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JCPSLP Volume 14, Number 2 2012 107
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.
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