Naturalistic developmental behavioural interventions (NDBI) are a group of evidence-based early interventions for autism spectrum disorders (ASD). Caregivers can be trained to deliver NDBI strategies during interactions with their young child with ASD. However, NDBI research predominantly comes from high-income countries, and the evidence base for NDBI in low/middle-income countries (LMICs) and across cultures is lacking. To understand the ‘fit' of an NDBI approach in LMICs, it is crucial to understand and be able to measure the nature of interactions between caregivers and their children with ASD and the context wherein caregiver-child interactions occur. This study sought a) to evaluate the utility of a specific measure of caregiver-child dyadic interactions and b) to examine daily routines in which caregiver-child interactions occurred in low-resource South African contexts. Methodology Children with ASD (between 18-72 months old) and their ≥18-year-old caregivers were recruited under a larger project. Interactions of 21 caregiver-child dyads were video-recorded using a standardised parent-child interaction (PCI) protocol with two 6-minute-long free-play sessions (Part I: child explored the room and available toys while the caregiver remained seated; Part II: caregiver interacted with their child as they would at home). Two research-reliable raters rated the videos using 16 items from the Joint Engagement Rating Inventory (JERI), a 7-point Likert scale behavioural coding system. Reliability and descriptive analyses were conducted. Structured interviews were conducted with ten caregivers using the Parent Survey of Home and Family Experiences (PSHFE) to explore the context of daily routines. Descriptive analyses were performed. Results For caregiver-child interactions, observer agreement for 12 of 16 items was reasonable, with weighted kappas (within 1 scale point) of 0.66-1, an estimated accuracy of 88-99%, and percentage agreements of 75-100% for all items. Ratings for items across Parts I and II of the JERI showed variability without any ceiling effects. Six items showed floor effects. Most caregiver item ratings were at the mid-point of the 7-point Likert scale. In Part II, children used more expressive language and paid more attention to their caregivers. On the PSHFE, most children participated daily in various child routines, play and early literacy activities with mothers as main partners. Most children never participated in spiritual and community activities, typically due to the child's age, safety and other reasons not specified in interview response categories. Conclusion Reliability, floor/ceiling, behavioural and Part I vs Part II profiles suggested that the JERI, used for the first time in a South African context, has potential utility both to describe caregiver-child interactions and be used as an intervention outcome measure in LMICs. The PSHFE results provided contextual data of common daily activities into which NDBI strategies could be embedded to support child generalisation of skills in South Africa.

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Autism diagnoses are on the rise and part of the explanation is that society is making increasing demands on us and our brains. Autism is largely about how we perceive and interpret our surroundings, so there should be opportunities to support people with autism through thoughtful architecture to reduce stress levels and save energy. What is autism-friendly architecture and what might it look like?  In this project, I have designed a service residence (a type of LSS accommodation) for adults diagnosed with autism. By reviewing relevant literature and reference projects on the topic, I have tried to find keys on how to design a home that can support a person with autism. The overall objectives of the design are to reduce stress, enhance the individual's independence and support social interaction. The architectural aspects I have mainly worked on to achieve this are daylight, views, visual connections and boundaries and the organisation of the programme. Since people with autism have, among other symptoms, a different sensory experience often being hyper- or hypersensitivity to sensory input, an autism-friendly architecture is very much about designing for the senses.  The conclusion is that accommodation suitable for a person with an autism diagnosis can suit most people. It’s more about avoiding certain things that may be experienced as disturbing in different ways by people with autism, rather than adding special features.

