NGHIEN CUU & UNG DUNG
DANH GIA TRE TU KY
ThS. N g u y i n T h | Thanh Truong Cao ddng Suphgm Trung uang L D A T V A N D ^
Djnh nghTa theo DSM-FV- TR: ty ky ndm ti-ong nh6m cdc rli logn phdt triln Ian tod (PDD: Pervasive Developmental Disorders); Ld mpt nh6m h^i chiing dugc djc trung bdi suy gidm n$ng nl vd Ian tod trong nh&ng ITnh vyc phdt triln: tirong tdc x3 h$i, giao dip vd cd nhihig hdnh vi rgp khudn, djnh hinh.
1. Suy gidm ve tutnig tdc x3 h$i: Tre bj suy gidm nhieu trong tuang tdc qua Igi vdi mgi ngudi, hdu hit he ty ky (TTK) bilu hien su CO Igp, thich choi mgt minh.
2. Suy gidm ve giao tiep Trong giao tiSp bdng ,ngay, TTK khong quan tdm din Idi ndi ciia doi tugng giao tilp.
Tre khdng c6 phdn ling khi gpi ten minh, khong quan tdm d8n moi ngudi xung quanh, khong lam theo nh&ng hudng dan cua ngudi khac trong khi do tre vdn cd cae ki ndng nghe nhu tre binh thudng. Co mgt s6 TTK d dang cam, tiic la chua bao gid noi, mdc dii tre cd dm ngu nhung khong giao tilp, khdng noi. Tre khong c6 nhu cau chia s6 vdi moi ngirdi xung quanh, lupn dam chim suy nghi trong thi gidi rieng cua minh.
Da phdn TTK gJip kho khan trong dien dgt Idi n6i, mdt so tre khdng hi€u ngudi khdc noi gi nen khong bilt ndi gi khi giao tiep.
MQt so tre khdc hilu noi dung giao tilp nhung khong ndi. Khi giao tiep vdi nhihig ngudi xung quanh, tre thudng c6 dnh mat nhin Idng tranh, Idiong nhin vdo mat ngudi khdc khi tr6 chuyen de nhan bi8t khi ndo tdi phi8n minh ndi chuySn, khi ndo nhudng cho ngudi khdc. Khi \xh mu6n,dilu gi, tr8 khdng dung Idi ndi dl yeu cau, khdng diing cdc tin hieu cii chi de bdo cho ngudi khac bilt md thudng keo tay hg den chd tre Ngay nhgn bai 20/12/2012; Ngay duyel dang 1 0 • TAP CHI THIET BI GIAO DUC
3. Hdnh vi cd tfnh r|p khudn, djnh hinh
Cdc hieu chiing ndy xudt hi?n trudc 3 tuoi. Trong qud trinh can thi§p sdm cho TTK, ddnh gid Id mQt vi$c 1dm quan trpng giiip chiing ta cd till gidi ddp dugc tilde mdc: tch cd bj Ty ky khdng?
M&c dp Id njng hay nh?? Cd khuylt tgt ndo di kfem khong?...
Tren co sd dd 1dm cdn cd quan trgng d l tiln hdnh xay dyng ehuong trinh Can thi?p sdm cho trd Cling nhu vi^c tu van, hudng din phu huynh.
II. NOI DUNG
Trong qud trinh ddnh gid nhd chuy8n mdn cdn sd dung cdc phuong h§n, cdc c6ng cu danh gia de dua ra kit luan chinh xac, khoa hgc. Vi?c ddnh gia TTK can thyc hi$n cdc budc nhu sau:
Budc 1: Quan sdt nhfing dau hi|u it tr£ c6 the nghi ngd I d T v k ^
- Ve ngdn ngit. TTK khong biet bap be luc 12 thdng, khong bilt ndi tu don liic 16 thdng, khong ndi dugc cum t& doi mot cdch ty^nhien liic 24 thdng.
- Ve quan hf xa hgi: TTK khong biet cudi Idn tieng hoac co nhihig bieu Ip vui v8, thich thii khac d 6 thdng tu6i. Khong chia sfi qua Igi vdi nhiing am thanh, nu cudi, ho$c bilu 16 net m a t d liic 9 thdng, rat dgc lap, giao tilp mdt kem d trong chinh thi gidi cua ti-e, khdng hod hgp, khdng quan tam din tre khdc, khdng bilt bdt chude vdo liic 24 thdng.
