Systematic Review of the Measurement Properties of Tools Used to Measure Behaviour Problems in Young Children with Autism

Background
Behaviour problems are common in young children with autism spectrum disorder (ASD). There are many different tools used to measure behavior problems but little is known about their validity for the population.

Objectives
To evaluate the measurement properties of behaviour problems tools used in evaluation of intervention or observational research studies with children with ASD up to the age of six years.

Methods
Behaviour measurement tools were identified as part of a larger, two stage, systematic review. First, sixteen major electronic databases, as well as grey literature and research registers were searched, and tools used listed and categorized. Second, using methodological filters, we searched for articles examining the measurement properties of the tools in use with young children with ASD in ERIC, MEDLINE, EMBASE, CINAHL, and PsycINFO. The quality of these papers was then evaluated using the COSMIN checklist.

Results
We identified twelve tools which had been used to measure behaviour problems in young children with ASD, and fifteen studies which investigated the measurement properties of six of these tools. There was no evidence available for the remaining six tools. Two questionnaires were found to be the most robust in their measurement properties, the Child Behavior Checklist and the Home Situations Questionnaire—Pervasive Developmental Disorders version.

Conclusions
We found patchy evidence on reliability and validity, for only a few of the tools used to measure behaviour problems in young children with ASD. More systematic research is required on measurement properties of tools for use in this population, in particular to establish responsiveness to change which is essential in measurement of outcomes of intervention.

PROSPERO Registration Number

CRD42012002223

Essays in health economics: Volume-Outcome Effect, upcoding behaviour and the evaluation of a short-term intervention program

Evidence in the literature suggests a negative relationship between volume of medical procedures and mortality rates in the health care sector. In general, high-volume hospitals appear to achieve lower mortality rates, although considerable variation exists. However, most studies focus on US hospitals, which face different incentives than hospitals in a National Health Service (NHS). In order to add to the literature, this study aims to understand what happens in a NHS. Results reveal a statistically significant correlation between volume of procedures and better outcomes for the following medical procedures: cerebral infarction, respiratory infections, circulatory disorders with AMI, bowel procedures, cirrhosis, and hip and femur procedures. The effect is explained with the practice-makes-perfect hypothesis through static effects of scale with little evidence of learning-by-doing. The centralization of those medical procedures is recommended given that this policy would save a considerable number of lives (reduction of 12% in deaths for cerebral infarction).

Bullying as a social process : factors influencing bystander behaviour

Bullying was approached as a social phenomenon in the present study. The central aim of this thesis was to uncover some of the factors that contribute to the attitudes and behavioural choices of bystanders during bullying situations. With this type of information, interventions can be tailored to change the behaviour of bystanders during bullying situations, and thus the ethos of the larger group. Thus, acting to alter the available sources of reinforcement for bullying behaviour and peer intervention attempts. Six hundred and twenty-six students participated. Students were sampled from grades 4 (n=140), 5 (n=l 13), 7 (n=205), and 8 (n=168). Students were measured for their involvement in bullying and victimization, as well as for involvement in the following bystander behaviours: encouraging, onlooking, defending, and seeking adult support. In addition, students were measured for tolerance of deviance, pro-victim attitudes, social anxiety and fear, and self-efficacy for peer intervention. Last, students were asked to complete a series of qualitative measures, including a series of hypothetical vignettes and open-ended questions. Analyses centered on the following areas: 1) rates of bullying, victimization, and bystander behaviour; 2) the influence of age and gender on bystander behaviour; 3) the characteristics associated with students who predominantly report involvement with defending, seeking adult assistance, encouraging, and onlooking behaviour; and 4) the influence of past involvement with bullying and victimization on bystander behaviour. b .--' -i . k Rates of bullying, victimization, and bystander behaviour were comparable to findings in the existing literature, where male students were more likely than female students to report involvement in both bullying and victimization. Boys were more likely than girls to report participation in encouraging and onlooking behaviours, while being less likely to report involvement in defending and seeking adult assistance. Partly consistent with existing findings, older students were more likely to report involvement in bullying, encouraging, and onlooking behaviour than younger students, who were more likely to report victimization, defending, and seeking adult assistance. Self-identified encouragers and onlookers reported a similar array of characteristics, in that they tended express high levels of tolerance of deviance, while expressing low levels of pro-victim attitudes and self-efficacy for peer intervention. Likewise, self-identified defenders and seekers of adult assistance tended to report a similar array of characteristics to each other, in that they tended to report low levels of tolerance of deviance, while expressing high levels of pro-victim attitudes and self efficacy for peer intervention. Additionally, self-identified bullies and self-identified bully-victims tended to report increased involvement in encouraging and onlooking, whereas self-identified victims tended to report increased involvement in defending behaviour and seeking adult assistance. Results are discussed in terms of implications for bullying prevention and intervention. Specifically, evidence from the present study suggests that as bystanders, students predominantly act to either support bullying acts or to support the victims of these acts, or alternatively, to actively remain outside bullying situations. Thus, encouraging students to make small changes in the way they express these sentiments during bullying situations would act to alter the culture of the larger peer group and the sources of reinforcement available for bullying acts as well as peer intervention attempts.

