A selection from Stockholm University publication database

• A Cluster Randomized Trial of Promoting Alternative Thinking Strategies (PATHS®) With Swedish Preschool Children

  2021. Lilianne Eninger (et al.). Frontiers in Psychology 12

  Article

  The preschool edition of Promoting Alternative THinking Strategies (PATHS(R)) is a school-based, teacher implemented universal intervention developed in the United States designed to promote social emotional competence (SEC) in children as a foundation for improved mental health. PATHS is delivered as a curriculum and it is based on theories and research regarding SEC, brain development, and optimal school environments. A majority of children in Sweden attend preschool, which is government-subsidized and follows a national curriculum focusing on both academic and social emotional learning. However, there is not so much focus on formal instruction nor manual-based lessons. The purpose of this study was to assess the short-term (pre- to post-test) effects of PATHS in the Swedish preschool setting. Using a two-wave cluster randomized trial with multi-method and informant assessment (N = 285 4 and 5-year-old Swedish children; n = 145 wait-list control; n = 140 intervention; K = 26 preschools; k = 13 intervention; k = 13 control) we assessed changes in child emotional knowledge, emotional awareness, social problem solving, prosocial play, inhibitory control, and working memory using structural equation modeling (SEM). We included schools with at least one classroom of 4-5-year-old children from three municipalities. We excluded open preschools, parent cooperative preschools, and family day homes. After random assignment, schools were informed of condition assignment. Research team members were not blind to assignment. We hypothesized that relative to children in control schools, children in intervention schools would evidence improvements in social emotional competence as well as other outcomes. Children in PATHS, relative to children in the control, evidenced improvements in working memory and prosocial play, but also showed an increase in hyperactive behaviors. Girls in PATHS, relative to girls in the control, showed improvement in emotional knowledge and reduced anxiety. These results are considered in light of efforts to promote positive development and mental health.

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• Early intervention program of extreme preterm born infants, status report three years into the project

  2021. Erika Baraldi (et al.).

  Conference

  Children born extremely preterm (e.g. before 28 gestational weeks, EPT) runs a greater risk of cognitive, motor and neurobehavioral impairment later in life, compared to children born at term. Moreover, being a parent of an EPT born child increases the probability of developing depression and posttraumatic stress disorder post-partum, as well as the premature birth may affect the parent-child interaction negatively. In an attempt to decrease the psychological and motoric negative impact of both the child and parents, our multi-professional team has developed an early intervention during the first year at home focusing om parent-child interaction of the EPT born children: Stockholm Preterm Interaction-Based Intervention, SPIBI (Baraldi et al., 2020a). The target of the RCT is 130 children and after 32 months 112 children has been included in the study, evenly distributed in the intervention group and control group. At children’s corrected age of one-year, parents from 14 of the first included families were interviewed about their experiences from the intervention program, resulting in a qualitative article. Three main themes of parental experiences of the first year at home emerged: child-related concerns (concerning child medical state, self-regulation and recovery), parental inner state (concerning loneliness, ambivalence and premature parental identity), and changed family dynamics (concerning the couple, siblings and intergenerational support). The parents from the  intervention group reported that the intervention had given them security, a sense that the interventionist has been knowledgeable and in some cases that the program was important but not necessary to them (Baraldi et al., 2020b). With 85% of the targeted subjects included it is clear that an extensive early home-visit intervention program is feasible in the Swedish context, even though the pandemic has slowed down the recruitment pace and has forced adjustments to be made such as the use of telemedicine, exclusion of toys in the follow-up process and intensified hygienic procedures.

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• Home-visits during the first year of life

  2020. Erika Baraldi (et al.).

  Conference

  In Sweden 400 children yearly are born extremely preterm (EPT; more than three months early). These children have an increased risk of later academic difficulties, neuropsychiatric disorder, cognitive and mental health issues. Since the first 1000 days of the brain development are so crucial for later development, the interdisciplinary Stockholm Preterm Interaction-Based Intervention (SPIBI) aims at strengthening the parent-child interaction, child development and parental mental health. 

