Russo et al. (2008)

June 30, 2015

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

 

ASD = Autism spectrum disorders

fo = fundamental frequency

H2 = second harmonic

NA = not applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

TD = typically developing

WNL = within normal limits

 

 

SOURCE:  Russo. N. M., E. Skoe, E., Trommer, B., Nicol, T., Zecker, S., Bradlow, N., Kraus, N. (2008). Deficient brainstem encoding of pitch in children with Autism Spectrum Disorders. Clinical Neurophysiology, 119, 1730-1731.

 

REVIEWER(S): pmh

 

DATE: June 21, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: B+ (The highest grade for this investigation, based on its design, is B+.)

 

POPULATION: Autism Spectrum Disorders (ASD)

 

PURPOSE: To investigate the subcortical responsiveness to prosody in children with ASD.

 

INSIGHTS ABOUT PROSODY:

  • The ability of children with ASD to encode pitch less was accurate/preserved and less robust than typically developing (TD) peers.
  • However, subgroup analysis of the ASD group revealed that a small group of children with ASD (i.e., ASD OUT) accounted for the poor pitch encoding scores.
  • The ASD OUT group included 5 Ps (about 20% of the overall ASD group) and they exhibited more Frequency and Slope errors as well as reduced pitch locking.

 

 

  1. What type of evidence was identified? Prospective, Nonrandomized Group Comparison Design
  1. Group membership determination:

 

  • If there were groups of participants were members of groups matched? Yes

                                                                    

  • The participants (Ps) were matched by age.
  1. Was participants’ communication status concealed?

                                                                                                           

  • from participants? No
  • from assessment administrators? No
  • from data analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

– How many participants were involved in the study?

  • total # of participants: originally there were 48 Ps but 6 Ps with ASD were eliminated due to abnormal brainstem responses (click evoked brainstem responses –atypical Wave V latency), noncompliance, parental choice, and/or relocation; the working total of Ps was 42
  • was group membership maintained throughout the experiment? 6 Ps withdrew/were eliminated from the investigation, as noted above
  • # of groups: 2
  • List names of groups: Autism Spectrum Disorders (ASD), typically developing (TD)
  • # of participants in each group: ASD = 21; TD = 21

                                                                                

– Characteristics of Ps:

CONTROLLED                                                                                           

  • age: 7 to 13 years
  • cognitive skills: Full scale IQ In which with the confidence intervals, the value is >80
  • hearing: within normal limits (WNL)
  • diagnosis: for the Ps with ASD, diagnosis by neurologist/psychologist and actively followed
  • neurological problems: lack of confounding neurological problems

 

DESCRIBED

  • age: mean age ASD = 9.9; mean age TD = 9.95 (no significant difference)
  • gender: ASD = 19m, 2f; TD = 13m, 8f
  • cognitive skills: for both groups the mean was WNL, although TD Ps scored significantly higher
  • expressive language: mean scores on the core portion of the Clinical Evaluation of Language Fundamentals were WNL, although TD Ps scored significantly higher
  • receptive language: mean scores on the receptive portion of the Clinical Evaluation of Language Fundamentals were WNL, although TD Ps scored significantly higher
  • overall language skills: mean scores of the core Clinical Evaluation of Language Fundamentals were WNL, although TD Ps scored significantly higher
  • diagnoses of Ps with ASD: parent reported the following specific diagnoses– autism, Asperger Disorder, PDD-NOS, combined diagnoses
  • supplemental observations by investigators of Ps with ASD: Ps displayed some or all of the following

   – limited eye contact

   – limited reciprocity

   – restricting range of topics in conversation

   – use of restricted or idiosyncratic language

   – abnormal prosody

   – echolalia or scripted speech

   – stereotyped movements

 

Were the communication problems adequately described? Yes, but I would have liked to see a description of the communication scores of ASD OUT versus ASD IN Ps.

  • disorder type: ASD
  • functional level: observations by investigators of Ps with ASD revealed that Ps displayed some or all of the following:

– limited eye contact

– limited reciprocity

– restricting range of topics in conversation

– use of restricted or idiosyncratic language

– abnormal prosody

– echolalia or scripted speech

 

  1. What were the different conditions for this research?
  • Subject (Classification) Groups? Yes: ASD, TD
  • Experimental Conditions? No
  • Criterion/Descriptive Conditions? Yes: passively evoked brainstem responses to

     – click evoked brainstem responses

     – speech evoked brainstem responses– speech syllables with descending and ascending pitch contours

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

– The dependent measures were

  • Dependent Measure #1: Wave V latency within the normal range (this was actually an exclusionary criterion; 2 Ps with ASD were excluded from the original 48 Ps)
  • Dependent Measure #2: Rate of frequency errors (an accuracy measure of encoding) for fo (fundamental frequency) and H2 (second harmonic)
  • Dependent Measure #3: Rate of slope error (a measure of preservation of the pitch contour) for fo (fundamental frequency) and H2 (second harmonic)
  • Dependent Measure #4: Rate of pitch strength (a measure of periodicity) for fo (fundamental frequency)
  • Dependent Measure #5: Composite score of overall pitch tracking (frequency errors of fo plus frequency errors and pitch strength of H2)
  • Dependent Measure #6: Relationship of age, sex, and intelligence on brainstem responses

None of the dependent measures that were subjective.

 

– All of the dependent/ outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No
  • Intraobserver for analyzers? No
  • Treatment/Procedural fidelity for investigators? No
  • Test/Retest Reliability? Yes. Six Ps with ASD were retested. There were no significant differences in the first and second administrations of the protocol using nonparametric statistical analysis. Accordingly, the Ps responses were judged to be stable and reliable.

