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  • 1. Barnevik Olsson, Martina
    et al.
    Holm, Anette
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Cognitive psychology. Gothenburg University, Sweden.
    Lundholm Hedvall, Åsa
    Gillberg, Christopher
    Fernell, Elisabeth
    Children with borderline intellectual functioning and autism spectrum disorder: developmental trajectories from 4 to 11 years of age2017In: Neuropsychiatric Disease and Treatment, ISSN 1176-6328, E-ISSN 1178-2021, Vol. 13, p. 2519-2526Article in journal (Refereed)
    Abstract [en]

    Background: Studies on autism have tended to focus either on those with intellectual disability (ie, those with intellectual quotient [IQ] under 70) or on the group that is referred to as high-functioning, that is, those with borderline, average or above average IQ. The literature on cognition and daily functioning in autism spectrum disorder combined specifically with borderline intellectual functioning (IQ 70-84) is limited. Methods: From a representative group of 208 preschool children diagnosed with autism spectrum disorder, those 50 children in the group with borderline intellectual functioning at ages 4.5-6.5 years were targeted for follow-up at a median age of 10 years. A new cognitive test was carried out in 30 children. Parents were interviewed with a semi-structured interview together with the Vineland Adaptive Behavior Scales (n=41) and the Autism-Tics, attention-deficit/hyperactivity disorder (AD/HD) and other comorbidities inventory (A-TAC) (n=36). Results: Most children of interviewed parents presented problems within several developmental areas. According to A-TAC and the clinical interview, there were high rates of attention deficits and difficulties with regulating activity level and impulsivity. Vineland Adaptive Behavior Scales composite scores showed that at school age, a majority of the children had declined since the previous assessment at ages between 4.5 and 6.5 years. Almost half the tested group had shifted in their IQ level, to below 70 or above 84. Conclusion: None of the children assessed was without developmental/neuropsychiatric problems at school-age follow-up. The results support the need for comprehensive follow-up of educational, medical and developmental/neuropsychiatric needs, including a retesting of cognitive functions. There is also a need for continuing parent/family follow-up and support.

  • 2. Barnevik Olsson, Martina
    et al.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Gothenburg University, Sweden.
    Lundstrom, Sebastian
    Giacobini, MaiBritt
    Fernell, Elisabeth
    Gillberg, Christopher
    Recovery from the diagnosis of autism - and then?2015In: Neuropsychiatric Disease and Treatment, ISSN 1176-6328, E-ISSN 1178-2021, Vol. 11, p. 999-1005Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to follow up the 17 children, from a total group of 208 children with autism spectrum disorder (ASD), who recovered from autism. They had been clinically diagnosed with ASD at or under the age of 4 years. For 2 years thereafter they received intervention based on applied behavior analysis. These 17 children were all of average or borderline intellectual functioning. On the 2-year follow-up assessment, they no longer met criteria for ASD. Methods: At about 10 years of age they were targeted for a new follow-up. Parents were given a semistructured interview regarding the child's daily functioning, school situation, and need of support, and were interviewed using the Vineland Adaptive Behavior Scales (VABS) and the Autism - Tics, Attention-deficit/hyperactivity disorder (AD/HD), and other Comorbidities (A-TAC) telephone interview. Results: The vast majority of the children had moderate-to-severe problems with attention/activity regulation, speech and language, behavior, and/or social interaction. A majority of the children had declined in their VABS scores. Most of the 14 children whose parents were A-TAC-interviewed had problems within many behavioral A-TAC domains, and four (29%) had symptom levels corresponding to a clinical diagnosis of ASD, AD/HD, or both. Another seven children (50%) had pronounced subthreshold indicators of ASD, AD/HD, or both. Conclusion: Children diagnosed at 2-4 years of age as suffering from ASD and who, after appropriate intervention for 2 years, no longer met diagnostic criteria for the disorder, clearly needed to be followed up longer. About 3-4 years later, they still had major problems diagnosable under the umbrella term of ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations). They continued to be in need of support, educationally, from a neurodevelopmental and a medical point of view. According to parent interview data, a substantial minority of these children again met diagnostic criteria for ASD.

  • 3. Blomqvist, My
    et al.
    Ek, Ulla
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Fernell, Elisabeth
    Holmberg, Kirsten
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Dahlloö, Göran
    Cognitive ability and dental fear and anxiety2013In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 121, no 2, p. 117-120Article in journal (Refereed)
    Abstract [en]

    Dental fear and anxiety (DFA), as well as dental behavior management problems, are common in children and adolescents. Several psychological factors in the child, and parental DFA, have been studied and found to correlate to the child's DFA. The aim of this study was to investigate the relationship between cognitive ability and DFA in a population-based group of children with identified behavior and learning problems. In conjunction with a dental examination at 11yr of age, 70 children were assessed with regard to DFA using the Children's Fear Survey Schedule Dental Subscale (CFSS-DS), and their cognitive ability was assessed using the Wechsler Intelligence Scale for Children. In addition, parental DFA was measured using the Corah Dental Anxiety Scale. The results revealed that DFA was significantly correlated to verbal intelligence quotient (IQ) but not to any other cognitive index. A significant correlation was found between parental DFA and child DFA. The results indicate that the child's verbal capacity may be one factor of importance in explaining dental fear in children.

  • 4.
    Borg, Elisabet
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Statistik för Beteendevetare2006Book (Other (popular science, discussion, etc.))
  • 5.
    Borg, Elisabet
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Statistik för beteendevetare: faktabok2012 (ed. 3)Book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Statistik för beteendevetare är en heltäckande grundbok i statistik. Författarna går steg för steg igenom hur du planerar, genomför och redovisar en statistisk undersökning:

    • Vilken undersökningsdesign ska jag välja?

    • Hur går jag till väga för att pröva min hypotes?

    • Vilka statistiska analyser kan jag göra?

    • Hur kan jag tolka och redovisa mina resultat?

  • 6.
    Borg, Elisabet
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Statistik för beteendevetare: övningsbok2013 (ed. 1)Book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Övningsbok till Statistik för beteendevetare är ett komplement till faktaboken med samma namn. Boken inleds med en kort repetition av grundläggande matematik och på omslagets insida finns ett flödesschema till hjälp för att avgöra vilken statistisk analys som bör väljas i en specifik situation.

  • 7. Carlsson, L. Höglund
    et al.
    Saltvedt, S.
    Anderlid, B. -M.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Cognitive psychology. Gothenburg University, Sweden.
    Gillberg, C.
    Westgren, M.
    Fernell, E.
    Prenatal ultrasound and childhood autism: long-term follow-up after a randomized controlled trial of first- vs second-trimester ultrasound2016In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 48, no 3, p. 285-288Article in journal (Refereed)
    Abstract [en]

    Objective: To analyze whether the frequency of autism spectrum disorder (ASD) in a cohort of Swedish children differs between those exposed to ultrasound in the 12th week and those exposed to ultrasound in the 18th week of gestation.

    Methods: The study cohort consisted of approximately 30 000 children born between 1999 and 2003 to mothers who had been randomized to a prenatal ultrasound examination at either 12 or 18weeks' gestation as part of the framework for a study on nuchal translucency screening. The outcome measure in the present study was the rate of ASD diagnoses among the children. Information on ASD diagnoses was based on data from the Swedish social insurance agency concerning childcare allowance granted for ASD.

