Number and controllability of reinforcers as predictors of individual outcome for children with autism receiving early and intensive behavioral intervention: a preliminary study

Although Early and Intensive Behavioral Intervention (EIBI) is an effective treatment for many children with autism, there is a substantial individual difference in outcome. This study was designed to investigate whether treatment gains were associated with the number and type of stimuli that function as reinforcers for 21 preschool-aged children with autism. Children with a large repertoire of socially mediated reinforcers benefited more from treatment. Children with many stereotypic behaviors, assumed to be an effect of a larger repertoire of automatic reinforcers, exhibited less benefit from treatment. These two dimensions taken together explained 49.9% of the variation in treatment gains for children after one year of EIBI. Due to the retrospective and indirect design of the study, results are to be interpreted with cautio

Måleegenskaper ved den norske versjonen av Vineland Adaptive Behavior Scales - Second Edition (Vineland-II)

Beskrivelse. Vineland Adaptive Behavior Scales (Vineland ABS) er et meget brukt kartleggingsinstrument for vurdering av adaptiv atferd (daglige aktiviteter som kreves for å klare seg på egen hånd, personlig og sosialt). Instrumentet ble først publisert i 1984 i USA. Vineland-II er en omfattende revisjon, publisert 2005; skandinavisk tilpasning og normering 2011. NCS Pearson Inc. er rettighetshaver. Den skandinaviske Vineland-II er gitt ut i tre versjoner: et intervjuskjema og et spørreskjema for foreldre (foreldreskjema) med skandinaviske normer, og et lærerskjema. Adaptiv atferd vurderes innenfor fire brede domener (indekser) for aldersgruppen 2 - 21 år: kommunikasjon, dagliglivets ferdigheter, sosiale ferdigheter og motorikk (< 7 år). Funnene summeres til Generelle adaptive ferdigheter. Litteratursøk. Vårt systematiske søk etter dokumentasjon for måleegenskapene ved den norske versjonen av Vineland-II førte til 33 treff. Tre artikler ble hentet inn i fulltekst, bare en hadde benyttet Vineland-II, og relevante data ble ikke rapportert i artikkelen. Det er gjort en skandinavisk (svensk-dansk- norsk) normering av foreldreskjema, som rapporteres i manualen for Vineland-II. Psykometri. Vår vurdering av testens psykometriske egenskaper baserer seg på data fra manualen (en skandinavisk representativ tverrsnittsundersøkelse; N = 1673). Normdata rapporteres omfattende. Begrepsvaliditet støttes ved godt samsvar med etablerte diagnostiske systemer. Konfirmatoriske faktoranalyser viste en rimelig god tilpasning. Data fra en liten studie barn med autisme viste avvik som forventet. Intern konsistens og split-half reliabilitet var meget tilfredsstillende både for Generelle adaptive ferdigheter og indeksene (> 0,90, med unntak av motorikk for noen aldersgrupper). Konklusjon. Vineland-II er nylig publisert, og det foreligger ikke ennå relevante norske eller skandinaviske publikasjoner utover studien som er rapportert i manualen. Den skandinaviske utgaven har et godt normeringsgrunnlag, som brukes til en omfattende og systematisk resultatfremstilling for det enkelte barn som vurderes. Psykometriske analyser indikerer gode psykometriske egenskaper for foreldreskjema. Intervjuskjemaet som fylles ut av utreder tilsvarer foreldreskjema, men det er ikke dokumentert at normer og de psykometriske egenskapene for dette skjemaet er de samme som for foreldreskjemaet

The effects of financial constraints on business fundamentals and asset returns : evidence from a small open economy

