Overview of research activity: Procedure

Activities following approval of research proposal at University January 2009

An initial meeting was held with school staff giving details of the research project scope, duration and key dates in addition to making an initial request for a suitable participant.

Development of CBT programme materials based on available evidence as to what aspects of a CBT programme to adapt for use with an adolescent with AS.

Questionnaire content and structure considered but not finalised. Assessment and Formulation tools considered and selected.

February/March 2009

Pilot of the ASD audit tool (x2 primary schools) Modification and proofing of audit tool.

Rewrite ASD audit tool to take account of pilot comments.

April/May 2009

Trial of some of the CBT resources with pupils on the autism spectrum, Realistic interview script written,

June/July 2009

Questionnaires, assessment tools and CBT materials finalised.

August 2009

Realistic interview script altered to include longer exposition from researcher, Consent form for parent finalised,

Request from school for Educational Psychology support for a pupil with AS September 2009

A request, made by school, for support with a pupil (B) diagnosed with AS experiencing difficulty in school.

Consent was sought from B’s parent for the EP to be involved.

A discussion with B’s mother to outline the planned intervention/research process of the study, in terms of its scope, aims and ethical considerations and to gain consent for the CBT intervention. Psycho-education (brief explanation of the process and psychological ideas underpinning a CBT intervention) was also discussed with B’s mother.

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An initial meeting was held in school with B by way of introduction to the EP.

September/October 2009

The ASD audit was conducted in school with the SENCO

A period of assessment and formulation

Assessment was conducted to determine the appropriateness of a CBT as an intervention to support B in school.

Formulation of the challenges for B in school:

ASD profile completed by B’s school tutor (who has an overview of B’s performance and behaviour across school)

ASD profile completed by B’s mother Suitability of B for CBT

WISC IV (UK)

Psycho-education with B in school Beck Youth inventory

Discussion and Psycho-education

A CBT programme was altered to reflect the needs and abilities of B as derived from the assessment and formulation

Evidence suggested that B’s verbal comprehension skills were generally low for his age on the WISC IV (UK) and a sampled AS normed group on this psychometric test. Therefore resources on emotional language were adapted to make language sheets that could be used as a quiz with visual reinforcement. Visual reinforcement and repetition were also used to counter potential difficulties with short term memory difficulties.

Table 5. The scores B obtained on the WISC IV (UK) and the composite scores for

the AS population of the same test

Scale Sum of Scaled

scores Composite score Percentile rank

Verbal Comprehension 24 89 (106) 23 Perceptual reasoning 26 92 (102) 30 Working memory 15 86 (95) 18 Processing speed 20 100 (86) 50

B’s scores are expressed as ‘scaled scores’ which have been converted form B’s raw test scores and compared to the standardised population. Composite scores, those made up of aggregates of individual tests are also compared against a standardised population, they have a mean (average) of 100 and two-thirds of the population

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would be expected to score in the range 85 to 115; the AS population scores are shown in brackets next to B’s scores under the composite scores heading. The percentiles scores indicate the percentage of children of a similar age who would be expected to score at the same or a lower level than B, percentiles scores range from 1 to 99.

A realistic interview was conducted with school staff in school November/December 2009

The realistic interview was planned for an after-school meeting, but on the day the school was closed due to snow; a second meeting was organised at lunch time at the school, to which there was a poor turnout. The realistic interviews were then conducted individually rather than as a group as planned.

Baseline (A) measures were conducted in school with the participant B

Beck Youth inventory (Beck et al, 2005) Resiliency scales (Price-Embury, 2007) Personal constructs (Butler and Green, 2007) Scaling activities/emotional language quiz

ASD profile administered to B’s mother and school tutor

SENCO completes the ‘ASD Audit’ January 2010

CBT Programme delivered as outlined and implemented over a seven-week period in school.

Post intervention (B) measures taken in school

Beck Youth inventory (Beck et al, 2005) Resiliency scales (Price-Embury, 2007) Personal constructs (Butler and Green, 2007) ASD profile (school tutor)

ASD profile (parent)

Post intervention intervie w questionnaires issued to parent, pupil and school staff

February/March 2010

Results analysed in terms of changes between pre and post intervention and realist analysis of the potential impact of mechanisms in school that may have influenced the observed outcomes.

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Feedback given to school and parent as to the outcomes of the therapy

The school which is the setting of the present study is a mainstream secondary school in the West Midlands of England. The school is described by OFSTED (2003) as having a pupil population drawn from a socioeconomically deprived catchment area and is characterised by lower than average academic achievement outcomes. The case study participant B, the pupil for whom the CBT programme was written, was identified at a termly planning meeting. Thus an opportunity sample was employed in the present study, the rationale being to have a consultation request from a school that represented a real or authentic piece of case work in that school. Opportunity samples are consistent with the use of multiple and single case study designs (Cohen et al., 2003). It should be clear that the case study does not represent any other case than the one presented, and there is no intention to generalise the results beyond those obtained here. The RE approach, with a retroductive analysis of data, does enable a discussion of what Lincoln and Guba (2000) have referred to as ‘transferability’, in which practitioners can take effective practice in one setting to what they deem to be a similar setting.