Lacava et al. (2010)

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.

Key:
ASD = Autism Spectrum Disorder
C = Clinician
CAM-C Faces = Faces subtest of the Cambridge Mindreading Face-Voice Battery for Children
CAM-C Total Concepts = Total from the Cambridge Mindreading Face-Voice Battery for Children
CAM-C Voices = Voices subtest of the Cambridge Mindreading Face-Voice Battery for Children
EBP = evidence-based practice
NA = not applicable
P = Patient or Participant
pmh = Patricia Hargrove, blog developer
SLP = speech–language pathologist
T or Tutor = school staff or investigator who monitored the Ps use of the computer program throughout the intervention

SOURCE: Lacava, P. G., Rankin, A., Mahlios, E., Cook, K., & Simpson, R. L. (2010). A single case design evaluation of a software and tutor intervention addressing emotion recognition and social interaction in four boys with ASD. Autism, 14 (3), 161- 178.

REVIEWER(S): pmh

DATE: February 21, 2010

ASSIGNED OVERALL GRADE: B (The highest possible overall grade based on the design of the investigation was A-.)

TAKE AWAY: Four single subject experimental design investigations revealed that a computer based intervention administered by a “tutor” was associated with moderate improvements on formal tests of prosodic and facial affect recognition. However, there only was limited support for generalization to social interaction with peers.

1. What was the focus of the research? Clinical Research

2. What type of evidence was identified? Single subject evidence
• What type of single subject design was used? Single Subject Experimental Design with Specific Client – Multiple Baseline across participants (Ps)
• What was the level of support associated with the type of evidence? Level = A-

3. Was phase of treatment concealed?
• from participants? No
• from clinicians? No
• from data analyzers? No

4. Were the participants adequately described? No
• How many participants were involved in the study? 8 (4 with Autism Spectrum Disorder, ASD. diagnosis; 4 typically developing matched peers)

– The following characteristics/variables were CONTROLLED: (only the Ps diagnosed with ASD were listed)
• age: 7 to 11 years
• cognitive skills: no cognitive disability confirmed by file review or parents
• literacy: text and computer literate
• educational of participant: attended public school
• Autism Spectrum Disorder Diagnosis (ASD): ASD with no cognitive disability confirmed by file review or parents
• Experience with the independent variable—Mind Reading computer software: No experience

– – The following characteristics/variables were DESCRIBED: (only the Ps diagnosed with ASD were listed)
• age: mean age 8-6; range 7-8 to 9-8
• gender: all male
• cognitive skills: no cognitive disability
• paraprofessional support: 0% (1P); 64% (2Ps); 100% (1P)
• diagnosis: PDD-NOS (2Ps); autism (2Ps)
• educational level of participant: 2nd grade (1P) ; 3rd grade (2Ps); 4th grade (1P)
• time in general education classes: 24% to 91%

• Were the communication problems adequately described? No
– The disorder type was ASD with no cognitive disability; communication but skills were not described.

5. Was membership in treatment maintained throughout the study? Yes

• If there was more than one participant, did at least 80% of the participants remain in the study? Yes
• Were any data removed from the study? Yes, but there was missing data because 1 P could not complete voice/auditory (prosodic) measures.

6. Did the design include appropriate controls? Yes
• Were baseline/preintervention data collected on all behaviors? Yes

• Did probes/intervention data include untrained data? Yes. Probes administered during intervention were only for the social interaction outcome, these were untrained.

