研究背景：自閉症類群障礙症（autism spectrum disorder‚ ASD）幼兒自發展早期起便開始顯現出溝通及社交困難，進而影響其認知、社會－情緒以及語言領域的發展。在眾多以實證研究為基礎的ASD早期介入模式中，丹佛早療模式（Early Start Denver Model, ESDM）因將傳統的應用行為分析及發展取向結合，並同時對多個重要發展領域進行介入而備受關注。過往研究已證實，長時間且中至高強度的ESDM介入對ASD幼兒具正向療效。然而，在資源有限的地區實施此介入時，仍面臨人力、時間與制度等多方面的挑戰。
研究目的：考量到台灣醫療系統的資源不足，本研究旨在大幅度降低ESDM介入的強度，以探究更低強度ESDM介入對台灣南部ASD幼兒的療效。
研究方法：本研究採單一受試研究設計之跨受試多基線設計。以3名生理年齡26至40個月的ASD幼兒為研究參與者，進行每週2小時、為期24週的低強度ESDM介入。將基線期、介入期及追蹤期幼兒與治療師互動的影片，以視覺分析的方式分析介入對模仿、語言表達及社會參與能力之影響。介入前後亦進行多項實驗室測量及家長問卷，以共享式注意力、模仿、遊戲、溝通、語言能力為近端療效指標，心智發展能力、症狀嚴重度、適應功能及行為問題則為遠端療效指標。
研究結果：互動影片的分析結果顯示，低強度ESDM介入對3名幼兒的模仿、語言表達、社會參與能力具個別差異，涵蓋輕微至極高的正向介入效果，追蹤期資料皆顯示上述目標行為具有一定程度的維持效果。此外，介入效果與維持效果皆呈現相似趨勢，語言表達表現最佳，社會參與次之，模仿則相對較低。實驗室測量及家長問卷方面，3名幼兒在多數近端療效指標皆有提升，遠端療效則整體變化有限，僅有2名幼兒在心智發展能力呈明顯進步。
結論：低強度ESDM介入能增進ASD幼兒於各項發展領域的能力，尤其在語言表達方面。未來研究宜納入更多的樣本，並透過實驗控制組前後測設計，以進一步驗證低強度ESDM介入對ASD幼兒的療效。

Young children with autism spectrum disorder (ASD) begin to exhibit communication and social difficulties early on, which subsequently affect their cognitive, social-emotional, and language development. The Early Start Denver Model (ESDM), which integrates applied behavior analysis and developmental approaches, has gained empirical support for improving multiple developmental domains in young children with ASD. However, delivering moderate- to high- intensity ESDM interventions remains challenging in regions with limited resources and high demand for early intervention services, such as Taiwan. This study aimed to evaluate the effectiveness of a significantly reduced-intensity ESDM intervention delivered for 2 hours per week over 24 weeks to three children aged 26 to 40 months in Southern Taiwan. A single-subject experimental design with a multiple-probe approach was employed. Child-therapist interactions were video-recorded during baseline, intervention, and follow-up phases, focusing on imitation, verbal expression, and social engagement. Additional laboratory-based assessments and parent questionnaires measured joint attention, play, communication, cognitive development, symptom severity, adaptive functioning, and behavioral problems before and after the intervention. Visual analysis revealed varied but positive effects on imitation, verbal expression, and social engagement, with verbal expression showing the most significant improvement, followed by social engagement and imitation. Although trend stability varied, follow-up data demonstrated maintenance of intervention effects across most target behaviors, with some participants exhibiting further progress. Most proximal outcomes improved in all participants, whereas distal outcomes showed minimal progress overall, except for cognitive development. These findings suggest that low-intensity ESDM can enhance developmental abilities in young children with ASD, especially verbal skills. Future studies with larger samples and controlled designs are needed to confirm these results.

