韩建忠、裴虹、崔琴
（南宁市青秀区含式幼教特教托管中心 广西南宁 5 30022）
［重庆爱德蒙（蒙台梭利教育体系）幼儿园 重庆 400000］
（重庆宝圣湖童之乐幼儿园 重庆 400000）
（成都市含式自闭症儿童关爱中心 四川成都 610000）
［摘要］：选择性缄默症通常是指儿童听说能力与发音器官并无问题，但面临特定的社会情境或人物时会持久地拒绝说话，而在其他场合言谈正常的一种行为。本文对1例选择性缄默症儿童在家庭、幼儿园和托管中心（以下简称中心）进行了为期8个月综合干预训练，效果显著。
［关键词］：选择性缄默症；家庭；幼儿园；综合干预训练
（一）引言
由于发现选择性缄默症的检出率大约是0.75%（Bergman，Piacentini， ＆ Mc Cracken，2002；Elizur ＆ Perednik，2003）。而且在男女生的比例上，女生略多于男生（女生与男生的检出比率是1.2～1.6∶1，Steinhausen ＆ Juzi，1996），目前中国对选择性缄默症的研究相对薄弱。
景景，男，5岁进行咨询，经过家长访谈、幼儿园实景观察、幼儿园老师（以下简称幼师）访谈、原生家庭实景观察后，本案例情况基本如下：
（1）在幼儿园两年表现为：沉默无语、绝少发问、有事也不表达、极端羞怯、行为退缩、脸部漠然或表情呆滞、与新人或陌生人相处动作相当迟缓、老师不辅助就不能完成独自上下楼梯、解便等平常动作、和同学基本没有语言及肢体交流、没有朋友，在幼儿园里只能做吃饭及走线课程，但在走线的课程上表现出极度紧张、小心翼翼、生怕有一丝出错。
（2）在家里表现为：过度依赖母亲、外婆、饶舌且表情丰富、自我陶醉、有时喜怒无常、易哭闹或发脾气、有时非常专横、有支配欲、极易受挫、除父母、外婆、外公四人外与他人基本没有交流。
（3）在户外只与家人交流，对其他人采取忽视、假装没听（看）到、眼神躲闪不会直视、逃避的方式，没有家人陪同不会去玩或独自完成任何事情。
由于景景在家中表现比较正常，家长对幼儿园老师反应景景在幼儿园表现异常的信息未给予足够的重视，加上景景每天一出幼儿园大门见到外婆后就马上变得谈吐自如，于是景景让这所高端幼儿园的园长及带班老师都倍感困扰。
有一次因为教室只有景景和爸爸两个人，无意中爸爸看到景景在教室里一个人玩得很高兴但当出现第二个人的时候就突然沉默不语、纹丝不动，于是景景的父母才意识到问题的严重，在家长、幼儿园等多方治疗均不见成效，而且问题越来越严重。
本文作者凭借在ASD儿童干预训练15年的技术和经验，从2016年5月开始，对景景进行了8个月的综合干预训练，取得了较好的效果，以下为干预训练的具体方案。
（二）对象
景景，男，2011年3月18日出生，足月，顺产，入读普通幼儿园，在家与爸爸妈妈及外婆外公同住，医院根据美国精神医学学会在其制定的“精神障碍的诊断与统计”第四版（简称DS阶Ⅳ，1994）诊断标准确诊为选择性缄默症，之前干预训练没有效果，本阶段训练时间2016年5月始至2016年12月，为期共8个月。
（三）方法及内容
1.干预训练方法
中心老师（以下简称特师）以密集行为干预（EBI） 、综合应用行为分析疗法（ABA）等干预技术为措施。
按照景景所在原生家庭（以下简称家庭）、幼儿园、托管中心（以下简称中心）为背景，进行3阶段共8个月的干预训练，每阶段大约两个半月，全天一对一等多种干预训练方式，每周休息0～2天，并对主要家长进行每个阶段不少于1次，每次2小时的培训指导。
根据SM的诊断标准和景景的实际症状，在经过分析、抽象、推理、综合、概括后，制定景景干预训练的科目、内容、形式、频次、强度及时间的指导思路，见表4-7：
2.干预训练的科目
第一阶段
暗示：由于景景非常容易对场景、人物、事件、语音语调、肢体动作、面部表情等做不同程度的病症化的自我暗示或受到他人暗示，但是由于景景的认知能力基本符合同龄儿童，所以我们把暗示作为干预训练的切入点，效果目标是要减弱、消退负面暗示，加强、提升正面暗示。
改变：暗示是为改变创造了基础，改变的核心内涵是打破景景认为对的模式，不断渐进地为他建立、塑造、强化新的模式（思维、语言、行为）。
第二阶段
不满足：在景景改变后，通过不断地不满足他对预期奖励或结果满意度的需求，渐进的达到训练的目标。