Cues to action : do they result in belief and behavioural change in women?

With incidence rates of osteoporosis increasing (Osteoporosis Canada, 2007), preventative efforts to minimize costs associated with condition diagnosis are a public health priority. Cues to action are specific internal (e.g., physical symptoms, family member with a condition) or external stimuli (e.g., public service announcements, health education campaigns) that are necessary to trigger appropriate health behaviours and serve to create an awareness of the health threat (Mattson, 1999). To date, limited understanding of the scope of influence cues to action have on health beliefs and behaviour associated with osteoporosis is known. The present investigation was designed to address this gap in the literature. More specifically, the influence of cues to action, a public service announcement (PSA) developed by Osteoporosis Canada and a bone screening by way of Quantitative Ultrasound, on health beliefs and health-enhancing physical activity (HEPA) across a four week period was investigated. Peri-and postmenopausal women (N= 174) were randomly assigned to one of three conditions 1) an osteoporosis public service announcement (PSA) condition; 2) a bone screening condition via quantitative ultrasound techniques, and 3) a PSA attention control condition. Health beliefs associated with osteoporosis were taken at three time points: prior to the cue to action intervention, immediately following the intervention, and four weeks post intervention. Knowledge of osteorporosis risk factors and HEP A were assessed pre and post-intervention only. Results of a regression analysis suggested that baseline health beliefs predicted baseline HEPA (R2 adj = .24; F (9, 161) = 6.49,p = .000; 95% CI = .12 - .35) with exercise barriers (p = -.33) being a negative predictor and health motivation (p = .21) being a positive predictor of HEP A. Baseline health beliefs predicted With incidence rates of osteoporosis increasing (Osteoporosis Canada, 2007), preventative efforts to minimize costs associated with condition diagnosis are a public health priority. Cues to action are specific internal (e.g., physical symptoms, family member with a condition) or external stimuli (e.g., public service announcements, health education campaigns) that are necessary to trigger appropriate health behaviours and serve to create an awareness of the health threat (Mattson, 1999). To date, limited understanding of the scope of influence cues to action have on health beliefs and behaviour associated with osteoporosis is known. The present investigation was designed to address this gap in the literature. More specifically, the influence of cues to action, a public service announcement (PSA) developed by Osteoporosis Canada and a bone screening by way of Quantitative Ultrasound, on health beliefs and health-enhancing physical activity (HEPA) across a four week period was investigated. Peri-and postmenopausal women (N= 174) were randomly assigned to one of three conditions 1) an osteoporosis public service announcement (PSA) condition; 2) a bone screening condition via quantitative ultrasound techniques, and 3) a PSA attention control condition. Health beliefs associated with osteoporosis were taken at three time points: prior to the cue to action intervention, immediately following the intervention, and four weeks post intervention. Knowledge of osteorporosis risk factors and HEP A were assessed pre and post-intervention only. Results of a regression analysis suggested that baseline health beliefs predicted baseline HEPA (R2 adj = .24; F (9, 161) = 6.49,p = .000; 95% CI = .12 - .35) with exercise barriers (p = -.33) being a negative predictor and health motivation (p = .21) being a positive predictor of HEP A. Baseline health beliefs predicted

