本研究探討體驗設計是否可以協助自閉症兒童的家庭有正向且具親密感的刷牙體驗，以及藉由此是否可以增進刷牙技巧並降低口腔敏感症狀。以研究一讓三個自閉症家庭使用我們的設計驗證假設一，具視覺提示和感覺回饋的互動裝置能夠促進學習刷牙技巧，並積極強化孩童使用動機。研究一和研究二的結果顯示，該互動裝置確實有助於兒童更好地理解指示並預測步驟，從而幫助學習過程。然而，照顧者的監督仍然是習得刷牙技巧的重要關鍵，因為兒童在獨立刷牙：掌握刷牙拿牙刷的手勢以及維持清潔確實度仍然有困難。儘管感覺回饋最初吸引了兒童的興趣，但隨著時間興趣會衰退，說明儘管有感覺回饋，仍需要多樣化的回饋機制來維持參與度。

在家使用設計裝置一個月的實驗二探討了假設二：體驗設計是否會增加孩童動機，帶來正向的體驗並促進家庭的互動。結果顯示出不同的結果：一個家庭發現這個過程愉快並能提升親子關係，另一個家庭卻因刷牙檢查的要求而增加了衝突。研究強調了照顧者參與的重要性，因為有效持續的刷牙習慣與結構化的家長指導密切相關。結果也顯示基於家庭動力、兒童自身能力和照顧者策略與個性的個體差異。

假設三檢驗了家庭互動模式的變化，結果顯示，一個家庭的合作與互動有所改善，而另一個家庭由於程序要求而遇到了更多衝突。儘管研究受到樣本量小、程序非標準化和受試者選擇偏差的限制，但它強調了結構化的互動設計在以家庭為中心自我照護技能介入方面的益處。

在本研究中，我們介紹新的介入方式：將互動設計、體驗設計結合在以家庭為中心的介入。跟傳統以家庭為中心或關係導向的介入方式不同，這些方法通常讓家長在彈性的情境，跟隨孩童興趣引導孩子完成活動，但我們的方法專注於刷牙，並且提供了結構化的流程和設計的輔具，以及衛教，來使這一日常生活任務具體且讓家長容易執行。傳統的家庭為中心的治療通常依賴於家長的調整和指導，但有了我們的設計，介入過程變得直觀且容易執行，減輕了家長的照顧負擔。

此外，我們藉由在介入中應用體驗設計，提出了關於ASD兒童內在動機的新觀點。這種方法成功地吸引並促進了每個孩子在研究一和研究二中與輔具互動並跟家長合作刷牙。結果顯示，ASD兒童，尤其是像B家庭中年紀較小且自閉症狀較嚴重的孩子，在介入期間對科技互動輔具表現出強烈的動機。這種對科技的興趣促進了他們對先前不熟悉任務的初步興趣和嘗試的動機，而一旦孩子對任務產生興趣，科技互動輔具就像一塊敲門磚，鼓勵他們嘗試並最終享受跟家長一起完成這一個原先他們不喜歡的活動。過程中，輔具還作為增強了孩子與家庭之間的互動的一種媒介，藉由共享活動促進了合作和親子關係。

我們的研究結果表明，通過提供結構化、有趣的家庭環境中的體驗，以體驗設計所做的互動設計裝置可以顯著增強家長實施的ASD介入效果。它可以協助ASD兒童與其照顧者之間的互動鴻溝，使像刷牙這樣的自我照護任務變得更易於執行和享受。最終，研究強調基於實證有效的介入方式，來進行設計，並且以彈性的方式來進行以家庭為中心介入，協助ASD兒童自我照護技能的發展。

This study explores whether interactive technology can enhance toothbrushing skills and reduce oral hypersensitivity in children with Autism Spectrum Disorder (ASD) through collaborative activities with their parents. The study is structured around three main hypotheses.

Hypothesis 1: Technology with visual cues and sensory feedback will facilitate learning toothbrushing techniques and positively reinforce the behavior.