杜正治（2006）。單一受試研究法。心理出版社。
李沿澈、吳進欽、李羽涵（2016）。自閉症類群疾患幼兒語言能力相關因素：共享式注意力與模仿。中華心理學刊，58(3)，187-206。https://doi.org/10.6129/CJP.20160829
吳進欽、姜忠信、侯育銘（2005）。自閉症兒童的立即模仿與延遲模仿之研究。中華心理衛生學刊，18(2)，1-24。https://doi.org/10.30074/FJMH.200506_18(2).0001
林初穗、張淑慧（2010）。中文版嬰幼兒語言溝通及象徵性行為量表之預測效度研究。行政院國家科學委員會專題研究計畫成果報告（NSC99-2410-H-033）。
林怡均（2022）。台灣自閉症兒童父母關注、診斷及早期療育年齡之影響因素分析〔未出版碩士論文〕。國立成功大學公共衛生研究所。
林姿伶、姜忠信、吳欣治（2016）。自閉症類群兒童綜合性早期療育的療效研究：文獻回顧。中華心理衛生學刊，29(1)，1-46。 https://doi.org/10.30074/FJMH.201603_29(1).0001
周錦淑（2011）。臺北市自閉症者家庭應用社會福利服務資源現況之調查〔未出版碩士論文〕。國立臺北大學社會工作系。
陳怡群、黃惠玲、趙家琛（修訂）（2009）。阿肯巴克實證衡鑑系統。心理出版社。
徐卉昀、黃湘涵、蕭右欣、蔡宜芳、陳怡妤（2022）。丹佛早療模式和相關因子於自閉症類群障礙幼童之療效：文獻回顧。職能治療學會雜誌，40 (2), 243-273。https://doi.org/10.6594/JTOTA.202212_40(2).0004
曾凡慈（2010）。醫用者的運籌行動:形塑早期療育的照護軌跡。台灣社會學刊，45，63-116。https://doi.org/10.6786/TJS.201012.0063
衛生福利部統計處（2025）。身心障礙者人數按年齡及類別分。中華民國衛生福利部。https://dep.mohw.gov.tw/DOS/cp-5224-62359-113.html
劉惠美、曹峰銘（2010）。華語嬰幼兒溝通發展量表（台灣版）。心理出版社。
盧台華、陳心怡（2009）。適應行為評量系統第二版（ABAS-II）中文－幼兒版。中國行為科學社。
蘇怡菁（2019）。動態擷取介入對自閉症類群障礙幼兒社會參與之療效研究〔未出版碩士論文〕。國立政治大學心理學系研究所。
Achenbach, T. M., Rescorla, L. A. (2000). Manual for the ASEBA preschool forms and profiles: An integrated system of multi-informant assessment. University of Vermont, Research center for children, youth & families.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.
Bayley, N. (2006). Bayley scales of infant and toddler development (3rd ed.). Harcourt Assessment.
Begus, K., & Southgate, V. (2018). Curious learners: How infants’ motivation to learn shapes and is shaped by infants’ interactions with the social world. In: Saylor, M., Ganea, P. (Eds.), Active Learning from Infancy to Childhood. Springer, Cham, 13-37. https://doi.org/10.1007/978-3-319-77182-3_2
Canoy, J. P., Boholano, H. B. (2015). Early start DENVER model: A meta- analysis. Journal of Education and Learning, 9(4), 314-327. https://doi.org/10.11591/edulearn.v9i4.2494
Chiang, C. H., Lin, T. L., Lin, H. Y., Ho, S. K., Wong, C. C., & Wu, H. C. (2023). Short-term low-intensity Early Start Denver Model program implemented in regional hospitals in Northern Taiwan. Autism, 27(3), 778-787. https://doi.org/10.1177/13623613221117444
Cidav, Z., Munson, J., Estes, A., Dawson, G., Rogers, S., & Mandell, D. (2017). Cost offset associated with Early Start Denver Model for children with autism. Journal of the American Academy of Child & Adolescent Psychiatry, 9, 777-783. https://doi.org/10.1016/j.jaac.2017.06.007
Colombi, C., Narzisi, A., Ruta, L., Cigala, V., Gagliano, A., Pioggia, G., Siracusano, R., Rogers, S. J., Muratori, F., & Team, P. P. (2018). Implementation of the Early Start Denver Model in an Italian community. Autism, 22(2), 126-133. https://doi.org/10.1177/1362361316665792
Dawson, G., Rieder, A. D., & Johnson, M. H. (2023). Prediction of autism in infants: progress and challenges. The Lancet Neurology, 22(3), 244-254. https://doi.org/10.1016/S1474-4422(22)00407-0
Dekker, V., Nauta, M. H., Timmerman, M. E., Mulder, E. J., van der Veen-Mulders, L., van den Hoofdakker, B. J., van Warners, S., Vet, L. J. J., Hoekstra, P. J., & de Bildt, A. (2019). Social skills group training in children with autism spectrum disorder: a randomized controlled trial. European Child & Adolescent Psychiatry, 28, 415-424. https://doi.org/10.1007/s00787-018-1205-1