    Results: Between 1999 and 2003, a total of 14 726 children were born to women who underwent a 12-week ultrasound examination and 14 596 to women who underwent an 18-week ultrasound examination. Of these, 181 (1.2%) and 176 (1.2%) children, respectively, had been diagnosed with ASD. There was no difference in ASD frequency between the early and late ultrasound groups.

    Conclusions: Women subjected to at least one prenatal ultrasound examination at either 12 or 18weeks' gestation had children with similar rates of ASD. However, this result reflects routine care 10-15 years ago in Sweden. Today, higher intensity ultrasound scans are performed more frequently, at earlier stages during pregnancy and for non-medical purposes, implying longer exposure time for the fetus. This change in the use of ultrasound necessitates further follow-up study of the possible effects that high exposure to ultrasound during the gestational period has on the developing brain.

  • 8. Carlsson, Lotta Höglund
    et al.
    Norrelgen, Fritjof
    Kjellmer, Liselotte
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Gillberg, Christopher
    Fernell, Elisabeth
    Coexisting Disorders and Problems in Preschool Children with Autism Spectrum Disorders2013In: Scientific World Journal, ISSN 1537-744X, E-ISSN 1537-744X, p. 213979-Article in journal (Refereed)
    Abstract [en]

    Objectives. To analyze cooccurring disorders and problems in a representative group of 198 preschool children with autism spectrum disorders (ASD) who had had interventions at a specialized habilitation center. Methods. Parents and children were seen by a research team. Data were based on parental interviews, pediatric assessments, and tests of the child. Information on autistic symptoms, general cognitive function, speech and language, motor function, epilepsy, vision, hearing, activity level, behavior, and sleep was collected. Results. Three ASD categories were used: (1) autistic disorder (AD), (2) autistic-like condition (ALC) or Asperger syndrome, and (3) one group with autistic symptoms/traits but not entirely all its criteria met for ASD. Children with autism had a mean of 3.2 coexisting disorders or problems, the ALC/Asperger group had a mean of 1.6, and children with autistic traits had a mean of 1.6. The most common disorder/problems in the total group pertained to language problems (78%), intellectual disability (ID) (49%), below average motor function (37%), and severe hyperactivity/ADHD (33%). Conclusions. The results accord with the concept of early symptomatic syndromes eliciting neurodevelopmental clinical examination (ESSENCE), and highlight the need of considering ASD in a broad perspective taking also other cooccurring developmental disorders into account.

  • 9.
    Dalkvist, Jan
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Montgomery, William
    Montgomery, Henry
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Reanalyses of group telepathy data with a focus on variability2010In: Journal of parapsychology, ISSN 0022-3387, Vol. 74, no 1, p. 143-171Article in journal (Refereed)
    Abstract [en]

    Reanalyses of data from experiments on telepathic communication of emotions, as evoked by slide pictures, between groups of senders and groups of receivers are reported. In the present study, variability in performance rather than level of performance was in focus. Fits between variability in distributions of hits expected by chance and variability in empirical distributions were explored. The expected distributions were derived by means of the hypergeometric distribution, which provides the number of successes in a sequence of n draws from a finite population without replacement. Session level analyses showed that the variability in hit-rate was smaller than that expected by chance, particularly when the session groups who started as senders and those who started as receivers were analyzed separately and when the geomagnetic activity was low. Monte Carlo analyses indicated that these results could not be explained by stacking effects. Individual level analyses did not show any effects. In a second part of the study, the variability of responses to the individual target pictures was explored. The variability differed significantly among the pictures. Simulation showed that this effect was not attributable to stacking effects. Two predictions to be tested in an ongoing replication experiment are presented.

  • 10. Dalkvist, Jan
    et al.
    Mossbridge, J.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    How to remove the influence of expectation bias in presentiment and similar experiments: a recommended strategy2014In: Journal of parapsychology, ISSN 0022-3387, Vol. 78, no 1, p. 80-97Article in journal (Refereed)
    Abstract [en]

    Here we reconsider expectation bias in so-called presentiment experiments, with focus on how to handle it. In such experiments, presentiment is usually thought to be demonstrated by showing that significant physiological differences precede stimuli presumed to give rise to different arousal levels. Often these differences suggest that physiological arousal is more likely to precede arousing rather than calming stimuli. Conceivably, however, such reactions can be explained as resulting from expectation bias of the gambler’s fallacy type. This bias is based on the (false) notion that the likelihood of an arousing stimulus being presented grows as the number of consecutive calming stimuli increases. Different ways of controlling or avoiding the bias are discussed. Our resulting recommendation is to use analysis of variance (ANOVA) to separate the effect of the bias from the hypothetical presentiment effect, preferably at the trial-by-trial level. We also recommend applying ANOVA to each participant separately and using a “counting” method to test for possible presentiment effects at the group level. Application of ANOVA is illustrated using a simulated example. We anticipate ANOVA can handle not only the gambler’s fallacy bias but also similar biases, in presentiment experiments as well as in some conscious precognition experiments.

  • 11.
    Dalkvist, Jan
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    A bias caused by inappropriate averaging in experiments with randomized stimuli2006In: Journal of Parapsychology, ISSN 0022-3387, Vol. 70, no 2, p. 233-254Article in journal (Refereed)
    Abstract [en]

    Using simulations, a bias caused by inappropriate averaging in experiments with randomized stimuli is described. As an illustrating example, experiments aimed at demonstrating "presentiment" by showing arousal to be higher prior to arousing stimuli than prior to calm stimuli are considered. It is shown that such results could be obtained if (a) the participant believes that the likelihood of an activating stimulus being presented on the next trial increases after a calm stimulus has been presented (the gambler´s fallacy) and (b) overall arousal means are calculated across individual arousal means or for a pooled sample of all possible stimulus sequences. The effect becomes very small when participants are pooled before averaging, provided that the number of trials per participant and/or the number of participants is sufficiently large. The bias decreases as the length of the stimulus sequence increases, and becomes zero in an infinitely long sequence. Basically, the bias can be explained by the fact that the expected mean arousal level before calm stimuli increases as a function of sequence length. Various possible strategies for reducing or eliminating the bias are discussed, but none of them is judged to be fully satisfactory. A generalized version of the bias is outlined and discussed. It is argued that, in some form, the bias may occur in various types of experiments, both within and outside parapsychology. It is also argued that numerous previous experiments need to be checked for occurrence of the bias.

  • 12.
    Ek, Ulla
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Fernell, Elisabeth
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Holmberg, K
    Olsson, P O
    Gillberg, C
    Cognitive strengths and deficits in schoolchildren with ADHD.2007In: Acta Paediatrica, Vol. 96, no 5, p. 756-761Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Few studies provide detailed analyses of the various aspects of the entire cognitive profile of children with ADHD. MATERIAL AND METHODS: Cognitive test data were analysed for 10- to 11-year-old children with (1) ADHD, (2) subthreshold ADHD and (3) milder attention and/or learning problems, and compared with normative data. RESULTS: Thirty-two had ADHD and 10 met the criteria for subthreshold ADHD, prevalence rates of 5.4% and 1.6%, respectively. On a group level, children with ADHD/subthreshold ADHD, and those with milder attention and/or learning problems had almost identical cognitive profiles for the 13 subtests comprising the WISC III, with particularly low results on the arithmetic, coding, information and digit span subtests (ACID profile). When analyzed individually, a complete or incomplete ACID profile (three of four subtests) was equally common in children with ADHD/subthreshold ADHD and in children with milder problems, found in about 1/5. The relative strengths of both groups were in areas demanding logical thinking, reasoning and common sense. CONCLUSION: The specific ACID profile is as common in children with ADHD as in those with minor attention and/or learning problems. The cognitive weaknesses reflected in the ACID profile might play a role as an underlying factor in various developmental disorders.

