1 SUMMARY OF PROJECT
Aims, Methods and Data Analysis
1.1 Overview
This section outlines that aims and methodology for this project. This includes participant
demographics and selection criteria. The project procedure, a summary of all questionnaires
used and data analysis protocols are also provided.
1.2 Aim(s)
While the use of remote technologies has been shown to be successful in continuity of service
provision in a variety of disability populations (Marshall et al., 2008), literature examining
the efficacy of using these technologies to provide early interventions services to children
with ASD is limited, and has been described as being in its “infancy” (Liebert, 2009, p.419).
This study aimed to explore the advantages, disadvantages, cost-effectiveness and efficacy of
providing support via remote technologies as compared to face-to-face delivery for four
children with ASD, aged between 2 and 7 years, their parents/carers, and local service
providers (SPs) in rural Queensland, Australia.
1.3 Methods
1.3.1 Participants and Selection
Participants were 4 parents/carers of children with ASD aged between 2.92 and 6.92 years (M
= 5.04 years, SD = 2.13); 8 local SPs [i.e., 3 teachers, 1 Head of Special Education (HOSE), 2
Occupational Therapists (OT) and 2 Speech Therapists (ST)] supporting these 4 families; and
one Occupational Therapist from Autism Queensland (AQ). In order to be a client of Autism
Queensland, the children must have a diagnosis of an ASD (e.g., Autistic Disorder, Asperger
Syndrome or Pervasive Developmental Disorder – Not Otherwise Specified). Depending on the
age of the child, diagnosis was confirmed using The Modified Checklist for Autism in
Toddlers (M-CHAT; Robins, Fein, Barton & Green, 2001; 1.3 to 2.5 years) or the Social
Communication Questionnaire (SCQ; Rutter, Bailey & Lord, 2003; aged 2 to 6 years).
The parents/carers and children with ASD were all from rural areas in Queensland (e.g.,
Roma, Inglewood, Alpha) and all had previously received face-to-face early intervention by
the AQ Occupational Therapist who had travelled to these rural areas to deliver a week-long
early intervention program. Some of the local SPs had previously been involved in the faceto-face intervention (n = 4), while others had not (n = 4). All local SPs (n = 8) and one parent
had used remote technology previously. Demographic information for parents, children and
local SPs is presented in Table 1.1.
1.3.2 Procedure
The 4 parents/carers of children with ASD, 8 local SPs working with these children and the
AQ Occupational Therapist were all invited to take part in this study. Participation involved
the families and local SPs taking part in a one-week intervention program with the AQ
Occupational Therapist using remote technology. The intervention consisted of 5 x 1.5 hour
sessions with each family. Families and local SPs were required to use their own personal
equipment (e.g., laptop or desktop computer, iPad, webcams, internet connection etc.) to
connect with the AQ Occupational Therapist based in Brisbane.
The AQ Occupational Therapist and AQ IT staff researched and trialled several remote
technology software programs prior to the intervention program commencing. The programs
trialled were:

Cisco WebEx Meeting Centre

Citrix GoToMeeting

Adobe Connect

Skype
A detailed comparison between these various remote technology software programs based on
key variables (e.g., features, cost, benefits, limitations, system requirements) was conducted.
Following this trial and comparison, Cisco WebEx Meeting Centre was chosen as the
preferred software program to be used for delivering the early intervention program.
Table 1.1.
Participant Demographics
Variable
Child’s chronological age (years)
Mean (SD)
5.04 (2.13)
Range
2.92 – 6.92
Child’s gender
Male (n/%)
Female (n/%)
3 (75.0)
1 (25.0)
AD (n/%)
PDD-NOS (n/%)
3 (75.0)
1 (25.0)
2 yrs (n/%)
3 yrs (n/%)
3 (75.0)
1 (25.0)
Diagnosisa
Time since diagnosis
Child’s Early Education Setting
Mainstream (n/%)
2 (50.0)
Early Childhood Development Program
1 (25.0
(n/%)
Home (n/%)
1 (25.0)
Previous intervention
Occupational Therapy (n/%)
3 (75.0)
Speech Therapy (n/%)
3 (75.0)
Physiotherapy (n/%)
1 (25.0
Ethnicity
Australian (n/%)
3 (75.0)
Other (n/%)
1 (25.0)
Mother’s chronological age (years)
Mean (SD)
39.25 (2.22)
Range
37 – 42
Father’s chronological age (years)
Mean (SD)
43.5 (3.11)
Range
41 – 48
Parental marital status
Single (n/%)
0 (0.0)
Married/Defacto (n/%)
4 (100.0)
Separated (n/%)
0 (0.0)
Highest Level of Education - Mother
High school level (up to 10yrs) (n/%)
1 (25.0)
High school level (up to 11-12yrs) (n/%)
2 (50.0)
Tertiary education level (13yrs +) (n/%)
1 (25.0)
Highest Level of Education - Father
High school level (up to 10yrs) (n/%)
3 (50.0)
High school level (up to 11-12yrs) (n/%)
0 (0.0)
Tertiary education level (13yrs +) (n/%)
1 (25.0)
Local SP – Length time in profession (years)
Mean (SD)
6.44 (6.99)
Range
0.12 – 20.0
Local SP – Length time in remote location
(years)
Mean (SD)
4.45 (6.19)
Range
0.12 – 17.0
Note: a Previous diagnosis of an ASD made by a psychologist, paediatrician, psychiatrist or
neurologist
The AQ therapist was asked to record a) the time spent with each family setting up the
WebEx remote technology prior to the early intervention program commencing b) time each
family took to connect to WebEx each session c) quality of audio during each session on a 5point Likert scale 1-5 (1 = very poor quality, 5 = high quality) d) quality of video during each
session on a 5-point Likert scale 1-5 (1 = very poor quality, 5 = high quality).
Following completion of the early intervention program using remote technology,
parents/carers, local SPs and the AQ Occupational Therapist were invited to take part in a
semi-structured interview aimed at exploring their experiences, and their opinion of the
advantages and disadvantages of receiving early intervention services via remote technologies
as compared to face-to-face. They were also asked to complete the System Usability Scale
(SUS; Brooke, 1996) following the completion of the intervention program.
1.3.3 Questionnaires and Interview
Demographics Questionnaire. A demographics questionnaire was completed by each child’s
parent/carer. This included questions pertaining to marital status, education, ethnicity,
language spoken at home, child’s past therapy, ASD diagnosis and other previous diagnoses.
Semi-structured Interviews. The parents/carers, local SPs and AQ therapists’ experiences
using remote technology were assessed through semi-structured interviews lasting
approximately 30 minutes. Participants were interviewed following completion of the early
intervention program. The semi-structured interviews consisted of questions pertaining to the:

