Holck (2004)


Single Subject Designs


Note: The summary can be viewed by scrolling about two-thirds of the way down on this page.


SOURCE: Holck, U. (2004). Turn-taking in music therapy with children with communication disorders. British Journal of Music Therapy, 2, 45-53.




DATE: April 12, 2014


ASSIGNED OVERALL GRADE: D- (Due to the case study design, D+ is the highest possible assigned overall grade.)


TAKE AWAY: Due to the nature of the design, the support for this intervention is weak. Nevertheless, the investigator provides a thoughtful guide for using music to facilitate turn taking with a Danish speaking child who did not show interest in interactions and did not signal communicative intent.


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 StudiesDescription with Pre and Post Test Results

  • Single Subject Experimental Design with Specific Client   

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? No

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

b. The following characteristics/variables were described:

• age: 2 ½ years

• gender: M

• cognitive skills: moderate learning disabled  

• sensory skills: tended to be overwhelmed by sensory stimulation

4c. Were the communication problems adequately described? No

• The disorder types was language impairment.

• Other aspects of communication that were described included

— imitated and played with speech sounds

— did not display communicative intent

— did not point or show interest in give and take game

— had few words that were only spoken with mother


5. Was membership in treatment maintained throughout the study? Not applicable, there was only one P.

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, no baseline/preintervention data were provided.

b. Did probes/intervention data include untrained data? No, no probe /intervention data were provided.

c. Did probes/intervention data include trained data? No, no probe /intervention data were provided.

d. Was the data collection continuous? No, no probe /intervention data were provided.

e. Were different treatment counterbalanced or randomized? Not Applicable


7. Were the outcomes measure appropriate and meaningful? Unclear, the investigator’s definition of outcome measures were not clear but they appeared to be more closely tied to music than conversation.

a. The outcomes were

OUTCOME #1: To increase the rate of appropriate turn yielding and taking

OUTCOME #2: To improve preverbal and social skills

(continue numbering as needed)



8. Results:

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

b. The overall quality of improvement for each of the outcomes is difficult to discern because the investigator did not provide sufficient data. The ratings listed below are estimates:

• OUTCOME #1: To increase the rate of appropriate turn yielding and taking–limited

• OUTCOME #2: To improve preverbal and social skills—limited



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?



13. Were generalization data reported? No








PURPOSE: To explain and illustrate how music therapy and turn analysis can be used to improve preverbal and social skills.


POPULATION: language disorder (limited social and verbal communication); child





ELEMENTS OF PROSODY USED AS INTERVENTION: music (rhythm, pauses, intonation, stress, pitch)




DOSAGE: 6 sessions (length and frequency were not specified)


ADMINISTRATOR: music therapist




• 6 sessions


– Session 1:

• C assisted P (for safety) as he bounced on a large physical therapy ball. This was an activity that P liked. C and P sat side-by-side in front of a mirror.

• While P was bouncing, C sang lines from familiar songs or sang descriptions of P’s actions.

• Occasionally, C would sing a line about stopping and would physically stop P’s bouncing.

• After a brief interval, C would sing a phrase indicating that C could begin bouncing again and allowed him to continue bouncing again.


– Session 2 and 3:

• During Session 2, P spontaneously vocalized in an excited manner with his vocalizations moving from one pitch to the next (glissando). When C attempted to join him, he stopped.

• When he next used glissando, C interrupted him and then handed the turn over to him by

1. singing a short (3 note) glissando ,

2. stressing the last note (a common strategy for yielding a turn in conversation),

3. C shortened P’s glissisandi by interrupting him at progressively shorter intervals.

4. P was allowed to keep bouncing during the glissandi work as long as he maintained attention or and his speech sounds were not “diffuse” (?, not sure what this is, pmh). In such cases, C sang the song directing him to stop and physically stopped him.

• During these sessions, C moved to the floor and asked P’s mother to hold him. C introduced the guitar playing a repetitious sequence of chords which provided a rhythm to replace the bouncing.


– Sessions 4, 5, and 6

• At this point, P was regularly using short 3 notes, sung in a “favorite” key, ending in a rising then falling terminal contour.

• C and P imitated speech sounds, included sounds that sounded like Danish words.



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