  The research is based on pedagogical, motor-developmental, medical and psychological science. The program is based on Vygotski’s theory of the zone of proximal development, as well theoretical frameworks of early intervention (Guralnick; Shonkoff). Additionally, Als’ synactive theory of understanding premature infant communication and needs, Bowlby’s attachment theory, and Emde’s emotional availability theory have been applied. 

  SPIBI is an ongoing research project funded by Stockholm-County-Stockholm-University joint-collaboration grant 20160881. It is an RCT targeting 130 EPT infants and their parents in Stockholm with a 3-year inclusion period starting September 2018. The intervention consists of ten home-visits during the first year by trained interventionists, supporting the next developmental step of the child through a scaffolding process, strengthening parental sensitivity to infant cues, and promoting infant’s self-regulation. SPIBI has recruited and trained six multi-professional-NICU-experienced interventionists. Control group participants receive TAU plus an extended follow-up program.

  The overall aim is to present the framework and theory of change of SPIBI, relating to research findings, welfare policies and recommendations for infant’s “chain of care”. So far, sixty eligible infants have been identified within four neonatal units; of which 48 approved participation. The primary outcome is emotional availability of the parent and child, where we hypothesize that the intervention will affect the parental sensitivity and structure of interaction with the child. Secondary outcomes concern child development, i.e. motor development, cognition and occurrence of neuropsychiatric symptoms, parental mental health, anxiety and self-efficacy, where we also hypothesize positive effects of the intervention. 

  • Since Nordic countries have neonatal intensive care of high quality, the amount of EPT survivors is high compared to other countries; therefore, the educational systems must follow achievements reached by health care system and develop new evidence-based interventions in early childhood education, which are appropriated for EPT born children and their parents, following recent European Standards of Care for Newborn Health (2018).
  • Insights from neuro-cognition, early intervention and educational research has shown the importance of interdisciplinary interventions, and this should be spread around the Nordic countries.
  • Nordic countries offer a unique social environment, with governmental funded parental-leave, enabling early-interventions delivered by parents.
  • The EPT children in Nordic countries are less affected by socioeconomic factors, as is often the case where maternity welfare and obstetrics is not publically financed. Hence, Nordic countries have a unique opportunity to perform research targeting EPT students and their parents specifically, with less confounding factors.
  • Some Nordic countries have adopted policies concerning home-visiting support and infants’ rights, as recommended by the World Association of Mental health’s policy statement from 2016, and Nordic knowledge exchange and collaboration on these policies is warranted. 

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• Parents’ Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention

  2020. Erika Baraldi (et al.). International Journal of Environmental Research and Public Health 17 (24)

  Article

  With increasing survival rates of children born extremely preterm (EPT), before gestational week 28, the post-discharge life of these families has gained significant research interest. Quantitative studies of parental experiences post-discharge have previously reported elevated levels depressive symptoms, posttraumatic stress-disorder and anxiety among the parents. The current investigation aims to qualitatively explore the situation for parents of children born EPT in Sweden during the first year at home. Semi-structured interviews were performed with 17 parents of 14 children born EPT; eight parents were from an early intervention group and nine parents from a group that received treatment as usual, with extended follow-up procedures. Three main themes were identified using a thematic analytic approach: child-related concerns, the inner state of the parent, and changed family dynamics. Parents in the intervention group also expressed themes related to the intervention, as a sense of security and knowledgeable interventionists. The results are discussed in relation to different concepts of health, parent–child interaction and attachment, and models of the recovery processes. In conclusion, parents describe the first year at home as a time of prolonged parental worries for the child as well as concerns regarding the parent’s own emotional state.