• Did probes/intervention data include trained data? No

• Was the data collection continuous? Yes, for the social interaction outcome only. _x__ No ___

• Were different treatment counterbalanced or randomized? NA

7. Were the outcomes measure appropriate and meaningful? Yes

• The outcomes
OUTCOME #1: Percentage of correct responses on the Faces subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Faces) –pre and post test data only
OUTCOME #2: Percentage of correct responses on the Voices subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Voices)– pre and post test data only
OUTCOME #3: Overall percentage of total concepts passed on the Cambridge Mindreading Face-Voice Battery for Children (CAM-C- Total Concepts)- pre and post test data only
OUTCOME #4: Percentage of correct naming of emotions from colored pictures from the training material Library (Color Pictures)- pre and post test data only
OUTCOME #5: Percentage of correct naming of emotions from black and white pictures that were not part of the training procedure (Black and White Pictures)– pre and post test data only–
OUTCOME #6: Percentage of correct naming of emotions from cartoons that were not part of the training procedure (Cartoons) –pre and post test data only
OUTCOME #7: Percentage of Positive Social Interactions observed with peers at school –continuous data
OUTCOME #8: Rating of parental and teacher perception of the social validity of the intervention –only collected post intervention
OUTCOME #9: Comparison of each P’s performance to a matched typically developing peer on CAM-C and the Positive Social Interactions with peers measure—pre and post or continuous data, as appropriate.
• All of the outcomes were subjective.

• None of the outcomes were objective.

• The outcome measures associated with reliability data were

PRE-EXISTING RELIABILITY:
• The investigators cited extant data supporting the reliability of CAM-C
for Outcomes #1to #3 as well as for the CAM-C portion of Outcome #9. For easier reference, the outcomes with pre-existing outcome data were
OUTCOME #1: Percentage of correct responses on the Faces subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Faces)
OUTCOME #2: Percentage of correct responses on the Voices subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Voices)
OUTCOME #3: Overall percentage of total concepts passed on the Cambridge Mindreading Face-Voice Battery for Children (CAM-C- Total Concepts)
OUTCOME #9: Comparison of each P’s performance to a matched typically developing peer on CAM-C and the Positive Social Interactions with peers measure (the reliability data were fro CAM-C, only)

CURRENT INVESTIGATION’S RELIABILITY DATA
• Reliability data were provide for Outcome #7 only. In Table 3 he investigators reported
– overall mean interobserver reliability was 94.7%
– the overall mean range of interobserver was 91.2% to 97.3%

• For easier reference, OUTCOME #7 was Percentage of Positive Social Interactions observed with peers at school –continuous data

8. Results:
• Did the target behavior improve when it was treated? Yes
• The overall quality of improvement for each of the outcomes was

OUTCOME #1: Percentage of correct responses on the Faces subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Faces) –moderate
OUTCOME #2: Percentage of correct responses on the Voices subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Voices)–limited
OUTCOME #3: Overall percentage of total concepts passed on the Cambridge Mindreading Face-Voice Battery for Children (CAM-C- Total Concepts)- moderate
OUTCOME #4: Percentage of correct naming of emotions from colored pictures from the training material Library (Color Pictures)- moderate
OUTCOME #5: Percentage of correct naming of emotions from black and white pictures that were not part of the training procedure (Black and White Pictures) pre and post test data only—moderate (3Ps); ineffective (1P)
OUTCOME #6: Percentage of correct naming of emotions from cartoons that were not part of the training procedure (Cartoons) –moderate (3Ps); ineffective (1P)
OUTCOME #7: Percentage of Positive Social Interactions observed with peers at school –continuous data–—limited (3Ps); ineffective (1P)
OUTCOME #8: Rating of parental and teacher perception of the social validity of the intervention –moderate
OUTCOME #9: Comparison of each P’s performance to a matched typically developing peer on CAM-C and the Positive Social Interactions with peers measure—ineffective

9. Description of baseline:
• Were baseline data provided? Yes, but they were provided for only one outcome:
OUTCOME #7: Percentage of Positive Social Interactions observed with peers at school. The number of baseline session varied:
– P1: 5 sessions
– P2: 9 sessions
– P3: 7 sessions
– P4: 4 sessions

• Was baseline low (or high, as appropriate) and stable?
– P1: moderate and stable
– P2: low and stable
– P3: variable and unstable
– P4: low and stable

• What was the percentage of nonoverlapping data (PND)?
– P1: 46%– unreliable/ineffective
– P2: 27%– unreliable/ineffective
– P3: 0%– unreliable/ineffective
– P4: 25%– unreliable/ineffective
– PND was not calculated but visual inspection suggests it also would be low.

