Miller & Toca (1979)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Miller, S. B., & Toca, J. M. (1979). Adapted Melodic Intonation Therapy: A case study of an experimental language program for an autistic child. Journal of Clinical Psychiatry, 40, 201-203.

 

REVIEWER(S):  pmh

 

DATE:  6.4.13

ASSIGNED OVERALL GRADE:  D-

 

TAKE AWAY:  This case study provides limited support for the use of an adapted form of Melodic Intonation Therapy (including signing) in establishing meaningful speech in a preschooler with autism.

 

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 StudiesProgram 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?  List here:  1

b.  The following characteristics were described

•  List characteristics controlled:

•  List characteristics described:

•  age:  3 years, 2 months  when referred to school; after a year of treatment with little progress, Adapted Melodic Intonation Therapy (AMIT)  was administered

•  gender:  m                                    

•  cognitive skills:  functioned at 16 month level

•  expressive language:  severe deficit

•  receptive language:  severe deficit

•  MLU:  not currently  speaking,  stopped talking at 24 months

•  Hearing:  adequate for communication

•  Previous therapy:  4 times a week, combined simultaneous communication (signing + verbalization), did not make progress commensurate with peers.

                                                 

c.  Were the communication problems adequately described? Yes

•  The disorder types were  autism with secondary diagnosis of cognitive delay; severe receptive and expressive language impairment

Other aspects of communication that were described

•  lack of speech for communication

•  used adult’s hand as an instrument

Other characteristics of concern were

•  reduced response to pain

•  limited eye contact

•  finger flapping

                                                                                                                       

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, this was a case study. 

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

b.  Did probes/intervention data include untrained data?  No

c.  Did probes/intervention data 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?  Unclear

a.  The outcome was

  OUTCOME #1:  Production of functional communication using words

b.  Was it subjective?  Yes

c.  Was it objective:?  No

d.  Was the outcome measure reliable?  No

 

8.  Results:

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

b.  The overall quality of improvement

OUTCOME #1:  Production of functional communication using words–Moderate

 

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?  Not Provided

 

12.  Were maintenance data reported?  No

 

13.  Were generalization data reported?  Yes. Throughout the description of the outcomes, the investigator noted instances of generalization in untrained contexts or in the use of words that were not taught during treatment.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To describe the effectiveness of the use of Adapted Melodic Intonation Therapy (AMIT, addition of signing to the protocol) in establishing verbalizations in a 4 year-old with autism.

POPULATION:  Autism

 

MODALITY TARGETED:  expressive

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  intonation

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  meaningful verbalization

DOSAGE:  not clear, may be 4 times a week

 

ADMINISTRATOR:  not clear, probably SLP

 

STIMULI: auditory, visual (signing)

GOAL ATTACK STRATEGY:  not clear

 

MAJOR COMPONENTS:

TECHNIQUES:

•  modeling

•  fading

•  questioning/elicitation

•  physical manipulation

•  shaping

•  intoning

•  signing

 

PHASE I:  25 sessions

•  Target:  word representing a desired object/food

•  C sings and signs target word (e.g., drink or cookie) 3 times  (only used 2 target words at start)

•  C intones and signs the following question to P: “What do you want?” paired with signing

•  C repeats singing and signing of the target word while signing

•  Acceptable response = signing or verbalizing target word

•  Reinforcer – verbal praise plus access to desired food

PHASE II:  approximately 5 sessions
•  Target = drink

•  P was responding to question for cookie but not for drink

•  P shapes the response “ing” to “ink”, then to an approximation of “drink”

PHASE III:  (continues with signing and signing)

•  Target =  additional food items added

PHASE IV:  (continues with signing and signing)

•  Target = multiword sentences

•  C models  “more” before the target word

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