de la Cuesta, G. G. (2009). Trends in the economic costs of autism in the UK. Tizard Learning Disability Review, 14(3), 41-44. https://doi.org/10.1108/13595474200900029
Devescovi, R., Colonna, V., Dissegna, A., Bresciani, G., Carrozzi, M., & Colombi, C. (2021). Feasibility and outcomes of the Early Start Denver Model delivered within the public health system of the Friuli Venezia Giulia Italian region. Brain Sciences, 11(9), 1191. https://doi.org/10.3390/brainsci11091191
Devescovi, R., Monasta, L., Mancini, A., Bin, M., Vellante, V., Carrozzi, M., & Colombi, C. (2016). Early diagnosis and Early Start Denver Model intervention in autism spectrum disorders delivered in an Italian public health system service. Neuropsychiatric Disease and Treatment, 12, 1379-1384. https://doi.org/10.2147/NDT.S106850
Esler, A. N., Bal, V. H., Guthrie, W., Wetherby, A., Weismer, S. E., & Lord, C. (2015). The autism diagnostic observation schedule, toddler module: Standardized severity scores. Journal of Autism and Developmental Disorders, 45, 2704-2720. https://doi.org/10.1007/s10803-015-2432-7
Fenson, L., Dale, P. S., Reznick, J. S., Thal, D. J., Bates, E., Hartung, J. P., Pethick, S., & Reilly, J. S. (1993). The MacArthur communicative development inventories: User’s guide and technical manual. Singular Publishing Group.
Fuller, E. A., Oliver, K., Vejnoska, S. F., & Rogers, S. J. (2020). The effects of the Early Start Denver Model for children with autism spectrum disorder: A meta-analysis. Brain sciences, 10(6), 368. https://doi.org/10.3390/brainsci10060368
Ganz, M. L. (2007). The lifetime distribution of the incremental societal costs of autism. Archives of Pediatrics and Adolescent Medicine, 161, 343-349. https://doi.org/10.1001/archpedi.161.4.343
Gast, D. L., & Ledford, J. R. (2014). Applied research in education and behavioral sciences. Single case research methodology (pp. 1-18). Routledge.
Harrison, P. & Oakland, T. (2003). Adaptive Behavior Assessment System (2nd ed.). Harcourt Assessment.
Hirota, T., & King, B. H. (2023). Autism spectrum disorder: A review. JAMA, 329(2), 157-168. https://doi.org/10.1001/jama.2022.23661
Ho, H.-K. (2010). Early intervention for young children with special needs in Taiwan. International Journal of Early Childhood Special Education, 2, 1-11. https://doi/org/10.34097/jeicom_2_1_ june2020
Holzinger, D., Laister, D., Vivanti, G., Barbaresi, W. J., & Fellinger, J. (2019). Feasibility and outcomes of the Early Start Denver Model implemented with low intensity in a community setting in Austria. Journal of Developmental & Behavioral Pediatrics, 40(5), 354-363. https://doi.org/10.1097/DBP.0000000000000675
Horlin, C., Falkmer, M., Parsons, R., Albrecht, M. A., & Falkmer, T. (2014). The cost of autism spectrum disorders. PloS One, 9(9), e106552 https://doi.org/10.1371/journal.pone.0106552
Huang, A. X., Jia, M., & Wheeler, J. J. (2013). Children with autism in the people’s Republic of China: Diagnosis, legal issues, and educational services. Journal of Autism and Developmental Disorders, 43, 1991-2001. https://doi.org/10.1007/s10803-012-1722-6
Innocenti, M. S. & White, K. R. (1993). Are more intensive early intervention programs more effective? A review of the literature. Exceptionality, 4(1), 31-50. https://doi.org/10.1207/s15327035ex0401_3
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2(3), 217-250.
