**NATURE OF PROSODIC DISORDERS **

**ANALYSIS FORM**

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**Key:**

AS = Asperger syndrome

ASD = Autism Spectrum Disorder

HFA = High Functioning Autism

NA = not applicable

P = participant

PEPPER = *Programs to Examine Phonetic and Phonologic Evaluation Records *

pmh = Patricia Hargrove, blog developer

PVSP = *Prosody-Voice Screening Profile*

WNL = within normal limits

wpm = words per minute

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**SOURCE: **Shriberg, L. D., Paul, R., McSweeney, J. L., Klin, A., Cohen, D. J., & Volkmer, F. R. (2001). Speech and prosody characteristics of adolescents and adults with High-Functioning Autism and Asperger syndrome. *Journal of Speech, Language, and Hearing Research, 44, *1097-1115.

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**REVIEWER(S): **pmh

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**DATE:** December 27, 2014

**ASSIGNED GRADE FOR OVERALL QUALITY: **C+ (The highest possible grade, based on the design of the investigation was C+.)

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**POPULATION: **Autism Spectrum Disorders, High Functioning Autism, Asperger Syndrome; Adults, Adolescents

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**PURPOSE: **To describe the segmental and nonsegmental aspects of the conversational speech of adolescents and adults with High-Functioning Autism (HFA) and Asperger syndrome (AS). (This review will focus only on the nonsegmental/prosodic results of the investigation.)

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**INSIGHTS ABOUT PROSODY: **

- For the most part, speakers with AS and HFA present with similar prosodic pattern. However, both groups tend to differ from a comparison group of adolescent and adult males who are considered to be typical speakers (TS).
- The investigators found that the AS and/or HFA groups differed from the TS group on the following prosodic variables:

– Overall Phrasing errors such as

- sound repetition errors
- word repetition errors
- 1 word repetition errors

– Slow/pause time errors (within the Rate category)

– Overall Stress errors

– Excessive/equal/misplaced stress (within the Stress category)

– Too loud (within the Loudness category)

- The exceptions to the characterizations of similar prosody among speakers with AS and HAS are

– sound syllable repetitions (AS Ps produced significantly more)

– repetition and revision errors (AS Ps produced significantly more)

– slow articulation/pause errors (HFA Ps produced significantly more)

- Other features:

– The investigators provided a comprehensive and thoughtful review of the literature pertaining to the prosody of speakers who have been diagnosed with Autism Spectrum Disorders (ASD).

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Retrospective, Nonrandomized Group Comparison Design*What type of evidence was identified?*

*Group membership determination:*- If there were groups of participants were members of groups matched?
**Yes** - The matching strategy involved

- All the participants (Ps) were male.
- There were no significant differences for AS and HFA groups on the following variables:

– age

– average word per utterance

– performance on Intelligence tests, *Vineland Adaptive Behavior Scale, *and the *Test of Language Competence*

- There was not a significant difference between the typical comparison speakers (TS) and the AS and HFA speakers on the following variables:

– age

– number of words processed

*Was participants’ communication status concealed?*- from participants?
**No** - from assessment administrators?
**No** - from data analyzers?
**Unclear. Even if the analyzers were not informed of group identify, it is highly likely they would be able to distinguish TS from AS and HFA speakers on the basis of their spontaneous speech.**

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Yes*Were the groups/participants adequately described?*- How many participants were involved in the study?

**total # of participants:**83**was group membership maintained throughout the experiment?**Yes**# of groups:**3**List names of groups:**Asperger syndrome (AS), High-Functioning Autism (HFA), and Typical Speakers (TS)**# of participants in each group:**AS = 15, HFA = 15, TS = 53

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- The following variables were controlled and/or described:

- age:
**overall range was 10 – 49 years; mean AS age = 20.7; mean HFA age = 21.6; mean TS = 26.4** - gender:
**all Ps were male** - cognitive skills:
**all within normal limits (WNL);** - performance on language tests:
**Composite Score on Test of Language Competence: AS = 90.7; HFA = 88.4; TS not tested** - adaptive behavior:
**Composite Score: AS = 58.9; HFA = 55.3; TS not tested** - performance on
*Autism Diagnostic Observation Scale –Communication Subtest*:**AS = 3.7; HFA = 5.4; TS not tested (AS and HFA significantly different)** - performance on
*Autism Diagnostic Observation Scale –Socialization Subtest*:**AS = 9.9; HFA = 12.0; TS not tested (AS and HFA significantly different)**

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- Were the communication problems adequately described?
**Yes**

**disorder type: (List)**ASD, social language

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*What were the different conditions for this research?*- Subject (Classification) Groups?

