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Bejnö, H., Roll-Pettersson, L., Klintwall Högberg, L., Långh, U., Odom, S. L. & Bölte, S. (2023). Adapting the Preschool Environment to the Needs of Children on the Autism Spectrum in Sweden: A quasi-experimental study. Scandinavian Journal of Occupational Therapy, 30(3), 278-297
Open this publication in new window or tab >>Adapting the Preschool Environment to the Needs of Children on the Autism Spectrum in Sweden: A quasi-experimental study
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2023 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 30, no 3, p. 278-297Article in journal (Refereed) Published
Abstract [en]

BACKGROUND Children on the autism spectrum may receive Early Intensive Behavioural Intervention (EIBI) in Sweden to support development by providing learning opportunities. However, research suggests a need to improve the quality of their learning environment.

AIM This pre-registered study (#NCT03634761) aimed to evaluate the Swedish Autism Program Environment Rating Scale (APERS-P-SE) as a means to promote the quality of the pre-school learning environment for children on the autism spectrum, along with outcomes for these children, and their pre-school staff.

MATERIAL AND METHODS In a quasi-experimental study, pre-school staff (n = 35) conducted either EIBI supported by in-service training and on-site coaching based on APERS-P-SE assessment (at k = 9 preschools) or EIBI only (k = 8), during an 8-months period.

RESULTS The quality of the immediate learning environment (primary outcome) increased significantly in the EIBI/APERS-P-SE preschools. However, changes in child and pre-school staff measures were not significant.

CONCLUSIONS AND SIGNIFICANCE In-service training and on-site coaching based on APERS-P-SE assessments can increase the quality of the learning environment in Swedish pre-school. Studies of longer duration and larger sample size are required to determine if using the APERS-P-SE can also achieve desired behavioural change for children-, and impact pre-school staff applying EIBI.

Keywords
autism spectrum disorder, coaching, early intensive behavioural intervention, early intervention, environmental enrichment, learning environment
National Category
Applied Psychology Pedagogy
Research subject
Special Education
Identifiers
urn:nbn:se:su:diva-197604 (URN)10.1080/11038128.2021.1993330 (DOI)000710779700001 ()2-s2.0-85118169159 (Scopus ID)
Funder
Swedish Research Council, 2015-01212
Available from: 2021-10-09 Created: 2021-10-09 Last updated: 2023-03-27Bibliographically approved
Ringer, N., Benjaminson, C. & Bejnö, H. (2023). Living with Paediatric acute-onset neuropsychiatric syndrome (PANS) – a qualitative study of Children’s experiences in Sweden. Cogent Psychology, 10(1), Article ID 2259745.
Open this publication in new window or tab >>Living with Paediatric acute-onset neuropsychiatric syndrome (PANS) – a qualitative study of Children’s experiences in Sweden
2023 (English)In: Cogent Psychology, E-ISSN 2331-1908, Vol. 10, no 1, article id 2259745Article in journal (Refereed) Published
Abstract [en]

Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a relatively new diagnosis, characterized by an abrupt and dramatic onset of obsessive-compulsive disorder, together with neuropsychiatric symptoms. The study aimed to understand the experience of living with PANS from the perspective of children with the diagnosis. The study employed semi-structured interviews with nine children, aged 10–18 years old, with a diagnosis of PANS. An inductive qualitative content analysis approach was used as a guide for analysis of data. The analysis identified three main categories: (1) “Suffering” reflects the aversive emotional, cognitive, and physical experiences of PANS, and its negative consequences on life; (2) “Powerlessness” reflects a lack of control, difficulties involved with predicting and managing the symptoms, not having words to describe one’s needs, and experiencing a lack of understanding from healthcare providers; and (3) “Being encouraged” entails experiences of finding support and encouragement by receiving flexible treatments, adjusted to the person one is, and having someone who does not give up. The conclusions are that PANS has major negative consequences for the children’s well-being, and they experience limited possibilities to manage the symptoms. Flexible and personally adjusted treatments, and caregivers who are a stable source of support, are empowering.