要求：在景景达到基本的训练目标后，我们可以在他熟悉的环境中挑出较高的目标供其参照，并以此参照目标作为我们的要求目标，以此量化出具体的训练要求。这样做的原因是因为景景尚在低龄阶段，所以可以尝试最大化的训练目标。
第三阶段
挑战：由于对景景提出了较高的训练目标，所以当他出现停滞不前的时候，我们需要有策略地、控制好力度地、选择性地对他进行挑战，于是当一个大目标被分解成若干个可被较安全、较可控的小目标而被挑战时，会增加大目标实现的可能性。
全面泛化：由于景景不仅需要面对目前的幼儿园，还要面对学校、社会、就业、婚恋的极大压力，所以我们需要对景景目前的家庭生活和学习、幼儿园的学习和生活以及中心的生活和学习进行全面的各项能力的整合，并训练他能够将习得的各种能力进行有效的自我泛化。
3.干预训练的内容
干预训练的内容包括六个应对和一个统合，具体如下：
环境应对：首先是三个大环境，即家庭、幼儿园、中心，然后再增加社区环境及社会环境等，同时对每个大环境再根据需要进行细分，例如幼儿园的大厅、教室、寝室、餐厅、走廊、楼道、活动室等，针对景景在以上不同环境下做出没有达到应有应对程度的障碍进行的干预训练。
人物应对：按和景景接触度和亲密度来划分，可分为妈妈、外婆、爸爸、特师、幼师、保安叔叔、医生姐姐等，针对景景在以上不同人物下做出没有达到应有应对程度的障碍进行的干预t训练。
身体、面部表情应对：在不同环境及人物的前提下，针对景景的走、站、跑、跳、蹲、坐、躺、表情等做出的没有达到应有应对程度的障碍进行的干预训练。
语言应对：在不同环境、人物及身体动作的前提下，针对景景的被动语言和主动语言等做出的没有达到应有应对程度的障碍进行的干预训练。
沟通应对：在不同环境、人物、身体动作及语言的前提下，针对景景的被动和主动沟通交流等做出的没有达到应有应对程度的障碍进行的干预训练。
事件应对：在不同环境、人物、身体动作、面部表情、语言及沟通的前提下，针对景景每天面对的日常事件以及突发事件等做出的没有达到应有应对程度的障碍进行的干预训练。
视听信息统合：视觉和听觉是人的大脑信息输入的主要通道，将景景每天在不同场景、人物、身体（面部表情）、语言、沟通、事件共六部分信息内容全部统合。
（1）干预训练的形式
干预训练的形式分为：一对一、情景对话、情绪表达（释放）、多对一、冲突模拟应对、电视动画片及电脑游戏。
干预训练的阶段、时间、科目、内容、形式之间的关系见表4-8：
以上内容均由特师给景景所在幼师、相关人员及家长同步讲解、培训及示范，做到全员参与，并要求景景家长将训练成果泛化到日常生活。
（四）技术路径、训练步骤及要点
1.第一阶段干预训练：暗示和改变
实施前，特师对景景做了家庭及幼儿园的初始状态的评价，并留存视频资料。
材料：摄像机、无字图卡、智能手机、手机游戏、幼师照片一批、幼儿园照片一批、景景爸妈及外婆外公照片一批、奖励品（强化物）。
（1）关注特师
步骤：景景妈妈第一天自己当着景景的面拿走一件景景最不常玩（最不喜欢）的玩具，第二天妈妈和特师一起当着景景的面再拿走一件景景较不常玩（较不喜欢）的玩具，第三天特师自己当着景景的面再拿走一件景景较常玩（较喜欢）的玩具，第四天特师自己当着景景的面再拿走一件景景常玩（喜欢）的玩具，第五天特师自己当着景景的面再拿走一件景景最常玩（最喜欢）的玩具。
要点：第一，拿走玩具就是把玩具带离景景的家；第二，拿走玩具时不要说话，也不要有眼神交流；第三，拿走玩具时的整个过程可以稍微拖长一点；第四，妈妈拿走玩具时，特师负责观察；第五，对景景的任何无论是对谁的发问以及无论是否涉及拿走玩具这件事，都由特师回应；第六，景景对在家里特师已经熟悉到可以视而不见（特师前期在景景家做拍摄观察时，不当着景景的面和景景的家人做任何交流，其中包括眼神、动作等）。
效果测评：第一，景景开始关注特师（渐进的矫正景景和妈妈的原有关系）；第二，对改变过去的模式产生不适应的反应。
（2）特师建立影响力
步骤：特师对景景进行幼儿园全天陪读，渐进的协助景景完成幼儿园的生活和学习，每天都给他一点要求（根据景景的状态，把要求分为可轻松完成的、努力可完成的、较难完成的）。
要点：第一，陪读时对景景在幼儿园的需求满足的步骤可划分为，提前满足、即时满足、眼神交流满足、延时满足、语言提示满足等；第二，陪读中特师和景景的交流步骤可划分为，零语言交流、眼神交流、肢体动作交流、关键词或字交流、正常语句交流、超长语句交流、提示性语句交流等。
