Alla barn med autism har utmaningar med socialt samspel. Många av dem har också avvikande ögonkontakt. Att kunna titta andra människor i ögonen är en förutsättning för mer avancerade sociala färdigheter och ökar möjligheterna till delaktighet i lek- och lärandesituationer. Det här kapitlet beskriver hur ögonkontakt hos barn med autism kan främjas på ett lekfullt sätt. I kapitlet ingår ett exempel från en aktuell studie som använder metoder grundade i tillämpad beteendeanalys. Kapitlet syftar även till att fungera som inspiration och vägledning för pedagoger i förskola eller skola.

Lack of social eye contact is a common characteristic of autism spectrum disorder (ASD) and can limit opportunities for social interaction and social learning. The current study examined a parent-implemented shaping procedure delivered through telehealth to promote eye contact during naturalistic social play for two preschool-aged children with ASD in India. The intervention was implemented without prompting or nonsocial reinforcers, instead relying on preferred social activities. Both children learned to make eye contact, of various durations, across different activities. Self-reports from the participating parents, along with individualized indices of happiness observed in the children, indicate a high degree of social validity. The findings support and extend prior research on shaping without prompting, suggesting that socially maintained eye contact in children with ASD can develop through flexible, naturalistic methods implemented by parents with remote supervision. Limitations of the study and directions for future research are discussed.

Background:  Psychoeducation is a recommended first-line intervention for transition-aged autistic youth, but it has not been previously evaluated in an internet-delivered format. SCOPE (Spectrum Computerized Psychoeducation) is an 8-week individual, internet-delivered, therapist-supported psychoeducative intervention.

Objective:  This study aimed to investigate the effectiveness of SCOPE through a 3-armed randomized controlled trial. The intervention aims to increase participants’ understanding of autism and, in doing so, increase their quality of life (QoL).

Methods:  SCOPE was codeveloped with clinicians and autistic young adults. It contains 8 autism-related modules, each with (1) text describing the module topic, (2) four video vignettes with recurring characters who describe their lives and perspectives on the module topic, (3) a list of neurotypical characteristics related to the module’s topic, and (4) self-reflection using 3 or 4 questions about the module topic, answered by multiple-choice bullets and voluntary open-ended written comments. Participants were randomized (2:1:1) to SCOPE, an active control (web-based self-study), or treatment as usual (TAU). The primary outcome was participants’ autism knowledge, assessed using the Autism Spectrum Disorder Quiz, and secondary outcomes included acceptance of diagnosis, QoL, and symptoms of mental health problems. All outcomes were assessed at the baseline, postintervention, and 3-month follow-up time points, using mixed-effects models to assess change in outcome measures across time points.

Results:  Between 2014 and 2020, a total of 141 participants were randomized to 1 of the 3 treatment arms. The SCOPE participants had significantly greater autism knowledge gains at the posttreatment time point compared to TAU participants with a moderate effect size (d=0.47; P=.05); gains were maintained at the 3-month follow-up (d=0.46; P=.05). The self-study participants also had increased knowledge gains compared to TAU participants at the posttreatment time point with a moderate effect size (d=0.60; P=.03) but did not maintain these gains at the 3-month follow-up, and their autism knowledge scores returned to baseline (mean change score: –0.13, 95% CI –1.20 to 0.94; P=.81). In addition, SCOPE participants reported improved QoL at the postintervention (d=0.37, P=.02) and 3-month follow-up time points (d=0.60; P=.001), compared to the combined controls. The gained autism knowledge was not mirrored by changes in symptoms of anxiety or depression.

Conclusions:  Effective internet-delivered interventions may facilitate first-line service access to individuals who are unable or unwilling to use traditional health care interventions or who live in geographically remote locations. Additionally, an intervention such as SCOPE could impart and sustain the knowledge gained through psychoeducation in transition-aged autistic youth. For future research, qualitative studies could further our understanding of the lived experiences of intervention participation and outcomes after internet-delivered psychoeducation.

Background: Psychoeducation is a recommended first-line intervention for transition-aged autistic youth, but it has not beenpreviously evaluated in an internet-delivered format. SCOPE (Spectrum Computerized Psychoeducation) is an 8-week individual,internet-delivered, therapist-supported psychoeducative intervention.Objective: This study aimed to investigate the effectiveness of SCOPE through a 3-armed randomized controlled trial. Theintervention aims to increase participants’ understanding of autism and, in doing so, increase their quality of life (QoL).Methods: SCOPE was codeveloped with clinicians and autistic young adults. It contains 8 autism-related modules, each with(1) text describing the module topic, (2) four video vignettes with recurring characters who describe their lives and perspectiveson the module topic, (3) a list of neurotypical characteristics related to the module’s topic, and (4) self-reflection using 3 or 4questions about the module topic, answered by multiple-choice bullets and voluntary open-ended written comments. Participantswere randomized (2:1:1) to SCOPE, an active control (web-based self-study), or treatment as usual (TAU). The primary outcomewas participants’ autism knowledge, assessed using the Autism Spectrum Disorder Quiz, and secondary outcomes includedacceptance of diagnosis, QoL, and symptoms of mental health problems. All outcomes were assessed at the baseline,postintervention, and 3-month follow-up time points, using mixed-effects models to assess change in outcome measures acrosstime points.Results: Between 2014 and 2020, a total of 141 participants were randomized to 1 of the 3 treatment arms. The SCOPEparticipants had significantly greater autism knowledge gains at the posttreatment time point compared to TAU participants witha moderate effect size (d=0.47; P=.05); gains were maintained at the 3-month follow-up (d=0.46; P=.05). The self-study participantsalso had increased knowledge gains compared to TAU participants at the posttreatment time point with a moderate effect size(d=0.60; P=.03) but did not maintain these gains at the 3-month follow-up, and their autism knowledge scores returned to baseline(mean change score: –0.13, 95% CI –1.20 to 0.94; P=.81). In addition, SCOPE participants reported improved QoL at thepostintervention (d=0.37, P=.02) and 3-month follow-up time points (d=0.60; P=.001), compared to the combined controls. Thegained autism knowledge was not mirrored by changes in symptoms of anxiety or depression.Conclusions: Effective internet-delivered interventions may facilitate first-line service access to individuals who are unable orunwilling to use traditional health care interventions or who live in geographically remote locations. Additionally, an interventionsuch as SCOPE could impart and sustain the knowledge gained through psychoeducation in transition-aged autistic youth.

