Syfte Övergripande syfte i studien är att undersöka vad som är möjligt att tillämpa av systemteori i interventionsstudier för barn i behov av särskilt stöd samt vilka teoretiska och praktiska implikationer det kan få för interventioner för dessa barn.   Metod En ideal systemteoretisk intervention konstruerades, med hjälp av generell systemteori och dynamisk systemteori för att användas som ett verktyg för analys. Därefter vidtog en systematisk litteraturstudie baserat på ett hermeneutiskt och systemteoretiskt angreppssätt.   Resultat Resultat av litteraturundersökningen blev att endast tre artiklar inkluderades. Dessa artiklar analyserades i jämförelse med den ideala systemteoretiska interventionen. Analysen visar att systemteori fortfarande används på ett övergripande sätt och att man i interventionerna inte använder systemteori under hela interventionsprocessen. Aspekter som saknades i interventionerna är ekologisk validitet, reaktivitet och systemkarakteristika. Lite förenklat innebär detta att man inte beaktar de processer som pågår i relationen mellan det specifika barnet och en specifik kontext. Andra aspekter som saknades i interventionerna var stabiliserande central attraktor (SCA), självstabiliserande och destabiliserande processer. I interventionerna beaktades således inte vad som var systemets stabiliserande kärna, det vill säga vad som upprätthåller systemet i balans och inte vilka processer som stabiliserar och destabiliserar systemet.   Studiens betydelse Sammantaget implicerar den här undersökningen att systemteoretiska interventioner för barn i behov av särskilt stöd behöver utvecklas teoretiskt såväl som praktiskt. Framtida forskning bör på ett teoretiskt plan använda sig av systemteori och dess termer för att kunna följa alla faser i en interventionsprocess. På ett praktiskt plan bör man försöka genomföra systemteoretiska interventioner för olika barn i behov av särskilt stöd i vilka man kontinuerligt uppmärksammar attraktorer för att på så sätt kunna hjälpa så många barn och ungdomar som möjligt i de system de vistas i.

Obesity is a growing concern in North America and current research suggests that for addressing childhood obesity, family-based behavioural interventions targeting children are the treatment of choice. Due to the lack of clinics that offer face to face treatment, the Internet may serve as a viable method for the delivery of such interventions. Three studies are presented in order to explore the viability of the internet as a treatment modality for delivering family-based interventions for children who are overweight. The first study attempted to deliver a family-based behavioural intervention via the internet - the Healthy Eating and Active Living Throughout Youth (HEALTHY) - for children aged 8 to 14 (M = 10.5). The initial goal was to evaluate the effectiveness of the internet as a treatment modality for childhood obesity. A total of 20 families consisting of 25 child-parent dyads consented to the intervention. However, adherence and attrition were significant issues throughout the 3-month intervention and only two child-parent dyads (8%) completed the 3-month intervention. Therefore the goals of this study changed to become primarily exploratory, with the aims of identifying factors related to treatment adherence and attrition. For the second study, the parents of the 20 families who consented to the HEALTHY intervention were invited to participate in a telephone interview around their impressions of the study, barriers to participation, and their needs in seeking services for their children. Sixteen families (80%) provided consent and thematic analyses were conducted. Four categories of themes emerged from the data and included: 'Knowledge and Education', 'Social Supports', 'Tools for Success', and 'Program Goals'. These categories, and the themes embedded within each category are presented and discussed. For the third study a systematic review of exclusively web-based studies for paediatric obesity was conducted. Five health and social sciences databases were search between 1995 and March 2012 (including an initial and updated search). A total of 2432 bibliographic records were identified (following de-duplication) and were subjected to title and abstract screening, and a further 120 records were subject to full-text screening. Two reviewers independently assessed the eligibility of each bibliographic record at these multiple levels and conflicts were resolved by third party. Three records were included in the review, and a further three records were identified as noteworthy in that they reported on one larger web-based study with a minimal face-to-face component (i.e., 4 sessions over 2 years). Data regarding attrition, adherence, and body composition changes were extracted by two independent reviewers. Attrition rates from the included studies ranged from 43% to 85%. The noteworthy study reported 18% overall attrition at six months (following randomization: 18% from the intervention group) and 34% overall attrition at two years (following randomization: 36% from the intervention group). Adherence measures were varied, but suggested low adherence to study components. Body composition changes were marginal in the short-term, but then lost in the longer-term. Implications for research and practice will be discussed. The contributions of this thesis include examining whether family-based interventions for pediatric obesity delivered over the internet are feasible. This question will be answered by exploring baseline characteristics that are related to treatment adherence and attrition, investigating barriers that interfere with adherence and contribute to attrition, and reviewing other research conducted in the field. Following from this thesis, and other relevant research, implications and recommendations for future research and clinical practice will be discussed