效果测评：第一，依赖特师；第二，信任特师；第三，喜欢特师；第四，开始改变原来固有的模式。
（3）特师建立权威
步骤：每天把景景接到中心住宿，妈妈或外婆陪同，每天给景景设定目标，若景景能够完成，可以得到相应的奖励，增加其对特师的信任度，减少其对母亲和外婆的依赖度，渐进增加没有母亲或外婆在身边的时间长度，前期基本控制在每周（7天）回家2天、中心住宿5天。
要点：第一，中心渐进的锻炼景景的生活自理能力；第二，每天渐进地运动；第三，每天用无字图卡、智能手机中的游戏、幼师照片、幼儿园照片、景景爸妈及外婆照片作为语言类及动作肢体类的游戏和故事。
效果测评：第一，在乎特师；第二，服从特师。
2.第二阶段干预训练：不满足和要求
第一阶段完成后，要评估通过后才能实施本阶段的干预训练。
材料：摄像机、有字故事书、玩具（枪、剑、车、积木、球、跳绳）、智能手机、奖励品。
（1）关注过程
步骤：让景景每天回忆幼儿园里发生的人和事，回忆的方式可分为，特师叙述，由他回答对错（特师先是讲一句让他回答一句，双方渐进地增加语句，在此方式中特师可通过故意说错或意思相反等方式提升景景的语言能力及记忆能力）及特师简单提醒景景自己说直至最后的无提醒自己说出全天幼儿园的人和事。回忆的内容可以先只是回忆幼儿园中发生的特别事件，再到回忆全天事件，事件的回忆基本完整后再开始回忆人，回忆人的顺序是，幼师、同桌、班级活跃分子等，回忆的内容侧重着装、情绪、动作、冲突等，这一步完成后再将人物和事件进行整体回忆叙述。
要点：第一，分别回忆人物和事件；第二，特师和景景的对错练习要有难度梯度；第三，事件的回忆侧重在过程及细节；第四，人物的回忆最终侧重在当事人的心理活动；第五，人物和事件的整体回忆侧重在正面的意义。
效果测评：第一，景景关注过程和细节的能力有提升；第二，回忆能力有显著提高；第三，语言表达能力有显著提高。
（2）结果导向
步骤：景景每天在中心，特师都会使用有字故事书讲故事，用玩具（枪、剑、车、积木、球、跳绳）和他一起做游戏。
要点：第一，故事书讲故事的侧重点是记住故事的关键含义；第二，玩玩具时的状态一定要很高（声音大、动作大、情绪高），可以在不被他察觉的前提下故意让他积极获胜。
效果测评：第一，可以复述特教给他讲的故事书；第二，可以将故事书转述给幼师；第三，可以给同桌转述故事书内容。
（3）分享进步
步骤：每周景景回家时能够开心地给妈妈、爸爸、外婆分享在幼儿园和中心的人物和事件，对妈妈、爸爸、外婆有问必答。
要点：第一，被动分享的程度；第二，主动分享的次数。
效果测评：第一，是否分享；第二，是否加入了自己的想法；第三，和家人做游戏时是否很积极地想赢。
3.第三阶段干预训练：挑战和全面泛化
实施本阶段干预训练的前提是，第一和第二阶段的目标达成，并且景景身体健康状态较好（天气温度适宜，可进行较多的室外活动）。
材料：摄像机、室外场所（游乐场、超市、动物园等）、智能手机、奖励品。
（1）参与竞争（上进心）
步骤：鼓励景景参加幼儿园班级里的竞技运动，鼓励景景参加幼儿园组织的竞技比赛，鼓励景景回应幼师含有时间或速度要求的任务或课程。
要点：第一，鼓励参与；第二，鼓励快速回应。
效果测评：第一，较注意听讲；第二，能够理解竞技内容及规则；第三，较积极回应（参加）。
（2）争取第一（全力以赴）
步骤：在中心特师的带领下景景能够在室外场所（游乐场、超市、动物园等）和陌生儿童展开各类比赛（跑步、原地跳远、摸高等）。
要点：第一，情绪较高昂地参与；第二，鼓励他得第一名。
效果测评：第一，主动性较高；第二，较积极地争取第一名。
（3）自我激励（自我正面暗示）
步骤：无论是在幼儿园、中心还是在家庭，景景都能够较正面地暗示自己要回应他人的交流，在超市也能够独立有语言地购物及和回答服务员的各种提问，参加幼儿园组织的圣诞集体表演（景景在幼儿园的首秀）。
要点：第一，陌生场合和陌生人主动交流；第二，上台集体表演。
效果测评：第一，有问有答；第二，能够基本完成全套舞台的表演动作。
以上每阶段都对景景的家长和幼师进行培训，在确保大家完整确切地理解本阶段干预训练的内容、方法及要点的基础上，充分讨论。
（ 五）训练效果
