An interesting factor emerged regarding the children’s diagnoses of ASD. A paediatrician, two occupational therapists (OTs), and a school principal were responsible for recruiting
children for the study. Additionally, these professionals were certain that the children were on the Autistic Spectrum. However, the school principal who referred the twin boys mistook a speech and language therapist’s report as a formal diagnosis and the mother did not have a written diagnosis from the medical doctor who had diagnosed the children. This was only discovered in the final stages of the research when investigating the personal school files.
An in-depth discussion of the details and processes involved in the administration and coding of the ADOS is beyond the scope of this dissertation. Furthermore, the validation of the ADOS for African South African children was not the focus of this study. Nevertheless, the researcher of this study accessed the specialised and extensive training required to administer the ADOS, through the larger K-ASD study. Training included learning comprehensive ADOS manuals and repeatedly viewing recommended training DVDs, as recommended by the developers of the ADOS (Lord et al., 2002). Competency was attained by comparing coding scores with clinicians trained in the ADOS. On completion of the K-ASD study, the author of this study had coded and/or administered the ADOS to a total of 35 children on both studies.
Once the DoE had granted consent to approach public schools, identified principals of LSEN schools or gatekeepers in the greater Durban and Pietermaritzburg areas were contacted telephonically by the author of this study or another Masters research student (A. Wilford) or Dr Killian. After briefly informing school principals of the purpose and process of the
overarching K-ASD study, two principals declined an invitation to participate. Hence, emails with the details of the study were sent to five principals (see Appendix B). An additional email was sent to the principals, by the author of this study, requesting permission to
interview the African parents of children with ASD at the school, as this was not included in the K-ASD study (see Appendix C).
Staff members such as OTs were selected by the principals at participating schools and were responsible for identifying children for the study. Involved staff members then contacted children’s parents, explained the nature of the study to them, and invited participation. After obtaining verbal consent, from the parent/s, they were sent a letter outlining what was
required of them (see Appendix D). As the interviews with the parents were to be audio- recorded, and the ADOS assessment with the children video-recorded, it was necessary to draw the participants’ attention to this at the consent stage of this research. Participants were
also asked for their consent for the clinical psychologist and researcher to access their child’s personal school file (see Appendix D).
The participants were asked to bring the completed informed consent form with them to the first interview. Before the commencement of interviews, the aims of the study were clarified.
Participants were also assured that the information would remain confidential and video footage from the ADOS assessments would only be viewed by researchers on the K-ASD study for research purposes.
An important component of case study research is the use of multiple data sources which enhances data credibility and validity through triangulation (Baxter & Jack, 2008; Yin, 2003).
The essential elements of the various data gathering processes used in this study appear in Figure 2 (see below). Two in-depth, semi-structured interviews were conducted with parents (see Appendix E). Although an isiZulu speaking psychologist was available to translate interviews, only one mother used this service. The interviews ranged in duration from 1 hour 30 minutes to 2 hours 30 minutes. The longer sessions enabled detailed clinical data and in- depth discussion to be recorded.
The ADOS took approximately 45 to 70 minutes to complete. A small table and chairs, appropriate for young children, were used so the examiner could be at the same level as the child, and part of Module 1 was administered on a mat on the floor. Consistent with the ADOS protocol for Module 1, the mother of the child was present and assisted the examiner when necessary (Lord et al., 2002). The OTs at two of the schools, with whom the children are familiar and comfortable, were present during Module 2 sessions. This was done to ensure each child’s comfort, in line with a primary ethical consideration. The examiner closely monitored the children’s behaviour for signs of anxiety, distress or fatigue. One assessment was discontinued when a child started to become agitated and could not be re- engaged in activities. Immediately after the ADOS assessment, the codes that most
accurately reflected a child’s performance were discussed, and consensus reached between the researcher and a psychologist or trained researcher who operated the video camera.
Figure 2. Stages of data collection
The video-recordings of the children’s assessments were carefully viewed by members of the K-ASD study, systematically checked for clinical accuracy, and the coding verified. The involvement of additional clinicians was fully explained to the participants before the commencement of the research. All diagnoses were made in collaboration with a registered clinical psychologist. Oral feedback of the ADOS was offered to the parents, and appropriate interventions discussed, where necessary. This feedback session was considered ethically appropriate and was not used for the information gathering process of this research.