  • 13.
    Ek, Ulla
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Norrelgen, Fritjof
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Dahlman, Andrea
    Elizabeth, Hultby
    Fernell, Elisabeth
    Teenage outcomes after speech and language impairment at preschool age2012In: Neuropsychiatric Disease and Treatment, ISSN 1176-6328, E-ISSN 1178-2021, Vol. 8, p. 221-227Article in journal (Refereed)
    Abstract [en]

    Aim: Ten years ago, we published developmental data on a representative group of children (n = 25) with moderate or severe speech and language impairment, who were attending special preschools for children. The aim of this study was to perform a follow-up of these children as teenagers. Methods: Parents of 23 teenagers participated in a clinical interview that requested information on the child's current academic achievement, type of school, previous clinical assessments, and developmental diagnoses. Fifteen children participated in a speech and language evaluation, and 13 participated in a psychological evaluation. Results: Seven of the 23 teenagers had a mild intellectual disability, and another three had borderline intellectual functioning. Nine had symptoms of disorders on the autism spectrum; five of these had an autism spectrum disorder, and four had clear autistic traits. Six met criteria for attention-deficit hyperactivity disorder (ADHD)/subthreshold ADHD. Thirteen of 15 teenagers had a moderate or severe language impairment, and 13 of 15 had a moderate or severe reading impairment. Overlapping disorders were frequent. None of the individuals who underwent the clinical evaluation were free from developmental problems. Conclusion: A large number of children with speech and language impairment at preschool age had persistent language problems and/or met the criteria for developmental diagnoses other than speech and language impairment at their follow-up as teenagers. Language impairment in young children is a marker for several developmental disorders, particularly intellectual disability and autism spectrum disorder.

  • 14.
    Ek, Ulla
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Fernell, Elisabeth
    General versus executive cognitive ability in pupils with ADHD and with milder attention problems2013In: Neuropsychiatric Disease and Treatment, ISSN 1176-6328, E-ISSN 1178-2021, Vol. 9, p. 163-168Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to analyze two main types of cognitive domains in school children with different types and severities of attention-related problems. The cognitive domains examined were general cognitive ability and executive abilities. Methods: Three different clinical samples of pupils with school problems were analyzed to assess their cognitive Wechsler Intelligence Scale for Children profiles. In particular, the general cognitive ability index and the executive markers (ie, verbal memory index and processing speed index) were of interest. Of the total sample (n = 198), two main groups were contrasted; one met the full criteria for attention deficit hyperactivity disorder (ADHD)/subthreshold ADHD, and one was comprised of those with milder attention problems, insufficient to meet the criteria for ADHD/subthreshold ADHD. Results: It could be demonstrated that both groups had a significantly higher score on the general cognitive ability index than on measures of working memory and processing speed. This difference was more pronounced for boys. Conclusion: These types of cognitive differences need to be considered in children with different kinds of learning, behavior, and attention problems; this is also true for children presenting with an average general intelligence quotient and with milder attention problems. Current educational expectations are demanding for children with mild difficulties, and such cognitive information will add to the understanding of the child's learning problems, hopefully leading to a better adapted education than that conventionally available.

  • 15.
    Ek, Ulla
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Furmark, Catarina
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Fernell, Elisabeth
    Sahlgrenska Akademien, Göteborgs universitet.
    An audit of teenagers who had not succeeded in elementary school: a retrospective case review2012In: Clinical Audit, ISSN 1179-2760, Vol. 4, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Objective: The aim was to perform a retrospective case review of pupils who had not succeeded in elementary school, in order to analyze barriers at individual and system levels. Methods: Forty-five pupils, aged 16–20 years, who had not qualified for senior high school, were consecutively assessed within the school health unit to determine their cognitive function, school history, measures taken, previous assessments, and diagnoses given. Results: School health records revealed early problems with learning, reading, mathematics, and attention, but very few students had received an appropriate diagnosis. Our review and assessment when all the data had been compiled demonstrated that the vast majority (96%) of participants had clear developmental problems. Attention problems or full attention deficit/hyperactivity disorder dominated. About half of the students reported extensive truancy. Mean intelligence quotient in the study group was 83.9, about 1 standard deviation below the mean. Fluid intelligence was significantly superior to crystallized intelligence. Conclusion: Screening and identification are needed throughout the school years of children who present symptoms that could interfere with their academic achievement. Intervention needs to be based on skilled assessment, with consideration given to each individual's broad panorama of cognitive deficits and assets, as well as concomitant social adversities that may underlie their school failure. Since there can be a significant negative impact of limited educational opportunities on future socioeconomic outcomes, the question of who is at risk is important both for affected individuals and more generally for public health. Limitations: The study group was small and may not have been fully representative. In spite of limited confidence about generalizing from the results, the findings call for reflection.

  • 16.
    Ek, Ulla
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Holmberg, K.
    Fernell, E.
    Academic performance of adolescents with ADHD and other behavioural and learning problems: a population-based longitudinal study2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 3, p. 402-406Article in journal (Refereed)
    Abstract [en]

    Aim: To study academic performance (final grades at the age of 16 years) in individuals with i) attention-deficit/hyperactivity disorder (ADHD) and ii) other learning and/or behavioural problems. Methods: Of a total population of 591 children, originally assessed at the age of 10-11 years, it was possible to obtain final grades for 536 16-year-olds (in grade 9). Those fulfilling the criteria for ADHD/sub-threshold ADHD (n=39) and those with 'Behaviour and Learning Problems' (BLP group), (n=80) and a comparison group (n=417) were contrasted. Results: The ADHD and BLP groups had a significantly lower total mean grade at the age of 16 years than the comparison group. In addition, the ADHD and BLP groups also qualified for further studies in the upper secondary school to a significantly lesser extent than the controls (72%, 68% and 92%, respectively). All IQ measures (at the age of 10-11 years) were positively correlated with the overall grade after grade 9, with especially strong correlations for verbal capacity. Conclusion: ADHD and similar problems entail a risk of underachievement at school. The results indicate that pupils with ADHD underachieve in the school situation in relation to their optimal cognitive capacity. The contextual situation and the particular requirements should be considered in order for adequate educational measures to be undertaken.

  • 17.
    Ek, Ulla
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Holmberg, Kirsten
    Fernell, Elisabeth
    Self-esteem in children with attention and/or learning deficits: the importance of gender2008In: Acta Paediatrica, ISSN 0803-5253, Vol. 97, no 8, p. 1125-1130Article in journal (Refereed)
    Abstract [en]

    Objective: Our objective was to analyze self-esteem in children within a spectrum of attention disorders, that is, besides attention deficit hyperactivity disorder (ADHD), also children with subthreshold ADHD and even milder attention deficits and/or learning problems.