- vi giao tiep: TTK khdng ddp ling khi ggi t8n, khdng tiieo hudng din, khong nhin vao mat va mdt ngudi khdc khi giao tilp, CO liic nghe nhung liic khdc lai khong nghe.
, - Ve hdnh vi: Nhiing can ndi gian, tdng dgng, khdng hgp tdc bode chdng dli, di nhdn gdt.
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gdn bd khdc thudng vdi mdt s6 dd choi, qud nhay cam vdi mdt so cdm gidc, xiic gidc hoac am thanh, cd nh&ng kilu van dong ngdn tay bode co thi khac la.
Budc 2: Ddnh gil sdng Ipc TTK theo Bdng kilm M - CHAT
Cdu hdi ciia bdng kilm M - CHAT (ddnh cho tr6 d dp tudi 16-36 tiidnghioi)
1. Tr6 cd thich thu duoc du dua bode nhdy tr§n ddu gdi ban khdng?
2. Tre cd quan tdm din tre khdc khdng?
3. Tre cd thich leo, treo cSu thang khdng?
4. Tre cd thich choi li oa hoac tim mpt dd vat hi,ddu di khong?
5. Tre ed bilt choi gia va, vd: noi chuy?n di?n thogi, cham blip be ho^c trd choi gia vd khac khdng?
6. Tre cd su dung ngdn cho de chi ho^c chia tay de xin cdi ^ do khdng?
_ 7. Tre co chi bdng ngon tro de the hi^n sy quan tdm ve thur gi do khdng?
8. Tre cd choi diing each voi dd choi khdng (xe 6 td, bo xep hinh...) md khdng bd vao mieng, thao tdc rdp khudn ho^c nera di khdng?
, 9. Tre cd dua cho ban nhung dd choi hodc do vat de chi cho ban khdng?
10. Tre cd nhin vdo mat b ^ nhieu hem 2 gidy khdng?
11., Tre ed v8 qud nhay cam vdi tieng ddng khdng? (vd: bit tai)
12. Tre cd cudi de dap lai nu cudi cua ban khdng?
13. Tre cd bat chudc ban khdng?
14. Tr8 cd ddp dug khi tre gpi ten ban khdng?
15. Khi ban chi mpt dd chcri trong phdng, tre cd nhin theo
NGHIEN CUU & UNG DUNG khdng?
16. Tre cd di binh thudng khdng?
17. Tre cd nhin dd vdt md ban nhin khdng?
18. Tre CO 1dm nhiing cu dgng bdt thudng cua ngdn tay gdn m$t fre khdng?
19. Tre c6 1dm ban chii y din sinh boat ciia tr6 khdng?
20. Co bao gid ban nghi con ban hi diec khong?
21. Tre cd hieu dieu ngudi khdc noi khdng?
22. Ddi khi tre co nhin ddm ddm dieu gi hodc di lang thang khdng chii dich khdng?
_ 23. Tre co nhin vao mdt b ^ dS ki8m tra phdn ling ciia ban khi ddi di^n vdi dieu ban khdng quen thuOc khdng?
, Bang kiSm M - CHAT se cho ket qua nguy co cao khi tre cd it nhdt ba cau trd Idi bat ky ho$c hai cdu then cbdt (nSjn trong cdc cau s6 2, 7, 9, 13, 14, 15) la khdng.
Tuy nhiSn, vdi cdc cau 11,18,20, 22 thi cau tra Idi co lai dm chi nguy ca tre bi ty ky.
Birorc 3: Sir dung thang ddnh gid mirc do t u ky Childhood Autism Rating Scale (CARS) d l xem TTK d muc d6 ndo?
Mdi linh vyc ciia thang CARS cd mdt d trdng d dudi moi miic dO d8 ghi chii kit qua quan sat dugc tuong \mg vdi mdi miic dp.
