Whipple (2004)

 

SECONDARY REVIEW CRITIQUE

 

NOTE:  Scroll down abou 1/3  of the way down to read the summary of the intervention procedures

 

SOURCE:  Whipple, J. (2004).  Music in intervention for children and adolescents with autism: A meta-analysis.  Journal of Music Therapy, 41, 90-106.

 

REVIEWER(S):  pmh

 DATE:   February 28, 2014

LEVEL OF EVIDENCE:  B

 ASSIGNED OVERALL GRADE:  B

TAKE AWAY:  This meta-analysis supports the effectiveness of music therapy (pitch and rhythm) for the improvement of a variety of skills (i.e., communication, social/behavioral skills, cognition.)                                                                                                         

What type of secondary review?  Meta Analysis

1.  Were the results valid? Yes

a.  Was the review based on a clinically sound clinical question?  Yes

b.  Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)?  Yes

c.  Authors noted that they reviewed the following resources:  

•  conference posters 

•  references from identified literature

•  theses/dissertations 

•  specified journals

d.  Did the sources involve only English language publications?  Yes

e.  Did the sources include unpublished studies?  Yes

f.  Was the time frame for the publication of the sources sufficient?  Yes

g.  Did the reviewers identify the level of evidence of the sources?  No

h.  Did the reviewers describe procedures used to evaluate the validity of each of the sources?  No

i.  Was there evidence that a specific, predetermined strategy was used to evaluate the sources?  Yes

j.  Did the reviewers or review teams rate the sources independently?  No

k.  Were interrater reliability data provided?  No

l.  If the reviewers provided interrater reliability data, list them:  NA

m.  If there were no interrater reliability data, was an alternate means to insure reliability described?  No

n.  Were assessments of sources sufficiently reliable?  Not applicable

o.  Was the information provided sufficient for the reader to undertake a replication?  Yes

p.  Did the sources that were evaluated involve a sufficient number of participants?  Unclear/Variable

q.  Were there a sufficient number of sources?  Yes

2.  Description of outcome measures:

•  Outcome #1:  reduction of challenging behaviors

•  Outcome #2:  improve rate of correct responses to directions involving gross motor completion tasks

•  Outcome #3:  improve accuracy on a computer task

•  Outcome #4:  improved use of communication acts

Outcome #5:  increase rate of correct responses to directions involving shapes and the accurate identification of shapes

•  Outcome #6:  increase score on a formal test of receptive vocabulary  (Peabody Picture Vocabulary Test)

•  Outcome #7:  increase appropriate pointing to and looking at stimuli during songs

•  Outcome #8:  improve eye contact and verbalization

•  Outcome #9:  increase rate of spontaneous speech

•  Outcome #10:  increase eye contact, initiation, and social acknowledgement

•  Outcome #11:  to eye contact and communicative acts

•  Outcome #12:  to decrease the rate of self-stimulatory behaviors

 

 

3.  Description of results:           

a.  What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size?

•  standardized mean difference (d)

•  confidence interval

b.  Summarize overall findings of the secondary review:

Overall, the results were positive. All the outcomes improved with d ranging from 0.09 (negligible) to 3.36 (large) and  mean of 0.83 (large). In addition, the confidence interval did not cross zero. The investigators removed the largest positive outcome (3.36) because it was a statistical outlier. The results remained strong and positive. The effect size of 3 of the outcomes was small (0.20-0.49), 4 were moderate (0.50-.079), and 6 were large (>0.80)

c.  Were the results precise?  Yes

d.  If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? Yes

e.  Were the results of individual studies clearly displayed/presented?  Yes

f.  For the most part, were the results similar from source to source?  Yes

g.  Were the results in the same direction?  Yes 

h.  Did a forest plot indicate homogeneity?  Not Applicable

i.  Was heterogeneity of results explored?  Yes 

j.  Were the findings reasonable in view of the current literature?  Yes

k.  Were negative outcomes noted?  No, there were no negative outcomes.

 

4.  Were maintenance data reported?  No

 

 

SUMMARY OF INTERVENTION

 

Prosodic Targets:   none

Nonprosodic Targets:

 

•  reduction of challenging behaviors

•  rate of correct responses to directions involving gross motor completion tasks, shapes

•  accuracy on a computer task

•  use of communication acts

•  accurate labeling of shapes

•  score on a formal test of receptive vocabulary

•  appropriate pointing to and looking at stimuli during songs

•  eye contact

•  verbalization

•  spontaneous speech

•  initiation

•  social acknowledgement

•  rate of self-stimulatory behaviors

Aspects of Prosody Used in Treatment of Nonprosodic Targets:  The interventions involved music therapy that included at least pitch and rhythm activities.

 

 

DESCRIPTIONS OF PROCEDURES:  The investigator provided only brief information about each intervention.  I have included the sources associated with each approach to facilitate reader’s access to the original sources.