Keywords
aediatric Acute-onset Neuropsychiatric Syndrome, PANS/PANDAS, children, interviews, lived experience
National Category
Psychiatry
Identifiers
urn:nbn:se:su:diva-221772 (URN)10.1080/23311908.2023.2259745 (DOI)001076053300001 ()2-s2.0-85171986529 (Scopus ID)
Funder
Stockholm UniversityStockholm UniversityStockholm University
Note

Associated dataset: https://doi.org/10.58141/xbec-wq09

Available from: 2023-10-02 Created: 2023-10-02 Last updated: 2024-01-08Bibliographically approved
Bejnö, H., Bölte, S., Linder, N., Långh, U., Odom, S. L. & Roll-Pettersson, L. (2022). From Someone Who May Cause Trouble to Someone You Can Play With: Stakeholders' Perspectives on Preschool Program Quality for Autistic Children. Journal of autism and developmental disorders, 52(9), 3890-3908
Open this publication in new window or tab >>From Someone Who May Cause Trouble to Someone You Can Play With: Stakeholders' Perspectives on Preschool Program Quality for Autistic Children
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2022 (English)In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 52, no 9, p. 3890-3908Article in journal (Refereed) Published
Abstract [en]

In Sweden, young autistic children typically attend community-based preschool programs, which may not be adapted to their needs. In the current study, stakeholders to autistic children receiving Early Intensive Behavioral Intervention were interviewed following a quasi-randomized study (#NCT03634761) aimed at improving the preschool program quality using the Swedish version of the Autism Program Environment Rating Scale (APERS). Stakeholders provided their perceptions and experiences concerning key factors for high quality preschool programs as well as well as their experiences of the abovementioned APERS study. Applying thematic analysis, stakeholder groups differed in what they emphasized, but all highlighted staff’s competence, children’s inclusion and participation, collaboration, and the learning environment as key program areas that had been positively influenced by the APERS-based intervention.

Keywords
Autism, Learning environment, Preschool, Program quality
National Category
Applied Psychology
Research subject
Special Education; Psychology
Identifiers
urn:nbn:se:su:diva-197178 (URN)10.1007/s10803-021-05268-2 (DOI)000695633100001 ()34499273 (PubMedID)2-s2.0-85114648632 (Scopus ID)
Funder
Swedish Research Council, 2015-01212
Available from: 2021-09-28 Created: 2021-09-28 Last updated: 2022-08-16Bibliographically approved
Bejnö, H. (2021). Early intervention and autism: Improving preschool program quality for children with autism spectrum disorder receiving Early Intensive Behavioral Intervention using the Autism Program Environment Rating Scale (APERS). (Doctoral dissertation). Stockholm: Department of Special Education, Stockholm University
Open this publication in new window or tab >>Early intervention and autism: Improving preschool program quality for children with autism spectrum disorder receiving Early Intensive Behavioral Intervention using the Autism Program Environment Rating Scale (APERS)
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The quality of the learning environment in preschool is of significant importance for children with autism spectrum disorder (ASD). However, very limited research has addressed how this environment can be improved. In regard to early intervention, most previous studies have primarily focused on child characteristics, and intervention content and quantity, rather than the broader learning environment in which interventions are delivered. Thus, the overall aim of this thesis was to study the quality of the learning environment for children with ASD. In particular, the focus was on children who receive Early Intensive Behavioral Intervention (EIBI) in community-based Swedish preschools, using the Autism Program Environment Rating Scale (APERS). Within this framework, three studies were conducted.

In study 1, we translated, culturally adapted, and systematically assessed the content validity of APERS, a rating scale designed to assess the program quality for children with ASD in educational settings. In the process, the scale was modified to make the instrument as relevant as possible for the Swedish preschool context, and re-named APERS-P-SE. Nine experts rated the clarity and comprehensiveness of the individual items, as well as the relevance of the scale in its entirety. In study 2, we evaluated APERS-P-SE as the foundation for professional development for preschool staff working with children with ASD receiving EIBI, to promote preschool learning environment quality (primary outcome), and outcomes for autistic children, and preschool staff (secondary outcomes). Using a quasi-experimental design, preschool staff either implemented EIBI enriched by in-service training and on-site coaching based on APERS-P-SE assessments (k = 9), or EIBI only (k = 8) during 8 months. A total of 17 children and 35 preschool staff participated, across 17 preschools. In study 3, individual interviews and focus-group interviews were conducted with preschool staff, preschool principals, habilitation supervisors, and parents to children with ASD who had participated in study 2 and received the APERS-P-SE-based intervention. Through these interviews, the different groups of stakeholders provided their thoughts about what they found to be the most important aspects of preschool programs for autistic children who receive EIBI, and their opinions and experiences of participating in study 2.