Sau khi quan sdt tre ddnh gid ket qud tuong ling vdi moi muc ciia muc do do. Tai moi muc, khoanh
trdn vdo so dng vdi tinh trang md td diing nhdt cua tre. Chiing ta cd thi chi ra tr8 cd tinh y ^ g nam gifta hai miic dp bdng viec cho dilm 1,5; 2,5 hodc 3,5. Mdi miic dd cd gde ti8u y{ ddnh gid ngdn ggn.
Sau khi quan sdt vd ddnh gid xong chung ta tien hdnh tong hpp diem. Cdn cii vdo dilm cuoi ciing chiing ta cd the di din kit ludn tr8 bi Ty ky muc dg ndo nhu sau:
- Dirdi 30 dilm: Id tre binh tiiudng; Tft 30 din 36 dilm:
la TTK cd miic dO nh?; Tii 37 din 40 dilm: Id TTK cd miic dg nSng; Tir 41 din 60 dilm: la TTK cd muc dq rat n5ng.
III. KET LUAN Trong qua trinh ddnh gia de cho ket luan cd the mang tinh toan di8n hon chiing ta c6 the ket hap ciing vdi bac s j dl dien nSo dd xem tre cd b} tdng dgng khdng, ddi song nhu thi ndo? Xet nghiem mau xem co bi nhiem dgc thiiy ngan va cdc kim loai nang khac khong, cd di ling thiic an khdng?...
Ddnh gid sai 1dm hoac cham tre se Id van de nghiem trpng, lam mdt co hoi cho vi?c tiiyc hien cdc chuang trinh CMI thiep sdm va 1dm gidi ban kien thiic khoa hoc ve qua trinh phdt trien ciia tr8, cung nhu anh hudng tdi kit qud chfta tri cho TTK.
Tdi li|u tham khdo 1. Vu Thi Bich Hanh. Ty ky phat
hi?n sdm vd can thi?p sdm. NXB Y hQC,H. 2007.
2. Nguyin Vdn Tt^aih. Tr8 em Ty 1^ phuong thiic gido due. NXB Ton gido, H. 2006.
3. V5 Nguyen Tmh Van. Nudi con bj Ty k^. NXB Bamboo, Austialia. 2002.
4. V6 Nguyin Tinh Van.
De hieu ty l^^. NXB Bamboo, Ausyalia, 2002.
5. Gary Mesibov & Marie Howley. Accessing the Curriculum for pupil with Autistic speclum Disorder. David Fulton Publishers, 2003.
6. Michael D. Powers.
Children with Autism: A Parent's Guide (2"^ Edition 2001).
Summary Assessment is an important step in the process of early intervention for children witii autism. The assessment can provide us with information that help diagnose if the child has autism syndrome or not? If yes, what the level it is? Based on the assessment results, conclusions on the children status can be formulated, iirom which we can develop the intervention plan for children as well as provide appropriate consultation to their parents. In this article we will present the steps and tools of the assessment for children with autism, that enable us to orient and conduct the assessment in most effective ways
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I. QUAN Ht V<n MQl NGlTdl Birth thudng: Co th^ thiy dugc mOt so hi^n tugng
bSn Ign, nhSng nhit ho^c kh6 chiu khi b] ySu c^u lam vi^c gl.
Muc dQ nh^: Tre tranh ti^p xuc vdi ngufn 1dm bSng inh mSX, ho^c trd n£n nhing nhit n€u co s^
tac d^ng cua nguai I6n, bSn ISn khdng phdn ihig v6i ngucri Ion, bim ch(St vSo bo m?.
M&c d0 trung binh: Thlnh thotog tre th^ hi$n s\f tach bi$t. D£ thu hiit sif chiS ^ cua tre, d6i khi can
nhfing no luc lien tyc va manh me.
Muc dg n^ng: tr£ ludn cich bi^t hoac khong nh|n thuc duqic nh&ng viec ngufri I6n dang Idm. Tre hau nhu khong bao gifr dip iJmg hoac khdi dau
quan he voi ngufri Ion.
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II. B A T c H i r d c
Binh thu&ng: tre c6 the bfit chudc fim thanh, I6i n6i, hanh dpng phCi hgp vdi khd nang ci^a minh.
Miic dp nhe- lr6 bit chuoc du<;rc cdc hinh dong don gidn nhu v6 tay ho$c Idi noi. Thinh thoang tre chi bat
truoc khi cd s\r khich le ciia ngudi khac.
