METHODOLOGY Research design

A quasi-experimental design was used for the current study, because the sample consisted of pre- existing groups in the form of two classes. The participants could not be randomly assigned to

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treatment or experimental conditions and the school would not permit the changing or separation of the participants in the classes (Thomas et al., 2011:345).

Subjects

A governmental primary school for autistic learners was recruited from the Cape Town area. This school was selected because the population was a sample of convenience and because of financial and logistical considerations.

At the school, 2 classes (N=14) were assigned by the occupational therapist to take part in this study. Five subjects’ whose parents/legal guardians did not sign consent and 2 subjects, who did not complete the study, were excluded from the current study. Therefore, the final sample size consisted of 7 participants (6 boys and 1 girl) between the ages of 8 and 13 years. One class formed the experimental group (n=4) and the other formed the control group (n=3). Participants’ in the control group received pre- and post- testing only, while the experimental group participated in the researcher-designed group intervention programme. The control group continued with their usual academic work and recreational activities. All the children were at a similar level of autistic function according to the occupational therapists at the school.

Inclusion and exclusion criteria

All children recruited had to be in one of the participating classes of the selected school. All participants were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition-Text Revision (DSM-IV-TR) (APA, 2000:69). Any child who presented physical injuries was excluded from the study. If a participant did not wish to participate in the intervention programme, they were not forced and were excluded. The child of any parent or guardian who did not give consent for their child to participate was also excluded and the child of any parent or guardian, who did not complete the Social Responsiveness Scale-2 questionnaire, was excluded from the study.

Place of study

The study took place on the grounds of the school. The motor assessment test was performed in an assigned occupational therapy room, psychology room or assessment room. The group intervention programme was performed in the available assessment room, occupational therapy room or staff room.

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Ethical approval

The researcher submitted a research proposal which clearly defined the aims and objectives of this study and detailed the procedures within a methodology to the ethics committee at Stellenbosch University for approval (#HS1015/2013). Permission to perform this study was obtained from the Western Cape Education Department (WCED). The principal of the selected school provided the researcher and the WCED with written consent to conduct the study at the recruited school.

Consent forms were sent out to all parents or legal guardians of each child recruited to take part in this study. Parents or legal guardians provided written informed consent for their child to participate in the current study and the teachers provided written informed consent, allowing their class to participate in the current study, before any testing procedures were conducted. Once these forms had been returned, an assent form was given to each child. All participants were asked to volunteer to take part in this study. The researcher verbally explained to each child the procedures of the study and what they would do if they chose to participate. Children were given the opportunity to ask questions and any uncertainty was addressed by the researcher. Each child then signed the assent form if they agreed to participate. Any participant, who did not wish to take part in the study, was not forced to do so. All the data that was collected in relation to this study remains confidential and will only be released with permission from the parents or legal guardians or as required by law. All information collected will be kept for a maximum of 3 years at the Department of Sport Science at Stellenbosch University on a password protected computer. All data and questionnaires will be stored in a file in a locked office that only the researcher and the study leader will have access to during the study.

Any obstacles and equipment that may have caused injuries was removed from the area where the group intervention programme and testing took place. The participants were supervised at all times during the intervention as well as the testing, by the investigator who is a qualified Kinderkineticist (01/013/02/1314/005) with a Level One First Aid qualification. A teacher or occupational therapist was present during the motor assessment and an occupational therapist was on call at all times. The researcher who performed the test had competent knowledge of the relevant test being conducted. If any injuries occurred, the school’s protocol regarding injuries was immediately followed.

Statistical procedures

The data collected was statistically analysed by Prof M. Kidd of the Centre for Statistical Consultation at Stellenbosch University. The possible effects of the intervention were tested using

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mixed model repeated measures ANOVA with group and time as fixed effects and the participants as random effects. Post hoc testing was done using Fisher least significant difference (LSD) testing. The group-time interaction effect was investigated to determine if the experimental group showed a different effect from the control group over time. The results were summarised and reported as means and standard deviations and the level of significance was set at (p<0.05). The 2 assessments conducted in this study will now be discussed.

Testing procedures

One developmental assessment and one screening questionnaire were completed. The developmental assessment was completed by the selected group of children with ASD who voluntarily participated in the study and the screening questionnaire was completed by the relevant teachers and parents or guardians of the participating children.

Both the experimental and control group performed a developmental assessment called the Movement Assessment Battery for Children-2 (MABC-2) (Henderson et al., 2007) and the teachers and parents or guardians of consented participants completed a questionnaire called the Social Responsiveness Scale-2 (SRS-2) previously named the Social Reciprocity Scale (Constantino & Gruber, 2005) during the pre- and post-tests. The group intervention programme lasted 12 weeks and was developed using information from a range of literature (Cheatum & Hammond, 2000:80- 307) and personal experience as a qualified Kinderkineticist. The experimental group participated in the group intervention programme, while the control group did not perform any gross motor activities besides their normal physical and recreational activities at school. During the 12-week group intervention programme there were 2-weeks where children had school holidays. During one of the weeks a home programme was sent to the parents or legal guardians and during the other week the researcher used this as a forced retention period where no home programme was sent home with the children. Only the experimental group performed the MABC-2 again, before and after this period of no intervention to determine if this natural retention had an effect on the learnt skills. Two researcher-designed questionnaires (Appendix G) along with the SRS-2 were completed by parents or guardians of the participants to indicate relevant information regarding the participants’ medical and physical activity history, as this may have influenced the results. A participant may have had an injury or illness which the researcher needed to be aware of during the testing or intervention periods. In addition, the researcher needed to be aware of how many additional motor activities the participants were involved in, as this may have altered the results.

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The Movement Assessment Battery for Children-2 (MABC-2) (Henderson et al., 2007)

The MABC-2 is a result of an accumulation of research which began in 1966 (Henderson et al., 2007:113). This test of motor competence is an improved version of the Movement Assessment Battery for Children (MABC) (Henderson & Sugden, 1992, cited in Henderson et al., 2007:113), which was revised from a test called the Test of Motor Impairment (TOMI) (Stott et al., 1972, cited in Brown & Lalor, 2009:88).

The MABC-2 is used for the identification of movement difficulties in clinical examinations, planning of an intervention, programme evaluation and as a research instrument in experimental studies (Henderson et al., 2007:5). This test battery is one of the most widely used measures of motor proficiency (Chow & Henderson, 2003:574 & Holm et al., 2013:795), and has been extensively used to examine children with (Whyatt & Craig, 2012:1801; Liu & Breslin, 2013:1245) and without (Wagner et al., 2011:675; Holm et al., 2013:796), ASD in school environments.

The MABC-2 is often used with several different groups of children who have observable movement difficulties such as children with Attention Deficit Hyperactivity disorder (ADHD), children who are classified as “at risk" who are suffering from Foetal Alcohol Spectrum Disorder (FASD), children with genetic disorders such as Tourette’s Syndrome, Williams Syndrome, Turner Syndrome and Fragile X Syndrome, and lastly, children with Developmental Coordination Disorder (DCD) (Henderson et al., 2007:6-9). Children with ASD, like children with DCD have been recognised as being clumsy and uncoordinated (Ghaziuddin et al., 1992:651). For this reason, the MABC-2 is an excellent test to use on the population chosen for this study.

The MABC-2 is made up of 2 complementary mechanisms: the Standardised Test and the

Checklist. The standardised test involves children having to perform a number of gross and fine

motor tasks, which fall under 3 subtests (Henderson et al., 2007:3; Brown & Lalor, 2009:87). The 3 subtests are presented below in Table 3.1.