1.在幼儿园改善情况
景景每天从入园到离园的整体表现都有进步。例如，回应校门卫的招呼、和同学打招呼、回应幼师的指令、自主入厕（喝水、进餐、排队）、上课举手、主动交朋友的意愿明显增强。具体见表4-9：
表4-9 在幼儿园调查表
续表
2.在家改善情况
景景的家人反应景景在家的表现进步显著，具体见表4-10。
表4-10 在家调查表
（六）研究结论与未来研究
经过对景景共8个月的综合干预训练，总有效率100%，虽然景景在幼儿园的语言、行为、沟通都有了显著的改善，但是说话声音较柔弱、音量较小、音调较无变化、说话时较表情呆板、木讷，仍然需要继续干预训练，为景景未来学龄教育创造最好的条件。
2016年景景所在的爱德蒙幼儿园在一家五星级酒店里举办了场面宏大的圣诞节晚会，这是景景的首次舞台表演，景景的父母在欣喜之余也对同样患有SM的患儿家长感同身受，同意将大量景景训练前后对比的录影视频提供给学术研究，在此，中心全体老师深表感谢！
希望本案例能够为国内外学者对SM研究的深入，带来有益的帮助。
注：本论文已被日本特殊教育类的英文期刊选用，具体名称和内容略有删减。
A Case Study of Selective Mutism（SM）Children Training Program Family，kindergarten and childcare center-based comprehensive intervention training(www.xing528.com)
Han Jianzhong、Pei Hong、Cui Qin
（Hanshi Preschool and Special Education ＆ Childcare Center，Qingxiu District，Nanning，Guangxi 530022）
（Chongqing Edmond（Montessori Educational System） Kindergarten Chongqing 400000）
（Chongqing Baosheng Lake Kindergarten Chongqing 400000）
（Chengdu Hanshi ASD Children Care Center Chengdu，Sichuan 610000）
［Abstract］：Selective mutism is a childhood social communication disorder in which children persistently fail to speak in social settings or to specific people despite the ability to understand and to use language. 8-month-long comprehensive intervention training was conducted on one SM case at home，kindergarten and the childcare center（hereinafter referred to as the “Center”）and the results were remarkable.
［key words］：Selective Mutism（SM），family，kindergarten，comprehensive intervention training
（一）Foreword
Because the SM detectable rate is around 0.75%（Bergman，Piacentini，＆ McCracken，2002：Elizur ＆ Perednik，2003），and with a slightly higher percentage of girls detected SM than boys（the proportion of girls and boys detected with SM is 1.2～1.6∶1，Steinhausen ＆ Juzi，1996）. At present，China’ s research on SM is relatively weak.