In this thesis we investigate whether financially constrained firms are fundamentally riskier than unconstrained firms, whether this risk is priced in the form of a financial constraint factor, and whether the financial constraint factor represents an independent source of return movements. The investigation will be in the context of the Norwegian economy and securities markets. Using various measures of financial constraints, we form portfolios of constrained and unconstrained firms in a similar fashion to Fama and French (1992). Following Campello and Chen (2010) we estimate differences in the real business risk of constrained and unconstrained firms by regressing their median real operating earnings- and investment growth on macroeconomic and credit market variables. We test whether the risk is priced by subtracting the monthly stock market returns of constrained firms from unconstrained firms, creating a financial constraint factor. Finally, following Lamont et al. (2001), we investigate whether the financial constraint factor represents an independent source of movement in returns by regressing it on benchmark asset pricing models, including Sharpe (1964) and Lintner (1965)’s CAPM, the Fama and French (1992) three-factor model and the Fama and French (2015) five-factor model. We find evidence that financially constrained firms are fundamentally riskier than unconstrained firms, and that this risk is priced in the form of a financial constraint factor. The results point to financial constraints being time-varying and binding more in downturns than expansions. We find that a negative oil price shock is associated with increasing financial constraints in the Norwegian economy. Furthermore, we find that financially constrained firms in Norway behave in a similar fashion to constrained firms in the US, suggesting that financial constraints are not significantly different across various economic settings. Finally, the combined real-financial results point to the existence of a macroeconomy-equity valuation channel along the lines of Gertler and Bernanke (1989).nhhma

Bedre medisinkurveføring

KLoK-oppgaven på 11. semester ved Det medisinske fakultet i Oslo innebærer å planlegge et prosjekt der man har som mål å forbedre et område innen helsesektoren. Som medisinstudenter på siste året har vi erfart at standardene for føring av medisinkurver varierer mellom sykehus, og avdelinger innen samme sykehus. Vi legger prosjektet til sengeposten ved kardiologisk avdeling Rikshospitalet, OUS. Her vil vi forsøke å redusere antall medisinkurveføringsfeil ved å innføre nye lokale retningslinjer for korrekt kurveføring. Vi har sett nærmere på hvordan mangelfull kurveføring kan medføre feilmedisinering, og i verste fall legemiddelskade. Vi har innhentet kunnskap ved å søke i McMaster Plus, Tidsskriftet for Den norske legeforening og på Helse- og omsorgsdepartementets nettsider. Her har vi også funnet data som sier noe om antatt effekt ved forskjellige tiltak rettet mot bedre medisinkurveføring. Det er gjort minst to store studier av feilmedisinering i Norge, hvorav begge studiene påpeker at feil kurveføring er et faktisk problem. Til organiseringen av prosjektet har vi benyttet lærdom fra John P. Kotter, og hans artikkel ”Leading Change: Why Transformation Efforts Fail”, samt forbedringsmodellen med tilhørende PUKK-sirkel. Vi ser for oss at det settes ned en prosjektgruppe som skal utarbeide de endelige retningslinjene. Retningslinjene ønsker vi at skal basere seg på kunnskapsgrunnlaget, hvilke kurveføringsfeil de finner ved sengeposten, og på tilbakemeldinger fra leger og sykepleiere ved sengeposten. Prosjektet vil bli evaluert ved å telle feil i et bestemt antall medisinkurver før prosjektstart, og etter at tiltaket er iverksatt. Vi konkluderer med at vårt prosjekt bør gjennomføres. Det er godt dokumentert i litteraturen at bedre medisinkurveføring medfører færre legemiddelskader. Derfor vil prosjektet sannsynligvis være kostnadseffektivt for sengeposten, ettersom legemiddelskader fører til flere liggedøgn på sykehus for de som rammes

Comparing procedures on the acquisition and generalization of tacts for children with autism spectrum disorder

Generalization is a critical outcome for individuals with autism spectrum disorder (ASD) who display new skills in a limited range of contexts. In the absence of proper planning, generalization may not be observed. The purpose of the current study was to directly compare serial to concurrent multiple exemplar training using total training time per exemplar, mean total training time, and exposures to mastery across three children diagnosed with ASD. Additionally, we assessed the efficiency of presenting secondary targets in the antecedent and consequence portions of learning trials and evaluated generalization to tacts not associated with direct teaching. Results suggested that all training conditions produced acquisition and generalization for trained and untrained exemplars. However, the serial multiple exemplar training condition was more efficient for two participants, whereas the instructive feedback condition was the most efficient for the third. Findings are discussed considering previous studies and areas for future research

Does routine child health surveillance contribute to the early detection of children with pervasive developmental disorders? – An epidemiological study in Kent, U.K.