Objective: To explore interventions that support children and parents making health decisions. Systematic Review: A systematic review was conducted to synthesize evidence on interventions that support children’s health decision making. Five studies of variable quality were included. Interventions that improved decision making were decision coaching with or without an educational resource, or education alone. Pre-/post-test pilot: A pre-/post-test study evaluated the feasibility and acceptability of decision coaching guided by the Ottawa Family Decision Guide for children with type 1 diabetes and their parents. Of 16 families invited, 7 participated. Compared to children/parents who preferred one option at baseline, participants who were unsure of the best option rated decision coaching as more acceptable and had larger decreases in decisional conflict. Conclusions: Few studies have evaluated interventions supporting children’s decision making. The piloted decision support intervention was feasible and acceptable, particularly with children and parents who were unsure of the best option.

The chronic and severe executive functioning (EF) and self regulation deficits experienced by children with fetal alcohol spectrum disorders (FASD) are well documented and EF and self regulation have been identified as core targets for intervention. The goals of this dissertation were to: (i) examine the effects of a self regulation treatment for children with FASD on a range of EF measures (ii) examine neural markers of treatment outcome and determine if functional magnetic resonance imaging (fMRI) can differentiate treatment responders from nonresponders; (iii) determine if treatment effects generalize to child compliance and qualitatively examine the treatment process. Twenty-five children with FASD participated. Using a wait-list control design children were assigned to an immediate treatment (TXT; n = 12) or delayed treatment control (DTC; n = 13) condition. All children received an evaluation of EF and fMRI at baseline and 12-week follow-up. Parents also completed questionnaires assessing EF and behavior as well as a feedback questionnaire upon completion of treatment. A subset of parents tracked compliance over the course of their child’s therapy. For the TXT group only, parent questionnaires were readministered at 6 month follow-up. At 12-week follow-up, children in the TXT group displayed significant improvements in inhibitory control and social cognition. Additionally, parents reported improved behavioral and emotional regulation. This improvement, along with a further improvement in parent-rated inhibitory control, was maintained at the 6-month follow-up. Neuroplastic changes were also observed as the TXT group showed increased BOLD response in the right prefrontal cortex (PFC) and left caudate on a task of inhibitory control. When treatment responders were compared to nonresponders a pattern of increased BOLD response was found bilaterally in the PFC and left caudate. Compliance tracking revealed that self regulation therapy generalized to improved child compliance at home. Qualitative analysis indicated that perceived clinician competence, caregiver insight about child’s problems and caregiver perceptions of child’s insight about their problems, were the most commonly endorsed themes by caregivers. Results from this research signify that children with FASD are responsive to psychotherapy and following a brief intervention, showed improvements in self regulatory abilities that generalize to other EF areas and parent-reported behaviors.

Children with autism often display oppositionality and severe disruptive behaviour in relation to academic tasks and other parental requests. Social deficits also represent a core symptom of this disorder. As a means of treating the challenging behaviours of these children, Ducharme and Drain (2004) evaluated a proactive, non-aversive intervention, errorless academic compliance training that was focused on building child tolerance to challenging demands. In this study, the four children demonstrated impressive improvements in child compliance to academic requests throughout and following treatment. Substantial generalization to untrained academic and non-academic requests also occurred. The current study replicated the intervention used in Ducharme and Drain (2004) with a larger sample of children with autism (eight) to further substantiate the efficacy of the approach and to examine potential covariant change in child social behaviours as a result of the intervention. In a multiple baseline across subjects design, parents implemented errorless academic compliance training with their children. During baseline, they delivered various academic and household requests to determine the probability of compliance for each request. We then developed a hierarchy of academic requests ranging from high probability (i.e., Level 1) to low probability (i.e., Level 4). At the beginning of treatment, parents delivered academic requests from Level 1 and provided praise and reinforcement for compliant child responses. Children were gradually introduced to increasingly more challenging requests from subsequent probability levels and rewarded for compliance to these requests. During both baseline and treatment, we also measured aspects of child social behaviour during sessions in which parents engaged in activities with their children. Participant children demonstrated high levels of compliance throughout and following treatment, as well as generalized cooperation to untrained academic and general household requests that were not the focus of treatment. Parents reported covariant behavioural improvements (i.e., reduced problematic behaviour and positive social gains), particularly for children exhibiting more core deficits of autism. Treatment gains were maintained up to 6 months following treatment. Errorless academic compliance training appears to hold considerable potential for improving the learning and social opportunities of children with autism.

