EBP THERAPY ANALYSIS for
Single Subject Designs
Note: The summary of the intervention procedure(s) can be viewed by scrolling about two-thirds of the way down on this page.
C = Clinician
EBP = evidence-based practice
NA = not applicable
P = Patient or Participant
pmh = Patricia Hargrove, blog developer
SLP = speech–language pathologist
SOURCE: Saperston, B. (1973). The use of music In establishing communication with an autistic mentally retarded child. Journal of Music Therapy, 10, 184-188.
DATE: January 11, 2015
ASSIGNED OVERALL GRADE: D- (The highest possible grade was D+.)
TAKE AWAY: This descriptive case study, with limited data, describes a music therapy approach to initiating communication interactions with an 8 year-old, nonverbal, cognitively impaired boy who had been diagnosed with autism. The investigator details an intervention in which by following the child’s lead he was able to help the child establish a link between the child’s actions and the music played by the music therapist and eventually establish eye contact and beginning forms of interpersonal communication.
- What was the focus of the research? Clinical Research
- What type of evidence was identified?
- What type of single subject design was used? Case Study- Description of the course of treatment with a single participant (P)
- What was the level of support associated with the type of evidence? Level = D+
- Was phase of treatment concealed
- from participants? No
- from clinicians? No
- from data analyzers? No
- Was the participant adequately described? No
- How many participants were involved in the study? 1
- The following characteristics were described:
- age: 8 years old
- gender: m
- cognitive skills: 27 “social quotient”
- expressive language: nonverbal
- Were the communication problems adequately described? No
- The disorder type was nonverbal
- Other aspects of communication that were described:
– C did not observe any communicative behavior by P or any relating to people or objects
– no eye contact
– P usually sat on the floor with his head near his knees and his eyes shut. At times, P rocked or walked across the room and sat down again on the floor.
- Was membership in treatment maintained throughout the study? Not applicable (NA)
- If there was more than one participant, did at least 80% of the participants remain in the study? NA
- Were any data removed from the study? The investigator did not provide
- Did the design include appropriate controls? No. However, the investigator noted that no one else worked with P during the 18 months of intervention
- Were baseline/preintervention data collected on all behaviors? No. There were no baseline data.
- Did probes/intervention data include untrained data? No. There were no probes.
- Did probes/intervention data include trained data? No. There were no probes.
- Was the data collection continuous? NA
- Were different treatment counterbalanced or randomized? NA
- Were the outcomes measures appropriate and meaningful? Yes
- The outcomes were
Note: The outcomes were changed as P made progress. The clinician (C) followed P’s lead when determining when to change outcomes. The overall purpose of the intervention was to establish communication with P using music
OUTCOME #1: C improvised on the piano without requiring specific responses from P
OUTCOME #2: P had to produce some movement for C to play music (i.e., P could cause music to start and stop.)
OUTCOME #3: P responded to C’s playing a chord and singing “Hello, (P’s name)”
OUTCOME #4: P controlled changes In music played by C using select motor movements.
OUTCOME #5: to increase eye contact
- All of the outcomes were subjective: All
- None of the outcomes were objective: None
- The investigator did NOT provide reliability data for the outcome measures.
- Did the target behavior improve when it was treated? Yes
- b. For each of the outcomes, list the overall quality of improvement:
- This reviewer cannot make a judgment about the quality of improvement because no data were provided. That is, the investigator only made general statements about outcomes such as “something very exciting happened ….”, followed by a description of a P behavior.
- However, the investigator modified outcomes as P made progress. Therefore, the following may be offered as evidence of improvement:
OUTCOME #1: (C improvised on the piano without requiring specific responses from P): Sessions 1-3: P did not appear to change his behavior relative to the music.
OUTCOME #2: [P had to produce some movement for C to play music (i.e., P could cause music to start and stop.)]: Actually, the first session when C initiated this change, C played for 10 minutes without requiring a change. Sessions 4-19—P did not appear to link music and movement; in session 20 he make the link by laughing and stomping which appeared to be intentional to the investigator.
OUTCOME #3: [P responded to C’s playing a chord and singing “Hello, (P’s name)”]. During the 4th month of intervention, P began to look at C while he was at the piano. C began to sing “Hello, (P’s name)” during this time. Gradually, the frequency of P’s glances at C increased and P began smiling at C.
OUTCOME #4: (P controlled changes in music played by C using select motor movements.) P introduced this step during Months 5 and 6: P could change the timing and intensity of the music by modifying his movements. He exhibited the ability to control music playing and would often laugh, glance briefly at C, and smile. By month 10 he was moving about the whole room and would happily sit by C at the piano. The investigator noted at the end of 18 months P was beginning to vocalize.
OUTCOME #5: (to increase eye contact): Starting about Month 10, C held P’s head in his hands and sang his name for 10 minutes. By the next month, P appeared to enjoy this activity. C then sang P’s name contingent on direct eye contact. Over the next 2 months, the time that P sustained eye contact increased to 1 minute. C administered this step for only 10 minutes of each session. Other outcomes were targeted during the rest of the session,
- Description of baseline:
- Were baseline data provided? No
- What was the magnitude of the treatment effect? NA
- Was information about treatment fidelity adequate? Not Provided _____
- Were maintenance data reported? No
- Were generalization data reported?
OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: ____D-_____
SUMMARY OF INTERVENTION
PURPOSE: To describe an intervention for establishing initial communication skills using music therapy
POPULATION: Autism Spectrum Disorders, Cognitive Impairment; Children
MODALITY TARGETED: production
ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm, loudness, pitch, tempo (music)
OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: eye contact, interaction–begin
DOSAGE: 30 minute sessions, 3 times a week, for 18 months:
Sessions #1-19 involved 7-10 minutes of musical interaction. The remainder of the time, the P did not interact or move
Sessions #w20 – to about Month 4 of treatment: musical interaction increased to about 15 minutes of the session
Sessions from the 10 month of treatment: 30 minutes of interaction
ADMINISTRATOR: music therapist (C)
STIMULI: auditory (music)
OUTCOME #1: C improvised on the piano without requiring specific responses from P
OUTCOME #2: P had to produce some movement for C to play music (i.e., P could cause music to start and stop.) Actually, the first session for this outcome when C initiated this change, C played for 10 minutes without requiring P to make a movement. When P walked around the room, initially C would
– play a low G for movement of the P’s foot
– play an octive higher G for movement of P’s right foot
– play a mid-range tone cluster when P sat down.
Eventually, C paired other movements with other music:
– walking remained the same as above but the tempo and loudness of the music would also change with the intensity and speed of walking
– stomping = lower range tone cluster
– rocking = C played an I-IV progression in F major. Forward rocking was paired with an I chord and backward rocking was paired wit an IV chord.
– shuffling = C rapidly played broken chords
– hand pounding = C played a C major chord
OUTCOME #3: P responded to C’s playing a chord and singing “Hello, (P’s name)” During the 4th month of intervention, P began to look at C while he was at the piano. C began to sing “Hello, (P’s name)” during this time. Gradually, the frequency of P’s glances at C increased and P began smiling at C.
OUTCOME #4: P controlled changes in music played by C using select motor movements. C introduced the following during Months 5 and 6: P could change the timing and intensity of the music by changing his movements.
OUTCOME #5: to increase eye contact: Starting about Month 10, C held P’s head in his hands and sang his name for 10 minutes. Once P appeared to enjoy this activity, C sang P’s name contingent on direct eye contact. This activity was administered for only 10 minutes of each session. Other outcomes were targeted during the rest of the session.