10. What was the magnitude of the treatment effect? NA

11. Was information about treatment fidelity adequate? Yes. Treatment fidelity checks were administered for an average of 18% of treatment sessions. The overall fidelity was 94.1% with the range of averaging from 82% to 98.6%.

12. Were maintenance data reported? No

13. Were generalization data reported? Yes. Several of the measures could be considered to be generalizations:

• Outcome #7 (Percentage of Positive Social Interactions observed with peers at school) Overall, improvement was limited.

• Outcomes #1 through #3 and #5 and #6 could be considered generalizations because the pictures were different in teaching and testing. The improvement for these outcomes was variable ranging from ineffective to moderate. For easier understanding the outcomes in question are listed below.

OUTCOME #1: Percentage of correct responses on the Faces subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Faces)
OUTCOME #2: Percentage of correct responses on the Voices subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Voices)
OUTCOME #3: Overall percentage of total concepts passed on the Cambridge Mindreading Face-Voice Battery for Children (CAM-C- Total Concepts)
OUTCOME #5: Percentage of correct naming of emotions from black and white pictures that were not part of the training procedure (Black and White Pictures)
OUTCOME #6: Percentage of correct naming of emotions from cartoons that were not part of the training procedure (Cartoons)

14. Brief description of the design:

• Multiple baseline across participants single subject experimental design.
• There were 4 participants.
• Investigators administer pre and post tests as well as regular probes throughout the intervention.
• Outcomes included
– formal/informal tests of emotion recognition (Outcomes #1- #6)
– observation of social interactions with peers (pre-post testing and weekly probes)
– parental/teacher perception of effectiveness and use (post testing only)
– a typically developing match peer for each of the Ps who was administered pre-post tests and probes

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

SUMMARY OF INTERVENTION

PURPOSE: To continue the investigation of the effectiveness of computer software in improving emotion recognition of children with ASD

POPULATION: ASD

MODALITY TARGETED: comprehension

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: affect

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: social interaction with peers

OTHER TARGETS: perception of outcome effectiveness

DOSAGE: individual sessions; 1 to 2 hours per week; 7 to 10 weeks

ADMINISTRATOR: “tutor” = school staff (3Ps); investigator (1P)

STIMULI: auditory, visual

MAJOR COMPONENTS:

• The investigators installed the computer program (Mind Reading: The Interactive Guide to Emotions) onto the computer at the schools where the treatments were administered.
• The Mind Reading consisted of 3 components:
– The Library— contained audiorecordings, videos, descriptions, narrative, and pictures that represented a wide variety of emotions
– The Learning Center— contained graded lessons of levels of difficulty (preschool to adult) designed to teach the emotions, quizzes designed to provide positive feedback (e.g., access to reward items) for correct responses
– The Game Zone—contained interactive games designed to continue teaching emotion recognition in a game format
• The investigators explained the Mind Reading and all procedures to parents, teacher, appropriate staff, and Ps at the first meeting and at pre-test sessions.
• The investigators demonstrated and explained how to use the computer and the Mind Reading program to Ps and tutors (T) prior to the beginning of intervention.
• Ts were adult staff (or in one case, an investigator) who monitored Ps’ use of the computer program and facilitated the use of the program. Investigators monitored Ts and Ps during the intervention phase of the investigation and were available to and Ts’ questions/concerns.
• Ts’ responsibilities included:
– to sit next to Ps while they were using Mind Reading,
– to provide guidance regarding the use of Mind Reading,
– to ensure that Ps used all 3 components of Mind Reading,
– to limit use of the Game Zone to no more than 33% of time P used the computer program,
– to view all videos,
– to listen to all audio recordings,
– to discuss emotions that occur during activities of daily living,
– to “mime” emotions with Ps (p. 170), and
– to focus on emotions that had been identified as problematic during pretesting.
• Ps (with the Ts) were to use the computer program for 1 to 2 hours per week for 7 to 10 weeks in a quite location in their schools.

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