Kennedy, C. H. (2005). Single-case designs for educational research. Pearson.
Kevin Ramseur, I. I., de Vries, P. J., Guler, J., Shabalala, N., Seris, N., & Franz L. (2019). Caregiver descriptions of joint activity routines with young children with autism spectrum disorder in South Africa. Pediatric Medicine, 2, 6. https://doi.org/10.21037/pm.2019.03.04
Knapp, M., Romeo, R., & Beecham, J. (2009). Economic cost of autism in the UK. Autism, 13(3), 317-336. https://doi.org/10.1177/1362361309104246
Lane, J. D., & Gast, D. L. (2014). Visual analysis in single case experimental design studies: Brief review and guidelines. Neuropsychological Rehabilitation, 24(3-4), 445–463. https://doi.org/10.1080/09602011.2013.815636
Lifter, K. (2001). Linking assessment to intervention for children with developmental disabilities or at-risk for developmental delay: The developmental play assessment (DPA) instrument. In K. Gitlin-Weiner, A. Sandgrund, & C. Schafer (Eds.), Play Diagnosis and Assessment (pp. 228-260). New York Wiley.
Lifter, K. (2000). Linking assessment to intervention for children with developmental disabilities or at-risk for developmental delay: The developmental play assessment (DPA) instrument. In K. Gitlin-Weiner, A. Sandgrund, & C. Schafer (Eds.), Play diagnosis and assessment (2nd ed., pp. 228-261). John Wiley & Sons.
Lin, T. L., Chiang, C. H., Ho, S. Y., Wu, H. C., & Wong, C. C. (2020). Preliminary clinical outcomes of a short-term low-intensity Early Start Denver Model implemented in the Taiwanese public health system. Autism, 24(5), 1300-1306. https://doi.org/10.1177/1362361319897179
Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2012). Autism diagnostic observation schedule (2nd ed.) [Manual; Modules 1–4]. Western Psychological Services.
Mullen, E. M. (1995). Mullen scales of early learning (AGS ed.). American Guidance Service.
Ogilvie, E., & McCrudden, M.T. (2017). Evaluating the social validity of the Early Start Denver Model: a convergent mixed methods study. Journal of Autism and Developmental Disorders, 47(9), 2899-2910. https://doi.org/10.1007/s10803-017-3214-1.
Parker, R. I., Vannest, K. J., & Davis, J. L. (2011). Effect size in single-case research: A review of nine nonoverlap techniques. Behavior Modification, 35(4), 303-322. https://doi.org/10.1177/0145445511399147
Rogers, S. (2016). Early start Denver model. In Comprehensive models of autism spectrum disorder treatment: Points of divergence and convergence (pp. 45-62). Springer International Publishing.
Rogers, S. J., & Dawson, G. (2009). Early Start Denver Model curriculum checklist for young children with autism. Guilford Press.