Miic dQ trung binh: tre chi c 6 the bat chudc khi co sy giup dd thudng xuyen cua ngudi Ion.
Mfic 3$ ngng: trd rat it va khong bao gid bdt chudc am thanh, Idi ndi, hdnh d^ng ngay ca khi cd s\r khich IS vd
giiip do ciia ngudi Idn
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III. D A P fNG TtNH C A M Brn/; Ihu&ng: Tr6 th^ hi?n diing vdi tinh hu6ng vA tni^rc d^ tlnh cdm thdng qua ndi m^t di^u bO vA thii dO.
Mirc dp nhr- Tr6 ddi khi the hi^n tlnh c ^ khdng binh thudng vdi thd lo^i vd miic dO tinh ckm.
Phdn ling d^i khi khdng lien quan d6i tu(;mg ho(tc s\r vi^c xung quanh Mite dQ trung binh: Tr6 bi4u hi^n kh6ng binh thudng vdi tlnh hu6ng. Phdn ihig ciia Iti khd h^n ch^ ho$c qud mCrc ho^c khdng Ii8n quan den tlnh hu6ng; cd th^ Islm nhin nhd, cirdi to, hojc trd 16n m&y mdc du khong c6 si^ xuat hi^n d6i tu<;mg
ho^c sif vi^c gfiy xiic dpng.
Muc dq n^ng: Phdn iitig ciia tre rai ft khi phii hgp vdi tlnh huong; khi tr6 dang d mgt tam trgng ndo dd th) rit cd the thay doi sang tam trgng khdc.
Ngugc Igi, tr^ c6 the the hi^n rat nhieu tam trgng khdc nhau khi khong co si^ thay doi ndo cd 1 V . S I J D V N G D d V ^ T
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Binh thvcmg- Tre the hifn svr ham thich dd choi vii cdc do vgt khac phii h»;»p vdi khd nSng vd sir dyng
nhihig do choi ndy mgt cdch.
Muc dp nhf. Tr6 cd the the hien sir ham muon khdng binh thudng v^o mgt do chca ho^c sii dyng
nhiing dd chai ndy khdng phu hgp vdi tinh cdch cua Mk em (Vi dy dgp ho^c miit dd chm) Mice dp trung binh. Tre it ham thich do chcri. do vat ho|c c6 the chiem giir nhiing do choi, do vgt mgt each khdc thudng. Tre t|p trung vdo bg phgn khong noi bat eua dd choi, bi thu hiit vdo phan xg dnh sdng lien tyc di chuyen mgt vai bg p h ^ ciia
do vat, choi rieng vdi mgt do vgt.
Mite dQ ngng- Tre cd thS cd nhiing hdnh dgng nhir tren vdi miic dg cudng dd Idn hoTi. RSt khd cd th^ b| ddnh Igc hudng/ Idng quen khi da cd nhthig
hanh dgng nhu tren VII. SV PHAN CMG B A N G THI GIAC Binh thudng: Iri the hi§n s\r phdn ung bdng thj gidc binh thudng va phii hpp vdi lira tudi. Th] gidc phoi hgp vdi gidc quan khdc khi kham pha dd vgi mdi.
Muc dp nh^: Ddi khi tre phai dugc nhdc Igi bSng vi$c nhin [gi dd v^t. Tre cd the thich nhin vdo guong ho^c anh den hon chiing bgn, cd the thinh thoang chdm chii nhin len bau trdi ho|ic trdnh nhin
vdo mdt ngudi Idn.
Mite dp trung binh: Tre thudng xuySn phai dugc nhin vdo nhiing gi tr6 dang 1dm. Tr6 nhin chdm chSm vdo bau trdi, ne tranh nhin vao mjt ngudi Idn khi giao tiep, nhin vdo dd vat tii gde dg bit
thudng ho^c giii dd vat gin vdi mit 1 1,5
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TV. CAC B i f N P H A P C O T H £ : ^ I I Binh thuang: Tre chuySn ddng thodi mdi, nhanh nhe vd phoi hgp cac dgng tdc nhu nhiing trg binh thudng cung lira tudi.