Children with autism often display oppositionality and severe disruptive behaviour in relation to academic tasks and other parental requests. Social deficits also represent a core symptom of this disorder. As a means of treating the challenging behaviours of these children, Ducharme and Drain (2004) evaluated a proactive, non-aversive intervention, errorless academic compliance training that was focused on building child tolerance to challenging demands. In this study, the four children demonstrated impressive improvements in child compliance to academic requests throughout and following treatment. Substantial generalization to untrained academic and non-academic requests also occurred. The current study replicated the intervention used in Ducharme and Drain (2004) with a larger sample of children with autism (eight) to further substantiate the efficacy of the approach and to examine potential covariant change in child social behaviours as a result of the intervention. In a multiple baseline across subjects design, parents implemented errorless academic compliance training with their children. During baseline, they delivered various academic and household requests to determine the probability of compliance for each request. We then developed a hierarchy of academic requests ranging from high probability (i.e., Level 1) to low probability (i.e., Level 4). At the beginning of treatment, parents delivered academic requests from Level 1 and provided praise and reinforcement for compliant child responses. Children were gradually introduced to increasingly more challenging requests from subsequent probability levels and rewarded for compliance to these requests. During both baseline and treatment, we also measured aspects of child social behaviour during sessions in which parents engaged in activities with their children. Participant children demonstrated high levels of compliance throughout and following treatment, as well as generalized cooperation to untrained academic and general household requests that were not the focus of treatment. Parents reported covariant behavioural improvements (i.e., reduced problematic behaviour and positive social gains), particularly for children exhibiting more core deficits of autism. Treatment gains were maintained up to 6 months following treatment. Errorless academic compliance training appears to hold considerable potential for improving the learning and social opportunities of children with autism.

Det saknas en nutida nationell kartläggning av barnlogopedisk intervention. Tidigare studier har undersökt specifika enheter eller granskat interventionen historiskt. Syftet med föreliggande studie var att utifrån en enkät besvarad av kliniskt aktiva logopeder kartlägga det barnlogopediska behandlingsläget i dagens Sverige. Målet var att kunna beskriva interventionens karaktär samt vilka metoder och material som används. Enkäten bestod av 30 frågor och riktade sig till logopeder som för tillfället var verksamma inom det barnlogopediska fältet, exklusive barnhabilitering. Totalt deltog 57 personer i studien och samtliga var kvinnor. Svensk barnlogopedi överensstämmer med rekommendationer i litteraturen gällande exempelvis genomsnittlig längd på behandlingsperioder och -kontakter, medan antalet individuella besök per vecka ligger under den frekvens som i forskning har visat sig vara effektiv. Indirekt intervention tillämpas av majoriteten, men huvudfokus ligger överlag på individuell direkt behandling. Litteraturen är inte enig vad gäller effektiviteten hos någon av de olika interventionsformerna. Av deltagarna använder 70 % evidensbaserade metoder och material i någon utsträckning. Mer studier av behandlingseffekt behövs inom flertalet interventionsområden för att stärka evidensen. Praxis och Metafon är de vanligast tillämpade behandlingsmaterialen, tillsammans med egenhändigt tillverkat material samt spel och bilder.