    Methods: From a population-based group of 10–11-year-old children in a Swedish municipality those with ADHD/subthreshold ADHD (n = 30) and those with milder attention and/or learning problems (n = 64) were targeted for the study. The children completed the 'I think I am' scale, reflecting physical appearance, scholastic competence, mental well-being, relationships to parents and to others and global self-esteem. Data from boys and girls were compared and related to the parents' and teachers' ratings on the two dimensions of the Conners' 10-item questionnaire (impulsive-restless behaviour and emotional lability) and to the children's cognitive levels.

    Results: Significant gender differences were found, girls reporting lower self-esteem concerning mental well-being and poorer relationships with parents and peers. However, children with ADHD/subthreshold ADHD did not report significantly lower global self-esteem when compared to a reference population.

    Conclusion: Self-esteem in children with attention, behaviour and/or learning problems has to be carefully evaluated, especially in girls, and measures are needed to prevent a trajectory towards adolescent psychopathology.

  • 18. Engman, Mona-Lisa
    et al.
    Sundin, Mikael
    Miniscalco, Carmela
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology. University of Gothenburg, Sweden.
    Lewensohn-Fuchs, Ilona
    Gillberg, Christopher
    Fernell, Elisabeth
    Prenatal acquired cytomegalovirus infection should be considered in children with autism2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 8, p. 792-795Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to evaluate the prevalence of congenital cytomegalovirus infection (CMV) in a representative sample of children with autism spectrum disorder. Methods: In a representative group of 115 preschool children with autism spectrum disorder, of whom 33 also had intellectual disability, the dried blood spots from the newborn metabolic screening were analysed for CMV DNA using TaqMan polymerase chain reaction. Results: One of the 33 children with autism spectrum disorder and intellectual disability - 3% of that group - had congenital CMV infection. The corresponding prevalence in newborn infants in Sweden is 0.2%. None of the 82 children without intellectual disability had congenital CMV. Conclusion: The finding lends some further support for congenital CMV being one of the many aetiologies underlying autism spectrum disorder with intellectual disability. The rate of 3% of congenital CMV in children with autism spectrum disorder with intellectual disability has implications for the medical work-up. The finding of congenital CMV also indicates the need for repeated hearing assessments in the child. There is a need for similar studies with much larger samples.

  • 19. Eriksson, Mats Anders
    et al.
    Lieden, Agne
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Bremer, Anna
    Wincent, Josephine
    Sahlin, Ellika
    Gillberg, Christopher
    Fernell, Elisabeth
    Anderlid, Britt-Marie
    Rare copy number variants are common in young children with autism spectrum disorder2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 6, p. 610-618Article in journal (Refereed)
    Abstract [en]

    AimSeveral studies have suggested that rare copy number variants (CNVs) are an important genetic contributor to autism spectrum disorders. The aims of the study were to use chromosomal microarray to investigate the presence of rare copy number variants in a population-based cohort of well-characterised young children with autism spectrum disorders and to relate the genetic results to neurodevelopmental profiles and medical conditions. MethodsWe performed chromosomal microarray on samples from 162 children who had been referred to the Stockholm Autism Centre for Young Children in Sweden after being diagnosed with autism spectrum disorder between 20 and 54months of age. ResultsPathogenic aberrations were detected in 8.6% of the children and variants of uncertain significance were present in another 8.6%. CNVs were more frequent in children with congenital malformations or dysmorphic features as well as in the subgroup with intellectual disability. ConclusionOur results support the use of chromosomal microarray methods for the first tier genetic analysis of autism spectrum disorder. However, it is likely in the near future that chromosomal microarray methods will probably be replaced by whole-exome and whole-genome sequencing technologies in clinical genetic testing.

  • 20. Eriksson, Mats Anders
    et al.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Anderlid, Britt Marie
    Gillberg, Christopher
    Fernell, Elisabeth
    First-degree relatives of young children with autism spectrum disorders: Some gender aspects2012In: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 33, no 5, p. 1642-1648Article in journal (Refereed)
    Abstract [en]

    Prenatal risk factors, with special focus on gender distribution of neurodevelopmental and psychiatric conditions were analysed in first-degree relatives in a population-based group of young children with autism spectrum disorders (ASD). Multiple information sources were combined. This group was contrasted with the general population regarding data from the Swedish Medical Birth register. In the ASD group, information was also obtained at parental interviews focusing on developmental and psychiatric disorders in the family. Compared to the general population, fathers of children with ASD were older and parents more often of non-European origin. Mothers of children with ASD had an increased rate of antidepressant and psychoactive medication use, and of scheduled caesarean sections. Fathers and brothers of children with ASD had high rates of ASD including the broader phenotype. Mothers of children with ASD had high rates of depression and other psychiatric disorders. These findings, hypothetically, could reflect a different ASD phenotype and difficulties diagnosing ASD in females or be an example of the close genetic relation between ASD and other psychiatric disorders. The results suggest that, in clinical and research settings, the familial background in ASD should be reviewed with a broader approach, and not be restricted to looking out only for diagnoses and symptoms traditionally accepted as being part of or typical of ASD. The high rate of parents of non-European origin has been noted in many Swedish studies of ASD, but the reason for this association, remains unclear.

  • 21.
    Eriksson, Mats Anders
    et al.
    Karolinska Institutet.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hedvall, Åsa
    Sahlgrenska Akademien, Göteborgs universitet.
    Åmark, Per
    Karolinska Institutet.
    Gillberg, Christopher
    Sahlgrenska Akademien, Göteborgs universitet.
    Fernell, Elisabeth
    Sahlgrenska Akademien, Göteborgs universitet.
    Medical conditions affect the outcome of early intervention in preschool children with autism spectrum disorders2013In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 22, no 1, p. 23-33Article in journal (Refereed)
    Abstract [en]

    The aim was to explore the frequency of genetic and other medical conditions, including epilepsy, in a population-based group of 208 preschool children with early diagnosis of Autism spectrum disorders (ASD) and to relate outcome at a 2-year follow-up to the co-existing medical findings. They had all received early intervention. The Vineland Adaptive Behaviour Scales (VABS-II) composite score served as the primary outcome measure. In the total group, 38/208 children (18 %) had a significant medical or genetic condition. Epilepsy was present in 6.3 % at the first assessment and in 8.6 % at follow-up and was associated with more severe intellectual impairment. A history of regression was reported in 22 %. Children with any medical/genetic condition, including epilepsy, as well as children with a history of regression had significantly lower VABS-II scores at the 2-year follow-up. Children with a medical/genetic condition, including epilepsy, had been diagnosed with ASD at an earlier age than those without such conditions, and early age at diagnosis also correlated negatively with adaptive functioning outcome. The results underscore the importance of considering medical/genetic aspects in all young children with ASD and the requirement to individualize and tailor interventions according to their specific needs.