BACKGROUND: Recently changed guidelines for child health surveillance in the United Kingdom (U.K.) suggest targeted checks only, instead of the previously conducted routine or universal screening at 2 years and 3.5 years. There are concerns that these changes could lead to a delay in the detection of children with autism and other pervasive developmental disorders (PDD). Recent U.K. studies have suggested that the prevalence of PDD is much higher than previously estimated. This study establishes to which extent the routine checks contributed to the early detection and assessment of cases of PDD. Simultaneously we have evaluated the process involved and estimate the prevalence of PDD in our district. METHODS: Retrospective study design utilising community medical files. Headteachers of schools (n = 75) within Maidstone district (Kent) were asked to report all children with an established diagnosis of autism or PDD attending year 4 (born '91 and '92 / n = 2536) in October 2000 based on educational records. RESULTS: 59 schools (78.7%) took part in the study. A total of 33 children were reported. 21 fulfilled the inclusion criteria (12 falsely reported). The prevalences were (per 10,000): PDD 82.8 (male to female ratio 6:1), childhood autism 23.7, Asperger's syndrome 11.8 and autistic spectrum disorder 47.3. Co-existing medical conditions were noted in 14.3%; 52.4% were attending mainstream schools. In 63.2% of cases concerns – mainly in the area of speech and language development (SLD) – had been documented at the 2 year check. At the 3.5 year check concerns were noted in 94.1% – the main area was again SLD (76.5%), although behavioural abnormalities were becoming more frequent (47.1%). A total of 13 children (68.4%) were referred for further assessment as a direct result of the checks. CONCLUSIONS: The prevalences for different types of PDD were similar to figures published recently, but much higher than reported a few years ago. Analysis of our data suggests that routine surveillance is a valuable contributing factor for the early detection of PDD and thereby facilitates early intervention. Thus, if routine surveillance ceases, then an alternative method of early detection should be put in place

Intensive behavioural interventions based on applied behaviour analysis for young children with autism : an international collaborative individual participant data meta-analysis

This individual participant data meta-analysis is the most intensive possible evaluation of the effectiveness of early intensive applied behaviour analysis?based interventions for pre-school autistic children compared with treatment as usual/eclectic interventions. Data from 491 participants (originally collected in 10 studies) were included. Children receiving early intensive applied behaviour analysis?based interventions improved more on the Vineland adaptive behaviour scale (MD?=?7.00; 95% confidence interval?=?1.95?12.06) and cognitive ability (intelligence quotient) (MD?=?14.13; 95% confidence interval?=?9.16?19.10) relative to comparators at 2?years; though effects varied considerably across studies. Evidence for other outcomes was inconclusive due to insufficient evidence and there were few data on longer-term effects. All studies were at risk of bias across several domains, often due to the lack of randomisation or blinding of outcome assessors. Given the emerging evidence of modest, albeit short term, effects of a range of pre-school autism interventions and the limitations of the quality of evaluation studies to date, future research should investigate which supports and interventions are most effective for children and families prioritising outcomes measures that are meaningful for the autism community and longer-term follow-up. Further systematic reviews of the existing evidence are unlikely to add to the findings presented here.Lay abstractEarly intensive applied behaviour analysis?based interventions are designed to support young autistic children?s learning and development. Unfortunately, the available evidence about the effectiveness of these interventions remains unclear. Several reviews have focused on the published findings rather than contacting the authors to collect and analyse data about the individual participants in the original studies. Also, most of the studies were carried out by groups involved in delivering the interventions leading to the potential bias in interpreting the results. Our research team (supported by an international advisory group) carried out an independent individual patient data review by collecting the original participant data from the authors of the studies, to examine the effectiveness of these interventions. The results suggested that early intensive applied behaviour analysis?based interventions might lead to some changes in children?s cognitive ability (intelligence quotient) and everyday life skills after 2?years, compared with standard treatments. However, all the studies had problems with the way they were designed. Also, few of the studies looked at outcomes that have been described as most important to autistic people or followed children beyond 2?years. We think that further systematic reviews of the existing evidence are unlikely to add to the findings of our review. Furthermore, we recommend that future research should investigate which types of supports and interventions are most effective for children and families, prioritising outcomes measures that are meaningful for the autism community and include, wherever possible, longer-term follow-up