Lee (2008)

EBP THERAPY ANALYSIS for
Single Subject Designs

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

Key:
ADHD = Attention Deficit Hyperactivity Disorder
ASD = Autism Spectrum Disorder
C = Clinician
Nan-Hu = a traditional, 2 string musical instrument
P = participant or patient
pmh = Patricia Hargrove, blog developer

SOURCE: Lee, L. L. (2008). Music enhances attention and promotes language ability in young special needs children. In L. E. Schraer-Joiner & K. A. McCord (Eds.), Selected Papers from the International Seminars of the Commission on Music in Special Education, Music Therapy, and Music Medicine (pp. 34- 45). Malvern, Victoria, Australia. Malvern, Victoria, Australia: International Society for Music Education.
Paper—http://issuu.com/official_isme/docs/2006-2008_specialed_proceedings/41

REVIEWER(S): pmh

DATE: July 2, 2014

ASSIGNED OVERALL GRADE: B- (The highest possible grade was A- because of the experimental design of the investigation.)

TAKE AWAY: This multiple baseline investigation demonstrates the effectiveness music therapy in improving attention and language in developmentally delayed children from Taiwan who were speakers of Mandarin Chinese. The investigator provided a clear description of the phases of treatment.

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 Clients:- Multiple Baseline
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 described
• age: 4 to 5 years
• gender: 2 m; 1 f
• cognitive skills: all developmental delays and one each of ASD, ADHD, and Down syndrome
• expressive language: at baseline—“no language ability (1P); no words (1P); did not want to speak and speech was unclear (1P)
c. Were the communication problems adequately described? Yes___ No _x__
• List the disorder type(s): language impairment, speech sound impairment
• List other aspects of communication that were described:
–At baseline, the author described the expressive language of each of the P’s”
– “no language ability (1);
– no words (1);
– did not want to speak and speech was unclear (1)

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? Varied. I would have liked to see data describing change or lack of change when a target was not being treated (other than baseline). Figure 2 may have contained some of this information but I needed more explanation of the figure.
a. Were baseline data collected on all behaviors? Yes
b. Did probes data include untrained data? Yes
c. Did probes data include trained data? No
d. Was the data collection continuous? Unclear, some data were collected throughout the investigation (Figure 2) but I could not interpret them. For example, I was not sure what the target objectives during baseline were and I did not know what the 1-8 scale represented. Also, I think the investigator only collected data on an outcome/target during the time it was targeted in intervention.
e. Were different treatment counterbalanced or randomized? Not Applicable, there was only one treatment.

7. Were the outcomes measure appropriate and meaningful? Yes
a. The outcomes of interest were
OUTCOME #1: Improve attention span
OUTCOME #2: Produce speech sounds
OUTCOME #3: Produce words
OUTCOME #4: Produce simple sentences
b. All of the outcomes were subjective.
c. None of the outcomes were objective.
d. All of the outcome measures were supported by reliability data.
e. The interobserver reliability data supporting each outcome measure–
OUTCOME #1: Improve attention span = .8691
OUTCOME #2: Produce speech sounds = .8444
OUTCOME #3: Produce words = .7619
OUTCOME #4: Produce simple sentences = .9096

8. Results:
a. Did the target behavior improve when it was treated? Yes
b. The overall quality of improvement was
OUTCOME #1: Improve attention span—all Ps improved markedly from pre to posttest (i.e., strong improvement)
OUTCOME #2: Produce speech sounds—all Ps improved markedly from pre to posttest (i.e., strong improvement)
OUTCOME #3: Produce words—all Ps improved markedly from pre to posttest (i.e., strong improvement)
OUTCOME #4: Produce simple sentences—all Ps improved markedly from pre to posttest (i.e., strong improvement)

9. Description of baseline:
a. Were baseline data provided? Yes
Because the baselines were staggered, each P had a different number of baselines.
P1: 4 sessions
P2: 6 sessions
P3: 8 sessions
(continue numbering as needed)

b. Was baseline low (or high, as appropriate) and stable? (The numbers should match the numbers in item 7a.)
OUTCOME #1: Improve attention span—low, stability not described
OUTCOME #2: Produce speech sounds—low, stability not described
OUTCOME #3: Produce words—low, stability not described
OUTCOME #4: Produce simple sentences—low, stability not described

c. What was the percentage of nonoverlapping data (PND)? Not applicable, insufficient data.

