| 1. |
- Dahlberg, Anton
(author)
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Capturing and addressing preschool children’s emotional and behavioural problems : Using parents’, teachers’ and children’s perspectives
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Emotional and behavioural problems (EBP) are among the most common mental health problems in preschool children. EBP are also associated with poor parent mental health. Untreated, EBP can persist or worsen over time. In order to capture and address preschool children’s EBP, we need scientifically valid instruments that can access the perspectives of informants from different contexts of the child. We also need cut-off values for questionnaires assessing EBP that are representative of the population. Parenting support is a recommended intervention for addressing EBP in preschool children. Most parenting support programmes have a solid evidence-base and show positive effects on child EBP and parent wellbeing. However, we need a better understanding of the children’s emotional and relational experiences, especially in relation to their parents. Further, although the implementation of evidence-based interventions is a complex matter with substantial impact on intervention success, few studies assess the implementation process of parenting programmes. The studies constituting this thesis focused on preschool children. The Strengths and Difficulties Questionnaire (SDQ) was assessed for capturing EBP. Study I assessed the construct validity of the SDQ and its five subscales, when rated by fathers and preschool teachers. Confirmatory factor analysis was applied to evaluate construct validity. Results indicated that the SDQ can be used as an instrument to measure EBP in preschool children, rated by parents and preschool teachers. In study II, we established Swedish norms for the SDQ for preschool children. Results suggested lower SDQ cut-offs for Swedish preschool children compared with other countries, and higher cut-offs for boys compared with girls. In study III, preschool children whose parents participated in a parenting programme were interviewed regarding their emotional and relational experiences at home. Data were analysed using qualitative content analysis. The children provided accounts of negative and positive interactions with their parents, elaborately describing a coercive cycle with escalating conflicts and lack of problem resolution. In study IV, the implementation of the parenting programme Triple P in a preschool setting was assessed using the RE-AIM framework. Results indicated a successful implementation that relied on customisation of the programme; assessment of the process from parent, staff, and organisation levels; interdisciplinary collaboration; and continuous work on securing maintenance over time. This thesis provides pieces to a complex puzzle of understanding and addressing child mental health problems, particularly EBP. Assessing EBP from different perspectives and promoting children’s voices are essential, as well as actively working with the implementation of evidence-based programmes.
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| 2. |
- Hassler Hallstedt, Martin, 1973-
(author)
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Closing the Gap : How an Adaptive Behavioral Based Program on a Tablet Can Help Low Performing Children Catch Up in Math: a Randomized Placebo Controlled Study
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Early mathematic skills have a substantial impact on later school achievement. Children with poor school achievement are at risk for adverse consequences later in life. Math competencies also have consequences for the economy at large because societies are becoming increasingly dependent on skill sets including mathematics. Proficiency with basic arithmetic, also known as math fact (i.e., 3+8, 12-3), is considered to be a critical early math skill. Intervention research in mathematics have demonstrated that math fact deficits among students with low math performance can be improved with additional targeted, non- technological interventions (i.e., small-group tutoring).The aim of the present thesis was to investigate the effect, using a randomized placebo controlled design, of addititional adaptive, behavioral based, math training on a tablet on low performing second graders. The first study (study I), investigated if arithmetic skills could be assessed in a reliable and valid way on tablet. The examination showed that arithmetic scales could be transferred from paper-based tests to tablet with comparable psychometric properties, although not for a pictorial scale, and that separate norms are needed for tablet. Study II demonstrated that training on a tablet, for on average 19 hours across 20 weeks, improved basic arithmetic skills after training in the math conditions compared to control/ placebo conditions. The effects were medium sized at post assessment. There was a fadeout of effects at 6 months follow-up, where small effects were shown, and the effects decreased further at 12 months follow-up. Children with lower non-verbal IQ seemed to gain significantly more at follow- ups than children with higher non-verbal IQ. The study found no additional effects of combining working memory training and math training. Study III, using a machine learning analysis, found that children demonstrating a positive response at 6 months follow-up were characterized by having completed 90 % or more of the math program at the default level, in combination with having a fairly favorable socioeconomic background.In summation, this work demonstrates how an adaptive behavioral based program on a tablet can help low performing children improve critical early math skills.
