Bellon-Harn et al. (2007)

 

EBP THERAPY ANALYSIS

 for 

Single Subject Designs

 

SOURCE:  Bellon-Harn, M., Harn, W. E., & Watson, G. D.  (2007).  Targeting prosody in an eight-year-old child with high-functioning autism during an interactive approach to therapy.  Child Language Teaching and Therapy, 23, 157-179.

 

REVIEWER(S):   PMH

 

DATE: 7.01.12

 

ASSIGNED OVERALL GRADE (derived from level of evidence and quality of report.  See “Letter Grades for Overall Quality” in Terms and Definition on the dashboard.)    Grade = C

 

TAKE AWAY:  A promising approach that combines explicit and interactive components to resolve lengthening and pausing problems of a child diagnosed with High Functioning Autism.

                                                                                                        

1.  The focus of the research was  Clinical Research

                                                                                                           

2.  What type of evidence was identified?                              

a.   The type of single subject design was  Case Studies Description of One Event

 b.  The level of support associated with the type of evidence? 

                                                                                                           

3.  Was phase of treatment concealed?                                             

a.  from participants? No

b.  from clinicians?  No

c.  from data analyzers?  No

 

4. Were the participants adequately described?   Yes

a.  How many participants were involved in the study? 1

 b.  The following characteristics were described:

•  age:  8 years

•  gender:  M

•  language skills:  after 3 years of therapy he produced complex semantics and syntax morphology; he was able to actively participate in conversation and functioned well in contextualized and decontextualized contexts.  His language was labeled as ‘stable.’  His prosody continued to be considered impaired.

c.  Were the communication problems adequately described?        Yes

•  disorder type:  High Functioning Autism (HFA)

•  other:  At the beginning of therapy, 3 years prior, he exhibited significant language impairment included prosodic problems.

                                                                                                                                                                    

5.  Was membership in treatment maintained throughout the study?  Not Applicable

a.  If there was more than one participant, did at least 80% of the participants remain in the study?  Not Applicable

b.  Were any data removed from the study?  No

 

6.  Did the design include appropriate controls?  No, but this is a case study which by definition does not include controls.

a.  Were baseline data collected on all behaviors?  Yes

b.  Did probes include untrained data?  Yes

c.  Did probes include trained data?  No

d.  Was the data collection continuous?  No

e.  Were different treatment counterbalanced or randomized? Not applicable

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  List the outcomes of interest (dependent variable):

Outcome #1:  percentage of inappropriately lengthened syllables

Outcome #2:  rate of inappropriately lengthened syllables

(percentage of inappropriate occurrences/total # syllables or utterances)

b.  List the outcome measures that are  subjective:  #1 and #2

c.  List  the outcome measures that are  objective:  Neither

                                                             

8.  Did the target behavior improve when it was treated?   Variable                                           

 

9.  Overall quality of improvement:  Limited

•  NOTE:   improvement trend (intervention is stronger) in both probes and intervention, although the trend during intervention is stronger.  It should be considered that familiarization with the clinician as a possible factor.  The progress in the initial probes could have been modeled by the clinician since the outcomes were derived from spontaneous speech.

a.  Were baselines low or high (as appropriate) and stable?  No, they were predominately high with some instability.

b.  What was the percentage of nonoverlapping data (PND)?  Not provided.

c.  Does inspection of data suggest that the treatment was effective?  Unclear

                                                                                                              

10.  What was the magnitude of the treatment effect?   Not provided

 

NOTE:  The data suggest that an interactive approach alone was not sufficient to yield progress in prosody,  although other aspects of communication did improve.  Once an explicit component that focused on prosody  was added to intervention, prosody began to improve.

 

                                                        SUMMARY OF INTERVENTION PROCEDURES

 

PURPOSE:  To describe prosodic intervention for an 8 year-old child with HFA

 

POPULATION:  HFA

 

MODALITY:  Expression

 

ELEMENTS OF PROSODY TARGETED (Dependent variable): lengthening and pause

 

DOSAGE:  5 weeks; 2@ week; length of session unknown

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory, visual, tactile

 

GOAL ATTACK STRATEGY:  Horizontal

 

MAJOR COMPONENTS:

 

•           Each session comprised 2 major components:  Explicit Prosody Therapy  and Interactive Therapy

 

•           EXPLICIT PROSODY THERPAY

 

•           Targets were derived from previous semester which employed interactive therapy alone.  Analyzers compared each syllable to its’ predecessor and its follower to determine if its duration (length) was typical or atypical.   Pauses were also judged as typical or atypical.  Intonation patterns were identified as \, /, /\, \/, – and the analyzer judged whether it matched the perceived intent of the utterance (statement, question, direction, command).  Intonation was judged to be typical; lengthening and paused were considered atypical.

 

•           C employed:  auditory, tactile visual feedback; modeling; discrimination; metalinguistics

 

1.  C translated targets into Good Speech Rules (e.g., “No big pauses between words.”)

 

2.  Each session C reviewed the targeted rules.

 

3.  P read and retained the card during the session for reference.  Each card provided an example from the P’s speech of typical and atypical use.

 

4.  C provided

•  tactile illustrations (e.g., provided one rope with knots and another without knots),

•  verbal feedback (e.g., identified atypical lengthening or pausing in P’s speech),

•  non-verbal feedback (e.g., gesturing to a Rule Card),

•  modeling (e.g., C repeating an error  utterance with appropriate lengthening or pausing), and

•  metalinguistic feedback (C and P discussed prosody)

 

•           INTERACTIVE THERAPY

 

1.  Following the introduction of the prosody targets for each session, the C conducted the rest of the session using Interactive Therapy:

 

2.  This was a conversationally theme- based intervention

 

•  C employed a variety of scaffolding techniques

•  C provided background information, answered and asked questions, offered directions, responded to P’s initiations

DEPENDENT VARIABLE(S)/OUTCOME(S):

 

Outcome #1:  percentage of inappropriately lengthened syllables

Outcome #2:  rate of inappropriately lengthened syllables

(percentage of inappropriate occurrences/total # syllables or utterances)

 

 

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