Hargrove et al. (1989b)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Hargrove, P. M., Roetzel, K., & Hoodin, R. B. (1989b).  Modifying the prosody of a language-impaired child.  Language, Speech, and Hearing Services in Schools, 20, 245-258,

 

REVIEWERS::  Amy Anderson (Minnesota State University, Mankato), Jessica Jones (Minnesota State University, Mankato), pmh

 

DATE:  12.22.08                                          ASSIGNED OVERALL GRADE:  B-

 

TAKE AWAY:  This investigation provides limited evidence that stress patterns can be modified in the speech of a language impaired child using an elicitation task.  

 

1.  What was the focus of the research?  Clinical Research

 

2.  What type of evidence was identified?                              

a.  What  type of single subject design was used?  Single Subject Experimental Design with Specific Client: Multiple Baseline

b.  What was the level of support associated with the type of evidence?  Level =  A-      

                                                                                                           

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? 

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

b.  The following characteristics were described:

•  age:  6 ½ years

•  gender:  m

•  cognitive skills:  WNL

•  expressive language:  WNL

•  receptive language:  WNL

•  MLU:  WNL

•  hearing:  WNL

•  social skills:  WNL

•  fluency:  WNL

•  percentage of complete and intelligible utterances:  87.5%*

this was described as an overestimation of P’s functioning in day-to-day conversation because transcribers were allowed to replay the recording as many times as necessary.

c.  Were the communication problems adequately described? Yes_

•  The type of communication disorder:  Specific language impairment (SLI)

•  Other aspects of communication that were described:

–  excessive and equal stress

  –  imperceivable terminal contours

  –  atypical pitch changes

  –  excessive rate

  –  frequent unintelligibility in conversation

  –  screener for developmental apraxia of speech (DAS) = 70% probability of DAS

                                                                                                                       

5.  Was membership in treatment maintained throughout the study? Not applicable, there was only 1 P.

 

6.  Did the design include appropriate controls?  Yes

a.  Were baseline/preintervention 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?  Yes

e.  Were different treatment counterbalanced or randomized?  Yes

fIf “6e” was yes, was it counterbalanced or randomized? Randomized the order of treating objectives

 

7.  Were the outcomes measure appropriate and meaningful? Yes

a.  The outcomes of interest were

  OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour.

  OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.

  OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.

b.  The subjective outcomes are Outcomes #1-3

c.  The objective outcomes are–  none of the outcomes are objective

d.  The outcome measures that are reliable–  Investigators provided overall reliability data, not data for specific outcomes

e.  The data supporting overall reliability are

•  Intraobserver reliability = 87%

•  Interobserver reliability = 76%

 

8.  Results:

a.  Did the target behavior improve when it was treated?  Yes

b.  The overall quality of improvement for each of the outcomes was derived from visual inspection of probes (Figure 1) and daily performance during intervention (Table 3).  The results are

OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour. Strong improvement

OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.  Moderate improvement

OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.   Moderate-slight improvement

9.  Description of baseline:

a.  Were baseline data provided?  Yes, the number of data points for baseline of  each dependent outcome was

OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour.  3 data points

OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.  9 data points

OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.  16 data points

b.  Was baseline low (or high, as appropriate) and stable? (

    OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour.  Low and stable

OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.  Primarily low and unstable

OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.  Unstable

9c.  What was the percentage of nonoverlapping data (PND)?  The PND data which follow were calculated by the reviewers from Figure .

OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour.  PND  83%

OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.  PND = 57%

OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.  PND = 40%

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

OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour.  Fairly effective

OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.  Questionable effectivenes

OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.

Ineffective

 

 

10.  What was the magnitude of the treatment effect? NA, only PND was calculated.

 

11.  Was information about treatment fidelity adequate?  Yes. C adhered to treatment protocol 98.1% and 100% of the time in two randomly selected sessions.

 

12.  Were maintenance data reported?  Yes. Maintenance data consisted of probes after P had reached criterion for an objective while other objectives were being treated. Accordingly, maintenance results are available only for the first two phases of treatment—Subject and Verbing targets. In both cases, the results for the maintenance phase were unstable with the average percentage correct during probes  not exceeding 40%.

 

13.  Were generalization data reported?  Yes. The pre-intervention probe data can be considered generalization data because future target (e.g., Verb = ing and Object) were measured while P was working on the Subject target.   There appeared to be some generalization, particularly on the final (Object) target.

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  B-

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To determine if prosodic skills can be changed in a child with impaired language.

POPULATION:  SLI

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  stress-emphatic; intonation-terminal contour; overall contour

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable; list only if prosody is being used as a treatment technique with a nonprosodic outcome):

DOSAGE: 2 sessions per day for 9 days in two consecutive weeks.  Length of sessions were not reported but intervention was limited to 27 probe tasks and 27 treatment task for each session.

 

ADMINISTRATOR:  SLP

 

STIMULI:  small dolls, toys, or objects; auditory stimuli; visual/kinesthetic cues

GOAL ATTACK STRATEGY:  Vertical

 

MAJOR COMPONENTS:

 

Pretreatment task:

•  C taught P proper names for each of the dolls involved in treatment and in probes.

•  If necessary, C taught P name of each of the toys or objects.

•  NOTE:  different nouns and verbs were used in the treatment and probe tasks.

Intervention session:

     Parts:  Each session consisted of a treatment and probe section. The probe always occurred after the treatment.

     Treatment Phases:  Because this investigation involved a multiple baseline design there were 3 phases. Each phase lasted 7 sessions or until P’s performance during the probe for the target was 78% correct or better. There were 3 treatment phases:

•  Subject

•  Verb + ing

•  Object

Treatment Procedures:

•  C enacts a scene using toys that could be described by a Subject + Verb+ing + Object sentence (e.g., Bo is holding the hat.)

•  C asks a question in which one part of the sentence is incorrect  (e.g., Is Pam holding the hat?)

•  The C’s incorrect sentence is tied to the Treatment Phase.  Thus, during the Subject Phase, C only produces the wrong subject in the questions; during the Verbing Phase, C produces only the wrong verb; and so forth.

•  P’s targeted response consists of the production of a Subject + Verbing + Object sentence in which the “error” word from C’s production is contradicted using emphatic stress (No, BO is holding the hat.)  NOTE:  because “is” was occasionally omitted in P’s spontaneous speech, “is” was not required.

•  If P is correct, C provides verbal and tangible reinforcement.

•  If P is incorrect, C chooses from a variety of techniques to elicit the correct response including explanation, modeling, hand cues, imitation requests, and redirection.

•  To avoid P fatigue, C limits attempts to elicit a specific response to three.

DEPENDENT VARIABLE(S)/OUTCOME(S): 

OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour.

OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.

OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.

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