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? Yes. Baseline data were collected by observers in the classroom. Ps improved markedly on all outcomes from pre to post test which were administered by a pediatric physician.

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

SUMMARY OF INTERVENTION

PURPOSE: to investigate the effectiveness of music therapy on attention and language production in speech needs children

POPULATION: developmental delay, language impairment, speech sound impairment (Mandarin Chinese)

MODALITY TARGETED: expressive

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm (music)

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: vocalization, speech sounds, single words, simple sentences

OTHER TARGETS: attention

DOSAGE: 20 weeks, one hour per week

ADMINISTRATOR: Music Therapist

STIMULI: musical instruments, recorded music,

MAJOR COMPONENTS:

• Four phases of intervention:
1. Improving attention
2. Sound making/vocalizing
3. Producing single words
4. Producing simple sentences

• Overview of intervention:
– Prior to the intervention, the investigator administered baseline sessions and provided a free play session in which each P was allowed to select a favorite musical instrument.
– Each P selected a different instrument: rattles, drums, and hand bells.

• Phase1. Improving attention
– Goal: facilitate attention using musical instruments
– Steps:
1. Hello Song (C played a guitar song at the beginning of each session)
2. Attendance Song (C played P’s favorite instrument)
3. Musical Story Telling (C told story with sound effect instruments)
4. Relaxation Period (C played instrumental music which she had recorded)
5. Goodbye Song (C played a guitar song at the end of each session).

• Phase 2. Sound making/vocalizing
– Goal: facilitate the production of speech sounds (vocalizations)
– Steps:
1. Hello Song (C played and sung a guitar song and encouraged P to imitate the singing by vocalizing.)
2. Attendance Song (C played P’s favorite instrument. C encouraged P to imitate the instrument vocally.)
3. Sound Games [C played the Nan-Hu and encouraged P to imitate by vocalizing. C also played wind instruments (e.g., recorder, slide-whistle) and encouraged P to vocalize using approximations of lip shapes.]
4. Relaxation Period (C played soft music while P attempted to rest.)
5. Good-bye Song [C played a guitar song and sang a “soft sound song” (?) at the end of each session].

• Phase 3. Producing single words
– Goal: facilitate the production of single word utterances
– Steps:
1. Hello Song (C played and sung a guitar song and encouraged P to imitate a single word.)
2. Attendance Song (C played P’s favorite instrument. C encouraged P to imitate the instrument vocally using at least a single sound.)
3. Sound Games (C played the Nan-Hu and encouraged P to imitate the instrument and produce nonsense sounds.)
4. Relaxation Period (C played the guitar and sang a lullaby while P attempted to rest.)
5. Good-bye Song (C played a guitar song at the end of each session and P produced a single word from the song).

• Phase 4. Producing simple sentences
– Goal: facilitate the production of simple sentences
– Steps:
1. Hello Song (C played and sung a guitar song and encouraged P to imitate a simple greeting phrase.)
2. Attendance Song [C played P’s favorite instrument and sang a song. P produced a phrase (“Here I am”) in response to a prompt in the song.]
3. Singing Activities, Movement and Musical Storytelling [C played a variety of instruments (e.g., recorder, slide-whistle, sound effect instrument, bells, etc.) while telling a story. C encouraged P to imitate and then produce simple sentences.]
4. Relaxation Period (C played recorded soft music while P attempted to rest.)
5. Good-bye Song (C played a guitar song at the end of each session and P produced a simple greeting such as “See you” or “Good-bye”).

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