 Study 1 demonstrated a high level of content validity for the Swedish version of the APERS. In study 2, the EIBI/APERS-P-SE preschools significantly improved their learning environment, compared to the preschools that received EIBI only. Outcomes for autistic children and preschool staff did not differ significantly between the groups, despite positive descriptive findings. In study 3, four themes were identified as being key aspects of preschool programs with high quality to promote optimal development of children with ASD: (1) staff’s competence, (2) children’s inclusion and participation, (3) collaboration, and (4) learning environment. Overall, the stakeholders described the APERS-P-SE-based model as helpful in improving children’s participation, preschool staff’s engagement with the child, and optimizing child outcomes.

Taken together, the results indicate that APERS-P-SE is an instrument with a high level of content validity, and that it can be used in combination with in-service training and on-site coaching to improve preschool program quality for children with ASD.

Place, publisher, year, edition, pages
Stockholm: Department of Special Education, Stockholm University, 2021. p. 98
Keywords
Applied Behavior Analysis, Autism Spectrum Disorder, Early Intensive Behavioral Intervention, Learning Environment, Preschool, Autism, mångsidiga program, förskola, lärmiljö, tillämpad beteendeanalys
National Category
Applied Psychology Pedagogy
Research subject
Special Education
Identifiers
urn:nbn:se:su:diva-197605 (URN)978-91-7911-644-6 (ISBN)978-91-7911-645-3 (ISBN)
Public defence
2021-11-30, Lärosal 16, hus 2, Albanovägen 18 and online via Zoom, public link is available at the department website, Stockholm, 10:00 (English)
Opponent
Supervisors
Funder
Swedish Research Council, 2015-01212
Available from: 2021-11-04 Created: 2021-10-09 Last updated: 2022-02-25Bibliographically approved
Hansén-Larson, J., Bejnö, H., Jägerskogh, E., Eikeseth, S. & Klintwall, L. (2021). TRAS: Validity and sensitivity of a language assessment tool for children with ASD. Scandinavian Journal of Psychology, 62(4), 522-528
Open this publication in new window or tab >>TRAS: Validity and sensitivity of a language assessment tool for children with ASD
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2021 (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 62, no 4, p. 522-528Article in journal (Refereed) Published
Abstract [en]

Interventions for preschool children with autism typically require professionals and parents to identify which social and language skills the individual child shows deficits in. Many assessment tools aimed at identifying such deficits exist, but they often require extensive training to use. The present study investigated the potential usefulness for said assessment purposes of the Norwegian assessment tool, TRAS – “Tidig Registrering Av Språkutveckling” (i.e. Nordic acronym for assessment of early language development), which can be used by preschool teachers without any specific training. Participants were 54 children with ASD, aged 2–5 years, enrolled in a behavioral intervention program. Participants were scored using TRAS at three time points during treatment to investigate TRAS’ sensitivity for detecting change. Only participants who had TRAS scores registered at all three time points were used for this analysis (n = 27). At intake, children were also scored using the Vineland Adaptive Behavior Scales, the results of which was then compared to TRAS scores. Results showed that TRAS scores increased significantly across time points, indicating that the tool is sensitive to treatment effects. TRAS scores also correlated significantly with Vineland communication subscale (n = 50), indicating that the measure can be used to measure language abilities in children with ASD. We conclude that TRAS is a potential alternative to more comprehensive language assessment tools for children with ASD.

Keywords
language development, autism spectrum disorder, assessment tool, TRAS, Vineland
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-193990 (URN)10.1111/sjop.12736 (DOI)000649185800001 ()33977525 (PubMedID)
Available from: 2021-06-14 Created: 2021-06-14 Last updated: 2022-02-25Bibliographically approved
Hampus, B., Roll-Pettersson, L., Klintwall, L., Långh, U., Odom, S. L. & Bölte, S. (2019). Cross-Cultural Content Validity of the Autism Program Environment Rating Scale in Sweden. In: 12th Autism-Europe International Congress – September 13-15th 2019: Abstract book. Paper presented at Autism-Europe's 12th International Congress “A new Dynamic for Change and Inclusion”, Nice, France, September 13-15, 2019 (pp. 94-95).
Open this publication in new window or tab >>Cross-Cultural Content Validity of the Autism Program Environment Rating Scale in Sweden
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2019 (English)In: 12th Autism-Europe International Congress – September 13-15th 2019: Abstract book, 2019, p. 94-95Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Introduction: Increased diagnoses rates of autism and earlier identification pose new challenges to preschools and services delivering early intervention to children on the spectrum. A prerequisite for successful implementation of support is a high quality preschool learning environment. Here, we briefly describe the process of translating, culturally adapting and validating the contents of the Autism Program Environment Rating scale (APERS), originally designed for assessing the quality of the learning environment for children and adolescents with autism in the USA, to a European language and educational context.