  • 22. Fernell, Elisabeth
    et al.
    Bejerot, Susanne
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Miniscalco, Carmela
    Simila, Henry
    Eyles, Darryl
    Gillberg, Christopher
    Humble, Mats B.
    Autism spectrum disorder and low vitamin D at birth: a sibling control study2015In: Molecular Autism, ISSN 2040-2392, Vol. 6, article id 3Article in journal (Refereed)
    Abstract [en]

    Background: Insufficient vitamin D activity has attracted increasing interest as a possible underlying risk factor in disorders of the central nervous system, including autism. Methods: In this study, 25-hydroxyvitamin D (25(OH) D) was analysed in 58 Sweden-born sibling pairs, in which one child had autism spectrum disorder (ASD) and the other did not. The study group consisted of two representative samples; 47 Gothenburg sibling pairs with mixed ethnicities and 11 Stockholm sibling pairs with Somali background. 25(OH) D levels were analysed in the stored dried blood spots taken in the neonatal period for metabolic screening. Results: The collapsed group of children with ASD had significantly lower vitamin D levels (M = 24.0 nM, SD = 19.6) as compared with their siblings (M = 31.9 nM, SD = 27.7), according to a paired samples t-test (P = 0.013). The difference was-most likely-not only accounted for by a difference in season of birth between ASD and non-ASD siblings since the mean 25(OH)D levels differed with similar effect size between the sibling pairs born during winter and summer, respectively. All children with African/Middle East background, both the children with ASD and their non-ASD siblings, had vitamin D deficiency. Conclusions: The findings suggest that low prenatal vitamin D may act as a risk factor for ASD, however, there is a need for replication with larger samples. Future research should study whether or not adequate supplementation of vitamin D to pregnant women might lower the risk for ASD in the offspring.

  • 23. Fernell, Elisabeth
    et al.
    Hedvall, Asa
    Norrelgen, Fritiof
    Eriksson, Mats
    Höglund-Carlsson, Lotta
    Barnevik-Olsson, Martina
    Svensson, Liselotte
    Holm, Annette
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Gillberg, Christopher
    Developmental profiles in preschool children with autism spectrum disorders referred for intervention2010In: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 31, no 3, p. 790-799Article in journal (Refereed)
    Abstract [en]

    The aim was to characterize the panorama of developmental disorders in 208 preschool children with a clinical diagnosis of autism spectrum disorder (ASD), referred to a specialized centre, the Autism Centre for Young Children (ACYC), for intervention. At the centre, a research team examined all children according to structured protocols and interviews. All available test data from their assessments prior to referral were scrutinized. The boy:girl ratio was 5.5:1. In 22% of the total group a period of regression, including speech and language, had occurred. Epilepsy had been diagnosed in 6% of the children. In 38% of the children there was a definite or highly suspected learning disability/mental retardation according to cognitive test results. About the same proportion had a developmental delay that at the time of assessment could not be definitely classified and in 23% there were clear indications of a normal intellectual function. About 40% of the group exhibited hyperactivity. Differences in expressive vocabulary and adaptive functioning were strongly related to cognitive level. About 20% of the group had AD as the dominating developmental disorder, i.e., they represented a clinical picture of ""classic"" autism. The majority in this group also had learning disability. Another 20%, had ASD combined with a normal intellectual level, some of these conformed to the clinical picture of Asperger syndrome. In a relatively large group (more than half) learning disability or a general developmental delay was as evident as the ASD. In a smaller group (8%) ASD criteria were questionably met. In this group attention deficits in connection with speech and language problems were prominent. The highly individual developmental profiles seen in children with ASDs have to be taken into account when planning intervention and follow-up. The children's medical characteristics also vary considerably and will be detailed in a further report.

  • 24. Fernell, Elisabeth
    et al.
    Hedvall, Åsa
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Höglund Carlsson, Lotta
    Eriksson, Mats
    Barnevik Olsson, Martina
    Holm, Anette
    Norrelgen, Fritjof
    Kjellmer, Liselotte
    Gillberg, Christopher
    Early intervention in 208 Swedish preschoolers with autism spectrum disorder: A prospective naturalistic study2011In: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 32, no 6, p. 2092-2101Article in journal (Refereed)
    Abstract [en]

    Early intervention has been reported to improve outcome in children with autism spectrum disorders (ASDs). Several studies in the field have been randomized controlled trials (RCTs). The aim of this study was to assess ASD outcome in a large naturalistic study. Two hundred and eight children, aged 20–54 months, with a clinical diagnosis of ASD were given intervention and monitored prospectively in a naturalistic fashion over a period of 2 years. The toddlers were considered representative of all but the most severely multiple disabled preschool children with ASD in Stockholm county. They fell into three cognitive subgroups: one with learning disability, one with developmental delay, and one with normal intellectual functioning. Data on intervention type and intensity were gathered prospectively in a systematic fashion. Intervention was classified into intensive applied behaviour analysis (ABA) and non-intensive, targeted interventions, also based on ABA principles. Children were comprehensively assessed by a research team before the onset of intervention, and then, again, 2 years later. Change in Vineland adaptive behaviour scales composite scores from intake (T1) to leaving the study (T2) was set as the primary outcome variable. The research team remained blind to the type and intensity of interventions provided. One hundred and ninety-eight (95%) of the original samples stayed in the study throughout the whole 2-year period and 192 children had a complete Vineland composite score results both at T1 and T2. Vineland composite scores increased over the 2-year period. This increase was accounted for by the subgroup with normal cognitive functioning. There was no significant difference between the intensive and non-intensive groups. Individual variation was considerable, but no child in the study was “problem-free” at follow-up. Our data do not support that children with ASD generally benefit more from the most intensive ABA intervention programs than from less intensive interventions or targeted interventions based on ABA.

  • 25.
    Hadlaczky, Gergö
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Sensitivity to coincidences and paranormal belief2011In: Perceptual and Motor Skills, ISSN 0031-5125, E-ISSN 1558-688X, Vol. 113, no 3, p. 894-908Article in journal (Refereed)
    Abstract [en]

    Often it is difficult to find a natural explanation as to why a surprising coincidence occurs. In attempting to find one, people may be inclined to accept paranormal explanations. The objective of this study was to investigate whether people with a lower threshold for being surprised by coincidences have a greater propensity to become believers compared to those with a higher threshold. Participants were exposed to artificial coincidences, which were formally defined as less or more probable, and were asked to provide remarkability ratings. Paranormal belief was measured by the Australian Sheep-Goat Scale. An analysis of the remarkability ratings revealed a significant interaction effect between Sheep-Goat score and type of coincidence, suggesting that people with lower thresholds of surprise, when experiencing coincidences, harbor higher paranormal belief than those with a higher threshold. The theoretical aspects of these findings were discussed.

  • 26.
    Hadlaczky, Gergö
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Dalkvist, Jan
    The effects of automatic and controlled processing on the perception of remarkable coincidences with regard to paranormal beliefIn: Personality and Individual Differences, ISSN 0191-8869, E-ISSN 1873-3549Article in journal (Refereed)
    Abstract [en]

    Inferior probabilistic reasoning skills and loose associations have been suggested to affect the propensity to experience coincidences, and thereby to lead to the development of belief in the paranormal. Whether probabilistic skills and loose associations affect the automatic reaction of surprise, or the subsequent cognitively controlled analysis, has not yet been investigated. The aim of this explorative study was to look at how sensitivity to coincidences is affected by requiring participants to assess coincidences in probabilistic terms (reflecting controlled processing) compared to  relying on the emotion of surprise (automatic processing), with belief in the paranormal and loose associative processing as hypothetical moderator variables. Based on an experiment that exposed participants to fabricated coincidences, it was concluded that relying on automatic processing may affect judgments of coincidences differently than relying on controlled processing, but only when individual differences in paranormal belief and associative processing are taken into account.