Rogers, S. J., & Dawson, G. (2014). 丹佛早療模式：促進自閉症幼兒的語言、學習及參與能力（姜忠信、劉瓊瑛、朱思穎譯）。洪葉文化。（原著出版年：2010）
Rogers, S. J., Estes, A., Lord, C., Munson, J., Rocha, M., Winter, J., Greenson, J., Colombi, C., Dawson, G., Vismara, L. A., Sugar, C. A., Hellemann, G., Whelan, F., & Talbott, M. (2019). A multisite randomized controlled two-phase trial of the Early Start Denver Model compared to treatment as usual. Journal of the American Academy of Child & Adolescent Psychiatry, 58(9), 853-865. https://doi.org/10.1016/j.jaac.2019.01.004
Rogers, S. J., Hepburn, S. L., Stackhouse, T., & Wehner, E. (2003). Imitation performance in toddlers with autism and those with other developmental disorders. Journal of Child Psychology and Psychiatry, 44(5), 763-781. https://doi.org/10.1111/1469-7610.00162
Rogers, S. J., Yoder, P., Estes, A., Warren, Z., McEachin, J., Munson, J., Rocha, M., Greenson, J., Wallace, L., Gardner, E., Dawson, G., Suger, C. A., Hellemann, G., & Whelan, F. (2021). A multisite randomized controlled trial comparing the effects of intervention intensity and intervention style on outcomes for young children with autism. Journal of the American Academy of Child & Adolescent Psychiatry, 60(6), 680-682. https://doi.org/10.1016/j.jaac.2020.06.013
Rogge, N., & Janssen, J. (2019). The economic costs of autism spectrum disorder: A literature review. Journal of Autism and Developmental Disorders, 49(7), 2873-2900. https://doi.org/10.1007/s10803-019-04014-z
Ryberg, K.H. (2015). Evidence for the implementation of the Early Start Denver Model for young children with autism spectrum disorder. Journal of the American Psychiatric Nurses Association, 21, 327-337. https://doi.org/10.1177/1078390315608165
Sandbank, M., Bottema-Beutel, K., Crowley, S., Cassidy, M., Dunham, K., Feldman, J. I., Crank, J., Albarran, S. A., Raj, S., Mahbub, P., & Woynaroski, T. G. (2020). Project AIM: Autism intervention meta-analysis for studies of young children. Psychological Bulletin, 146(1), 1-29. https://doi.org/10.1037/bul0000215
Schlosser, R. W., & Sigafoos, J. (2006). Augmentative and alternative communication interventions for persons with developmental disabilities: Narrative review of comparative single-subject experimental studies. Research in Developmental Disabilities, 27(1), 1-29. https://doi.org/10.1016/j.ridd.2004.04.004
Schreibman, L., Dawson, G., Stahmer, A., Landa, R., Rogers, S. J., McGee, G. G., Kasari, C., Ingersoll, B., Kaiser, A. P., Bruinsma, Y., McNerney, E., Wetherby, A., & Halladay, A., (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 2411-2428. https://doi.org/10.1007/s10803-015-2407-8
Shaw, K. A., Williams, S., Patrick, M. E.., Valencia-Prado, M., Durkin, M. S., Howerton, E. M., Ladd-Acosta, C. M., Pas, E. T., Bakian, A. V., Bartholomew, P., Nieves-Muñoz, N., Sidwell, K., Alford, A., Bilder, D. A., Dirienzo, M., Fitzgerald, R. T., Furnier, S. M., Hudson, A. E., Pokoski, O. M., …, Maenner, M. J. (2025). Prevalence and early identification of autism spectrum disorder among children aged 4 and 8 years—Autism and Developmental Disabilities Monitoring Network, 16 sites, United States, 2022. MMWR Surveillance Summaries, 74(SS-2), 1-22. https://doi.org/10.15585/mmwr.ss7402a1
Shonkoff, J. P., Hauser-Cram, P., Krauss, M. W., & Upshur, C. C. (1990). The early intervention collaborative study: Executive summary of findings from phase one. University of Massachusetts Medical School.
Song, J., Reilly, M., & Reichow, B. (2024). Overview of meta-analyses on Naturalistic Developmental Behavioral Interventions for children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 55(1), 1-13. https://doi.org/10.1007/s10803-023-06198-x
Stone, W. L., Coonrod, E. E., Ousley, O. Y. (2000). Brief report: Screening tool for autism in two-year-olds (STAT): Development and preliminary data. Journal of Autism and Developmental Disorders, 30(6), 607-612.
Talbott, M. R., Estes, A., Zierhut, C., Dawson, G., & Rogers, S. J. (2016). Early start Denver model. Early Intervention for Young Children with Autism Spectrum Disorder, 113-149.