Jing Jing，male，five years old，after interview with the parents，kindergarten on-site observation and interview with the kindergarten teachers，and the on-site observation at the SM kid’ s home，the general information of this case is as below：
（1） The performance at the kindergarten over the past two years：silent，rarely asking questions，not speaking out even as needed，extremely shy，timid，different or lifeless in his facial expression，very slow in getting along with newcomers or strangers，unable to walk up/down staircases or relieve himself and other daily movements on his own without a teacher’ s help. And almost having no verbal or body language communication with his classmates，and having no friends. He can only dine and complete Montessori Walking the Line at the kindergarten but was extremely nervous and very careful at the Walking the Line class，afraid of making even a tiny mistake.
（2） Performance at home： Overdependent on his mother and grandmother，garrulous and with rich facial expression，self intoxicated，sometimes moody，prone to cry or lose his temper，sometimes very unruly，domineering，vulnerable to frustration，having little communication with others except the four persons，his parents and his maternal grandparents.
（3） When staying outdoors，only communicating with family members，turning a blind eye and deaf ear to others，dodging and avoiding eye contact with them，would not play or do anything on his own without the company of his family members.
Because of the relatively normal behaviors of Jing Jing at home，his parents did not pay due attention to the information from the kindergarten teachers about the abnormal behaviors of Jing Jing at the kindergarten，and Jing Jing talked and behaved quite normally after seeing his grandma upon going out of the kindergarten，both the director and the class teacher of this high-end kindergarten were perplexed by Jing Jing.
Once because there were only Jing Jing and his daddy in the classroom，by accident his daddy noticed Jing Jing was having fun when playing alone in the classroom and suddenly became silent and stood stone still when a third person appeared，until then did the parents of Jing Jing realize the severity of the problem，no improvement after treatment by multiple parties such as parents and the kindergarten，and his symptoms became worse and worse.
On the strength of 15-years expertise and experience in ASD intervention training，the author conducted 8-month-long comprehensive intervention training on Jing Jing starting from May 2016，and achieved good results. Below is the specific program for the intervention training.
（二） The Trainee
Jing Jing，male，born on March 18，2011，born full gestation and normal delivery，enrolled in a regular kindergarten，he lives together with his parents and （maternal）grandparents，and diagnosed as SM by a hospital pursuant to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders（DS Ⅳ，1994），published by American Psychiatric Association （APA），and the previous intervention training was in vain. This stage of training lasted a total of eight months starting from May 2016 to December 2016.
（三）Methods and Contents
1.Intervention Training Methods
The teacher at the center （hereinafter referred to as “Special Education Teacher”）applied intervention techniques such as early intensive behavioral intervention（EIBI）and Applied Behavior Analysis（ABA） among other measures.
A total of eight months long intervention training in three phases with Jing Jing’Family of Origin（his family），the kindergarten and the children care center（the Center）as the settings，each phase lasted about two months and a half，conducted various intervention training methods such as one-on-one all day long，a break for 0-2 days every week，and each phase gave key parents/grandparents a minimum of one time（two hours）training guidance.
Based on SM diagnosis criteria and the actual symptoms of Jing Jing，after analysis，abstraction，inference，synthesis and summing-up，the guidelines of the items，contents，forms，frequency and intensity and duration of intervention training for Jing Jing were developed as shown in Table 4-7：
2.Items of Intervention Training
Phase 1
Hinting：because Jing Jing was very prone to varying degrees of symptom-caused self-hinting or hinting by others of situations，characters，incidents，intonations and tones，body gestures and facial expressions，while the cognitive competence of Jing Jing was almost on a par with his same-age kids，we employed hinting as the starting point for intervention training，and the results goals were to tone down and decrease negative hinting but tone up and increase positive hinting.
Changing： hinting was to set the foundation for changes，and the core of changes was to break the modes that Jing Jing thought it right，and continuously and incrementally establish，shape and reinforce new modalities（thinking，language and behavior）for him.
Phase 2
Dissatisfying：after Jing Jing made changes，continuously dissatisfying his expected prizes or satisfied demand，to progressively realize the training objectives.
Requirements：after Jing Jing met basic training objectives，we can pick out some relatively higher objectives in his familiar environment for his reference，and take theses reference objectives as our required objectives thereby quantifying specific training requirements，in doing so because Jing Jing is still in a low-age period，we can try maximized training objectives.