Description of Procedure #1—(Social Stories Set to Music)

•  Brownell (2002) and Pasiali (2002)

•  Individual sessions

•  Used a Developmental Social-Pragmatic (DSP) strategy focusing on activities of daily living, following the child’s lead, responding to the child’s communicative attempts, interpreting atypical behaviors as communicative if the evidence supports it, focusing on the child’s strengths, and assisting the child in regulating and expressing affect.

  C presented social stories using live music and encouraged the P’s active involvement.

•  The songs were either standards selected by C or P-preferred music.

 

Evidence Supporting Procedure/Source #1—(Social Stories Set to Music)

•  The effect sizes were 0.67 and 0.52  (both moderate improvement.)

 

 

Description of Procedure #2—(Sung Instructions)

•  Carroll (1983) and Laird  (1997)

•  Individual sessions

•  Used a Discrete Trial-Traditional Behavioral (DT-TB) intervention strategy.  Although activities of daily living were targets, they were presented in massed trials in environments with minimal distractions. Generally, trials consisted of a stimulus presented by C, the P’s response, and reinforcement and/or feedback by C.

•  Using live original or children’s music, C presented songs containing instructions and encouraged the child’s active involvement.

 

Evidence Supporting Procedure/Source #2—(Sung Instructions)

•  Effect sizes were 0.38 and 0.79 (small to moderate improvement.)

 

 

Description of Procedure/Source #3—(Background Music)

  Clauss (1994), Wood (1991), Litchman (1976)

•  Individual or group sessions

•  Clauss (1994) use a Contemporary Applied Behavioral Analysis (CABA) strategy.  In CABA, C reinforces targeted responses but focuses on P’s  communicative initiations, P’s interests and preferences, and limits structure.

•  Wood (1991) used DSP strategy.  DSP is the Developmental Social-Pragmatic strategy that focuses on activities of daily living, following the child’s lead, responding to the child’s communicative attempts, interpreting atypical behaviors as communicative when supported by the evidence, focusing on the child’s strengths, and assisting the child in regulating and expressing affect.

•  Litchman (1976) used a DT-TB. DT-TB is the Discrete Trial-Traditional Behavioral intervention strategy. Although activities of daily living were targeted, the targets were presented in massed trials in environments with minimal distractions. Generally, trials consisted of a stimulus presented by C, the P’s response, and reinforcement and/or feedback by C.

•  C provided background music during the DT-TB, CABA or DSP sessions.

•  In all cases, the P’s involvement in the music was considered to be passive.

•  Clauss used live piano music, Wood used recordings of Baroque and Hemi-Sync music, and Litchman used recordings of children’s music.

 

Evidence Supporting Procedure/Source #3—(Background Music)

•  Two of the sources targeted 2 outcomes each and one source targeted one outcome.

•  The effect size of four outcomes were positive 0.29 (small), 0.42 (small), 0.95 (large), and 1.71 (large).

 

Evidence Contraindicating Procedure/Source #3—(Background Music)

•  One effect size was minimal – 0.09.

 

 

Description of Procedure/Source #4—(Picture Identification and Direction Following)

•  O’Loughlin (2000)

•  Individual sessions

•  Used a CABA strategy.  CABA involves reinforcing targeted responses but focusing on P’s communicative initiations, P’s  interests and preferences, and limits structure.

•  C presented pre-recorded language based songs and encouraged P’s active involvement.

 

Evidence Supporting Procedure/Source #4——(Picture Identification and Direction Following)

•  There were two outcomes; the effect sizes were  0.83 (large) and 0.62 (moderate).

 

Description of Procedure/Source #5—(Reinforcer was a music therapy session)

•  Watson (1979)

•  Individual sessions

•  Used a CABA strategy.  CABA involves reinforcing targeted responses but focusing on P’s communicative initiations, P’s interests and preferences, and limits structure.•

•  C presented a therapy session using live, rhythm instruments. C encouraged P’s active involvement.

 

Evidence Supporting Procedure/Source #5—(Reinforcer was a music therapy session)

• The effect size was 1.19 (large.)

 

Description of Procedure #6—(Several Music Therapy Sessions)

•  C administered several music therapy sessions.

•  Individual sessions

•  Used a DSP strategy.  DSP is the Developmental Social-Pragmatic strategy that focuses on activities of daily living, following the child’s lead, responding to the child’s communicative attempts, interpreting atypical behaviors as communicative when supported by evidence, focusing on the child’s strengths, and assisting the child in regulating and expressing affect.

•  C encourages P to participate actively in musically accompanied games, movements, and singing.

 

Evidence Supporting Procedure #6—(Several Music Therapy Sessions)

•  Effect size is 3.36 (large).

 

Evidence Contraindicating Procedure #6—(Several Music Therapy Sessions)

•  This source was removed from the overall meta-analysis as an outlier. The effect size was more than 2 standard deviations above the other sources.

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