Methods: In an authorized step-wise procedure, the 59 item scale was translated by a PhD level clinician fluent in English with expertise in autism and psychometrics. Subsequently, following internal feedback from the research team, adaptions addressing translation and cultural adaption of the scale were made. Then, five Swedish external preschool and early intervention experts were invited to provide feedback on the cultural appropriateness of the adapted scale. Lastly, nine additional independent external experts within the field of autism, preschool and early intervention were invited to rate the content validity of the adapted scale. Relevance of subdomains and domains was assessed as well as clarity and comprehensiveness for all of the scale’s items. Experts also rated the practical relevance, need, usefulness, and feasibility of the scale as a whole, and provided anecdotal formative feedback.

Results: All items, subdomains, and domains of the scale were estimated by the raters as showing sufficient content validity (Content validity index &#8805,.79). Several Swedish experts highlighted the need for such a scale, and the usefulness of the scale as a means to assess and then support preschool staff to improve learning environment for children with autism. However, some concerns were raised about the comprehensiveness of the scale and the challenges preschools will meet in improving their learning environment. 

Discussion There seems to be a need for a rating scale to assess and improve the learning environment for children with autism in preschool settings. Although the usefulness and content validity of the translated and adapted scale was established, little is still known about other psychometric properties of the scale, and more work needs to be done to assess its usefulness as a tool for systematic improvement of preschool program quality.

Keywords
Assessment, Preschool, Program
National Category
Learning Pedagogical Work Applied Psychology
Identifiers
urn:nbn:se:su:diva-173380 (URN)
Conference
Autism-Europe's 12th International Congress “A new Dynamic for Change and Inclusion”, Nice, France, September 13-15, 2019
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2022-02-26Bibliographically approved
Bejnö, H., Roll-Pettersson, L. R., Klintwall, L., Långh, U., Odom, S. L. & Bolte, S. (2019). Cross-Cultural Content Validity of the Autism Program Environment Rating Scale in Sweden. In: : . Paper presented at ABAI 10th International Conference, Stockholm, Sweden, September 29-30, 2019.
Open this publication in new window or tab >>Cross-Cultural Content Validity of the Autism Program Environment Rating Scale in Sweden
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2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Increasing rates of autism spectrum disorder (ASD) and younger age at diagnosis pose a challenge to preschool intervention systems. In Sweden, most young autistic children receive intervention service in community-based preschool programs, but no tool is yet available to assess the quality of the preschool learning environment. This study adapted the Autism Program Environment Rating Scale Preschool/Elementary to Swedish community context (APERS-P-SE). Following translation and a multistep modification process, independent experts rated the content validity of the adaptation. Findings indicate high cross-cultural validity of the adapted APERS-P-SE. The cultural adaption process of the APERS-P-SE highlights similarities and differences between the American and Swedish preschool systems and their impact on early ASD intervention.

National Category
Applied Psychology Pedagogical Work
Identifiers
urn:nbn:se:su:diva-178183 (URN)
Conference
ABAI 10th International Conference, Stockholm, Sweden, September 29-30, 2019
Available from: 2020-01-20 Created: 2020-01-20 Last updated: 2022-02-26Bibliographically approved
Bejnö, H., Roll-Pettersson, L., Klintwall, L., Långh, U., Odom, S. L. & Bölte, S. (2019). Cross-Cultural Content Validity of the Autism Program Environment Rating Scale in Sweden. Journal of autism and developmental disorders, 49(5), 1853-1862
Open this publication in new window or tab >>Cross-Cultural Content Validity of the Autism Program Environment Rating Scale in Sweden
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2019 (English)In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 49, no 5, p. 1853-1862Article in journal (Refereed) Published
Abstract [en]

Increasing rates of autism spectrum disorder (ASD) and younger age at diagnosis pose a challenge to preschool intervention systems. In Sweden, most young autistic children receive intervention service in community-based preschool programs, but no tool is yet available to assess the quality of the preschool learning environment. This study adapted the Autism Program Environment Rating Scale Preschool/Elementary to Swedish community context (APERS-P-SE). Following translation and a multistep modification process, independent experts rated the content validity of the adaptation. Findings indicate high cross-cultural validity of the adapted APERS-P-SE. The cultural adaption process of the APERS-P-SE highlights similarities and differences between the American and Swedish preschool systems and their impact on early ASD intervention.