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• Stockholm preterm interaction-based intervention (SPIBI) - study protocol for an RCT of a 12-month parallel-group post-discharge program for extremely preterm infants and their parents

  2020. Erika Baraldi (et al.). BMC Pediatrics 20 (1)

  Article

  Background: Improved neonatal care has resulted in increased survival rates among infants born after only 22 gestational weeks, but extremely preterm children still have an increased risk of neurodevelopmental delays, learning disabilities and reduced cognitive capacity, particularly executive function deficits. Parent-child interaction and parental mental health are associated with infant development, regardless of preterm birth. There is a need for further early interventions directed towards extremely preterm (EPT) children as well as their parents. The purpose of this paper is to describe the Stockholm Preterm Interaction-Based Intervention (SPIBI), the arrangements of the SPIBI trial and the chosen outcome measurements.

  Methods: The SPIBI is a randomized clinical trial that includes EPT infants and their parents upon discharge from four neonatal units in Stockholm, Sweden. Inclusion criteria are EPT infants soon to be discharged from a neonatal intensive care unit (NICU), with parents speaking Swedish or English. Both groups receive three initial visits at the neonatal unit before discharge during the recruitment process, with a strengths-based and development-supportive approach. The intervention group receives ten home visits and two telephone calls during the first year from a trained interventionist from a multi-professional team. The SPIBI intervention is a strengths-based early intervention programme focusing on parental sensitivity to infant cues, enhancing positive parent-child interaction, improving self-regulating skills and supporting the infant’s next small developmental step through a scaffolding process and parent-infant co-regulation. The control group receives standard follow-up and care plus extended assessment. The outcomes of interest are parent-child interaction, child development, parental mental health and preschool teacher evaluation of child participation, with assessments at 3, 12, 24 and 36 months corrected age (CA). The primary outcome is emotional availability at 12 months CA.

  Discussion: If the SPIBI shows positive results, it could be considered for clinical implementation for child-support, ethical and health-economic purposes. Regardless of the outcome, the trial will provide valuable information about extremely preterm children and their parents during infancy and toddlerhood after regional hospital care in Sweden.

  Trial registration: The study was registered in ClinicalTrials.gov in October 2018 (NCT03714633).

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• A longitudinal model of executive function development from birth through adolescence in children born very or extremely preterm

  2019. Johanna Stålnacke (et al.). Child Neuropsychology 25 (3), 318-335

  Article

  Executive function deficits are often reported as a specific weakness in preterm children. Yet, executive function development is still not fully understood. In a prospective longitudinal study, 115 preterm born children, <= 31 weeks of gestation, were recruited at birth and subject to neuropsychological assessments at ages 5.5 and 18 years. By applying Miyake and colleagues' integrative framework of executive function to our data, two core components of executive function, working memory and cognitive flexibility, were identified through confirmatory factor analysis. Developmental stability was investigated in a serial multiple mediator structural equation model. Biological, medical, and social factors as well as mental development at 10 months were entered as predictors. Both components of executive function were highly stable from 5.5 to 18 years. Gestational age, intrauterine growth, lack of perinatal medical complications, and female sex were positively related to mental development at 10 months, which together with parental education influenced both core executive functions at 5.5 years. Working memory at 5.5 years mediated outcome in working memory at 18 years. In addition to the mediation of cognitive flexibility at 5.5 years, perinatal medical complications and restricted intrauterine growth had a continued direct negative impact on cognitive flexibility at 18 years. The application of a theoretical framework added to our understanding of executive function development in preterm born children. The study supports early identification of executive deficits among children born preterm, as deficits are unlikely to diminish with maturation.

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• Clinical Protocol & Research Process of Stockholm Preterm Interaction-Based Intervention, SPIBI

  2019. Erika Baraldi (et al.). Pediatric Research 86 (Suppl.), 54-55

  Article

  Background

  Extremely preterm (EPT) born children are at increased risk of cognitive and neurodevelopmental impairment, neuropsychiatric disorders and academic difficulties. Parents of EPT born children are extra vulnerable for anxiety, posttraumatic stress disorder and depression and the parent-child interaction is negatively affected by prematurity. There is some evidence that early interventions have beneficial effects on neurocognitive and motor outcomes (Spittle A et al 2015). Based on a previous intervention (Verkerk G et al 2012) and adjusted to the Swedish context with 480 days paid parental leave, we created a post–discharge intervention, SPIBI, for families of EPT born children.

