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.

Allt fler barn får autismdiagnos, i yngre åldrar. Nästan alla av dessabarn i Sverige går i förskolor tillsammans med jämnåriga, under en tiddär hjärnan är under utveckling och potentialen är stor till lärande avviktiga färdigheter för resten av livet. Forskning pekar dock mot att för-skolans lärmiljöer inte alltid är så väl matchade mot barn med autismoch deras sätt att fungera, och att stödet som ges kan vara otillräck-ligt. Bristande stöd och lärmiljöer som inte är autismvänliga riskeraratt påverka dessa barn negativt genom minskade möjligheter tilllärande och delaktighet. Det riskerar också att göra tidiga insatser medsyfte att stödja deras lärande, utveckling och delaktighet i förskolanmindre hjälpsamma och effektiva. I det här kapitlet får du läsa omautism i förskola, tidiga beteendeinsatser, och vikten att arbeta medförskolans lärmiljö för att ge alla barn bästa möjliga förutsättningar tilllärande, välmående och utveckling.

The purpose of a neuropsychological assessment is to describe a child's difficulties and strengths to enable treatments and contextual adjustments. Typically, the assessment is summarized in the form of a written clinical report. However, such texts have been criticized for being too difficult for parents and teachers to read and comprehend. The purpose of this pre-registered and randomized controlled study was to evaluate five writing rules to improve readability and accessibility in clinical reports: to structure the text with functional domains, exemplify cognitive tasks with examples from daily life, use examples from the daily life of the child, avoid jargon, and to write shorter sentences. We created two separate reports based on the same assessment information of a hypothetical child: one "standard" report, and one where the five writing rules were applied. One hundred teacher students at a teacher education program were randomized to read one of the reports, and then rated readability and answered a comprehension quiz. Results showed that the five writing rules led to improved ratings of readability, and helped readers recall more information immediately afterward. Effects were medium to large. Future studies need to investigate whether the findings generalize to parents and other potential readers. Additionally, future work should address how psychologists can be taught to improve their writing through writing guidelines. Clinical trial registration: https://aspredicted.org/ac96p.pdf.

A common challenge for people on the autism spectrum with intellectual disability, is indoor navigation and related daily activities, as found in previous research. In this paper we report on co-design of assistive augmented reality applications, where the goal is to help people on the autism spectrum to gain more independence in their daily lives. This study is based on initially two full-day workshops with staff only, followed by ten individual workshops with the end-users and their staff at day centers, using a mix of methods and prototypes. The results show a clear potential of augmented reality as assistive technology for indoor navigation, depending on individual capability and/or complexity of environments, as well as for other activities. We also found that new barriers may arise, which are discussed for future research.

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.

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

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

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

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

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

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

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.

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.