Dysfagi, sväljsvårigheter, förekommer i alla åldrar och vid en rad olika sjukdomstillstånd och skador. Evidensläget för de olika metoder som används för diagnostik och intervention vid dysfagi är i många fall osäkert. Syftet med denna studie var att ur ett evidensperspektiv granska forskningen med avseende orofaryngeal dysfagi hos vuxna. En omfattande databassökning genomfördes i PubMed mellan april och augusti 2011, begränsad till engelska och svenska studier, med deltagare över 19 år. Sökorden som användes var bland annat dysphagia (43 259 träffar), deglutition disorders (36 278 träffar), intervention, management, assessment, evidence, validity och reliability. Kvaliteten hos de 137 studierna som inkluderades i arbetet granskades av författaren utifrån principerna för evidensbaserad medicin, EBM. Resultaten relaterades till befintliga metoder vid Akademiska sjukhuset, Uppsala. De visade bland annat att de befintliga diagnostiska metoderna inom verksamheten är de som inom forskningen stöds av högst grad av evidens. Studien visade vidare att forskningen inom detta fält i många fall inte har några säkra, entydiga svar. Därmed blir logopedernas kunskap och erfarenhet viktig att ta till vara på, till exempel genom att dokumentera och utvärdera resultat av befintliga metoder. / Dysphagia, swallowing dysfunction, occurs in all ages and at a variety of medical conditions and injuries. The level of evidence supporting the different methods used for diagnostic and intervention of dysphagia is in many cases uncertain. The aim of this study was to review and evaluate the research from an evidence perspective with regard to oropharyngeal dysphagia among adults. An extensive database search was carried out using PubMed between April and August 2011, limited to English and Swedish studies, with participants over 19 years. The search terms included dysphagia (43 259 items), deglutition disorders (36 278 items), intervention, management, assessment, evidence, validity and reliability. The quality of the included studies was assessed by the author, based on the principles of evidence based medicine, EBM. The results were related to the methods used at the University Hospital, Uppsala. They showed that the current diagnostic methods are based on a high level of evidence. Further, the study showed that the research within this field in many cases does not have any definite, unequivocal answers. This makes speech therapists' knowledge and experience essential to take advantage of, for example by documenting and evaluating the results of the current methods.

Syftet med denna studie är att ta reda på hur arbetet med Skol-Komet gick till i arbetslagen som gick kursen och hur handledningen följdes och förstods, vid en mellanstor skola i Mellansverige, samt hur det fortskred efter avslutad kurs, relaterat till kursmaterialet.Detta görs genom observationer av den egna undervisningen, kvalitativa intervjuer av pedagoger och textanalys av handledningen. Resultatet visar att handledningen uppfattas som lätt att förstå, även om inte alla områden prövas och valda delar används efter avslutad kurs. Tendenser som anas, trots det ringa urvalet, är att återträffar behövs för vidmakthållandet och för att få en större programtrohet. Arbetet visar också på relevans för användandet av Skol-Komet, när det gäller uppförandeproblem av olika slag, både genom studier av litteratur och i det praktiska arbetet.

Syftet med studien var att identifiera och kartlägga faktorer av betydelse vid implementering av evidensbaserad omvårdnad. Metod, studiens design var en litteraturstudie vilken omfattade av 15 vetenskapliga artiklar publicerade mellan åren 2005 och 2007. I resultatet framkom fem olika kategorier av faktorer av betydelse vid implementering av evidensbaserad omvårdnad. Dessa kategorier var 1) Arbetsmiljön som visade att attityder och rådande kultur hade stor betydelse. 2) Riktlinjer och strategier i omvårdnad visade sig vara av stor klinisk betydelse för att forskningsresultaten skulle kunna omvandlas till klinisk användning. 3) Kunskaper och yrkesskicklighet ökade i en gynnsam lärandemiljö. 4) Stödjande organisationer innebar att det fanns personer med uttalad kompetens och funktion, exempel: bibliotekarie, mentor, underlättare eller kommittéer som gav stöd till sjuksköterskan vid användandet av evidensbaserad omvårdnad. 5) Hinder identifierades som tidsbrist, bristande kunskap eller intresse för evidensbaserad omvårdnad. Ett hälso- och sjukvårdssystem som satte press på de anställda, underminerade möjligheterna att lära och göra förändringar. Slutsats: Studien visade att olika faktorer ofta samspelade med varandra i ett komplext system, där ingen faktor ensamt kan klara implementeringen av evidens.