  • 27. Hedvall, Åsa
    et al.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Fernell, Elisabeth
    Holm, Anette
    Gillberg, Christopher
    Billstedt, Eva
    Autism and developmental profiles in preschoolers: stability and change over time2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 2, p. 174-181Article in journal (Refereed)
    Abstract [en]

    AimIncreasing numbers of young children are now being diagnosed with autism spectrum disorder (ASD). This study aimed to analyse developmental trajectories in a representative group of preschool children with ASD. MethodIn a naturalistic study, 208 preschool children with different subtypes of ASD were followed over a 2-year period. Their trajectories, as regards persistence of ASD diagnoses, developmental/intellectual levels, adaptive functioning and expressive speech, were monitored. ResultsDevelopmental profiles showed considerable change over time, especially in children with atypical autism and in those with developmental delay/borderline intellectual functioning at their first assessment. Approximately 50% of the children were found to have intellectual disability (ID) at follow-up and, of these, the majority had severe ID. This was in contrast to the first assessment by the referral team when ID had rarely been mentioned or discussed. ConclusionChanges in developmental profiles during preschool years are common in children with ASD. This implies that reassessments, covering different developmental areas, are needed. Such follow-up assessments prior to the start of school will yield a more valid estimation of the child's general cognitive level and a more accurate ASD diagnosis and thus form a better basis for realistic educational planning and intervention.

  • 28. Hedvall, Åsa
    et al.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Fernell, Elisabeth
    Norrelgen, Fritjof
    Kjellmer, Liselotte
    Barnevik Olsson, Martina
    Höglund Carlsson, Lotta
    Eriksson, Mats A.
    Billstedt, Eva
    Gillberg, Christopher
    Preschoolers with Autism Spectrum Disorder Followed for 2 Years: Those Who Gained and Those Who Lost the Most in Terms of Adaptive Functioning Outcome2015In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 45, no 11, p. 3624-3633Article in journal (Refereed)
    Abstract [en]

    Clinical predictors of 2-year outcome in preschoolers with ASD were studied in a population-based group of very young children with ASD (n = 208). Children who gained the most (n = 30) and lost the most (n = 23), i.e., increased or decreased their adaptive functioning outcome according to the Vineland Composite Score between study entry (T1) and follow-up (T2), 2 years later were compared. Individual factors that differed significantly between the two outcome groups were cognitive level, age at referral, not passing expected milestones at 18 months, autistic type behavior problems and regression. However, logistic regression analysis showed that only cognitive level at T1 (dichotomized into IQ < 70 and IQ a parts per thousand yen 70) made a unique statistically significant contribution to outcome prediction (p = <.001) with an odds ratio of 18.01. The findings have significant clinical implications in terms of information at diagnosis regarding clinical prognosis in ASD.

  • 29. Hesselmark, Eva
    et al.
    Eriksson, Jonna M.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Bejerot, Susanne
    Autism Spectrum Disorders and Self-reports: Testing Validity and Reliability Using the NEO-PI-R2015In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 45, no 5, p. 1156-1166Article in journal (Refereed)
    Abstract [en]

    Although self-reported measures are frequently used to assess adults with autism spectrum disorders (ASD), the validity of self-reports is under-researched in ASD. The core symptoms of ASD may negatively affect the psychometric properties of self-reported measures. The aim of the present study was to test the validity and reliability of self-reported data using the NEO personality inventory-revised (NEO-PI-R). Forty-eight adults with ASD and 53 controls completed the NEO-PI-R and a psychiatric interview. Results indicate satisfactory internal consistency of the NEO-PI-R, a satisfactory factor structure, predicted correlations with clinician ratings in the ASD group, and predicted differences in personality between the ASD group and controls. In conclusion, the present results support the use of self-reported measures when assessing adults with ASD .

  • 30. Höglund Carlsson, Lotta
    et al.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Cognitive psychology. Gothenburg University, Sweden.
    Barnevik Olsson, Martina
    Eriksson, Mats A.
    Hedvall, Åsa
    Gillberg, Christopher
    Fernell, Elisabeth
    Autism spectrum disorders before diagnosis: results from routine developmental surveillance at 18 months2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 7, p. 823-828Article in journal (Refereed)
    Abstract [en]

    Aim: This study investigated the results from the national, routine 18-month developmental surveillance at Child Healthcare Centres (CHCs) on children later diagnosed with autism spectrum disorder (ASD). Methods: Child Healthcare Centre records of 175 children, diagnosed with ASD before 4.5 years in Stockholm County, Sweden, were reviewed regarding the results of the eight-item neurodevelopmental surveillance. Results were contrasted with normative data from the general child population in Stockholm County. Results: More than one-third of the total ASD group, including half of the group with ASD and intellectual disability (ID), did not pass the required number of items, compared to one in 50 in the general child population. Of those with ASD and ID who had passed, more than one-third experienced developmental regression after 18 months of age. If the CHC surveillance had considered reported regulatory problems - crying, feeding and sleeping - then another 10% of the children with ASD and ID could have been identified during this surveillance. Conclusion: The existing CHC surveillance traced half of the group of children who were later diagnosed with ASD combined with intellectual disability. Adding an item on regulatory problems to the 18-month surveillance would have increased this number by another 10%.

  • 31. Kantzer, Anne-Katrin
    et al.
    Fernell, Elisabeth
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology. University of Gothenburg, Sweden.
    Hagberg, Bibbi
    Gillberg, Christopher
    Miniscalco, Carmela
    Young children who screen positive for autism: Stability, change and comorbidity over two years2018In: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 72, p. 297-307Article in journal (Refereed)
    Abstract [en]

    Background: Autism spectrum disorder (ASD) is a developmental disorder with a wide variety of clinical phenotypes and co-occurrences with other neurodevelopmental conditions. Symptoms may change over time.

    Aims: The aim of the present study was to prospectively follow 96 children, initially assessed for suspected ASD at an average age of 2.9 years.

    Methods and procedures: All children had been identified with autistic symptoms in a general population child health screening program, and had been referred to the Child Neuropsychiatry Clinic in Gothenburg, Sweden for further assessment by a multi-professional team at Time 1 (T1). This assessment included a broad neurodevelopmental examination, structured interviews, a cognitive test and evaluations of the childis adaptive and global functioning. Two years later, at Time 2 (T2), the children and their parents were invited for a follow-up assessment by the same team using the same methods.

    Outcomes and results: Of the 96 children, 76 had met and 20 had not met full criteria for ASD at T1. Of the same 96 children, 79 met full ASD criteria at T2. The vast majority of children with ASD also had other neurodevelopmental symptoms or diagnoses. Hyperactivity was observed in 42% of children with ASD at T2, and Intellectual Developmental Disorder in 30%. Borderline Intellectual Functioning was found in 25%, and severe speech and language disorder in 20%. The children who did not meet criteria for ASD at T2 had symptoms of or met criteria for other neurodevelopmental/neuropsychiatric disorders in combination with marked autistic traits. Changes in developmental profiles between T1 and T2 were common in this group of young children with ASD. The main effect of Cognitive level at T1 explained more than twice as much of the variance in Vineland scores as did the ASD subtype; children with IDD had significantly lower scores than children in the BIF and AIF group. Co-existence with other conditions was the rule.

