中華心理衛生協會

Purpose: A smooth transition to preschool is key for children in adapting to social life and the education system. Due to their limited social and communication skills, restricted interests and behavior, and hypersensitivity to contextual inputs, autistic children often have difficulty adapting to the school environment and adjusting to school routines. We aimed to (1) summarize the current literature concerning transitioning from medical-based early intervention (EI) services to school systems for autistic children, (2) identify the factors for transition success, and (3) explore intervention strategies used to facilitate this transition for autistic children. Methods: We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. First, we chose the following 4 key terms to develop the search strategy: autism spectrum disorders, transition, preschool, and early intervention. Results: We identified 563 articles using the 4 terms. After screening, we included 16 articles in our literature synthesis: 12 with a qualitative research design, 2 cross-sectional studies, 1 pre-post experimental study, and 1 mixed methods study. From these we identified 8 factors that impact autistic children's transition outcomes: kindergarten management, school teachers, parents and family, EI professionals, communication and coordination, policy and support system, children's characteristics, and social acceptance. Seven articles raised the issue of kindergarten management, and 7 articles concluded that school teachers are the key facilitator for children's transitions. When teachers (1) have autism-related knowledge and skills, (2) hold positive attitudes toward autistic children, and (3) value their own work, autistic children are more likely to adjust to school life better. Eight articles identified parents and families as the key to transition success. Parents' participation in transition meetings, making decisions in individualized education plan (IEP) meetings, and being positive about the transition all facilitate their children's successful transition. Despite serving as a critical stakeholder in the transition process, only 4 articles described how EI services impact autistic children's transitions. These include including providing transition readiness classes at EI centers, following up with parents on their children's transition process, and EI staff showing respect to the family culture when providing interventions. Policy support, communication and coordination among stakeholders, children's characteristics, and social acceptance are also essential for autistic children to succeed in transition. Surprisingly, although autistic children are the protagonists in the transition process, most research did not investigate whether or not children's skills and abilities impact their transition outcomes. We next summarized the transition programs and strategies based on 3 stages. In the pre-transition stage, the literature shows that providing transition readiness classes at the EI centers, home visits, and offering open house opportunities are helpful strategies for children and parents in preparing for school. During the transition, evaluation of newcomers' needs by a multidisciplinary team, involvement of parents in the decision-making process, and increasing the school's knowledge of the newcomer's disabilities all facilitate appropriate treatment for autistic children. In the post-transition stage, improving classroom accessibility, providing flexible schedules and temporarily shortening school days, and making individualized education plans help autistic children adapt to school life more smoothly. However, the current evidence is inadequate to draw a firm conclusion on the effectiveness of these transition strategies due to the lack of rigorous research in transition services. Conclusions: Using PRISMA guidelines we systematically and comprehensively reviewed current studies on the transition to preschools for autistic children. We identified 8 factors that impact autistic children's transition outcomes, and 3 stages of programs and strategies. Our analysis may contribute insight for clinical practitioners to consider when providing transition services. We also identified the limitations of previous studies and offered directions for future investigation.