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| 3. |
- Isaksson, Martina, 1985-
(author)
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Overcontrol in anorexia nervosa : assessment, occurrence, and treatment
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Excessive overcontrol – characterized by high risk aversion, compulsiveness, emotion inhibition, and social deficits – has been suggested to be a core mechanism for developing and maintaining anorexia nervosa. However, such factors are rarely targeted as key elements in treatment of the disorder. The overall aim of this thesis was to evaluate the occurrence of over- and undercontrolled personality styles in patients with eating disorders, and to evaluate the treatment effects and patient experiences of Radically open dialectical behavior therapy (RO DBT) for outpatients with anorexia. In a cross-sectional study (Study I) with two non-clinical samples (n = 483 and n = 197), psychometric evaluations showed that a new shortened version of the Ego Undercontrol Scale (EUC-13), measuring over- and undercontrol, and the Ego Resilience Scale (ER) measuring adaptive control, seemed promising for assessing the constructs. In a cross-sectional study (Study II) assessing the occurrence of overcontrol in a clinical and non-clinical population, findings showed that overcontrol was more common in restricting anorexia (n = 34) and atypical anorexia (n = 29), than in bulimia (n = 76), borderline personality disorder (n = 108), and a non-clinical sample (n = 444). Anorexia with binge eating and purging (n = 31) showed similar, but somewhat lower, levels of overcontrol compared with atypical and restricting anorexia. However, differences from the other eating disorder groups were not significant. In a single-case experimental design study with 13 patients (Study III), the effect of RO DBT – a treatment developed for disorders related to excessive overcontrol – was evaluated for outpatients with mild to moderate anorexia. Findings were that all completers (62%) were in remission after treatment, and that the treatment clinically and reliably reduced eating disorder psychopathology and clinical impairment, and increased quality of life. In a qualitative interview study (Study IV), 11 participants from Study III reported that they appreciated the comprehensive approach, where both the eating disorder and the overcontrol were addressed, and that sharing with others was important. Findings indicated that the EUC-13 and the ER seemed promising for assessing overcontrol, undercontrol, and resilience. The occurence of overcontrol in different types of AN raised questions regarding if treatment of AN would be more effective if these difficulties were addressed. Lastly, preliminary evidence showed that outpatient RO DBT could be effective for patients with mild to moderate AN and overcontrol, and that the treatment was well received by the patients.
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| 4. |
- Ljungman, Lisa, 1981-
(author)
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Parents of Children with Cancer : Psychological Long-Term Consequences and Development of a Psychological Treatment for Parents of Survivors
- 2016
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Doctoral thesis (other academic/artistic)abstract
- The aims of this thesis were to increase the knowledge about the long-term psychological consequences in parents of children diagnosed with cancer, including parents of childhood cancer survivors (CCSs) and bereaved parents, and to take the first steps towards developing a psychological treatment for parents of CCSs.Study I was a systematic review synthesizing the literature on psychological long-term consequences in parents of CCSs. Study II had a longitudinal design assessing posttraumatic stress symptoms (PTSS) from shortly after the child’s diagnosis (T1, N=259) up to five years after end of the child’s treatment or death (T7, n=169). Study I and II concluded that while most parents show resilience in the long-term, a subgroup report high levels of general distress and/or PTSS. In Study III, interview data from the last assessment in the longitudinal project (T7, n=168) was used. Participants described particularly negative and/or positive experiences in relation to their child’s cancer, and results pointed to the wide range of such experiences involved in parenting a child with cancer. In Study IV and V, parents of CCSs reporting cancer-related psychological distress were included (N=15). In Study IV, a conceptualization of this distress was generated by aggregation of individual behavioral case formulations. The conceptualization consisted of two separate but overlapping paths describing development and maintenance of symptoms of traumatic stress and depressive symptoms. In Study V, cognitive behavior therapy (CBT) based on the individual case formulations were preliminarily evaluated in an open trial. The CBT appeared feasible, and at post-assessment participants reported significant decreases in PTSS (p<.001), depression (p<.001), and anxiety (p<.01) with medium to large effect sizes (Cohen’s d=0.65-0.92).Findings indicate that psychological long-term consequences in parents of children with cancer consist of a broad range of negative as well as positive experiences, and that while most parents show resilience in the long-term, a subgroup report high levels of psychological distress. For parents of CCSs this distress is suggested to primarily consist of symptoms of traumatic stress and depression, and a preliminary evaluation of CBT targeting hypothesized maintaining mechanisms showed promise in terms of feasibility and treatment effect.