  Method

  The aim of (SPIBI) is to improve the quality of the parent-child interaction, child development and parental mental health in families with EPT born children. . SPIBI is a randomized controlled beginning at discharge and lasting until the child is 12 months corrected age. The trial design is a two arm randomized trial with four recruiting sites in Stockholm. Intervention group (target, n=65) receives 10 visits and two telephone calls from a trained interventionist and the control group (target n=65) receives treatment as usual plus an extended follow-up program. The SPIBI-team has recruited and trained 6 multi-professional and NICU-experienced interventionists. The training takes one year (0.2 of full time) and the content was both theoretical and practical, including pilot-cases. 

  Result

  SPIBI is an ongoing research project, beginning the 1st of September 2018 and planning to end recruitment the 31st of August 2020 and finishing the home-visits in August 2021. By the end of April 2019, 33 eligible infants had been identified within the four neonatal units in Stockholm; of which 26 children approved and 7 children declined participation. At this stage, three children have dropped out of the study, because of severe social challenges and child death. Identified challenges have been social and medical vulnerability of the EPT-families, finding the optimal multi-professional balance of motoric, psychological, pedagogical and medical kernels of the intervention, ethical considerations when to ask families for participation, lack of long-term discharge-planning of the neonatal units and large geographical spread of NICUs as well as families.

  Conclusion

  In conclusion, the protocol seem to be feasible and appreciated by parents in the target group. With regard to the small recruitment base, trials of this kind needs a long inclusion time. Since EPT-children and their parents displays a wide scope of difficulties and challenges, multi-professional cooperation is preferable, placing high demands of sensitivity, professional respect and time for long collaborative processes.

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• Implementation of a Swedish effectiveness trial of preschool PATHS

  2019. Laura Ferrer-Wreder (et al.).

  Conference

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• Simple Categorization of Human Figure Drawings at 5 Years of Age as an Indicator of Developmental Delay

  2019. S. Tukel (et al.). Developmental Neurorehabilitation 22 (7), 479-486

  Article

  Purpose: To elucidate the association between developmental stage of human figure drawing(HFD) and fine motor control, visual perception, and further investigate its potential to be used for screening developmental delay. Methods: Participants were 301 children at 51/2 years of age, 176 born preterm and 125 at term, whose HFDs were categorized into six developmental stages. Motor-Free-Visual-Perception Test, Movement-ABC, Performance Intelligence Quotient (PIQ: Wechsler Scale), and the Visual-Motor Integration test were used. Fine motor functions were explored using ImageJ. Results: Age-expected HFDs were drawn by 87% of the children, while 13%, mostly preterm boys, drew immature ones. Stages of HFD were related to both PIQ and Movement-ABC. Visuomotor control and visual perception significantly explained the HFD. The sensitivity and specificity of HFD as a screening tool was moderate to good. Conclusions: HFD is influenced by visual perception and visuomotor control and can be used for screening developmental delay at preschool age.

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• Stockholm Preterm Interaction-Based Intervention, SPIBI

  2019. Erika Baraldi (et al.).

  Conference

  Bakgrund

  I Sverige föds mellan 300 och 400 barn innan den 28 graviditetsveckan. Omkring 2/3 av de extremt prematurfödda barnen har ingen eller en mild funktionsnedsättning medan 1/3 har medelsvår till svår funktionsnedsättning vid skolstart (Serenius et al, 2016). De vanligaste svårigheterna efter extrem prematur födsel är intellektuell funktionsnedsättning (Jarjour, 2015), i synnerhet svårigheter med arbetsminnet och den exekutiva funktionsutvecklingen (Stålnacke et al., 2018;  Mulder et al., 2009). Även neuropsykiatriska funktionsnedsättningar som ADHD (Burnett et al., 2014) och autism är överrepresenterade i gruppen prematurfödda barn, 8- 29% av de extremt prematurfödda barnen skattas positivs på screeningtest för AST (Johnson et al., 2010; Kim, 2016 & Padilla et al., 2015).