L’appel conjoint de la FEE et d’Eurosif pour une amélioration de la divulgation de l’information extra-financière : « drive change in corporate behaviour »

Suite à la table ronde qui s’est tenue le 29 avril 2009 au Parlement européen consacrée au thème de la « Sustainability Disclosure », la Fédération des Experts comptables Européens (FEE) et l’European Sustainable Investment Forum (Eurosif) viennent de diffuser un plan d’actions destiné à améliorer la divulgation des informations extra-financières des sociétés cotées et non cotées contenues dans leurs documents financiers.

A preliminary evaluation of cognitive-behaviour therapy for clinical perfectionism: a case series

Objective: The construct of 'clinical perfectionism' has been developed in response to criticisms that other approaches have failed to yield advances in the treatment of the type of self-oriented perfectionism that poses a clinical problem. The primary aim of this study was to conduct a preliminary investigation into the efficacy of a theory-driven, cognitive-behavioural intervention for 'clinical perfectionism'. Design. A multiple baseline single case series design was used. Method: A specific, 10-session cognitive-behavioural intervention to address clinical perfectionism in eating disorders was adapted to allow its use in nine patients referred with a range of axis I disorders and clinical perfectionism. Results: The intervention led to clinically significant improvements in self-referential perfectionism from pretreatment to follow-up for six of the nine participants on two perfectionism measures and for three of the nine participants on the measure of clinical perfectionism. Statistically significant improvements from pre- to post-intervention for the group as a whole were found on all three measures. The improvements were maintained at follow-up. Conclusions: The finding that clinical perfectionism is improved in the majority of participants is particularly encouraging given that perfectionism has traditionally been viewed as a personality characteristic resistant to change. These preliminary findings warrant replication in a larger study.

Researching farmer behaviour in climate change adaptation and sustainable agriculture: lessons learned from five case studies

Understanding farmer behaviour is needed for local agricultural systems to produce food sustainably while facing multiple pressures. We synthesize existing literature to identify three fundamental questions that correspond to three distinct areas of knowledge necessary to understand farmer behaviour: 1) decision-making model; 2) cross-scale and cross-level pressures; and 3) temporal dynamics. We use this framework to compare five interdisciplinary case studies of agricultural systems in distinct geographical contexts across the globe. We find that these three areas of knowledge are important to understanding farmer behaviour, and can be used to guide the interdisciplinary design and interpretation of studies in the future. Most importantly, we find that these three areas need to be addressed simultaneously in order to understand farmer behaviour. We also identify three methodological challenges hindering this understanding: the suitability of theoretical frameworks, the trade-offs among methods and the limited timeframe of typical research projects. We propose that a triangulation research strategy that makes use of mixed methods, or collaborations between researchers across mixed disciplines, can be used to successfully address all three areas simultaneously and show how this has been achieved in the case studies. The framework facilitates interdisciplinary research on farmer behaviour by opening up spaces of structured dialogue on assumptions, research questions and methods employed in investigation.

Change in Managers’ Conceptions of Human Resources in Organisations : Outcomes of an Intervention

Managers’ conceptions of the importance of human resources are essential for creating ‘attractive workplaces’. This paper examines an intervention method aimed at creating insight among managers in small and medium-sized enterprises (SMEs) concerning the potential of human resources. The intervention method is called Focus Group Attractive Work (FGAW) and was conducted at eight enterprises in Sweden. Based on the analysis, it is concluded that the intervention method seems to be thought-provoking and to facilitate changes in managers’ conceptions of the importance of human resources, albeit to different degrees. 