Phase 3
Challenging：because we put forward relatively high training objectives for Jing Jing，when he stalled，we need strategically and appropriately and selectively change him，when we break down a big objective into several safe and controllable small objectives to challenge him，thus will increase the probability of realizing the big objective.
Comprehensive generalization： because Jing Jing not only needs to confront the kindergarten now，and has to confront extremely heavy pressure from schools，employment and marriage in the future，we need to comprehensively solidify his current capabilities of living and studying at home，the kindergarten and the Center，and train him to be able to effectively generalize various acquired capabilities on his own.
3. Contents of Intervention Training
Comprising six responses and one integration，namely：
Responding to environments： first，the three major environments，home，kindergarten and the Center，and then to add the community environment and the social environment，etc，at the same time，each major environment will be segmented as needed，e.g.，the kindergarten can be segmented into the lobby，classrooms，bedrooms，canteen，corridors，staircases and the function room，etc，to conduct intervention training on Jing Jing for the impediments that Jing Jing failed to make required appropriate response to the above different environments.
Responding to people： can be divided by their contact and closeness level with Jing Jing，and may be divided into mom，grandma，daddy，Special Education Teacher A，Kindergarten Teacher B，Security Guard uncle，doctor sister，etc，to conduct intervention training on Jing Jing for the impediments that Jing Jing failed to make required appropriate response to the above diferent people.
Responding to body and facial expressions： conduct intervention training on Jing Jing for his impediments in his response in walking，standing，running，jumping，squatting，sitting，lying and expressions etc that Jing Jing failed to make required appropriate response to diferent environments and diferent people.
Language response： conduct intervention training on Jing Jing for his impediments in his passive and proactive language response that Jing Jing failed to make required appropriate response to different environments and diferent people.
Communication response： conduct intervention training on Jing Jing for his impediments in his passive and proactive communication response that Jing Jing failed to make required appropriate response to different environments and diferent people.
Incident response： conduct intervention training on Jing Jing for his impediments in his response that Jing Jing failed to make required appropriate response to daily events and unexpected incidents.
Audiovisual information integration： the auditory sense and visual sense are the main channels of human brain information inputs，the training will integrate all the six parts of daily information about Jing Jing at diferent settings，facing different people，body（facial expressions），language，communication and incidents.
（1）Forms of Intervention Training
The forms of intervention training are divided into： one-on-one，situational dialogue，emotional expression（release），many to one，conflict simulation response，TV cartoon and computer games.
See Table 4-8 for the phases，duration，items，contents and the relations between forms：
The above contents were all taught，trained and demonstrated by the special education teacher to Jing Jing’ s kindergarten teachers，related staffs and parents/grandparents simultaneously，and all the people concerned participated and the parents/grandparents of Jing Jing were required to generalize the training results to daily life.
（四）Technical Approaches，Training Steps and Key Points
1.Intervention Training Phase 1：hinting and changing
Before implementation，the special education teacher would appraise the initial state of Jing Jing at home and the kindergarten，and keep the video on file.
Materials：a camcorder，wordless photo cards，a smart phone，cellphone games，some photos of the kindergarten teachers and the kindergarten，some photos of Jing Jing’ s parents and grandparents，some prizes（as incentives）.
（1）Pay attention to the special education teacher
Steps：Jing Jing’ s mom took away a toy of Jing Jing’ s he seldom played with（least liked）in the presence of Jing Jing on Day One，and on the second day his mom along with the special education teacher took away another toy of Jing Jing’ s with which Jing Jing did not play often（did not like it much）in the presence of Jing Jing，on the third day the special education teacher himself/herself took away a toy of Jing Jing’ s with which Jing Jing often played（liked）in the presence of Jing Jing，on the fourth day the special education teacher himself/herself took away a toy of Jing Jing’ s with which Jing Jing often played（quite liked） in the presence of Jing Jing，on the fifth day the special education teacher himself/herself took away a toy of Jing Jing’s with which Jing Jing played most often （he liked best） in the presence of Jing Jing.