Keywords
autism spectrum disorder, scale, preschool, assessment, cultural adaption, content validity
National Category
Applied Psychology Pedagogical Work
Research subject
Special Education; Psychology
Identifiers
urn:nbn:se:su:diva-164310 (URN)10.1007/s10803-018-03870-5 (DOI)000466001300008 ()
Funder
Swedish Research Council, 2015-01212
Available from: 2019-01-15 Created: 2019-01-15 Last updated: 2022-03-23Bibliographically approved
Bejnö, H., Bölte, S. & Roll-Pettersson, L. (2019). Using a competency based model to improve prerequisites for implementation of EIBI: Insights and perspectives from Sweden. In: : . Paper presented at International Society on Early Intervention Conference 2019, Research to Practice in Early Intervention: An International Perspective, Sydney, Australia, June 25-28, 2019.
Open this publication in new window or tab >>Using a competency based model to improve prerequisites for implementation of EIBI: Insights and perspectives from Sweden
2019 (English)Conference paper, Oral presentation only (Other academic)
Abstract [en]

A prerequisite for effective implementation of early intensive behavioral interventions is a high quality learning environment. However, research to date suggests that the learning environment in community based Swedish preschools is not optimal for children with ASD. A brief overview of the Swedish early intervention support system will be followed by a description of the cultural adaption of the Autism Program Environment Rating Scale (APERS-PE). Furthermore, an ongoing comparative study involving 17 preschools will be described. All participating preschools have children enrolled in EIBI preschool programs, entailing that paraprofessionals and parents obtain supervision at habilitation centers. In addition preschool staff in the study’s experimental group receive monthly on-site coaching, and in-service training on evidence based practices and autism. Outcome measures include pre-post APERS-PE assessments, child engagement and adaptive behavior, and staff knowledge and self-efficacy. Preliminary findings indicate increased learning environment quality in the study’s experimental group as rated by APERS-PE.

National Category
Applied Psychology Pedagogical Work
Identifiers
urn:nbn:se:su:diva-171278 (URN)
Conference
International Society on Early Intervention Conference 2019, Research to Practice in Early Intervention: An International Perspective, Sydney, Australia, June 25-28, 2019
Available from: 2019-08-05 Created: 2019-08-05 Last updated: 2022-02-26Bibliographically approved
Bejnö, H., Johansson, S., Ramnerö, J., Grimaldi, L. & Cepeda, R. (2018). Emergent Language Responses Following Match-to-Sample Training among Children with Autism Spectrum Disorder. International Journal of Psychology & Psychological Therapy / Revista Internacional de Psicologia y Terapia Psicologica, 18(1), 1-14
Open this publication in new window or tab >>Emergent Language Responses Following Match-to-Sample Training among Children with Autism Spectrum Disorder
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2018 (English)In: International Journal of Psychology & Psychological Therapy / Revista Internacional de Psicologia y Terapia Psicologica, ISSN 1577-7057, E-ISSN 2340-2857, Vol. 18, no 1, p. 1-14Article in journal (Refereed) Published
Abstract [en]

The present study explored the effects of match-to-sample training on emergent responses in the domains of receptive and expressive language among children with autism spectrum disorder (ASD) in an applied setting. A concurrent multiple probe design across six participants was applied, with a follow-up after 10 days. All six children participated in a match-to-sample training procedure. The participants were trained to match a picture card of an item with a word card corresponding to the name of the item, and a word card of an item with a picture card corresponding to the name of the item. After training, three participants developed the emergent responses of receptively identifying and expressively naming both picture cards and word cards. There was a correspondence between acquired matching skills and the development of emergent language responses. Follow-up measures showed that the acquired emergent responses remained somewhat stable over time. The results are discussed in relation to prior research and in terms of implications for teaching children with ASD language skills in applied settings such as preschools. The results are also discussed in relation to the participant’s prior verbal skills and to the retention of emergent language responses.

Keywords
emergent language responses, match-to-sample, matching training, language acquisition, autism spectrum disorder
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-154144 (URN)
Available from: 2018-03-16 Created: 2018-03-16 Last updated: 2022-02-28Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-7469-2666

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