**Yes: AS, HFA, TS**

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- Experimental Conditions?

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- Criterion/Descriptive Conditions?
**Yes: Performance on the***Prosody-Voice Screening Profile*(PVSP) and*Programs to Examine Phonetic and Phonologic Evaluation Records*(PEPPER)

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Yes*Were the groups controlled acceptably?*

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Yes*Were dependent measures appropriate and meaningful?*

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- The Prosody-Related Outcomes:

**Dependent Measure #1:**Percentage of utterances coded as prosodically appropriate on the PVS-**Dependent Measure #2:**Percentage of appropriate phrasing on the PVSP**Dependent Measure #3:**Percentage of sound/syllable repetition errors on the PVSP**Dependent Measure #4:**Percentage of word repetition errors on the PVSP**Dependent Measure #5:**Percentage of sound/syllable and word repetition errors on the PVSP**Dependent Measure #6:**Percentage of more than one repetition errors on the PVSP**Dependent Measure #7:**Percentage of sound/syllable repetition errors on the PVSP**Dependent Measure #8:**Percentage of one-word revisions on the PVSP**Dependent Measure #9:**Percentage of more than one word revisions on the PVSP**Dependent Measure #10:**Percentage of repetition and revision errors on the PVSP

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**Dependent Measure #11:**Percentage of appropriate rate on the PVSP**Dependent Measure #12:**Percentage of slow articulation/pause errors on the PVSP**Dependent Measure #13:**Percentage of slow/pause time errors on the PVSP**Dependent Measure #14:**Percentage of fast errors on the PVSP**Dependent Measure #15:**Percentage of fast/acceleration errors on the PVSP**Dependent Measure #16:**Percentage of appropriate stress on the PVSP**Dependent Measure #17:**Percentage of multisyllabic word stress errors on the PVSP**Dependent Measure #18:**Percentage of reduced/equal stress errors on the PVSP**Dependent Measure #19:**Percentage of excessive/equal/misplaced errors on the PVSP**Dependent Measure #20:**Percentage of multiple stress errors on the PVSP**Dependent Measure #21:**Percentage of appropriate loudness on the PVSP**Dependent Measure #22:**Percentage of too soft errors on the PVSP**Dependent Measure #23:**Percentage of too loud errors on the PVSP**Dependent Measure #24:**Percentage of appropriate pitch on the PVSP**Dependent Measure #25:**Percentage of low pitch/glottal fry errors on the PVSP**Dependent Measure #26:**Percentage of low pitch errors on the PVSP**Dependent Measure #27:**Percentage of high pitch/falsetto errors on the PVSP**Dependent Measure #28:**Percentage of high pitch errors on the PVSP**Dependent Measure #29:**Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Phrasing**Dependent Measure #30:**Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Rate**Dependent Measure #31:**Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Stress**Dependent Measure #32:**Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Loudness**Dependent Measure #33:**Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Pitch**Dependent Measure #34:**Words per minute (volubility)

- NON-PROSODIC OUTCOMES (these outcomes will not be analyzed or summarized in this review):

