voice output communication aid and naturalistic teaching. Journal of Applied Behavior Analysis,31, 561-578.
Schlosser, R. W. (2003). The efficacy of augmentative and alternative communication : towards evidence-based practice. Amsterdam ; Boston : Academic Press.
Schlosser, R. W. & Blischak, D. (2001). Is there a role for speech output in interventions for persons with autism? A review. Focus on Autism and Other Developmental Disabilities, 16 (3), 170-178.
Seal, B. C. & Bonvillian, J. D. (1997). Sign language and motor functioning in students with autistic disorder. Journal of Autism and Developmental Disorders, 27 (4), 437-466.
Sigafoos, J., Didden, R. & O'Reilly, M. (2003). Effects of speech output on maintenance of requesting and frequency of vocalizations in three children with developmental disabilities. Augmentative and Alternative Communication, 19 (1). 37-47.
Sigafoos, J., Drasgow, E., Halle, J. W., O'Reilly, M., Seely-York, S., Edrisinha, C. & Andrews, A. (2004). Teaching VOCA use as a communicative repair strategy. Journal of Autism and Developmental Disorders, 34, 411-422.
Sigafoos, J., O'Reilly, M., Seely-York, S. & Edrisinha, C. (2004) Teaching Students with Developmental Disabilities to Locate Their AAC Device. Research in Developmental Disabilities, 25, 371-383.
Sigafoos, J., O'Reilly, M., Seely-York, S., Weru, J., Son, S.H., Green, V.A. & Lancioni, G.E. (2004). Transferring AAC intervention to the home. Disability and Rehabilitation, 26(21/22), 1330-1334.
Sigafoos, J., O’Reilly, M., Ganzb, J.B., Lancioni, G.E. & Schlosser, R.W. (2005). Supporting self-determination in AAC interventions by assessing preference for communication devices. Technology and Disability, 17, 143-153.
Sonnenmeier, R., McSheehan, M. & Jorgensen, C.M. (2005). A case study of team supports for a student with autism’s communication and engagement within the general education curriculum: Preliminary report of the beyond access model. Augmentative and Alternative Communication, 21(2), 101-115.
Warren, S. F. & Kaiser, A. P.(1986). Incidental language teaching: A critical review. Journal of Speech and Hearing Disorders, 51, 291-299.
Wickstrom-Kane, S. & Golestein, H. (1999). Communtion assessment and intervention to address challenging behavior in toddlers. Topical in Language Disorders, 19(2), 70-89.