Freeman & Garstecki (1973)

Single Subject Designs


SOURCE: Freeman, S. R., & Garstecki, D. C. (1973). Child-directed therapy for nonorganic voice disorder: A case study. Language, Speech, and Hearing Services in Schools, 4, 8-12.


REVIEWER(S): pmh  


DATE:  7.30.13

ASSIGNED OVERALL GRADE:   D-   (Due to the level of evidence, D+ was the highest possible grade for this source.)


TAKE AWAY:  This investigation provides initial, limited support for the use of a child-directed intervention for the improvement of pitch (level, variability) and  loudness in an 11 year-old with a nonorganic voice problem.


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 Study – Description with Pre and Post Test Results       

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?  Variable, the listener groups were blind.  However, some of the outcome data were derived from participant and clinician data.                                        


4.  Were the participants adequately described?  No

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

b.  The following characteristics were described:

•  List characteristics controlled:

•  List characteristics described:

•  age:  11 years

•  gender:  f                                       

•  previous therapy:  none

c.  Were the communication problems adequately described? Yes

•  The disorder type was  nonorganic voice disorder

•  Other aspects of communication that were described include

–  pitch:  low  for CA

–  voice quality:  hoarse

–  inflection:  limited


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

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? 


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?  Yes

d.  Was the data collection continuous?  Yes

6e.  Were different treatment counterbalanced or randomized?  Not Applicable 


7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

  OUTCOME #1:  Improved self- and clinician ratings of overall voice in a read audiorecorded sample.

  OUTCOME #2:  Improved ratings of overall voice in a read audiorecorded sample by groups of listeners

b.  All of the outcomes were subjective.

c.  None of the outcomes were objective.

d.  The investigator provided present reliability data for  Outcome #1.

e.  The data supporting reliability for the outcome measure was

  OUTCOME #1: Improved self- and clinician ratings of overall voice in a read audiorecorded sample.

     The investigators charted the ratings by P and C.  The trends in ratings were similar but C consistently rated herself higher than P.


8.  Results:

a.  Did the target behaviors improve when they were treated?  Yes

b.  The overall quality of improvement was

  OUTCOME #1:  Improved self- and clinician ratings of overall voice in a read audiorecorded sample.  P’s rating stong; C’s rating moderate

OUTCOME #2:  Improved ratings of overall voice in a read audiorecorded sample by groups of listeners  Unclear (insufficient data provided) but the last session was rated as significantly better than the last session.

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?  No 






PURPOSE:  To determine if a child-directed approach to voice intervention focusing on inflection, intensity, pitch, and quality would result in improvements.

POPULATION:  child, nonorganic voice disorder


ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch (level and variability), intonation (overall contour), loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  voice quality, overall vocal behavior

DOSAGE:  nine weeks, one meeting per week


STIMULI:  auditory, written material


TECHNIQUES:  reading aloud, verbal feedback, self-monitoring, metalinguistics (explanations), positive reinforcement

STEP 1:  C defines and explains the parameter that will be the focus of intervention:  inflection (pitch variability, overall intonation contour), pitch (level), intensity (loudness), voice quality.  [Terms in parentheses are terms from the Prosodic Teaching Model (PTM, Hargrove & McGarr, 1994).  For the remainder of the investigators’ terminology will be used.]

STEP 2:  P practices producing and varying the parameters from Step #1: inflection, pitch, intensity, and quality.

STEP 3:  P reads and audiotapes a passage selected by C.  After each reading, P evaluates her audiotaped performance.  C provides positive reinforcement as appropriate.

STEP 4:  At the end of the session, P and C independently evaluate C’s overall performance on a 10-point scale and identify which of the 4 parameters (inflection, pitch, intensity, and quality) should be worked on in the following session.  (The investigator provided sample forms for the evaluation and outcome selection.)

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