Tateno, M., Inagaki, T., Saito, T., Guerrero, A. P. S., & Skokauskas, N. (2017). Current challenges and future opportunities for child and adolescent psychiatry in Japan. Psychiatry Investigation, 14(5), 525-531. https://doi.org/10.4306/pi.2017.14.5.525
Tateno, Y., Kumagai, K., Monden, R., Nanba, K., Yano, A., Shiraishi, E., Teo, A. R., & Tateno, M. (2021). The efficacy of Early Start Denver Model intervention in young children with autism spectrum disorder within Japan: A preliminary study. Journal of the Korean Academy of Child and Adolescent Psychiatry, 32(1), 35-40. https://doi.org/10.5765/jkacap.200040
Tiede, G., & Walton, K. M. (2019). Meta-analysis of naturalistic developmental behavioral interventions for young children with autism spectrum disorder. Autism, 23(8), 2080-2095. https://doi.org/10.1177/1362361319836371
Tupou, J., Waddington, H., van der Meer, L. & Sigafoos, J. (2022). Effects of a low- intensity Early Start Denver Model-based intervention delivered in an inclusive preschool setting. International Journal of Developmental Disabilities, 68(2), 107-121. https://doi.org/10.1080/20473869.2019.1707434
Vivanti, G. (2019). Towards a culturally informed approach to implementing autism early intervention: A commentary on Ramseur II et al., 2019. Pediatric Medicine, 2, 20. https://doi.org/10.21037/pm.2019.06.01
Waddington, H., van der Meer, L., Sigafoos, J., & Ogilvie, E. (2020). Evaluation of a low-intensity version of the Early Start Denver Model with four preschool-aged boys with autism spectrum disorder. International Journal of Developmental Disabilities, 66(4), 257-269. https://doi.org/10.1080/20473869.2019.1569360
Wang, S.-H., Zhang, H.-T., Zou, Y.-Y., Cheng, S.-M., Zou, X.-B., & Chen, K.-Y. (2023). Efficacy and moderating factors of the Early Start Denver Model in Chinese toddlers with autism spectrum disorder: A longitudinal study. World Journal of Pediatrics, 19(8), 741-752. https://doi.org/10.1007/s12519-022-00555-z
Wang, Z., Loh, S. C., Tian, J., & Chen, Q. J. (2022). A meta-analysis of the effect of the Early Start Denver Model in children with autism spectrum disorder. International Journal of Developmental Disabilities, 68(5), 587-597. https://doi.org/10.1080/20473869.2020.1870419
Wetherby, A. M., & Prizant, B. (2002). Communication and symbolic behavior scales developmental profile. Paul H Brookes.
Xu, Y., Yang, J., Yao, J., Chen, J., Zhuang, X., Wang, W., Zhang, X., & Lee, G. T. (2018). A pilot study of a culturally adapted early intervention for young children with autism spectrum disorders in China. Journal of Early Intervention, 40(1), 52-68. https://doi.org/10.1177/1053815117748408
Yoder, P., & Stone, W. L. (2006). A randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. Journal of Speech, Language, and Hearing Research, 49, 698-711. https://doi.org/10.1044=1092-4388(2006=051)
Yu, Y., Ozonoff, S., & Miller, M. (2024). Assessment of autism spectrum disorder. Assessment, 31(1), 24-41. https://doi.org/10.1177/10731911231173089
Yoder, P. J., Bottema-Beutel, K., Woynaroski, T., Chandrasekhar, R., & Sandbank, M. (2013). Social communication intervention effects vary by dependent variable type in preschoolers with autism spectrum disorders. Evidence-based Communication Assessment and Intervention, 7(4), 150-174. https://doi.org/10.1080/17489539.2014.917780
Zwaigenbaum, L., Bauman, M. L., Choueiri, R., Fein, D., Kasari, C., Pierce, K., Stone, W. L., Yirmiya, N., Estes, A., Hansen, R. L., McPartland, J. C., Natowicz, M. R., Buie, T., Carter, A., Davis, P. A., Granpeesheh, D., Mailloux, Z., Newschaffer, C., Robins, D., … Wetherby, A. (2015). Early identification and interventions for autism. Pediatrics, 136, 814-823. https://doi.org/10.1542/peds.2014-3667B