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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)
Stockholm University, Faculty of Social Sciences, Department of Special Education.ORCID iD: 0000-0002-7469-2666
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 [en]
Applied Behavior Analysis, Autism Spectrum Disorder, Early Intensive Behavioral Intervention, Learning Environment, Preschool
Keywords [sv]
Autism, mångsidiga program, förskola, lärmiljö, tillämpad beteendeanalys
National Category
Applied Psychology Pedagogy
Research subject
Special Education
Identifiers
URN: urn:nbn:se:su:diva-197605ISBN: 978-91-7911-644-6 (print)ISBN: 978-91-7911-645-3 (electronic)OAI: oai:DiVA.org:su-197605DiVA, id: diva2:1601700
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, 2015-01212Available from: 2021-11-04 Created: 2021-10-09 Last updated: 2022-02-25Bibliographically approved
List of papers
1. Cross-Cultural Content Validity of the Autism Program Environment Rating Scale in Sweden
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
2. Adapting the Preschool Environment to the Needs of Children on the Autism Spectrum in Sweden: A quasi-experimental study
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
3. From Someone Who May Cause Trouble to Someone You Can Play With: Stakeholders' Perspectives on Preschool Program Quality for Autistic Children
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

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