    Conclusions and implications: Reassessments covering the whole range of these conditions are necessary for an optimized intervention adapted to the individual child's needs.

  • 32. Lamarche, Anick
    et al.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Verduyckt, Ingrid
    Ternström, Sten
    The Swedish version of the Voice Handicap Index adapted for singers2010In: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 35, no 3, p. 129-137Article in journal (Refereed)
    Abstract [en]

    This study evaluates a Swedish version of the Voice Handicap Index adapted for singers. A total of 96 healthy singers and 30 singer-patients completed the questionnaire. Validity and reliability, internal coherence, and group differences were assessed. The singer- patient group had significantly higher scores than the control group. Reliability was confirmed by high Cronbach's (> 0.78) for test-retest scores, and for each of the sub-scales. Test-retest stability in both groups was confirmed by high correlation values alpha (> 0.8). Overall scores compared closely to those from previous reports. The Swedish translation of the adapted VHI for singers (RHI-s) is valid and reliable and shows sensitivity to the singer's concerns. It can be considered a useful tool in the clinical assessment of Swedish healthy or pathological singers.

  • 33. McDonnell, Maria
    et al.
    Sundberg, Johan
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lindestad, Per-Åke
    Larsson, Hans
    Vocal Fold Vibration and Phonation Start in Aspirated, Unaspirated, and Staccato Onset2011In: Journal of Voice, ISSN 0892-1997, E-ISSN 1873-4588, Vol. 25, no 5, p. 526-531Article in journal (Refereed)
    Abstract [en]

    Objectives/Hypotheses. Singers learn to produce well-controlled tone onsets by accurate synchronization of glottal adduction and buildup of subglottal pressure. Spectrographic analyses have shown that the higher spectrum partials are present also at the vowel onset in classically trained singers' performances. Such partials are produced by a sharp discontinuity in the waveform of the transglottal airflow, presumably produced by vocal fold collision. Study Design. After hearing a prompt series of a triad pattern, six singer subjects sang the same triad pattern on the vowel /i/ (1) preceded by an aspirated /p/, (2) preceded by an unaspirated /p/, and (3) without any preceding consonant in staccato. Methods. Using high-speed imaging we examined the initiation of vocal fold vibration in aspirated and unaspirated productions of the consonant /p/ as well as in the staccato tones. Results. The number vibrations failing to produce vocal fold collision were significantly higher in the aspirated /p/ than in the unaspirated /p/ and in the staccato tones. High frequency ripple in the audio waveform was significantly delayed in the aspirated /p/. Conclusions. Initiation of vocal fold collision and the appearance of high-frequency ripple in the vowel /i/ are slightly delayed in aspirated productions of a preceding consonant /p/.

  • 34. Olsson, M. Barnevik
    et al.
    Lundström, S.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Cognitive psychology. Gothenburg University, Sweden.
    Giacobini, M. B.
    Gillberg, C.
    Fernell, E.
    Preschool to School in Autism: Neuropsychiatric Problems 8 Years After Diagnosis at 3 Years of Age2016In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 46, no 8, p. 2749-2755Article in journal (Refereed)
    Abstract [en]

    The study presents neuropsychiatric profiles of children aged 11 with autism spectrum disorder, assessed before 4.5 years, and after interventions. The original group comprised a community sample of 208 children with ASD. Parents of 128 participated-34 with average intellectual function, 36 with borderline intellectual function and 58 with intellectual disability. They were interviewed using the Autism-Tics, AD/HD and other Comorbidities interview. Criteria for a clinical/subclinical proxy of ASD were met by 71, 89 and 95 %, respectively. Criteria for at least one of ASD, AD/HD, Learning disorder or Developmental Coordination Disorder were met by 82, 94 and 97 %. More than 90 % of children with a preschool diagnosis of ASD have remaining neuropsychiatric problems at 11, despite early intervention.

  • 35. Olsson, Martina Barnevik
    et al.
    Carlsson, Lotta Höglund
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Gillberg, Christopher
    Fernell, Elisabeth
    Autism before diagnosis: crying, feeding and sleeping problems in the first two years of life2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 6, p. 635-639Article in journal (Refereed)
    Abstract [en]

    Aim To chart early registered regulatory problems (RP) in a representative group of young children with and without autism spectrum disorder (ASD). Methods The target group comprised 208 preschool children with ASD, whose records from the Child Health Centres (CHC) were reviewed regarding numbers of consultations for excessive crying, feeding and sleeping problems. The records from an age- and gender-matched comparison group were obtained from the same CHCs as those of the index children Results Significant differences between the ASD and comparison groups were found for each domain studied and when domains were collapsed. Two or more consultations had occurred in 44% of the children in the ASD group and in 16% of the comparison group (p<0.001). No correlations were found with regard to gender, later severity of autism, cognitive level or degree of hyperactivity. Conclusion Regulatory problems (RP) were much more common in children who later received a diagnosis of ASD. Children with many RP in infancy require attention from CHC and paediatric services and need to be followed with regard to development and family support.

  • 36. Rollenhagen, Carl
    et al.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Development of a Safety Climate Questionnaire for Nuclear Power Plants2007In: Proceedings of the Joint 8th Annual IEEE Conference on Human Factors and Power Plants and 13th Annual Workshop on Human Performance. Monterey, California, August 26-31, 2007, IEEE , 2007, p. 4-8Conference paper (Refereed)
    Abstract [en]

    The present work describes the development of a safety climate questionnaire adapted for nuclear power installations. The survey was administered to all personnel at a Swedish nuclear power plant. Exploratory factor analysis revealed 8 factors together explaining 62% of the variance. The first factor was interpreted as Safety management and explained 38% of the variance. The other factors were labelled; Safety knowledge, Resources (time, personnel), Management/change management, Small group climate, Contractors, Documentation/experience feedback, and Occupational safety. The results are discussed and related to theoretical and methodological issues in safety culture and safety climate research.

  • 37.
    Rollenhagen, Carl
    et al.
    Department of Philosophy, Royal Institute of Technology.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lundberg, Jonas
    Department of Science and Technology, Linköping University,.
    Hollnagel, Erik
    MINES ParisTech, Centre for the Study of Risk and Crises, F-06904 Sophia Antipolis Cedex, France.
    The context and habits of accident investigation practices: A study of 108 Swedish investigators2010In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 48, no 7, p. 859-867Article in journal (Refereed)
    Abstract [en]

    The context and habits of accident investigation practices were explored by means of questionnaire data obtained from accident investigators in the healthcare, transportation, nuclear and rescue sectors in Sweden. Issues explored included; resources, training, time spent in different phases of an investigation, methods and procedures, beliefs about causes to accidents, communication issues, etc. Examples of findings were: differences in the extent to which the ‘human factor’ was perceived as a dominant cause to accidents; manning resources to support investigations were perceived as rather scarce; underutilization of data from safety related processes such as risk analysis and auditing data; the phase of suggesting remedial actions (recommendations) were comparatively brief and generally not well supported. A majority of the investigators thought that the investigations were free from pressures to follow a specific direction; the investigators also thought that performing an investigation in itself (regardless of the specific results) had positive influences on safety. A majority of the investigators thought that upper management had a relatively strong influence on safety in the organizations. The results are discussed in terms of suggestions for strategies to strengthen investigation practices – particularly those conducted as part-time work in organizations.