Ease of set up of remote technology and need for additional technical support

Advantages of carrying out early intervention using remote technology compared to
face-to-face

Disadvantages of carrying out early intervention using remote technology compared
to face-to-face
System Usability Scale (SUS; Brooke, 1996). The SUS is a short 10-item scale designed to
evaluate user-satisfaction with the technical aspect of web-based applications/technologies.
SUS total scores range from 0 to 100. An adjective rating scale with cut-off scores developed
by Bangor et al. (2009) was used to categorise participants’ total scores on this measure.
Participants were asked to complete this questionnaire following completion of the early
intervention program.
1.4 Data Analysis
1.4.1 Cost Analysis
The 4 families that took part in this project had a previously taken part in a face-to-face early
intervention program. Their participation in this project involved them taking part in a remote
program for which they were not charged. A cost analysis was conducted to ascertain the
difference in costs for conducting these different types of early intervention services.
1.4.2 Remote Technology Set-Up and Connection
Participant scores on the SUS and the AQ therapist’s recordings of the following were all
graphed:.
a) the time spent with each family setting up the Web-EX remote technology prior to the
early intervention program commencing
b) time each family took to connect to Web-EX each session
c) audio quality each session
d) video quality each session.
1.4.3 Qualitative Analysis of Interviews
All interviews were conducted via the telephone and audio-taped. Taped interviews were
transcribed verbatim.
Qualitative content analysis is a widely used method of eliciting meaning from text. It
facilitates contextual meaning in text through the development of emergent themes derived
from textual data (Bryman, 2001). Qualitative data from interviews were analysed using a
content analysis methodology outlined by Miles and Huberman (1994) who take a “middleground” approach to qualitative research and argue that induction and deduction are
“dialectical” (p.155) rather than mutually exclusive processes. The qualitative analysis was
an iterative process that involved a number of cyclical stages. At first level analysis,
transcribed interviews were analysed deductively for advantages and disadvantages of using
remote technology. Higher level analysis involved inductive analysis where data were
initially searched for a set of preliminary, descriptive themes, and then later for high-order,
pattern themes. Over time, these themes were refined, collapsed, expanded and added to until
they adequately captured the full breadth of the data.
Qualitative researchers need to be aware of the danger of imposing their own views, beliefs
and experiences upon the data (i.e., “researcher effects”; Miles & Huberman, 1994, p.265).
The rigour of the analysis and trustworthiness of the data were enhanced by use of multiple
coders. Two coders analysed the data independently for descriptive and pattern themes,
before comparing themes and sub-themes identified. Any discrepancies were resolved
through discussion and where necessary, theme refinements were made. One participant and
the AQ Occupational Therapist examined the final themes and subthemes and provided
feedback (Henwood & Pidgeon, 1992; Patton, 2002).
1.5 References
Bangor, A., Kortum, P., & Miller, J. (2009). Determining what individual SUS scores mean:
Adding an adjective rating scale. Journal of Usability Studies, 4, 114-123.
Brooke J. (1996). A “quick and dirty” usability scale. In Jordan, P.W., et al., eds. Usability
Evaluation in Industry. London: Taylor and Frances, 189-194.
Bryman, A. (2001). Social research methods. New York: Oxford University Press.
Henwood, K. L., & Pidgeon, N. F. (1992). Qualitative research and psychological theorizing.
British Journal of Psychology, 83, 97-111.
Liebert, M. (2009). Telemedicine and autism: researchers and clinicians are just starting to
consider telemedicine applications for the diagnosis and treatment of autism. Telemedicine
and e-Health, 15, 416-420.
Marshall, S., Shaw, D., Honles, G & Sparks, K. (2008). Interdisciplinary approach to the
rehabilitation of an 18-year old patient with bronchopulmonary dysplasia, using
telehabilitation technology. Respiratory Care, 53, 346-350.
Miles, M., & Huberman, A. (1994). Qualitative data analysis: A sourcebook of new methods
(2nd ed.). Thousand Oaks, CA: Sage.
Patton, M. Q. (2002). Qualitative research and evaluation methods. Thousand Oaks, CA:
Sage.
Robins D., Fein D., Barton M., & Green J (2001). The Modified Checklist for Autism in
Toddlers: An initial study investigating the early detection of autism and pervasive
developmental disorders. Journal of Autism and Developmental Disorders, 31, 131–151.
Rutter, M., Bailey, A., & Lord, C. (2003). Social Communication Questionnaire (SCQ).
USA: Western Psychological Services.