Clitic pronouns are linguistic elements which stand at the crossroads between different areas of the language faculty. They have specific morphology, syntax, and discourse functions. Use of this element requires the management of several aspects that draw from these areas of language. Clitics have been shown to appear early in typical acquisition, but to require longer for all aspects to be correctly managed, and they proved effortful in other modes of acquisition and atypical language, where they are clinical markers of impairment. In this work, we implement a comprehensive assessment of clitics aiming to investigate in what way different occurrences of this structure highlight different patterns of linguistic performance. To do so, we focus both on accuracy across conditions and on answer strategies, with an experimental protocol testing the following: comprehension of reference in binding constructions, production of clitics in two argument positions (direct object and indirect object), production of clitics in two sentence positions (preverbal and postverbal), production of clitics with different person features (1st/2nd and 3rd), and pragmatic abilities in the alternation with the lexical noun phrase and in perspective shift contexts. The assessment was tested on the following groups of native speakers of Italian: a group of pre-school and primary school typically developing children (Study 1), a group of adult heritage speakers of Italian living in the UK (Study 2), and four (pre)adolescents with a diagnosis of ASD (Study 3). Results found in this work showed that a comprehensive assessment of clitics can highlight similarities as well as differences in linguistic profiles according to different groups. Specifically, comprehension was not a discriminating factor in the populations: all populations tested showed to have access to abstract representations of clitics in binding constructions, as comprehension of simple clitics was generally unproblematic. An exception was found in the pre-schoolers, but this may have been due to task-related factors. In line with previous results on typical, atypical, and bilingual populations, production of Italian 3rd person direct object clitics with finite verbs showed different patterns across populations: in our data, typical children of all ages and ASD pre-adolescents showed to correctly produce this instance of the clitic the majority of the time, while heritage speakers of Italian showed poor production rates on this instance of the clitic. Importantly, our data shows similar results for indirect objects, showing that if the cliticization process is accessible, it is accessible regardless of the argument position occupied by the cliticised object. Another crucial result is that our studies find different patterns to be highlighted by the production of clitics on non-finite verbs as opposed to those on finite verbs: accuracy is similarly high in one high-performing ASD pre-adolescent and in the group results of 8-year-old children, but 4-year-old and 6-year-old children, as well as some ASD participants show chance or below chance performance in enclisis. The same was true for production of clitic combinations, although it was the least accurate structure across all groups, particularly in non-finite constructions. Here, heritage speakers and a few ASD speakers produce little to no instances of this construction, while those who produce it the most are the highest performing ASD participant and the oldest group of children. It is plausible to assume that the derivation of both enclitics and clitic combinations may require harder computation. These results allow us to conclude that if an individual or a population has issues on single DO and IO clitics with finite verbs, they will have issues with all other instances in the assessment. If an individual or a population shows no issues on single DO and IO clitics with finite verbs, they show typical language. In this, single clitics are coherent to their role of clinical markers. However, this study highlights the power of other instances of clitics, namely enclitics and clitic combinations, to unearth vulnerabilities to complex language. Types of non-target response also showed to be in part characterizing of different populations. The most striking result in this sense is the production of a lexical NP in place of the clitic. In typical development, this answer type only becomes the most used alternative answer in the hardest constructions, namely in enclisis; on the other hand, heritage speakers systematically use this construction as the alternative to clitics and use it more than they use clitics across all conditions. In our results, errors that are usually associated with impairment, particularly in younger participants, were marginally present in all groups. These are errors on the φ-features of the clitics, omissions, and misplacements (of which we found no instances), and they were limited to the youngest TD group, the heritage speakers, and the lowest-performing ASD participant. A recurrent alternative structure employed in conditions eliciting enclitics was the production of a simplified, finite verb structure.

Date:2023-05-31Level: Bachelor thesis in Business Administration, 15 cr Institution: School of Business, Society, and Engineering, Mälardalen University Authors: Anwaar Naser, Laura Maria Trandafir and, Asterios Mastorokostas Varsamidis Title: Inclusiveness of autistic consumers in the E-commerce Supervisor: Stylianos Papaioannou Keywords: Autism, ASD, niche, consumer, inclusiveness, e-commerce, website design. Research question: How is the inclusivity of ASD consumers addressed in online shopping? Purpose: The purpose of this thesis is to analyse the online shopping experience of consumers with autism to identify opportunities for e-commerce businesses to create more inclusive websites. Method: A relevant literature scan has been done to identify the gap and spot the topic, followed by a secondary data review to recognise which can serve the purpose.  Thereafter, the thesis followed a qualitative approach to research by conducting semi-structured interviews with autistic consumers, autism experts, and web designers. Eight interviewees in total, supported by three sources of secondary data. The collected data was thematically analysed then. Conclusion: This study identifies challenges faced by individuals with ASD when navigating online, including sensory issues, language comprehension difficulties, distraction, and decision-making challenges, leading to feelings of exclusion. Inclusive design strategies are proposed, such as simple navigation, clear language, straightforward layouts, and sensory-friendly visual elements. Understanding the unique needs of ASD consumers is emphasized to create an inclusive shopping environment. Benefits for businesses include expanding the customer base, fostering loyalty, increasing satisfaction, meeting corporate social responsibility goals, and improving growth. Inclusivity is both a moral imperative and a business opportunity, with transparency, trust-building, and customer service being key. By prioritising inclusiveness and adopting successful examples, businesses can create a welcoming and accessible online shopping experience for individuals with ASD while driving profitability and customer loyalty.