Muc dp nhf: Tri ddi khi th^ hi^n mgt sd hi£u bilt khac thudng nhd. Vi dy dgng tdc I$p di l$p Igi, hgp tac k^m, thinh thodng cd m$t so dgng tdc bat thudng
Muc dv trung binh: Tri nhin chftm chSm vdo mgt chd ndo dd tren co t h i T\r minh kfch dgng, du dua, ngdn tay ISc lu, xoay tay ho^c di nhdn chSn.
Muc dp n^ng: Tre nhin chdm chdm vdo mgt chd ndo do tren ca the. T\r minh kich dgng, du dua, ngdn tay Idc lu, xoay tay hodc di nhdn chan... miic dg lien t^c hon vd thdnh th\ic hon.
VI. THICH NGHI VOI SV'THAV DOI Binh thuang: Tre cd the ddng y ve nhiing thay ddi binh thudng. Tri chdp nhgn sy thay ddi tren ma khdng roi vdo tdm tr^ng lo Idng.
Muc dp nhe: Khi ngudi Idn thay doi cdc hogt dgng, tre cd the thirc hien dugc sy thay doi dd nhung khdng thuc hi^n ngay.
Muc dp trung binh: Tre chdng Igi sy thay ddi mdt each rd rang, tiep tyc vdi cdc hoat dgng cii va khd cd the bi ddnh Igc hudng. Tre cd thi trd nen cdu gian hogc buon philn khi nhOng thdi quen thdng thudng bi thay ddi.
Muc dp ngng: Tre phdn img rat gay gdt vdi su thay ddi.
Neu bi bugc phai thay doi, tre cd the trd nen rat cau gi§n, khdng hgp tdc va phan ling mdt cdch khd chju.
V m . S V PHAN iTNG B A N G T H I N H G I A C Binh thuang: Cdc bieu hi^n thfnh gidc ciia tre phu hgp vdi tre binh thudng. Thinh gidc dugc diing ciing vdi cac gidc quan khac.
Muc dp nhe: Tre doi khi phan ling vdi mgt so tieng ddng va am thanh tuy nhien hoi chdm Nhung tiing dgng, am thanh dd can dugc l§p Igi de gay su chii y ciia tre. Tre cd thi hi phan tan bdi dm thanh tir ben ngoai.
Mirc do trung binh: Tre khdng cd phdn ling ngay vdi am thanh va tilng ddng d Idn nghe dau tidn.
1 2 - TAP CHI THIET BI GIAO DUC - SO 90 • 02/2013
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Mii'c iJ^ nang' Tri lufln trSnh khdng nhin vka mat nguiti l<!rii ho$c c^c d6 vgt cv the n^o d6 vil c6 the th^ hi^n c^c hinh thiic khAc bi^t ciia cAc hi^n tiring khdc bifl ve th]
giac n6i trin.
IX V ! G i A c , K H L T U G I A C V A X O C G I A C Binh ihudng TrS khAm pha do vjl phii hi;fp \Cn Ilia lu^i bang xilc giSc vd thj giac, Khi phan uiig viSi nhttng khd ch)U nh6, thudng ng<ly Ihl lr£ the hi^n sv kh6 ch|u nhung khfing c& phan img
Mac dQ nhf Tr£ c6 thi nh^t d6 v{il v^o m^ng, ngiii ho$c n ^ c&c d6 vgl m i Dh&ng ah v$t dd khong dugc ph^p. cd
the phin ling vdi nhitng khd chju nhf.
Miic cfp Inmg hinh' Trt cd Ihfi b | khd ch|u d miic d$
trung binh khi sd. ngi>i hogc nim do vgl binh thudng
Mac elQ n^g Tii khd chju vdi vigc ngui. nem do vpt Trd cd the hoin toan bd qua dm gidc khd ch)u
XI. G I A O TiftP B A N G L d l Binh thirang Giao tiep bang Idi binh thudng phu hpp voi
nmg dp tudi va timg tinh hudng
Mirc do nb? Tri n6i ch^im nhChig lai ndi cd nghia Tuy nhien doi khi xual hi^n su Igp l^i may mdc hogc phat am bi dao \i>n trgt tv cau. Thinh thoang ire diing mpt so tir
khac thuang, hogc khdng rd nghTa.
