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  • 1.
    Bejnö, Hampus
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Roll-Pettersson, Lise
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Klintwall Högberg, Lars
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Långh, Ulrika
    Odom, Samuel L.
    Bölte, Sven
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Adapting the Preschool Environment to the Needs of Children on the Autism Spectrum in Sweden: A quasi-experimental study2023In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 30, no 3, p. 278-297Article in journal (Refereed)
    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.

  • 2.
    Bejnö, Hampus
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Roll-Pettersson, Lise
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Klintwall, Lars
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Långh, Ulrika
    Odom, Samuel L.
    Bölte, Sven
    Cross-Cultural Content Validity of the Autism Program Environment Rating Scale in Sweden2019In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 49, no 5, p. 1853-1862Article in journal (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.

  • 3.
    Bejnö, Hampus
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Roll-Pettersson, Lise Renat
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Klintwall, Lars
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Långh, Ulrika
    Odom, Samuel L.
    Bolte, Sven
    Cross-Cultural Content Validity of the Autism Program Environment Rating Scale in Sweden2019Conference paper (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.

  • 4. Gale, Catherine M.
    et al.
    Eikeseth, Svein
    Klintwall, Lars
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Children with Autism show Atypical Preference for Non-social Stimuli2019In: Scientific Reports, E-ISSN 2045-2322, Vol. 9, article id 10355Article in journal (Refereed)
    Abstract [en]

    The present investigation describes three studies testing the hypothesis that children with Autism Spectrum Disorder (ASD) show an atypical preference for non-social stimuli. Preference for non-social and social stimuli was assessed using applications on a portable tablet computer. Twenty-eight children with ASD were matched on developmental age with the chronological age of 41 typically developing (TD) children. The non-social stimuli consisted of six different films of abstract moving geometric patterns. Social stimuli were six different films of the face of young adults (Study 1 and 3) or six films of different dogs' faces (Study 2). When given a choice between the non-social and social stimuli, children with ASD preferred the non-social stimuli. When the human faces were replaced with dogs' faces the participants with ASD continued to prefer the non-social stimuli. A high reinforcement value of non-social stimuli was also demonstrated when the non-social stimuli were presented alone, suggesting the preference for the non-social stimuli was not simply an avoidance of social stimuli. Whenever an infant prefers non-social stimuli over social stimuli, non-typical development in social communication and social interests may result, together with the development of high levels and frequently occurring stereotyped and repetitive behavior. These behaviors define Autism.

  • 5.
    Hampus, Bejnö
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Roll-Pettersson, Lise
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Klintwall, Lars
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Långh, Ulrika
    Odom, Samuel L
    Bölte, Sven
    Cross-Cultural Content Validity of the Autism Program Environment Rating Scale in Sweden2019In: 12th Autism-Europe International Congress – September 13-15th 2019: Abstract book, 2019, p. 94-95Conference paper (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.

  • 6.
    Hansén-Larson, Johan
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Bejnö, Hampus
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Jägerskogh, Elin
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Eikeseth, Svein
    Klintwall, Lars
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    TRAS: Validity and sensitivity of a language assessment tool for children with ASD2021In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 62, no 4, p. 522-528Article in journal (Refereed)
    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.

  • 7.
    Klintwall, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Bellander, Martin
    Cervin, Matti
    Perceived Causal Problem Networks: Reliability, Central Problems, and Clinical Utility for Depression2022In: Assessment (Odessa, Fla.), ISSN 1073-1911, E-ISSN 1552-3489, Vol. 30, no 1, p. 73-83Article in journal (Refereed)
    Abstract [en]

    Personalized case conceptualization is often regarded as a prerequisite for treatment success in psychotherapy for patients with comorbidity. This article presents Perceived Causal Networks, a novel method in which patients rate perceived causal relations among behavioral and emotional problems. First, 231 respondents screening positive for depression completed an online Perceived Causal Networks questionnaire. Median completion time (including repeat items to assess immediate test–retest reliability) was 22.7 minutes, and centrality measures showed excellent immediate test–retest reliability. Networks were highly idiosyncratic, but worrying and ruminating were the most central items for a third of respondents. Second, 50 psychotherapists rated the clinical utility of Perceived Causal Networks visualizations. Ninety-six percent rated the networks as clinically useful, and the information in the individual visualizations was judged to contain 47% of the information typically collected during a psychotherapy assessment phase. Future studies should individualize networks further and evaluate the validity of perceived causal relations.

  • 8. Långh, Ulrika
    et al.
    Hammar, Martin
    Klintwall, Lars
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Bölte, Sven
    Allegiance and knowledge levels of professionals working with early intensive behavioural intervention in autism2017In: Early Intervention in Psychiatry, ISSN 1751-7885, E-ISSN 1751-7893, Vol. 11, no 5, p. 444-450Article in journal (Refereed)
    Abstract [en]

    Aim: Early intensive behavioural intervention (EIBI) for children with autism spectrum disorder (ASD) is often delivered using a community model. Behaviourmodification experts train and supervise non-experts (e.g. preschool personnel) to teach children according to applied behaviour analysis principles in their natural environment. Several factors predict EIBI outcomes in ASD, for example, knowledge of EIBI and EIBI allegiance among trainers. The aim of the present study was to survey levels of knowledge about and allegiance towards EIBI.

    Methods: Formal knowledge of EIBI and EIBI allegiance was surveyed in supervised preschool staff conducting EIBI (n = 33), preschool staff not involved in EIBI (n = 26), behaviour modification experts (n = 60), school staff (n = 25) and parents of children with ASD (n = 150) [N = 294]. A 27-item (15 knowledge and 12 allegiance questions) online questionnaire was collected.

    Results: Supervised preschool staff conducting EIBI had more knowledge than preschool staff not using EIBI, but they were not more allegiant. Compared with behaviour modification experts, the supervised EIBI preschool staff group showed markedly less knowledge and allegiance.

    Conclusions: Findings indicate potential for improvement regarding formal knowledge levels of preschool staff delivering EIBI to children with ASD in real-world settings. In addition, fostering EIBI allegiance might be prioritized when teaching EIBI among non-experts. Broadly increased EIBI knowledge levels among all preschool teachers should be achieved by adding behaviour modification techniques to common university curricula in preschool education. Allegiance of preschool personnel might be accomplished by EIBI supervisors meeting skepticism in practice with conveyance of evidence-based principles and discussions of ethical issues.

  • 9. Smith, Dean P.
    et al.
    Hayward, Diane W.
    Gale, Catherine M.
    Eikeseth, Svein
    Klintwall, Lars
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Treatment Gains from Early and Intensive Behavioral Intervention (EIBI) are Maintained 10 Years Later2021In: Behavior modification, ISSN 0145-4455, E-ISSN 1552-4167, Vol. 45, no 4, p. 581-601Article in journal (Refereed)
    Abstract [en]

    This study reports outcome in adolescents with autism who in their childhood received Early and Intensive Behavioral Intervention (EIBI). Nineteen children (16 boys) who had received two years of EIBI starting at a mean age of 2-years-and-11-months were followed up, on average, 12 years later. Results showed the participants significantly increased their cognitive and adaptive standard scores during the two years of EIBI, and that these gains were maintained at follow-up, 10 years after the EIBI had ended. Participants also showed a significant reduction in autism symptoms between intake and follow-up. At follow-up, none of the participants had received any additional psychiatric diagnoses, and none were taking any psychotropic medication. Results indicate that treatment gains achieved in EIBI are maintained into adolescence.

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