Autism Spectrum Disorder is a neurodevelopmental disorder characterized by language and communication deficits, and difficulties with social interaction (Twisk, 2001). Research has shown that 80% of youth with ASD experience sleep challenges which can lead to sleep-related health issues, exacerbate problematic behaviors, and increase vulnerability to anxiety and depression (Wachob & Lorenzi, 2015; Williams et al., 2004; Richdale & Schreck, 2009). Sleep plays a central role in adaptive functioning, and insufficient sleep can hinder learning, memory, and neuroplasticity for children with ASD (Cohen et al., 2014). As these unhealthy behavior patterns can lead to more adverse long-term health consequences, it is critical to develop interventions that may improve health-related behaviors in youth with ASD. Martial arts, especially judo, is unique because it integrates both physical activity and mind-body components (Bell et al., 2016). Judo may be particularly appealing to youth with ASD due to the structured format and repetitive exercises typically observed during judo sessions (Bell et al., 2016). Recent studies have found that judo interventions in youth with ASD may increase participation in physical activity, improve self-confidence, decrease levels of anxiety, and reduce the frequency of negative behaviors in this population (Morales et al., 2021; Garcia et al., 2020; Renziehausen et al., 2022). Research has shown that participation in physical activity may be associated with sleep quality in both NT youth and youth with ASD (Masters et al., 2019). Therefore, the purpose of this study was to examine the effects of a 16-week judo intervention on sleep quality in youth with ASD. It was hypothesized that this program would improve components of sleep quality in youth with ASD. METHODS: A USA Judo certified coach with prior experience teaching judo to youth with ASD led the 45-minute weekly sessions. Each participant was given an Actigraph GT9X accelerometer and a link to the Qualtrics parent surveys including a child sleep diary. Participants were instructed to wear the accelerometers for seven days and nights over two data collection points: baseline and post-intervention. A validated sleep algorithm was applied to the data to calculate total sleep time, sleep efficiency, sleep latency, and wake after sleep onset. Non-parametric t-tests were used to compare sleep quality outcome variables at pre- and post-intervention. RESULTS: The sleep data of 18 participants was analyzed, consisting of an approximately 80% male sample, a mean age of 13.17 ± 3.76, and approximately 55% of the sample being white. There was a positive statistical correlation between participation in the Judo program and increased sleep efficiency (p=0.05), decreased wake after sleep onset (p=0.02), and decreased sleep latency (p=0.001). CONCLUSION: Judo, a mindfulness form of martial arts, has the potential to serve as a therapeutic intervention to improve sleep outcomes in children with ASD.

Introduktion: Autismspektrumtillstånd (AST) är en komplex neurologisk funktionsnedsättning som börjar tidigt i livet, under spädbarnsåldern eller i barndomen. De största utmaningarna för individer med AST ligger inom områden för social interaktion och kommunikation med andra människor, samt repetitivt beteendemönster. Syfte: Att utforska föräldrars erfarenheter och upplevelser av att vara förälder till ett barn med autismspektrumtillstånd (AST). Metod: En beskrivande allmän litteraturöversikt med kvalitativ ansats gjordes enligt Friberg (2017). Litteraturöversikten baserades på 10 vetenskapliga originalartiklar. Teoretisk referensram var Antonovskys teori, känsla av sammanhang, KASAM.  Resultat: I resultatet presenteras tre kategorier: Brist på kunskap och förståelse, beskriver föräldrars erfarenheter av diagnosprocessen. Hälsa och autismens påverkan på familjen, beskriver föräldrars hälsa och upplevelser i det vardagliga livet. Välbefinnande, beskriver föräldrars sätt att kunna återhämta sig och få respit.  Slutsats: Denna studie visade att föräldrar till barn med AST upplever stor stress och arbetsbelastning, både psykiskt och fysiskt, vilket beskrivs i studien som osynligt för samhället. I studien framkommer det att inom hälso- och sjukvården är det svårt att få en tidig diagnos, på grund av brist på kunskap och förståelse hos vårdpersonalen och när diagnosen väl var fastställd kunde det vara svårt för vissa föräldrar att hantera situationen. Föräldrar i studien upplevde utmaningar i olika miljöer, inklusive hemmet, offentliga platser, hälso- och sjukvården samt skolan. Studien visade på samhällets brist på förståelse för AST och dess stereotypa syn på barns beteende, vilket bidrar till att föräldrar känner sig dömda, missförstådda och isolerade. Trots detta har majoriteten av föräldrarna en stor motståndskraft (resiliens) och flera föräldrar i studien beskrev att ha ett barn med AST bidrog till att de har fått en ökad personlig utveckling, en mer jordnära livssyn på livet samt en glädje för barnets framsteg i livet. / Introduction: Autism Spectrum Disorder (ASD) is a complex neurological impairment that begins early in life, during infancy or childhood. The greatest challenges for individuals with ASD lie within the areas of social interaction and communication with other people, as well as repetitive behavior patterns.  Aim: To explore parent’s experiences and perceptions of being a parent to a child with autism spectrum disorder (ASD). Method: A descriptive literature review with a qualitative approach was conducted according to Friberg (2017). The literature review was based on ten original scientific articles. Antonovsky’s theory, sense of coherence, SOC was used as the theoretical framework. Results: The results are presented in three categories: Lack of knowledge and understanding, which describes parent’s experiences of the diagnostic process. Health and the impact of autism on the family, which describes parent’s health and experiences in everyday life. Well-being, which describes parent’s ways of being able to recover and get respite.  Conclusion: This study demonstrated that parent’s of children with ASD experience significant stress and workload, both mentally and physically, which is often invisible to society. The study reveals that within healthcare, it is often challenging to get an early diagnosis due to a lack of knowledge and understanding among healthcare professionals. Once the diagnosis is established, it can be difficult for some parent’s to handle the situation. The parent’s in this study experienced challenges in various environments, including the home, public places, health care, and school. The study highlights society’s lack of understanding of ASD and stereotypical views on children’s behavior which contribute to parent’s feeling judged, misunderstood, and isolated. Despite this, most parent’s demonstrate a resilience for adversity, an enhanced personal growth, a more realistic perspective on life, and a joy for their children’s achievements in life.