Shaping is an effective and well-established gradual change procedure for teaching new skills that is sometimes combined with other strategies, such as prompting. However, to the best of our knowledge, no review has been published that provides an overview of applications of response shaping in interventions for persons with developmental disabilities. While it is possible to combine response shaping with various prompts, it can also be used without prompts. Results of the current scoping review include a description of the reviewed studies, and a synthesis of the findings. This includes a study of participant samples, experimental designs, teaching settings, assessments used, social validity, and shaping outcomes. This includes a study of participant samples, experimental designs, teaching settings, assessments used, social validity, and shaping outcomes. A majority of the studies targeted persons with autism spectrum disorder, even though other diagnoses were also represented. Most studies employed single-case experimental designs and reported positive outcomes of response shaping, for a variety of target behaviors. This presentation will highlight and discuss the presence or absence of prompting in the reviewed studies. 

There is a recognized need to improve inclusive learning environments for autistic children in primary school settings in Sweden. This study aimed to translate, cross-culturally adapt, and assess the content validity of the Swedish primary school version of the Autism Program Environment Scale (APERS), originally developed to evaluate autism program quality in educational settings in the United States. Following the translation into Swedish and the first cultural adaptation of the APERS, a content panel group of 14 professionals rated its content validity. Four of the content panel members also participated in individual interviews that provided a qualitative evaluation of the instrument's content validity. Finally, the authors piloted the APERS in 10 Swedish primary school classrooms to assess its feasibility. The ratings and qualitative information from the content panel members indicated a substantial need for the Swedish APERS in primary school, resulting in the culturally adapted APERS-Primary-Sweden (SE). The instrument demonstrated a high level of cross-cultural content validity for assessing the quality of the learning environment for students with autism in Swedish primary school settings. The pilot testing of the instrument resulted in further cultural adaptations. In conclusion, APERS-Primary-SE is a comprehensive scale that can be used to assess the quality of primary school learning environments for children with autism in Sweden. Further research is needed to evaluate the adapted instrument's effectiveness in improving the learning environment in Swedish primary school classrooms.

The Good Behavior Game (GBG) is a classroom management strategy that consistently demonstrates its ability to promote positive behaviors and peer relations among students, with immediate and long-term benefits. This scoping review aimed to provide an overview of peer-reviewed research on the GBG specifically focused on students with special educational needs (SEN) in mainstream education settings. Following a systematic search-and-selection procedure, 30 studies were included, 26 with an experimental design and 4 with a qualitative/mixed-methods design. SEN participants were mainly subgroups of students with baseline assessments of emotional-behavioral difficulties; there was, however, substantial clinical and methodological heterogeneity across studies. Integrative findings from quantitative and qualitative studies indicate that the GBG benefits most students with SEN in mainstream settings, while results for students with severe socio-behavioral difficulties are ambiguous. We identified a paucity of research on students with neurodevelopmental diagnoses such as attention deficit hyperactivity disorder or autism spectrum disorder, as well as on the perspectives of students and teachers and challenges associated with the GBG for students with severe difficulties. Schools implementing the GBG should be aware that some students may need individual adaptations to participate in the GBG, and teachers may need support to implement these adaptations. 

Academic environments differ between cultures and faculties, with some more hierarchical, and less supportive of women and minorities than others. Academic structures are often complex, competitive, and stressful, and one may be expected to work as many as six days a week. Affecting an individual’s survival and success within academia requires alignment of the outer and inner layers and contingencies within the individual’s ecological system. Outer-level contingencies may initially consist of having the economical means for basics including university tuition, enabling or not enabling an individual to pursue an academic career. Inner-level or proximal contingencies consist of collaborative relationships, leadership, colleagues, and friends, but also an inner drive: for example, to improve some aspect of society or the situation for groups of individuals. In this chapter I will present sources of tensions and support encountered within academia with a basis in my experience as a woman professor in Special Education and as a behavior analyst in Sweden. I will combine my personal story with a section on the Swedish “Folkhemmet” (the people’s home), a strong humane political ideology with epistemological roots in social solidarity and equality, followed by a section on the Swedish post-modernistic movement within teacher education and how my interest in applied behavior analysis evolved. The importance of collaborative partners and friendships in academia, and how those and my own continual reflection on how to avoid direct confrontation with mainstream pedagogy have affected the growth of behavior analysis in Sweden, will be discussed.

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.