Key points： first，taking away toys means taking the toys away from Jing Jing’ s home； second，saying nothing not having eye contact communication when taking toys away； third，the entire process of taking toys away could be longer； fourth，when the mom took away the toy，the special education teacher observed； fifth，it is the special education teacher who would respond to the questions of Jing Jing regardless of whom he asked and no matter whether the questions were related to taking away toys or not； sixth，Jing Jing had familiarized with the special education teacher at home to the extent that he could turn a blind eye to him/her（when the special education teacher shot videos or observed at Jing Jing’ s home before start of the training，he/she did not have any exchange with the family members of Jing Jing including eye contact，gestures in the presence of Jing Jing）.
Results assessment：first，Jing Jing began to pay attention to the special education teacher（progressively rectifying the relations between Jing Jing and his mom）；second，his response from having not adapted himself to changing the established mode.
（2）Special Education Teacher Establishing Influence
Steps：the special education teacher accompanied Jing Jing in the kindergarten all day long，progressively assisting Jing Jing in completing the life and studies in the kindergarten，raising one point of requirement on him every day（the requirements may be divided into easy to complete，can be completed with some eforts and hard to complete based on the shape of Jing Jing）
Key points：first，when accompanying Jing Jing in the kindergarten，steps of satisfying his demand in the kindergarten can be divided into，advance satisfying，instant satisfying，eye contact satisfying，delayed satisfying，verbal hint satisfying，etc； second，in the course of the accompanying，the communication steps between the special education teacher and Jing Jing can be divided into，no verbal communication，eye contact communication，body gesture communication，key word communication，normal sentence communication，lengthy sentence communication，suggestive sentence communication，etc.
Results assessment： first，relying on the special education teacher；second，trusting the special education teacher； third，liking the special education teacher； fourth，began to change his established modality.
（3）The special education teacher establishing authority
Steps：lodge Jing Jing at the Children Care center every day，accompanied by his mom or grandma. Set targets for Jing Jing every day，if Jing Jing can meet these targets，he can get corresponding prizes，to increase his trust on the special education teacher and reduce his reliance on his mom and grandma. Progressively lengthen the duration of mom or grandma not accompanying him. In the early period，the duration was basically controlled at two days at home，and five days lodged at the Center every week.
Key points：first，the Center progressively cultivated Jing Jing’ s capabilities of taking care of himself；second，increasing physical exercises day by day；third，using wordless photo cards，games in smart phone，some photos of the kindergarten teachers and the kindergarten，some photos of Jing Jing’s parents and grandparents as language and body gesture games and stories.
Results assessment：first，he cared about the special education teacher；second，he obeyed the special education teacher.
2. Intervention Training Phase 2：Dissatisfying and Requirements
The invention training of this phase may only be conducted and completion and passing the assessment of Phase 1.
Materials：a camcorder，storybooks with words，toys（toy gun，sword，car，building blocks，balls，skipping rope），a smart cellphone，prizes.
（1）Paying attention to processes
Steps：asking Jing Jing every day to recall the people and things happened at the kindergarten，which can be conducted in two ways，the special education teacher relates，and asking Jing Jing to answer right or wrong（the special education teacher spoke one sentence first and then asked him to answer，the two progressively increased sentences while in this way，the special education teacher may deliberately say something wrong or contrary thereby improving Jing Jing’ s language competence and memory ability）and the special education teacher may give some simple reminder to Jing Jing until he can speak out the people and things happened in the kindergarten the whole day without reminding. The contents of memorization may first only recall unusual incidents happened at the kindergarten，and then the incidents happened during the whole day. After the incidents recalled were basically complete，then began recalling people in the sequence of kindergarten teachers，desk-mate，active kids in the class，etc. The recalling should focus on dressing，sentiment，moves，and conflicts，etc. After completion of this step，recall the people and incidents as while to recall and relate.
Key points： first，recalling people and incidents separately； second，there should be incremental dificulty in the right and wrong exercises between the special education teacher and Jing Jing； third，the focus of recalling incidents should be on processes and details； fourth，the focus of recalling people should be finally on the mental activities of the people involved； fifth，the focus of recalling the people and incidents as a whole should on the positive significance.
Results assessment：first，the abilities of Jing Jing paying attention to processes and details improved； second，the memorizing abilities improved significantly；third，his language competence improved significantly.
（2）Results Oriented
Steps：at the Center，the special education teacher would use the storybooks with words to tell stories to Jing Jing every day，use toys（toy gun，sword，car，building blocks，balls，skipping rope） to play games together with him.