**Dependent Measure #35:**Percentage of appropriate laryngeal quality on the PVSP**Dependent Measure #36:**Percentage of breathiness errors on the PVSP**Dependent Measure #37:**Percentage of roughness errors on the PVSP**Dependent Measure #38:**Percentage of strained errors on the PVSP**Dependent Measure #39:**Percentage of break/shift/tremulous errors on the PVSP**Dependent Measure #40:**Percentage of register errors on the PVSP**Dependent Measure #41:**Percentage of diplophonia on the PVSP**Dependent Measure #42:**Percentage of multiple laryngeal feature errors on the PVSP**Dependent Measure #43:**Percentage of appropriate resonance quality on the PVSP**Dependent Measure #44:**Percentage of nasality errors on the PVSP**Dependent Measure #45:**Percentage of denasality errors on the PVSP**Dependent Measure #46:**Percentage of nasopharyngeal errors on the PVSP**Dependent Measure #47:**Percentage of excluded utterances on the PVSP**Dependent Measure #48:**Percentage of utterances excluded due to context issues (issue types were also compared)**Dependent Measure #49:**Percentage of utterances excluded due to environmental issues (issue types were also compared)**Dependent Measure #50:**Percentage of utterances excluded due to register issues (issue types were also compared)**Dependent Measure #51:**Percentage of utterances excluded due to state issues (issue types were also compared)**Dependent Measure #52:**Percentage Consonants Correct**Dependent Measure #53:**Percentage Vowels/Diphthongs Correct**Dependent Measure #54:**Percentage of Phonemes Correct**Dependent Measure #55:**Percentage of Consonants Correct –Revised**Dependent Measure #56:**Percentage Vowels/Diphthongs Correct–Revised**Dependent Measure #57:**Intelligibility Index**Dependent Measure #58:**Percentage of Ps with residual distortions**Dependent Measure #59:**Type of residual distortion errors**Dependent Measure #60:**Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Laryngeal Quality**Dependent Measure #61:**Percentage of HFA and AS Ps with more than 20% of their utterance coded as a fail on the PVSP for Resonance Quality

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**All**the dependent measures were subjective.

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**None of the**the dependent/ outcome measures were objective.

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*Were reliability measures provided?*- Interobserver for analyzers?
**Yes.**Interobserver reliability for PVSP coding ranged from 14.3% (stress coding) to 95.8%

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- Intraobserver for analyzers?
**Yes.**Intraobserver reliability for PVSP coding ranged from 46.7% (stress coding) to 94.5%

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- Treatment fidelity for investigators?
**Not Applicable**

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*Description of design:*

- The investigators coded preexisting spontaneous language samples using the PVSP.
- They compared the performances of the 2 clinical groups (HFA, AS) and the comparison group (TS) using nonparametric inferential statistics.
- The investigators also performed correlational analyses among cognitive, linguistic, and adaptive behavior functioning and prosody measures. (Because the correlations were generally nonsignificant and low to moderate, they received only limited attention in the paper and will not be discussed in the review.)

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*What were the results of the inferential statistical testing?*- The comparisons that are significant are bolded; the number in parentheses represents the page number of the article where the result can be found.

- Dependent Measure #1: Percentage of utterances coded as prosodically appropriate on the PVSP– :
**Percentage of appropriate utterances on the PVSP– Ps AS and Ps with HFA had significantly lower total percentages of appropriate responses in the PVSP than TS (p. 1106)**

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- Dependent Measure #2:
**Percentage of appropriate phrasing on the PVSP– Ps AS and Ps with HFA had significantly lower percentages of appropriate phrasing than TS (p. 1106)**

- Dependent Measure #3:
**Percentage of sound/syllable repetition errors on the PVSP—HFA Ps had significantly more utterances coded for this error than TS Ps (p. 1106); AS Ps had significantly more utterances coded for this error than HFA Ps (p. 1106)**

- Dependent Measure #4:
**Percentage of word repetition errors on the PVSP– HFA Ps had significantly higher more utterances coded for this error than TS Ps (p. 1106)**

- Dependent Measure #5: Percentage of sound/syllable and word repetition errors on the PVSP
- Dependent Measure #6: Percentage of more than one repetition errors on the PVSP
- Dependent Measure #7: Percentage of sound/syllable repetition errors on the PVSP

**Dependent Measure #8: Percentage of one word revisions on the PVSP– HFA Ps had significantly higher more utterances coded for this error than TS Ps (p. 1106)**

- Dependent Measure #9: Percentage of more than one word revisions on the PVSP

**Dependent Measure #10: Percentage of repetition and revision errors on the PVSP– AS Ps had significantly more utterances coded for this error than HFA Ps (p. 1106)**

- Dependent Measure #11: Percentage of appropriate rate on the PVSP –overall all 3 groups (HFA, AS, TS) had over 90% of their utterances coded for appropriate rate.

