Harding & Ballard (1982)

SOURCE:  Harding, C., & Ballard, K.D.(1982). The effectiveness of music as a stimulus and as a contingent reward in prompting the spontaneous speech of three physically handicapped preschoolers. Journal of Music Therapy, 19, 86-101.

 

REVIEWER(S):  pmh

 

DATE:  December 7, 2013

ASSIGNED OVERALL GRADE:  B (Based on the experimental design, the highest possible grade was A-.)

 

TAKE AWAY:  These 3 single subject experimental designs provide moderate support for the use of music as a stimulus and as a contingent reward for improving responses to questions, spontaneous verbalizations during story tell, and number of utterances during a story retelling task. The effectiveness for improving on task behavior is questionable.  Location is New Zealand.

 

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 across subjects with a reversal phase

                                                                                                           

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?  No

 

a.  How many participants were involved in the study? 3

b.  The following characteristics were

CONTROLLED

•  age:  3-5 years

•  vision and hearing:   sufficient skills for the treatment  and assessment procedures

•  educational level of participant: kindergarten (New Zealand)

•  motor skills:  capable of standing or sitting as well as manipulating items involved in treatment

•  diagnosis: physically handicapped

•  communication skills:  limited

DESCRIBED

•  age:  3 year, 4 months to 4 years, 5 months

•  gender:  2m,1f

•  cognitive skills:  delayed intellectual function (1P)

•  etiology:  hydrocephalus associated with intraventricular hemorrhage; unknown; achondroplasia

•  severity:  mild hemiplegia (1P)

•  expressive language: developing slowly (1P)

•  motor skills:  not walking (1P); crawling (1P), pull self to standing position (1P), stiff gait (1P)

•  therapies:  physical (2Ps), speech (2Ps), swimming (2Ps)

                                                 

c.  Were the communication problems adequately described?  No

•  The type of communication disorder was described as  limited verbal communication skills

                                                                                                                       

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

a.  If there was more than one participant, 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?  Yes

a.  Were baseline data collected on all behaviors?  Yes 

b.  Did probes include untrained data?  No

c.  Did probes/intervention data include trained data?  Yes

d.  Was the data collection continuous?  Yes

e.  Were different treatment counterbalanced or randomized? Not Applicable 

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

  OUTCOME #1:  Increased rate of P verbal responses to questions about pictures

  OUTCOME #2:  Increased P verbal initiations as C read a story

  OUTCOME #3Increased number of verbalization during a story retelling task

OUTCOME #4:  Rate of on-task behaviors

b.  All of the outcomes were subjective.

c.  None of the outcomes were objective.

d.  The investigators provided reliability data for  Outcomes #1-3

e.  Data supporting reliability for selected outcome measure is

OUTCOME #1:  Increased rate of P verbal responses to questions about pictures:  97.38%

OUTCOME #2:  Increased P verbal initiations as C read a story:  93.21%

OUTCOME #3:  Increased number of verbalization during a story retelling task:  89.19%

 

8.  Results:

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

b.   Based on the investigators’ interpretations, the overall quality of improvement for each of the outcomes was

OUTCOME #1:  Increased rate of P verbal responses to questions about pictures:  strong although for 2 of the Ps baseline was high

OUTCOME #2:  Increased P verbal initiations as C read a story: moderate to strong

OUTCOME #3:  Increased number of verbalization during a story retelling task:  moderate to strong

OUTCOME #4:  Rate of on-task behavior:  strong

9.  Description of baseline:

a.  Were baseline data provided?  Yes

•  The number of data points for all outcomes: 13-18 sessions

b.  Was baseline low and stable?

OUTCOME #1:  Increased rate of P verbal responses to questions about pictures:  yes (1P); no  (2Ps)

OUTCOME #2:  Increased P verbal initiations as C read a story:   after the 1st 5 baseline session–yes

OUTCOME #3:  Increased number of verbalization during a story retelling task:  yes

OUTCOME #4:  Rate of on-task behavior:  after the 1st 5 sessions-yes

                                                       

c.  What was the percentage of nonoverlapping data (PND)?

  OUTCOME #1:  Increased rate of P verbal responses to questions about pictures

     – P1 =  100%– highly effective

– P2 =  0% –ineffective

– P3 =  0% –ineffective

OUTCOME #2:  Increased P verbal initiations as C read a story

     – P1 =  100%– highly effective

– P2 =  10% –ineffective

– P3 =  86.7% — fairly effective

OUTCOME #3:  Increased number of verbalization during a story retelling task

     – P1 =  100%– highly effective

– P2 =  93.8% — highly effective

– P3 =  88.2% — fairly effective

OUTCOME #4:  Rate of on-task behavior

     – P1 =  0% –ineffective

– P2 =  0% –ineffective

– P3 =  0% –ineffective

 

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. Reports of generalization were anecdotal.  Ps’ teachers and parents noted

•  Ps increased the number of spontaneous verbalizations during group activities

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate whether the communication skills of children with physical handicaps increased as the result of an intervention using music as a stimulus and as a reward.

POPULATION:  kindergarteners with physical handicaps  (New Zealand)

 

MODALITY TARGETED:  expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  responding to questions, spontaneous utterances, story retelling

 

OTHER TARGETS:  on-task behavior

DOSAGE:  individual sessions, number of sessions (including baseline that lasted 13-18 sessions and a 3-session reversal) = 24-34 sessions

 

ADMINISTRATOR:  probably a Music Therapist

 

STIMULI:  verbal, auditory (music = singing and instruments such as electric organ, drum, tambourine, shakers), visual

 

MAJOR COMPONENTS:

 

•  Focus:  using singing and music to support teaching of concepts and production of spontaneous speech

•  Stimulus Activities:

1.  Singing (accompanied by music and pictures) of nursery rhymes: Following the singing, C elicited from the P comments and answers to questions about the rhyme.

2.  Finger play songs: Cs used these to elicit verbalizations and facilitate memory/ sequential ordering.

3.  Old MacDonald had a Farm: C elicited animal sounds during the song and singing during the song. After singing, C provided pictures to the child to facilitate retelling of the narrative.

4.  Rhyme Production:  C and P spoke rhymes and then stories to the beat of a drum

•  Reinforcement:

–  When P responded appropriately to a task, he/she was praised and allowed to select a song or musical instrument for the following task.

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