  Inte bara barnet påverkas av den extremt för tidiga födseln, även föräldrarna kastas snabbt in i ett stressigt föräldraskap till ett skört och ofta sjukt spädbarn som inte är som de föreställde sig under graviditeten. Dessa stressiga omständigheter bidrar till att föräldrarna löper en ökad risk för posttraumatisk stress och depressiva symtom än föräldrar till fullgångna barn (Holditch-Davis et al, 2003; Holditch-Davis et al, 2015; Kong et al., 2013 & Singer på al., 1999). Dessutom påverkas samspelet mellan föräldrar och barn och familjesituationen negativt (Forcada-Guex et al., 2006; Saigal et al., 2000 & Treyvaut et al., 2014). När en förälder är psykiskt labil påverkar detta barnet på ett socialt, beteendemässigt och funktionellt sätt, ända till det för tidigt föda barnet är i förskoleåldern (Huhtala et al., 2011 & Huhtala et al., 2014). Det ger därför dubbel utdelning att ta hand om föräldrarna till tidigt födda barn, både genom att påverka den vuxne direkt och barnet indirekt.

  Svenska Prematurförbundet (SPF) har under flera år pekat på de långsiktiga effekterna av för tidig födsel och därmed behovet av långsiktigt stöd till de drabbade familjerna (Prematurförbundet, 2019). Efter utskrivning från sjukhuset rapporterar många av föräldrarna att de känner sig ensamma, stressade och oroliga. Sådana stödprogram har inte införts eller utvärderats tidigare i Sverige.

  Sammanfattningsvis, utifrån risken för negativa långtidseffekter av extrem prematuritet samt Prematurförbundets önskan om ytterligare stöd, finns ett tydligt behov av interventioner riktade till barnen och deras föräldrar i syfte att stödja föräldra-barnsamspelet, barnets utveckling på sikt samt föräldrarnas psykiska hälsa. SPIBI är et interventionsprogram som ämnar fylla det behovet.

  Metod

  SPIBI består av en tvärprofessionell forskargrupp med neonatologer, psykologer, fysioterapeut och specialpedagog. Forskargruppen har designat en RCT i syfte att utvärdera effekten av ett samspelsbaserat interventionsprogram för extremt prematurfödda spädbarn och deras föräldrar, med sin början i utskrivningsprocessen som pågår under förta året hemma. Studien består av två armar, en interventionsgrupp och en kontrollgrupp, och barnen rekryteras från Stockholms fyra neonatalavdelningar under två års tid (sept 2018-sept 2020). Målet är att rekrytera 130 familjer på två år. Interventionsgruppen (IG) får 10 hembesök och två telefonsamtal från en specialutbildad behandlare. Interventionens fokus är styrkebaserat stöd av föräldra-barnsamspelet, öka förälderns lyhördhet för barnets signaler, stödja föräldern i att ge optimalt utvecklingsstöd till barnet samt öka barnets självreglerande förmåga. I det nationella uppföljningsprogrammet får alla extremt prematurfödda barn uppföljning vid 3 månader, 12 månader, 24 månader KÅ. Kontrollgruppens (KG) barn får utöver detta ett utökat uppföljningsprogram.  

  Studiens sex behandlare arbetar inom neontalvården till vardags och har utöver detta fått en ettårig utbildning i SPIBI en dag per vecka, med både teoretisk grund och praktisk träning i interventionen, inklusive sex pilotfallshembesök. Pilotfallen videofilmades och diskuterades i grupp under handledning. Handledningen gavs direkt av de två holländska forskarna Karen Koldewijn och Marie-Jeanne Wolf från Amsterdam Academic Medical Centre som forskat på den snarlika TOP-interventionen i över 20 år och kunnat påvisa effekt på motoriken (Koldewijn et al., 2009; Meijssen et al., 2011; Flierman et al., 2016 & Koldewijn et al., 2010). Grunden till SPIBI interventionen kom utöver TOP-programmet från Cochrane-rapporten från 2015 om post-discharge interventions (Spittle et al., 2015).