Key points：first，the focus of storytelling should be on memorizing the key meanings of the stories； second，he must be in good shape（speaking loud，physically active，and in high spirits）while playing with toys，may let him win without his awareness to boost his enthusiasm.
Results assessment：first，he can relate the stories the special education teacher told him；second，he can relate the stories to his kindergarten teacher；third，he can relate the stories to his desk-mate.
（3）Sharing Progress
Steps：every week Jing Jing could happily tell the people and things happened at the kindergarten and the Center to his mom，daddy，and grandma，and answer all the questions asked by his mom，daddy and grandma.
Key points：first，the level of passive sharing；second，the times of proactive sharing.
Results assessment：first，whether he shared the stories or not；second，whether he added his own ideas or not；third，whether he is proactive and highly motivated to win when playing games with his family members.
3. Intervention Training Phase 3：Challenging and Comprehensive Generalization
It is prerequisite that the objectives of Phase 1 and Phase 2 have been met and Jing Jing in good shape（may have more outdoor activities if the temperature is suitable）for implementing intervention training of this phase.
Materials：a camcorder，outdoor venues（amusement parks，supermarkets，zoos，etc）a smart phone，prizes.
（1）Participating in Competition（motivation）
Steps：encouraging Jing Jing to participate in competitive sports and activities in his kindergarten class，and encouraging Jing Jing to participate in competitive competition organized by the kindergarten，encouraging Jing Jing to respond to the tasks or courses assigned by the kindergarten teachers that have time or speed requirements.
Key points：first，encouraging participation；second，encouraging quick response.
Results assessment：first，paying more attention to listening；second，able to understand the contents and rules of competitive sports and activities；third，more proactively responding （participating）
（2）To Be Number One （go all out）
Steps ： led by the special education teacher of the Center，Jing Jing can participate in a variety of outdoor （amusement parks，supermarkets，zoos，etc）competition （running，standing long jump，jumping height，etc）with strange kids.
Key points：first，participating in high spirits；second，encouraging him to win first place.
Results assessment：first，quite proactive；second，highly motivated to win first place.
（3）Self Motivation（self positive hints）
Steps：Jing Jing can all give positive hints to himself to respond and communicate with others no matter whether he is in the kindergarten，or the Center or at home，and can independently shop at supermarkets by speaking something and answer various questions asked by shop assistants，and participated in the Christmas group performance organized by the kindergarten （Jing Jing’ s maiden show in his kindergarten）.
Key points：first，proactively communicating with strangers on strange occasions；second；coming onto the stage for group performance.
Results assessment：first，answered questions whenever being asked；second，able to complete the complete set of performance moves on the stage by and large.
Training was conducted on the parents/grandparents and the kindergarten teacher for each of the above phases，and ensure thorough discussion provided all the trainees involved completely and accurately understand the contents，approaches and key points of the intervention training of this phase.
（五）Training Results
1.Improvements in the Kindergarten
Jing Jing made progress in his overall performance every day from entering the kindergarten to leaving the kindergarten，e.g.，responding to the greetings from the kindergarten security guards，greeting his classmates，responding to the instructions of kindergarten teachers，going to the toilet on his own（drinking，dining，queuing），raising his hands at class，a lot more proactive to make friends. See Table 4-9 for details：
Table 4-9 Questionnaire in the Kindergarten
Continued
2.Improvements at Home
The family members of Jing Jing said that Jing Jing made remarkable progress in his performance at home. See Table 4-10 for details.
Table 4-10 At-Home Questionnaire
Continued
（六）Research conclusions and future research
After a total of 8 months of comprehensive intervention training，the total effective rate was 100%。Although the Jing Jing in the kindergarten’s language，behavior，communication has improved significantly，but the voice is weak，the volume is small，with no change in tone when talking，a stif stif facial expression，still need to continue training，Create the best conditions for the future school education。
In 2016，Edmond kindergarten，where the scene was held，held a grand Christmas party at a five star hotel，This is the first stage performance of Jing Jingo Jing Jing ’s parents in the joy of，but also for children suffering from SM parents feel the same，It is agreed that video and video comparisons will be provided for academic studies before and after a large amount of Jing Jing training，At this center，all the teachers are very grateful。
It is hoped that this case can provide useful help for the further study of SM at home and abroad。
免责声明：以上内容源自网络，版权归原作者所有，如有侵犯您的原创版权请告知，我们将尽快删除相关内容。