Theory of Mind (ToM) has repeatedly been defined as the ability to understand that others believe their own things based on their own subjective interpretations and experiences, and that their thoughts are determined independently from your own. In this study, we wanted to see if individual differences in ToM are capable of causing different perceptions of an individual's interactions with human like robotics and highlight whether or not individual differences in ToM account for different levels of how individuals experience what is called the "Uncanny Valley phenomenon" and to see whether or not having a fully developed theory of mind is essential to the perception of the interaction. This was assessed by inquiring whether or not individuals with Autism Spectrum Disorder (ASD) perceive robotics and artificially intelligent technology in the same ways that typically developed individuals do; we focused on the growing use of social robotics in ASD therapies. Studies have indicated that differences of ToM exist between individuals with ASD and those who are typically developed. Comparably, we were also curious to see if differences in empathy levels also accounted for differences in ToM and thus a difference in the perceptions of human like robotics. A robotic image rating survey was administered to a group of University of central Florida students, as well as 2 surveys - the Autism Spectrum Quotient (ASQ) and the Basic Empathy Scale (BES), which helped optimize a measurement for theory of mind. Although the results of this study did not support the claim that individuals with ASD do not experience the uncanny valley differently than typically developed individuals, there were significant enough results to conclude that different levels of empathy may account for individual differences in the uncanny valley. People with low empathy seemed to have experienced less of an uncanny valley feeling, while people with higher recorded empathy showed to experience more of an uncanny valley sensitivity.

Introduction: Adolescents with Autism Spectrum Disorder (ASD) demonstrate poor health-related behaviors, such as nutrition, compared to their typically developed (TD) counterparts. With the occurrence of the COVID-19 pandemic and mandatory stay-at-home orders, such health-related behaviors may be complicated and there is a need to focus on feasibility and acceptability of in-person and remote-based nutrition programs. Methods: Eleven high school students with ASD were recruited to participate in a modified nutrition program utilizing Zoom software during COVID-19. The duration was once a week for four weeks, and concepts reviewed included shopping for healthy food on a budget, introducing non-perishable but nutritious food items, and food preparation safety measures. Results: Ninety-seven percent of participants attended the remote-based nutrition program, while 87% attended the in-person nutrition program. While in-person demonstrated benefits including face-to-face interaction and hands-on cooking, the remote-based component demonstrated a high degree of feasibility and acceptability. Half of the students felt their health-related behaviors were negatively impacted by COVID-19 but reported that the implementation of the remote-based nutrition program positively impacted their nutrition choices. Conclusion: The enforcement of health-related behaviors in adolescents with ASD is significant especially during disaster-related situations. Future research should focus on efficacy and intertwining methods of in-person and remote-based learning of a nutrition or other health-related behavioral interventions in this population.