  Resultat

  SPIBI är ett pågående forskningsprojekt som hittills rekryterat 44 barn, medan ytterligare 12 familjer tackat nej till deltagande i studien. I nuläget har två barn uteslutits ur studien av svåra psykosociala skäl och ytterligare två barn har avlidit under första året hemma. Identifierade utmaningar har varit den sociala och medicinska skörhet som de här familjerna behöver hantera, att hitta den optimala tvärprofessionella balansen mellan fysioterapeutiska, psykologiska, pedagogiska och medicinska inslag i interventionen, otillräcklig utskrivningsplanering från de olika sjukhusen, stor geografisk spridning på sjukhusenheterna samt den etiska frågan när i barnets liv det optimala tillfället för frågan om studiedeltagande är. Eftersom rekryteringsprocessen idag kommit halvvägs tidsmässigt kan inga resultat presenteras än, men med ett 80 % deltagande i studien och mycket positiv återkoppling från familjerna kan man dra slutsatsen att denna forskning är efterfrågad och ett viktigt nästa steg i utvecklingen av vården för våra allra mest sköra patienter.

  Slutsatser

  Slutsatsen är att SPIBI-protokollet är både genomförbart i klinisk praxis och samtidigt uppskattat av föräldrarna i målgruppen. Med hänsyn taget till den smala rekryteringsbasen kan denna typ av studie kräva en lång inkluderingstid alternativt inkludering på nationell nivå. Eftersom extremt prematurfödda barn och deras föräldrar uppvisar en rad svårigheter och utmaningar, är tvärprofessionellt samarbete att föredra vilket ställer höga krav på lyhördhet, professionell respekt och got om tid för samarbete. På Perinataldagarna kan forskningsprocessen och interventionsprogrammet presenteras i syfte att öka förståelsen för uppföljningen och behovet av ett integrerat föräldrastöd.

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• The development of a post-discharge intervention program in Sweden for extremely preterm infants and their caregivers, through home visits during their first year of life

  2019. Erika Baraldi (et al.).

  Conference

  Sweden has a proactive neonatal intensive care, saving children born from gestation week 22, with a 90% survival rate in the extremely preterm (EPT) group. With increased survival rates, the long-term outcome of the EPT children has gained much research interest. Recent studies indicate that 1/3 of the EPT-children in Sweden show moderate to severe neurodevelopmental deficits when beginning school. An interdisciplinary research team has designed an intervention for EPT infants and their caregivers in their home-environment after hospital discharge and throughout the first year of life. The aim of the ongoing randomized controlled trial is to study intervention effects on the children’s cognitive, motor and psychosocial function, the parental mental health and the infant-parent interaction. This paper present the intervention’s theory of change, the validity considerations, and an overview of the syllabus of the training given to the interdisciplinary team of six clinicians who serve as interventionists. 

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• Grunderna i vår tids psykologi

  2012. Philip Hwang, Ingvar Lundberg, Ann-Charlotte Smedler.

  Book (ed)

  Bokinformation:

  Grunderna i vår tids psykologi ger en gedigen grund till den moderna psykologin. Några av Sveriges främsta forskare har här samlat den mest aktuella psykologiska vetenskapen utifrån ledande svensk och internationell forskning. Tack vare författarnas omfattande undervisningserfarenhet blir framställningen begriplig, levande och nyanserad. Resultatet är en heltäckande skildring av de byggstenar som behövs för att gå vidare inom psykologins olika tillämpningsfält.

  Grunderna i vår tids psykologi är:

  Människokunskap blir vetenskap

  Biologisk psykologi

  Motivation och emotion

  Kognitionspsykologi

  Utvecklingspsykologi

  Personlighetspsykologi

  Socialpsykologi

  Boken riktar sig främst till psykologistuderande, men kan läsas på alla utbildningar där grundkunskaper i ämnet ingår. Den ger också en utmärkt introduktion till den som är nyfiken på vår tids psykologi.

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