Population based intervention to change back pain beliefs and disability : three part evaluation

Objective To evaluate the effectiveness of a population based, state-wide public health intervention designed to alter beliefs about back pain, influence medical management, and reduce disability and costs of compensation. Design Quasi-experimental, non-randomised, non-equivalent, before and after telephone surveys of the general population and postal surveys of general practitioners with an adjacent state as control group and descriptive analysis of claims database. Setting Two states in Australia Participants 4730 members of general population before and two and two and a half years after campaign started, in a ratio of2:1:1; 2556 general practitioners before and two years after campaign onset. Main outcome measures Back beliefs questionnaire, knowledge and attitude statements about back pain, incidence of workers' financial compensation claims for back problems, rate of days compensated, and medical payments for claims related to back pain and other claims. Results In the intervention state beliefs about back pain became more positive between successive surveys (mean improvement in questionnaire score 1.9 (95% confidence interval 1.3 to 2.5), P<0.001 and 3.2 (2.6 to 3.9), P < 0.001, between baseline and the second and third survey, respectively). Beliefs about back pain also improved among doctors. There was a clear decline in number of claims for back pain, rates of days compensated, and medical payments for claims for back pain over the duration of the campaign. Conclusions A population based strategy of provision of positive messages about back pain improves population and general practitioner beliefs about back pain and seems to influence medical management and reduce disability and workers' compensation costs related to back pain.

Reducing sedentary behaviour and increasing physical activity among 10-year-old children: overview and process evaluation of the 'Switch-Play' intervention

Overweight and obesity has doubled among children in Australia. There is an urgent need to develop primary prevention strategies to prevent current and future unhealthy weight gain. The aims of this paper are to describe a randomized controlled trial (‘Switch-Play’) developed to prevent unhealthy weight gain among 10-year-old children and to report the findings of the process evaluation. Children from three government primary schools were randomized by class to one of four conditions: a behavioural modification group (BM; n = 69); a fundamental motor skills group (FMS; n = 73); a combined BM and FMS group (n = 90); or a control (usual classroom lessons) group (n = 61). Children in the BM group participated in 19 sessions that encouraged them to reduce screen-based behaviours, and identified physical activity alternatives. The FMS group participated in 19 lessons that focused on mastery of six skills: run, throw, dodge, strike, vertical jump and kick. The combined group participated in all the BM and FMS activities. The intervention specialist teacher reported that the children showed high enjoyment and engagement (88% lessons attended) in most aspects of the programme. At-home tasks were completed by 57–62% of the children, and 92% completed the in-class tasks. Two-thirds of the children in the BM group participated in the behavioural contracting to switch off the TV. Most of the children reported high enjoyment of the programmes, and only a small proportion (7–17%) reported difficulties in switching off their nominated TV shows. More than half the children reported reducing their TV viewing; however, less than half reported increasing their physical activity. It was found that most aspects of the intervention arms of the programme were successfully delivered to the majority of children participating in ‘Switch-Play’; that the programmes were delivered as intended; and that the programmes were favourably evaluated by participating children and their parents.

Reinforcement sensitivity theory (RST) and body change behaviour in males

According to the unrevised Reinforcement Sensitivity Theory two motivational systems shape personality: a behavioural approach system (BAS) that determines sensitivity to rewards, and a behavioural inhibition system (BIS) that determines sensitivity to punishments. The role of reinforcement sensitivity in body change behaviour in males was explored with a non-clinical sample of 120 men aged 18–40 years. Self-reported symptoms of unhealthy weight loss (weight preoccupation, fasting, bingeing/purging) and body development (muscle/size preoccupation, obligatory exercise, use of chemical supplements) were regressed on measures of BAS and BIS sensitivity. Significant relationships were observed between BAS sensitivity and body development, and between BIS sensitivity and weight loss. These relationships were mediated by internalization of the athletic/muscular ideal, body comparisons, the importance of achieving one’s ideal or ‘best possible’ body (in the case of BAS but not BIS), and body dissatisfaction (in the case of BIS but not BAS). These results support the proposition that body development in males is influenced by sensitivity to rewards associated with achieving a certain body shape, and that weight loss is influenced by sensitivity to punishments associated with possessing an unsatisfactory body shape.