Friedman (1985)


Single Subject Designs


SOURCE:  Friedman, M. (1985). Remediation of intonation contours of hearing-impaired students. Journal of Communication Disorders, 18, 259-272.




DATE:  3.02.13



TAKE AWAY:  Fair to weak support for this promising academic year-long curriculum to teach adolescents with hearing loss to discriminate, imitate, and produce falling terminal contours.  Although the adolescents involved in these case studies were hearing impaired, the procedures have potential for those whose hearing is within normal limits (WNL).


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?  Case Studies: Program Descriptions with Case Illustrations

b.  What was the level of support associated with the type of evidence? 

Level =  D+                                                      


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?  3

b.  The following characteristics were controlled: congenital severe-to-profound bilateral hearing loss

The following characteristics were described:

•  age:  14-18 years

•  gender:  2m, 1f

•  cognitive skills:  WNL

•  expressive language:

•  receptive language:

•  MLU:

•  SES:                                               

•  educational level of participant:

•  educational level of parents:

•  articulation:  good (1)

•  hearing acuity:  95 and 97 dB, 93 and 95 dB, 100 and 110 dB

•  Other (list):  no handicapping conditions

c.  Were the communication problems adequately described? Yes

•  The type of disorder was  Atypical intonation  contours

•  Other aspects of communication that were of concern

–  intonation contours:  flat and monotonous (2), inappropriate (1)

–  pitch variation:  phoneme related fluctuations

–  intelligibility:  reduced (2)


5.  Was membership in treatment maintained throughout the study?  Yes

a.  Did at least 80% of the participants remain in the study?  Yes

b.  Were any data removed from the study?  No


6.  Did the design include appropriate controls? No, this were case studies,

a.  Were baseline/preintervention data collected on all behaviors?  No baseline/preintervention reported.


7.  Were the outcomes measure appropriate and meaningful? Yes

a.  The outcomes were

  OUTCOME #1:  To discriminate auditorily fo contours in speech

  OUTCOME #2:  To imitate fo contours in speech

  OUTCOME #3:  To produce fo contours in speech

b.  The subjective outcomes were Outcomes #1-3

c.  None of the outcomes that are objective:   none

d.  None outcome measures are reliable.


8.  Results:

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

b.  The measure of achievement for the outcomes was the number of sessions needed to mastery (2 session 100% accuracy) for each of the steps in the curriculum.  (Steps were related to linguistic length and complexity of the utterances targeted for discrimination, imitation, and production.)

  OUTCOME #1:  To discriminate auditorily fo contours in speech:  moderate (P1), limited (P2, P3)

OUTCOME #2:  To imitate fo contours in speech:  moderate (P1), limited (P2, P3)

OUTCOME #3:  To produce fo contours in speech:  limited (P1, P2, P3)

9.  Description of baseline:

a.  Were baseline data provided? No


10.  What was the magnitude of the treatment effect?  NA


11.  Was information about treatment fidelity adequate?  No


12.  Were maintenance data reported?  No


13.  Were generalization data reported?  Yes. The author made some comments about generalization to conversation in the results section.  Conversation was not included in the hierarchical targets.








PURPOSE:  To describe strengths and weaknesses of a curriculum that includes the hierarchical sequencing of steps and the use of sensory aids) to improve falling terminal intonation contours (i.e., fo on vowels) of adolescents with hearing loss

POPULATION:  hearing impairment


MODALITY TARGETED:  comprehension (discrimination) and production


ELEMENTS/FUNCTIONS OF PROSODY TARGETED: intonation (terminal contour)

DOSAGE:  this was a (academic) year-long curriculum, individual sessions, 3-4 times a week, 40 minute sessions




STIMULI:  auditory, visual, vibrotactile

GOAL ATTACK STRATEGY:  combined vertical and horizontal




Treatment Tasks:

•  Auditory discrimination:  P determined if the terminal contour was in the P’s or C’s attempt.  Only hearing aids were used for this task.

•  Imitation:  P replicated the C’s model. Hearing aids, visual (facial cues, Visipitch), and vibrotactile cues were permitted. C gradually reduced the use of the cues.

•  Production:  On demand, the P produced a terminal contour on the targeted structures. Hearing aids, visual (facial cues, Visipitch), and vibrotactile cues were permitted to help elicit the target. C gradually reduced the use of the cues.


Hierarchical Targets:

•  C increased target length and complexity as P reached criterion on a step


STEP 1: isolated vowels

STEP 2: long-long-long CV syllables

STEP 3: long-short-long CV syllables

STEP 4: short-short-long CV syllables

STEP 5: 3 syllable real word phrases

STEP 6: 2 syllable real word phrases

STEP 7: 1 syllable real word phrases

*  Optional branching steps were added between Steps 1 and 2.

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