The findings from Study 1 and Study 2 indicated that the interactive device helped children understand instructions better and anticipate steps, thus aiding the learning process. Visual cues and sensory feedback were particularly effective in the initial stages. For instance, the device used LED lights to indicate where to brush next, making the instructions clear and engaging for children with ASD who are often visual learners. However, it was noted that consistent adult supervision remained crucial. Children struggled with independent brushing and correctly positioning the brush without guidance. While sensory feedback initially captured the children's interest, their engagement waned over time. This suggests a need for varied feedback mechanisms to maintain long-term interest and effectiveness.

Hypothesis 2: These experiences will increase motivation and foster family bonds.

The results showed mixed outcomes. One family found the process enjoyable and bonding, with the collaborative toothbrushing sessions becoming a positive routine. The structured protocol helped the family establish a predictable and engaging routine, which is beneficial for children with ASD who often thrive on structure and consistency. In this scenario, the interactive technology served as a medium for enhancing interactions between the child and their parents, promoting cooperation and bonding through a shared activity.

However, another family experienced increased conflicts due to the demanding procedural expectations. The rigid structure of the protocol, while beneficial in some contexts, was seen as burdensome in others, leading to frustration and resistance. This highlights the importance of flexibility and customization in interventions to accommodate the diverse needs and dynamics of different families.

The study underscored the critical role of caregiver involvement. Effective toothbrushing habits were closely linked to structured parental guidance and positive reinforcement. It also noted individual differences in responses, which were influenced by family dynamics, children’s abilities, and caregiver strategies. These findings suggest that while technology can be a powerful tool, its success depends significantly on how it is integrated into the family routine and supported by caregivers.

Hypothesis 3: Changes in family interaction patterns will be observed.

The study revealed varying impacts on family interactions. In one family, the intervention improved cooperation and interaction, creating a more harmonious and supportive environment. The interactive design helped reduce the child’s anxiety and resistance towards toothbrushing, turning a potential conflict into a cooperative activity. This positive shift was facilitated by the technology’s ability to provide clear instructions and engaging feedback, which made the task more manageable and enjoyable for the child.

Conversely, another family encountered more conflicts due to the procedural demands of the intervention. The structured approach, while effective in providing clear guidance, was perceived as too rigid, causing stress and frustration. This finding highlights the need for a balance between structure and flexibility in designing interventions. It also suggests that ongoing support and adaptation are crucial to addressing the evolving needs of families.

This study introduced a novel intervention combining assistive technology with family-centered therapy in the natural home environment. Unlike traditional family-centered or relationship-based interventions, which often leave parents to guide their children through activities that follow child’s interest, our approach focused specifically on toothbrushing. We provided a structured protocol and a device designed to make this daily living task concrete and manageable. Traditional home-based interventions typically rely on parents' adjustments and guidance, but our device made the process vivid and straightforward, reducing the burden on parents.

Furthermore, we incorporated a new perspective on the intrinsic motivation of children with ASD by applying experience design to the intervention. This approach successfully engaged and motivated every child to interact with the device and cooperate with toothbrushing in both Study 1 and Study 2. The study highlighted that children with ASD, especially younger and more severe cases, showed a strong affinity for technology during interventions. This technology intimacy facilitated their initial interest and positive experiences with previously unfamiliar tasks.

For example, once a child was interested in the task, technology acted as an inviting gateway, encouraging them to try and eventually enjoy the activity. The intervention also served as a medium for enhancing interactions between the child and their family, fostering cooperation and bonding through the shared activity. Our findings suggest that technology can significantly enhance the effectiveness of ASD interventions implemented by parents by providing structured, engaging, and motivating experiences in a home setting.

The study also emphasized the importance of flexible, technology-enhanced family-centered interventions that are grounded in effective principles to support the development of self-care skills in children with ASD. It demonstrated that interactive technology could bridge the interaction gap between children with ASD and their caregivers, making self-care tasks like toothbrushing more manageable and enjoyable.

In conclusion, this research underscores the potential benefits of structured, interactive designs in teaching self-care skills to children with ASD. It highlights the need for a balanced approach that combines clear guidance with flexibility to accommodate individual family dynamics and preferences. The use of technology in family-centered interventions offers promising avenues for enhancing engagement, motivation, and cooperation, ultimately improving the quality of life for children with ASD and their families.

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