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| 5. |
- Alfonsson, Sven, 1977-
(author)
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Impulsivity, Negative Mood, and Disordered Eating in Obesity
- 2014
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Doctoral thesis (other academic/artistic)abstract
- Bariatric surgery is a life-altering procedure that leads to substantial weight loss for most patients with obesity. Psychiatric conditions that may interfere with eating behavior and other behavioral prescriptions after surgery are common. Disordered eating is an established risk factor for inferior weight loss but the effects of negative mood and impulsivity are largely unknown. This thesis aims to investigate the prevalence of and associations between these potential risk factors and eating behavior in bariatric surgery patients.Study I assessed the prevalence of adult Attention Deficits/Hyperactivity Disorder (ADHD) symptoms in bariatric surgery patients. Symptoms of adult ADHD were elevated compared to the normal population and associated with symptoms of disordered eating, anxiety, and depression.Study II investigated whether treatment with Behavioral Activation (BA) could ameliorate binge eating and other symptoms of disordered eating in patients with obesity and Binge Eating Disorder. The results showed that BA was effective in increasing activity levels and improving mood but not in ameliorating binge eating in these patients.Study III was a prospective study on disordered eating, symptoms of depression and anxiety, symptoms of adult ADHD, and alcohol risk consumption before surgery and at follow-up after 12 months. After controlling for age, no variable measured before surgery could predict weight loss after surgery. Disordered eating after surgery was associated with inferior weight loss in men and a subgroup of older female participants.The present thesis concludes that symptoms of adult ADHD are common among bariatric surgery patients and associated with disordered eating. There is no indication that symptoms of adult ADHD are associated with short-term inferior weight loss after surgery. However, adult ADHD may be a risk factor for postsurgical alcohol abuse. The treatment study showed no direct association among activity, mood, and binge eating. BA, while effective in improving mood, was found not to be an effective treatment for BED, at least in the short group format investigated.
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| 6. |
- Björnsdotter, Annika, 1970-
(author)
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Evaluation of Family Check-Up and iComet : Effectiveness as well as Psychometrics and Norms for Parent Rating Scales
- 2014
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Doctoral thesis (other academic/artistic)abstract
- This thesis compromise four studies, three regarding psychometrics and norms of parent rating scales, and one study regarding effectiveness of two different interventions. A normative sample consisting of 1443 parents with children aged 10 to 13 years old, was used in the Study I, II and III. In Study IV, 231 self-referred parents with children aged 10-13 years old with externalizing behavior problem (EBP) were randomized to either Family Check-Up (FCU) or iComet.The Strengths and Difficulties Questionnaire (SDQ) used in Study I proved to be a reliable and valid instrument with high internal consistency, clear factor structure and high correlation with other similar instruments. In addition, the results support the online use of SDQ as well as using norms obtained through traditional administration even when the SDQ has been administrated online. The Emotion Regulation Questionnaire (ERQ) investigated in Study II was shown to have adequate reliability and construct validity. The specific use of expressive suppression or cognitive reappraisal as a parental emotion regulation strategy was correlated as expected to the couple’s satisfaction, family warmth, and the employment of adequate discipline strategies. Swedish norms for self-rated ERQs are also presented. Study III investigated the Parental Knowledge and Monitoring Scale (PKMS), which was shown to be a useful instrument for assessing parental knowledge and its sources. Family climate appears to moderate important relationships between parental knowledge and conduct problems with implications for such things as family interventions. Finally, a person-oriented analysis was used in Study IV to subtype the children according to combinations of prosocial behavior and EBP, such as different levels of attention deficit hyperactivity disorder (ADHD) symptoms and/or oppositional defiant disorder (ODD) behaviors. Despite being a heterogeneous group of children with EBP, they were meaningfully grouped into significantly different profiles. Both FCU and iComet resulted in post-treatment measurement within non-clinical range for three of the five profiles. The two profiles that included high levels of ADHD behaviors at baseline assessment continued to have residual symptoms post intervention.
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| 7. |
- Bergvall, Hillevi, et al.
(author)
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Development of competence in cognitive behavioural therapy and the role of metacognition among clinical psychology and psychotherapy students
- 2023
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In: Behavioural and Cognitive Psychotherapy. - : CAMBRIDGE UNIV PRESS. - 1352-4658 .- 1469-1833. ; 51:3
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Journal article (peer-reviewed)abstract
- Background:There is a paucity of research on therapist competence development following extensive training in cognitive behavioural therapy (CBT). In addition, metacognitive ability (the knowledge and regulation of ones cognitive processes) has been associated with learning in various domains but its role in learning CBT is unknown. Aims:To investigate to what extent psychology and psychotherapy students acquired competence in CBT following extensive training, and the role of metacognition. Method:CBT competence and metacognitive activity were assessed in 73 psychology and psychotherapy students before and after 1.5 years of CBT training, using role-plays with a standardised patient. Results:Using linear mixed modelling, we found large improvements of CBT competence from pre- to post-assessment. At post-assessment, 72% performed above the competence threshold (36 points on the Cognitive Therapy Scale-Revised). Higher competence was correlated with lower accuracy in self-assessment, a measure of metacognitive ability. The more competent therapists tended to under-estimate their performance, while less competent therapists made more accurate self-assessments. Metacognitive activity did not predict CBT competence development. Participant characteristics (e.g. age, clinical experience) did not moderate competence development. Conclusions:Competence improved over time and most students performed over the threshold post-assessment. The more competent therapists tended to under-rate their competence. In contrast to what has been found in other learning domains, metacognitive ability was not associated with competence development in our study. Hence, metacognition and competence may be unrelated in CBT or perhaps other methods are required to measure metacognition.
