McCann & Peppé (2003)

NATURE OF PROSODIC DISORDERS
ANALYSIS FORM

Note: Key–
AS = Asperger’s syndrome
ASD = Autism Spectrum Disorder
Nongrammatical pauses = hesitation or intraphrase pauses
P = participant
pmh = Patricia Hargrove, the blog developer
TD = typically developing

SOURCE: McCann, J., & Peppé, S. (2003). Prosody in autism spectrum disorders: A critical review. International Journal of Language and Communication Disorders, 38, 325-350.

REVIEWER(S): pmh

DATE: July 13, 2014

ASSIGNED GRADE FOR OVERALL QUALITY: B (The highest possible grade was B. This well written critical review had many, but not all, qualities of a classic systematic review.)

POPULATION: Autism Spectrum Disorders (ASD)

PURPOSE: to review the extant literature to determine if there is evidence for a prosodic disorder among speakers with autism including High Functioning Autism (HFA) and Asperger’s syndrome (AS)

INSIGHTS ABOUT PROSODY:
• The authors were not able to identify a single prosodic disorder or patterns of disordered prosody in their critical review of the research concerned with ADS.
• In fact, there was considerable variability, or even conflict, among the existing research.
• The authors suggested that this could be due, at least in part, to methodological differences.
• The authors reviewed research concerned with expressive and receptive prosodic function (stress, phrasing/chunking, affect) and form (intonation patterns), prosodic change, neurological processing of prosody, and echolalia.

1. What type of evidence was identified? Systematic Review

What type of secondary review? Narrative Systematic Review

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: internet based databases
d. Did the sources involve only English language publications?
e. Did the sources include unpublished studies?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? No
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: Not Applicable
m. If there were no interrater reliability data, was an alternate means to insure reliability described? No
n. Were assessments of sources sufficiently reliable? Unclear
o. Was the information provided sufficient for the reader to undertake a replication? No
p. Did the sources that were evaluated involve a sufficient number of participants? No, for the most part.
q. Were there a sufficient number of sources? Yes (overall but not for the specific aspects of prosody)

2. Description of outcome measures:
• Outcomes Associated with stress:
– PRODUCTION OUTCOMES–contrastive stress in conversation, contrastive stress in an elicited task; sentence stress in an elicited task; number and accuracy of stressing in read and imitated sentences; sentence, contrastive, and lexical stress in conversation
– RECEPTIVE OUTCOMES–lexical stress
• Outcome Associated with phrasing/chunking: placement of boundaries in spontaneous speech, occurrence of grammatical and nongrammatical pauses in narratives, occurrence of nongrammatical pauses in reading and imitation, phrasing errors in spontaneous speech, comprehension of grammatical phrasing
• Outcome Associated with affect: judgment of affect of sentences, judgment of excited or calm state in sentences
• Outcome Associated with intonation patterns: frequency range, terminal fall, intonation contour, declination effect, and covariance of frequency and intensity of spontaneous declarative sentences, differentiation of minimal pair sentences as declarative or interrogative
• Outcomes Associated with prosodic change: preference for one of 4 readings differing in prosody
• Outcome Associated with neurological processing of prosody: P3 responses on an EEG, location of processing using fMRI
• Outcome Associated with echolalia: communicative function of prosody in echolalia

3. Description of results:

a. What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? (Place an X next to all that apply) NA, the authors did not provide EBP measures

b. Summarize overall findings of the secondary review:
• The findings from the different sources were contradictory.
• In addition, differences in participant characteristics, elicitation contexts, and dependent measures make it difficult to identify prosodic patterns associated with ASD.
• Nevertheless, speakers with ASD appear to struggle with all forms of stressing- lexical, sentence, and contrastive. Studies concerned with the pausing aspect of phrasing/chinking, affect, and intonation are sparse and contradictory.
• The results for the various measures of prosody were
1. Outcomes Associated with stress:
– PRODUCTION OUTCOMES—
• contrastive stress in conversation (atypical),
• contrastive stress in an elicited task (double the number of misassignments of stress—most likely to be excess stresses);
• sentence stress in an elicited task (not significantly different from TD peers);
• number and accuracy of stressing in read and imitated sentences (more misassignments);
• sentence (lower than TD), contrastive (lower than TD), and lexical (lower than TD) stress in conversation
– RECEPTIVE OUTCOMES–lexical stress (HFA lower scores)

2. Outcome Associated with phrasing/chunking:
– placement of boundaries in spontaneous speech (grammatical pauses were similar to TD peers and ASD Ps used fewer nongrammatical or hesitation pauses),
– occurrence of grammatical and nongrammatical pauses in narratives (grammatical pauses were similar to TD peers and ASD Ps used fewer nongrammatical or hesitation pauses),
– occurrence of nongrammatical pauses in reading (more likely to add nongrammatical pauses) and imitation (trouble imitating chunking/phrasing pattern),
– phrasing errors in spontaneous speech (40% of ASD Ps exhibited phrasing/chunking errors but this may have represented dysfluencies),
– comprehension of grammatical phrasing (HFA Ps performed more poorly than TD peers)

3. Outcome Associated with affect:
– judgment of affect of sentences (adult ASD and HFA Ps performed more poorly than typical peers),
– judgment of excited or calm state in sentences (HFA and TD peers were highly successful on this task)

4. Outcome Associated with intonation patterns:
– frequency range (although Ps with AS were not significantly different from TD peers, their ranges tended to be very narrow or very broad). The authors did not report on the following measures terminal fall, intonation contour, declination effect, and covariance of frequency and intensity of spontaneous declarative sentences;
– differentiation of minimal pair sentences as declarative or interrogative (in reading, interrogatives of Ps with AS sounded like declaratives; imitation was better than reading for Ps with AS but their performance was correlated with severity of AS and sentence length)

5. Outcomes Associated with prosodic change: preference for one of 4 reading differing in prosody [prerformed like TD children and children with cognitive impairments. That is, Ps with ASD did not display a preference among the following reading styles—natural, monotone, staccato, and metronome (monotone and unstressed)].

6. Outcome Associated with neurological processing of prosody:
– P3 responses on an EEG (adults with ASD did not differ from typical adults)
– location of processing using fMRI (specific areas of activation differed for linguistic but not affective prosody)

7. Outcome Associated with echolalia: communicative function of prosody in echolalia (in a case study a young P with HFA tended to echo prosody and segments when asked a question)

c. Were the results precise? No
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? Not Applicable
e. Were the results of individual studies clearly displayed/presented? Yes
f. For the most part, were the results similar from source to source?
g. Were the results in the same direction? No
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? Yes

4. Were maintenance data reported? Not Applicable

5. Were generalization data reported? Not Applicable

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