JCPSLP Vol 14 No 2 2012

pathologists in different locations delivered therapy to an initial 40 families, with 35 families completing the program. Another 26 families were asked to act as a control group. The 26 families self-selected into two separate subgroups, 15 of the families received five home visits where general information on autism was discussed and educational toys were given, but no therapy was delivered. The remaining 11 families did not receive any visits or additional services. The Keyhole intervention program (Crawford, Doherty, Crozier, & Cassidy, 2006) involved a speech-language pathologist, an educator, and a psychologist. Each visit lasted an average of 90 minutes, and there were three main phases of the study. Phase 1 included a maximum of four visits at weekly intervals in which the speech- language pathologist provided information about ASD, answered questions, and provided support to the family. Phase 2 included 10–12 visits at fortnightly intervals. Common goals for each family included (a) development of a consistent communication system for each child, (b) demonstration by each child of co-operation in learning of new skills, (c) development of the child’s understanding of environments especially at home, and (d) development of parental skills in behaviour management and strategies to promote learning outcomes. During this phase, visual communication techniques were introduced to help the child’s understanding and to manage behaviour. PECS’s strategies were used to develop initiation and expressive communication skills. In Phase 3, families received one to four visits on a monthly basis to plan the withdrawal of visits from the speech-language pathologist and to discuss options for the child to attend a playgroup or nursery. Results of this study were reported in two ways. The first measure was taken on the parents’ opinions of the intervention program. To obtain this information, parents participated in semi-structured interviews and their answers were analysed thematically. A total of 34 mothers of the children receiving therapy were interviewed. All mothers reported that their child benefited from learning new things through the program, and 31 mothers (91%) reported that the family as a whole benefited from the program. A total of 30 mothers (88%) believed that the program helped them become more understanding of their child’s difficulties and more patient when dealing with their child. On the other hand, 14 mothers (41%) did not like the video-recordings, 8 mothers (24%) wished there would have been more sessions, and 6 mothers (18%) were not satisfied with the withdrawal and transfer arrangement. In the end, all parents who completed the program said they would recommend it to other families. The second set of outcome measures compared participants’ scores before and after the program. Children

were evaluated using the Psycho-Educational Profile – Revised (PEP-R; Schopler, Reichler, Bashford, Landing, & Marcus, 1990) which includes subscale tests in the following areas: imitation, perception, fine-motor, gross- motor, eye–hand, cognitive – non- verbal, and cognitive – verbal. The group that received therapy improved on all of these measures. Children also improved on the communication and daily living subscales of the Vineland Adaptive Behaviour Scale (Sparrow, Balla, & Cichetti, 1984), but some children showed more evident improvements than others. Children in the control group did not show similar improvements. This study has a number of limitations, some of which the authors address. The amount of time mothers spent using the recommended therapy procedures was not specified and they did not keep any formal records of this information. This lack of specified time periods for the therapy may be the reason for the variation in progress within the group who received therapy. The study relied largely on parental assessment of progress, which may not have been an accurate source of evidence. The authors use the name “contrast group” instead of “control group” as the untreated group was not well controlled. Additionally, the mean age of the control group was higher than the mean age of the group receiving therapy. This article confirms previous studies that home-based intervention approaches are beneficial to children with ASD, but fails to show how this program compares to other home-based approaches. Clinicians need to be aware that this study fails to outline the amount of time home-based intervention is needed for progress, and the many factors that may have played into the group receiving therapy. Further research needs to be done with a true control group, and with stricter guidelines for parents to follow. References Charlop-Christy, M. H., Carpenter, M., Le, L., Leblanc, L. A., & Kellet, K. (2002). Using the picture exchange system (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behaviour, and problem behaviour. Journal of Applied Behaviour Analysis , 35 , 213–231. Crawford, H., Doherty, K., Crozier, B., & Cassidy, A. (2006). The Keyhole Early Intervention Programme . Belfast: Autism Northern Ireland. Sparrow, S., Balla, D., & Cichetti, D. (1984). Vineland Adaptive Behaviour Scales . Circle Pines, MN: American Guidance Services. Schopler, E., Reichler, R. J., Bashford, A., Lansing, M. D., & Marcus, L. M. (1990). Psycho-Educational Profile-- Revised (PEP-R) , Volume I. Austin, TX: Pro-Ed.

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JCPSLP Volume 14, Number 2 2012

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