Promoting Inclusive Educational Environments for Children with Autism and Other Social-communication Challenges: Preschool Class and Primary School

This study evaluates the effect of using the Autism Program Environment Rating Scale (APERS) as the foundation for providing feedback, in-service training and coaching to teachers, to improve program quality for autistic (ASD) students and students with related social-communication challenges (SCC) in Swedish primary school classrooms. In the current study half of the participating classrooms will receive the APERS-based model for program quality improvement, while the other half will receive services as usual.

It is hypothesized that the APERS-based model will improve primary school program quality for children with ASD and SCC, as well as improve functioning for students with ASD/SCC and self-perceived self-efficacy among participating teachers, compared to the study's comparison group.

Study Overview

• Status: Completed
• Conditions: Autism Spectrum Disorder; Social Communication Challenges
• Intervention / Treatment: Behavioral: APERS-based model

• Study Type: Interventional
• Enrollment (Actual): 24
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Sweden
  • Stockholm, Sweden
    • Stockholm Municipality

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 years to 9 years (Child)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• autism diagnosis
• socio-communicative challenges identified by parents and/or school staff
• attending a primary school classroom (i.e., from pre-school class to third grade)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental group; In the experimental group, in-service training on autism, program quality, and APERS will be provided to participating staff. Furthermore, APERS-rating to assess the program quality for students with ASD/SCC will be conducted. Pertaining feedback on program areas of strength and improvement will be provided by the APERS-raters to the classroom teachers. Subsequently, assigned coaches (already employed at the school as special educators or equivalent) will based on the APERS-ratings develop an action plan to improve program quality for students with ASD and SCC, in collaboration with classroom teachers. Subsequently, the coach will provide weekly or bi-weekly coaching to promote program quality during the course of two school semesters (approximately 8-9 months).	Behavioral: APERS-based model; APERS-assessments followed by in-service training, APERS-feedback and on-site coaching to improve primary school classroom quality for students with ASD/SCC
No Intervention: Comparison group; The classrooms in the comparison group will also be rated with the APERS, and feedback will provided to classroom teachers. However, no further support will be provided in transforming APERS-ratings with pertaining feedback into best practice.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline in autism program quality assessed with the Autism Program Environment Rating Scale - Preschool and primary school (APERS-Fk/L-SE)	The APERS-Fk/L-SE is a rating scale designed to examine primary school program quality for autistic students in Sweden. It contains 10 domains including areas such as students' personal independence and competence, and challenging behaviors. The scale consists of 59 items rated on a five-point Likert-scale (1= low quality - 5 = high quality) resulting in individual item scores, subdomain scores, domain scores and a total score.	Baseline and about 9 months from baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline in how children feel about their school assessed with How I Feel About My School (HIFAMS)	The HIFAMS is a questionnaire designed to assess the happiness and subjective well-being of children in school. It is to to be completed by all children in all participating classrooms in the study. The questionnaire is composed of seven questions which asks children how they feel about school life, which are scored using a three-point Likert "face" scale (sad face, neutral face, happy face).	Baseline and approximately 9 months from baseline
Change from baseline in parents ratings on their children's body functions, activities and participation and contextual factors assessed with the International Classification of Functioning, Disability and Health (ICF) Core Sets for Autism	the ICF Core Sets for Autism is a questionnaire for parents to complete about their children. It contains a number of statements about their children's body functions, activities and participation, and contextual factors that may affect their children's functioning rater on a Likert-scale from either 0 to 10, or -5 to 5 (contextual factors), where higher ratings indicate higher levels of functioning and participation.	Baseline and approximately 9 months from baseline
Change from baseline in children's self-regulation and academic behavior assessed with children's self-regulation and academic behavior questionnaire	The Children's self-regulation and academic behavior questionnaire is designed for teachers to rate children's self-regulation and academic behavior skills in various situations in the classroom, rated on a five-point Likert scale from 0 to 4, across 11 items, where higher ratings indicate more skills and better self-regulation.	Baseline and approximately 9 months from baseline
Change from baseline in teachers' global impression of the child in the classroom	Teachers' global impression of the child in school during the latest week. Rated on a four-point Likert scale from 0 to 3, across four items, where higher ratings indicate more well-being, participation, engagement and adaptive behaviors.	Baseline and approximately 9 months from baseline
Change in teachers' stress assessed with the Teachers' Stress Scale	The Teachers' Stress Scale is a questionnaire designed for teachers to complete about their perceived work-related stress. It consists of five items, and is rated on a six-point Likert scale from 0 to 6 where higher ratings are associated with more stress.	Baseline and approximately 9 months from baseline
Change in teachers' perceived self-efficacy for supporting students with autism using the Autism Self-Efficacy Scale for Teachers	The Autism Self-Efficacy Scale for Teachers is a questionnaire for teachers to complete about their perceived self-efficacy for supporting students with ASD and socio-communicative challenges in their classroom. It consists of 28 items, and is rated on a six-point Likert scale from 0 to 5. Higher ratings indicate more self-efficacy.	Baseline and approximately 9 months from baseline
Change in teachers' work satisfaction assessed with the Teacher Work Satisfaction Questionnaire	The Teacher Work Satisfaction Questionnaire is designed for teachers to complete about their work satisfaction. It contains three items that are rated on a six-point Likert scale from 0 to 5, where higher ratings indicate more work satisfaction,	Baseline and approximately 9 months from baseline

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Social validity assessed with the Social Validity Scale	A scale designed to asses the social validity of the procedures, goals and outcomes of the study by participating school staff. It consists of 12 items rated on a Likert scale from 0 to 5, where higher ratings indicate higher levels of perceived social validity.	Follow-up approximately 9 months after onset of study
Social responsiveness measured with the Social Responsiveness Scale 2 (SRS-2)	The SRS-2 is a scale designed to identify the presence and severity of social impairment within the autism spectrum and to differentiate it from that which occurs in other conditions. In the current study used to assess the level of social challenges for the participating "index children" (i.e. children with autism or socio-communicative challenges participating in the study). The scale contains 65 items and is rated by the children's parents. Each item is rated on a scale from 1 to 4, where 1 is "not true" and 4 is "almost always true". Higher scores indicate more severe social impairment associated with autism, while lower scores indicate the opposite.	Baseline assessment

Collaborators and Investigators

• Sponsor: Stockholm University
• Collaborators: Karolinska Institutet
• Investigators: Principal Investigator: Lise Pettersson Roll, PhD, Stockholm University

Study record dates

Study Major Dates

• Study Start (Actual): August 15, 2022
• Primary Completion (Actual): July 1, 2024
• Study Completion (Actual): July 1, 2024

Study Registration Dates

• First Submitted: May 31, 2022
• First Submitted That Met QC Criteria: August 16, 2022
• First Posted (Actual): August 22, 2022

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 21, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Neurodevelopmental Disorders; Child Development Disorders, Pervasive; Autism Spectrum Disorder; Autistic Disorder
• Other Study ID Numbers: VR 2020-03267

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No