Miic dp trung binh: khSng ndi khi giao tiep hogc ndi Ian Iflfl gida nhiing Idi noi c6 nghia va kh6ng cd nghTa Lap ifii may mdc hogc phat 3m khong co trat ty cau (dao l^n).
Trong giao tiep cd nhiing cau hoi thira hogc khdng diing c h d d l
Mac dQ ndng: Tre thudng su d^ing nhimg Idi ndi khong cd n g h ^ . Thinh thoang keu Ih^t len nhitng lieng ky ta' tieng keu cua dpng vgt, tieng khdc cua em b6..
X l l l . MtTC B O HO-^T » 0 N G
Binh Ihieang: Tri ho^t dpng nhanh nhen hon hogc cham hon so vdi tre binh thudng cung Ilia tudi
Muc dQ nh?. Tr6 doi khi ludn hieu dgng hogc cd dau hi^u ludi va ch$m cbuyen d$ng Dieu dd dnh hudng rat
nhd d£n ket qua ho^t dpng ciia tri
Miic dQ trung binh: Tre rat hieu dpng va khd cd the kiem che Tre hoat d^ng khdng b i ^ m^t mdi vi khdng mudn ngO ve dSm. Ngupc l?i m§t s6 tri cSn phgi thiic giyc rii
nhieu mdi vgn d$ng
Muc dp nang Trd the hien qud hieu dpng hogc qua Ihu d^ng vd ddi khi ngtrpc l?i.
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Mvc d^ nqng: Tri phdn img vdi gm thanh d miic dp khdc thudng cho dii dm thanh dd cd tin s6 binh thudng vd quen thu^c T r i gi^t minh hogc che tai khi nghe thiy nhitng dm thanh thudng nggy nhu: iieng nhtic. iiing mgy xay. t i ^ g cat g j c h .
X. SV* s<? H A I H O A C H 6 I H p p
Binh thucmg: Tri th^ hi$n s^r ap hdi vd h^i h<lp phd hpp vdi tri binh thudng ciing ludi.
Mac dp nhf Tri ddi khi thi hi@n qud nhllu hogc qud It su sp hdi khi so vdi tri binh thudng trong nhCbig tinh hudng tuong tu
Muc dp Ining binh: Tri(Aio*wy:ic«>'^/i t h l h i ^ n s i i a p h d i s o vdi t r i binh thudng trong tlnh huong luong tir,
Mirc JQ ndng: Tri luon ludn the h i ^ qud nhieu hogc qud ft sif sp hdi khi so vdi ire binh thudng Irong nhihig tinfa hu6ng tuong Of
XII. G I A O T I 6 P K H O N G L d l
Binh ihuang: Giao tiep khdng Idi phd hpp vdi tung tinh hu^ng
M&c dQ nhe: Trong tlnh huong ddi tho^u su d^ing bdng Idi tri khdng ndi, Vi dy trd thudng chi tay hogc keo tay ngudi Idn tdi cdi md minh muon cd ddng 16 tri phdi ndi nhd lay hp bdng Idi
Miic dp trung binh: Trd khdng dien d^t bdng Idi nhiing diiu md t r i c i n hogc mong mudn. Tre khdng hieu dupe giao tiep khdng Idi cda ngudi khdc
Mirc dp ndng: Tri khon^ the diln dtit bdng Idi nhiing diiu ma tri cdn hodc mong mudn. Trd khong the hieu du^c giao tiip khdng idi ciia ngudi khic.
XIV. Mi:rc DO vA SV NHAT QUAN COA PHAN XA T H 6 N G M I N H
Binh Ihwang: Tre cd miic dp hieu blit nhu trd binh thudng
Miir dp nhf Tre khdng thong minh nhu nhttng tre binh thudng cdng lu^i; ky ndng hoi chgm tren cdc linh v\tc
Mirc rf{S irung binh Trd khdng thdng minh nhu nhihig Ire binh thudng cdng tudi, tuy nhien tre c6 thd cd khd ndng gdn nhu binh thudng ddi vdi m^t sd ITnh vyc c6 hen quan den vdn d$ng
Mirc dQ ngng: trd khdng the ]dm lol hon tre binh thudng ciing tuoi trong mpt hogc nhieu ITnh vuc
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