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**Dependent Measure #12: Percentage of slow articulation/pause errors on the PVSP—Ps with HFA had significantly more utterances coded for this error compared with AS and with TS (p. 1007)**

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**Dependent Measure #13: Percentage of slow/pause time errors on the PVSP Ps with HFA had significantly more utterances coded for this error compared with TS (p. 1007)**

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- Dependent Measure #14: Percentage of fast errors on the PVSP
- Dependent Measure #15: Percentage of fast/acceleration errors on the PVSP

**Dependent Measure #16: Percentage of appropriate stress on the PVSP–significantly more Ps with HFA and AS had inappropriate stress than TS (p. 1108); the 3 groups (HFA, AS, TS) differed significantly in the number of utterances codes as containing appropriate stress (p. 1107)**

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- Dependent Measure #17: Percentage of multisyllabic word stress errors on the PVSP
- Dependent Measure #18: Percentage of reduced/equal stress errors on the PVSP

**Dependent Measure #19: Percentage of excessive/equal/misplaced errors on the PVSP– Ps with HFA and AS had significantly more utterances coded for this error compared with TS Ps (p. 1007)**- Dependent Measure #20: Percentage of multiple stress errors on the PVSP
- Dependent Measure #21: Percentage of appropriate loudness on the PVSP –overall more than 90% of utterances for all 3 groups (AS, HFA, TS) were coded as appropriate (p. 1107)
- Dependent Measure #22: Percentage of too soft errors on the PVSP

**Dependent Measure #23: Percentage of too loud errors on the PVSP – AS and HFA Ps were more likely to be coded with this error than TS Ps )**

- Dependent Measure #24: Percentage of appropriate pitch on the PVSP– overall more than 90% of utterances for all 3 groups (AS, HFA, TS) were coded as appropriate (p. 1107)
- Dependent Measure #25: Percentage of low pitch/glottal fry errors on the PVSP
- Dependent Measure #26: Percentage of low pitch errors on the PVSP
- Dependent Measure #27: Percentage of high pitch/falsetto errors on the PVSP
- Dependent Measure #28: Percentage of high pitch errors on the PVSP

**Dependent Measure #29: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Phrasing–****significantly more AS Ps produced utterances with inappropriate stress than TS Ps (p. 1108)**

- Dependent Measure #30: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Rate

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**Dependent Measure #31: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Stress—significantly more HFA and AS Ps produced utterances with inappropriate stress than TS Ps (p. 1108)**

- Dependent Measure #32: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Loudness
- Dependent Measure #33: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Pitch

**Dependent Measure #34: Words per minute–WPM (volubility)****–Ps with AS produced significantly more WPM than Ps with HFA. (Investigators did not analyze this measure for TS Ps.)**

- What were the statistical tests used to determine significance? List the outcome number after the appropriate statistical test:
**Kruskal-Wallis, Wilcoxon-Mann-Whitney, Tests of Proportion**

- Were effect sizes provided?
**No**

- Were confidence interval (CI) provided?
**No**

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Some correlational testing was reported but it was not a major focus of the investigation and will not be reviewed here.*What were the results of the correlational statistical testing?*

*What were the results of the descriptive analysis?*

For Dependent Measure #19: Percentage of excessive/equal/misplaced errors on the PVSP–

The following results were not subjected to inferential testing but the investigators described differences in AS and HFA groups pertaining to the types of errors in the excessive/equal/misplaced stress subcode:

– Ps with HFA (39% of all codes for this error type) were more likely to produce word stress errors than AS Ps (22% of all codes for this error type)

– Ps with AS (54% of all codes for this error type) were more likely to produce prolongation errors than HA Ps (32% of all codes for this error type)

– Both HFA (25% of all codes for this error type) and AS (20% of all codes for this error type) were relatively unlikely to produce blocks (p. 1107)

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