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| 8. |
- Dahlberg, Anton, et al.
(author)
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SDQ in the Hands of Fathers and Preschool Teachers : Psychometric Properties in a Non-clinical Sample of 3-5-Year-Olds
- 2019
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In: Child Psychiatry and Human Development. - : Springer Science and Business Media LLC. - 0009-398X .- 1573-3327. ; 50:1, s. 132-141
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Journal article (peer-reviewed)abstract
- The Strengths and Difficulties Questionnaire (SDQ) is a well-established instrument for measuring social and behavioural problems among children, with good psychometric properties for older children, but less validity reports on pre-schoolers. In addition, there is a knowledge gap concerning fathers as informants. The present work is one of the few validity studies to include preschool teachers and the first on preschool children where fathers are included as separate informants. In this study, SDQs were collected from a large community sample (n = 17,752) of children aged 3-5, rated by mothers, fathers, and preschool teachers and analysed using confirmatory factor analysis. Our results revealed acceptable fit for all informant groups and measurement invariance across child gender, child age, and parental education level. Our findings suggest good construct validity of the SDQ for a non-clinical preschool population and imply that it may be used for assessing child behaviour problems from different informant perspectives.
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| 9. |
- Dahlberg, Anton, et al.
(author)
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Swedish norms for the Strengths and Difficulties Questionnaire for children 3-5 years rated by parents and preschool teachers
- 2020
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In: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 61:2, s. 253-261
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Journal article (peer-reviewed)abstract
- The Strengths and Difficulties Questionnaire (SDQ) is a widespread tool for assessing behavior problems in children and adolescents. Despite being investigated thoroughly concerning both validity and reliability, peer reviewed studies that provide norms, especially for preschool children, are lacking. This paper provides Swedish norms using data from a large community sample of children aged 3-5, based on mothers', fathers', and preschool teacher's ratings. Preschool teachers' ratings were generally lower than parents' ratings, which contradicts some previous studies. Differences between girls and boys were found, suggesting that boys display higher levels of behavior problems. Lower parental education and country of origin outside of Sweden were also associated with more difficulties. Cut-offs are presented for each age group, gender and rater category. Population-specific norms and percentile cut-offs provided in this study facilitate identifying children in need of interventions in paediatric care and enable cross-country comparisons of children's mental health problems.
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| 10. |
- Isaksson, Martina, 1985-, et al.
(author)
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Psychometric properties of the Eating Disorder Symptom List (EDSL), a brief questionnaire for weekly assessment of eating disorder symptoms
- 2021
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In: Scandinavian Journal of Psychology. - : John Wiley & Sons. - 0036-5564 .- 1467-9450. ; 62:5, s. 648-654
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Journal article (peer-reviewed)abstract
- Frequent assessment of eating disorder (ED) symptoms (e.g., on a weekly basis) may guide treatment planning in clinical services, and be an invaluable tool for improving clinical research. The aim of the present study was to evaluate the psychometric properties of a brief eight-item scale designed to assess ED behaviors during the preceding week (Eating Disorder Symptom List: EDSL). Cross-sectional data were collected in a non-clinical community sample (n = 406) and cross-sectional and longitudinal data were gathered in a clinical ED sample before and after treatment with Enhanced Cognitive Behavior Therapy for eating disorders (n = 47) and weekly during treatment with Radically Open Dialectical Behavior Therapy (n = 13). The EDSL showed acceptable to good internal consistency (α = 0.72–0.82) and test-retest reliability (r = 0.88). Convergent and divergent validity was satisfactory. Also, the EDSL was sensitive to change and could detect changes between before and after treatment, as well as on a weekly basis. We conclude that the EDSL is a brief scale entailing little patient burden, and that initial analyses of the scale provide preliminary evidence of satisfactory psychometric properties. The scale can be used for repeated measures in ED treatment studies and clinics to assess change or absence of change during treatment.
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