  • 38. Rollenhagen, Carl
    et al.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Naeswall, Katharina
    Professional subcultures in nuclear power plants2013In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 59, p. 78-85Article in journal (Refereed)
    Abstract [en]

    Using a safety climate survey as the point of departure, the present study explores some aspects of plant cultures vs. professional subcultures in three Swedish nuclear power plants (named A, B and C). The ratings on the safety climate survey by workers on power plant A were subjected to an exploratory factor analysis. A six-factor solution explained a total of 56.0% of the variance in the items included. The six factors were considered to measure Safety management, Change management and experience feedback, Immediate working group, Knowledge and participation, Occupational safety, and Resources. The six factor model was tested by running a confirmatory factor analysis on the ratings by workers on power plant B and C, respectively. The model fit for both plants was acceptable and supported the six factor structure. For each of the six factors, a 3 x 3 ANOVA was conducted on the ratings, with the three largest departments (Operation, Maintenance, Engineering support) and power plants (A, B, C) as the between-subjects factors. Differences between power plants as well as differences between departments were found for several factors. Overall, the differences between departments were larger than those between power plants. The results are discussed in terms of challenges for creating safety climate in organizations that harbor several professional subcultures.

  • 39.
    Sand, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Nilsson, Mats E.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Semantic priming goes both ways: Semantic content of subsequent target stimuli interferes with the discrimination of preceding priming stimuliManuscript (preprint) (Other academic)
    Abstract [en]

    Claims of subliminal semantic processing are commonly supported by experiments using stimuli that participants cannot discriminate between and therefore, it is said, cannot perceive. Critical to this operationalization of lack of perception is that discrimination performance is measured under optimal conditions and is not impaired by factors unrelated to perception. Here we report that in the standard paradigm of subliminal processing, prime-stimulus discrimination was underestimated due to the semantic content of the subsequent target stimulus: Just as the prime stimuli interfered with target-discrimination responses (leading to slower reaction times and more errors), the semantic content of target stimuli interfered with participants’ prime-discrimination performance. This is a hitherto neglected factor that may interfere with participants’ ability to report fleeting percepts of the prime stimuli, leading to underestimation of perception and potentially to false support of subliminal semantic processing.

  • 40.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Mina äventyr i parapsykologins förtrollade värld: Del 1. Vad är parapsykologi och vilka är forskarna?2011In: Qvintensen, ISSN Qvintensen, no 3, p. 14-15Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Joakim Westerlund skriver här första delen om sin forskning i ett kontroversiellt område. I början var det spännande, och lovande, men hur blev det sen? Och varför är det så att de första resultaten är lovande, sen dalar det utför – tills nästa omgång resultat kommer, som är lovande...

  • 41.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Recension av Richard Wisemans bok ”Paranormality”2011In: Folkvett, ISSN 0283-0795, no 3, p. 69-77Article, book review (Other (popular science, discussion, etc.))
  • 42.
    Westerlund, Joakim
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ek, Ulla
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Holmberg, Kirsten
    Uppsala Universitet.
    Näswall, Katharina
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Fernell, Elisabeth
    Karolinska Sjukhuset.
    The Conners' 10-item scale: findings in a total population of Swedish 10–11-year-old children2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 5, p. 828-833Article in journal (Refereed)
    Abstract [en]

    Aim: To present normative data for the Swedish version of the Conners' 10-item scale, to validate the scale by comparing children with and without attention deficit/hyperactivity disorder (ADHD), to explore the factor structure of this scale and to investigate behavioural characteristics and gender differences among 10- to 11-year-old children, as rated by parents and teachers respectively.

    Methods: Parents and teachers rated 509 10- to 11-year-old children (261 boys and 248 girls) from a population-based cohort in a Swedish municipality.

    Results: The Conners' 10-item scale discriminated very well between children with and without ADHD. Confirmatory factor analyses confirmed a two-dimensional structure of the scale with items measuring restless/impulsive behaviour in one factor and items measuring emotional lability in another. An ANOVA revealed that parents and teachers reported different behavioural characteristics in boys as compared to girls.

    Conclusion: The Conners' 10-item scale is a valid screening instrument for identification of ADHD. The two subscales can be used separately, in addition to the total score, to get a more detailed picture of the child's behaviour. Parents and teachers pay attention to different aspects of problem behaviour in boys and girls. The less disruptive behaviour of girls needs to be highlighted.

  • 43.
    Westerlund, Joakim
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hansen, Niklas
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Validation of the Swedish version of the NEO-PI-R: Correlations between self-reports and college peer ratings.2009In: Psychological Reports, ISSN 0033-2941, E-ISSN 1558-691X, Vol. 105, no 3, p. 815-824Article in journal (Refereed)
    Abstract [en]

    The NEO-PI–R has been one of the standard tools for measuring the Five Factor Model. Validity tests of the Swedish version of the NEO-PI–R have previously been limited to factor analyses and to testing the inventory’s congruent validity using Hogan’s Personality Inventory and the Karolinska Scales of Personality. The aim of the present study was to further investigate the validity of the NEOPI–R. 53 pairs of volunteer college students who were peers (77 women, 29 men; M age = 27.3 yr., SD = 7) from the Department of Psychology at Stockholm University rated themselves both on the NEO-PI–R and on single statements taken from the NEO-PI–R Summary feedback sheet as well as rating their respective peers on a short version of the NEO-PI–R and on single statements taken from the NEO-PI–R Summary feedback sheet. The pattern of correlations indicated some support for the convergent and discriminant validity of the Swedish version of the NEO-PI–R.

  • 44.
    Westerlund, Joakim
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Parker, Adrian
    Dalkvist, Jan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hadlaczky, Gergö
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Remarkable correspondences between ganzfeld mentation and target content - a psychical or psychological effect?2006In: Journal of parapsychology, ISSN 0022-3387, Vol. 70, no 1Article in journal (Refereed)
    Abstract [en]

    Remarkable correspondences between ganzfeld mentation and target content have been reported since the start of ganzfeld experiments in parapsychology. These correspondences may be due either to some form of anomalous information transfer (e.g., telepathy) or to a cognitive illusion on the part of the perceiver. This paper presents 4 studies conducted in order to investigate which of these two possibilities is the more probable. In Study 1, an external judge in a ganzfeld experiment selected 20 short segments that showed most remarkable correspondences between ganzfeld mentation and film clip content while being blind to whether the chosen film clip had been used as a target or as a decoy. Only 6 of the segments showed correspondences between the mentation and the target, which is close to chance expectation level. In Study 2, 11 students rated the 6 correspondences that were “hits” as being equally as impressive as the 14 that were “misses.” In Studies 3 and 4, the possibility that the 14 correspondences that were “misses” could have been due to a form of “displacement clairvoyance” was shown to be very unlikely. It was concluded that it is possible to obtain what at least some people consider to be very remarkable correspondences between mentation and film content by chance alone.

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