 

 

  1. Brief description of design:
  • The investigators compared Ps with ASD and TD peers on series of measures representing the subcortical processing of prosody using passively evoked brainstem responses.
  • Ps watched a video of their choice as the experimental stimuli were delivered to the right ear. The investigators instructed the Ps to ignore the sounds in their right ear.
  • Two sets of stimuli were presented:

– clicks (these were part of the exclusion criteria. Ps with abnormal Wave V latency were excluded from the investigation)

– speech (a single syllable [ya] with ascending and descending pitch contours)

  • The investigators compared the TD and ASD groups on the dependent measures using parametric statistics.
  • They then performed follow up with an statistical analysis of the ASD group (using nonparametrics) in which they identified two subgroups: ASD OUT and ASD IN.

 

 

  1. What were the results of the inferential statistical testing

 

– The comparisons that are significant are p ≤ 0.05.

NOTE: For several of the dependent measure, there were 2 sets of comparisons:

  • ASD vs TD and
  • a subgroup analysis for the ASD Ps — ASD OUT (n = 5) vs ASD IN (n = 16.)

The subgroups of ASD were classified on the basis of performance on the composite score (Dependent measure #5.) The ASD OUT group (i.e., deficient pitch trackers) had composite scores that were <1.65 standard deviations from the overall ASD mean composite score. The ASD OUT group comprised

– 3 Ps with Asperger Disorder

– 1 P with PDD-NOS

– 1 P with ASD with Sensory Integration Disorder

  • Dependent Measure #1: Wave V latency within the normal range (this was actually an exclusionary criterion)— no significant differences between ASD and TD groups, although 2 Ps with were eliminated from the investigation;

 

  • Dependent Measure #2: Rate of frequency errors (an accuracy measure of encoding) for fo (fundamental frequency) and H2 (second harmonic)

For fo, the overall ASD group was significantly less accurate than the TD group.

     — For H2, the overall ASD group was significantly less accurate than the TD group.

   — Reanalysis of the data with the ASD subgroups revealed that for fo and for H2, the ASD IN performed similarly to the TD group but that the ASD OUT group differed significantly more poorly than the TD group and the ASD IN subgroup.

 

  • Dependent Measure #3: Rate of slope error (a measure of preservation of the pitch contour) for fo (fundamental frequency) and H2 (second harmonic)

— For fo, no significant differences between ASD and TD groups.

   — For H2, no significant differences between ASD and TD groups.

  • Dependent Measure #4: Rate of pitch strength (a measure of periodicity) for fo (fundamental frequency)

For fo, the ASD group yielded significantly higher scores than the TD group.

   — Reanalysis of the data with the ASD subgroups revealed that for fo, the ASD IN performed similarly to the TD group but that the ASD OUT group differed significantly from TD and the ASD IN subgroup.

  • Dependent Measure #5: Composite score of overall pitch tracking (frequency errors of fo plus frequency errors and pitch strength of H2)

— Overall, the TD group was significantly better than the ASD group.

 

  • Dependent Measure #6: Relationship of age, sex, and intelligence on brainstem responses

— Overall, Ps in the ASD group had significantly poorer scores than the TD group on measures of language skills (CELF) and most measures of intelligence with the exception of performance mental skills.

     — For the ASD subgroups, there were no significant differences on the measures of language and intelligence.

– What were the statistical tests used to determine significance? MANOVA, Mann-Whitney U, Kruskal-Wallis, and Chi square.

– Were effect sizes provided? Yes, but only for some of the measures. If an effect size is not listed for a dependent measure, it was not provided in the paper.

  • Dependent Measure #2: Rate of frequency errors (an accuracy measure of encoding) for fo (fundamental frequency) and H2 (second harmonic)

— For fo, the effect size for ASD vs TD scores was d = 0.61 (moderate)

     — For H2, the effect size for ASD vs TD scores was d = 0.73 (moderate)

  • Dependent Measure #4: Rate of pitch strength (a measure of periodicity) for fo (fundamental frequency)

— For fo, the effect size for ASD vs TD scores was d = 0.56 (moderate)

  • Dependent Measure #5: Composite score of overall pitch tracking (frequency errors of fo plus frequency errors and pitch strength of H2)

– Were confidence interval (CI) provided? No

 

 

  1. What were the results of the correlational statistical testing?
  • Dependent Measure #6: Relationship of age, sex, and intelligence on brainstem responses

– For the overall ASD group and the ASD IN subgroup, significant differences were not noted for the following

  • pitch tracking and measures of intelligence
  • pitch tracking and language measures (CELF)

     – Correlational analysis could not be performed with the data for the ASD OUT subgroup due to the small n.

  • What was the statistical test used to determine correlation? Pearson Product
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Tosto et al. (2011)

June 18, 2015

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

 

AD = Altzheimer’s disease

NA = not applicable

NT = neurotypical

P = participant

pmh = Patricia Hargrove, blog developer

WNL = within normal limits

 

 

SOURCE: Tosto, G., Gasparini, M., G.L. Lenzi, G. L., & Bruno, G. (2011). Prosodic impairment in Altzheimer’s disease: Assessment and clinical relevance. Journal of Neuropsychiatry and Clinical Neuroscience, 23 (2), E21-E23.

Journal Address: http://neuro.psychiatryonline.org

REVIEWER(S): pmh

 

DATE: June 13, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: D (Based on the case study design, the highest possible grade was D+.)

 

POPULATION: Altzheimer’s disease (AD); Adult

 

PURPOSE: To describe comprehension and production of emotional prosody in an Italian male with mild, early onset AD.

 

INSIGHTS ABOUT PROSODY:

  • This case study diverges from the clinical literature on prosody in dementia in which the expectation is that

– problems with the comprehension of emotional prosody appear in the early stages of AD and then remain stable throughout the mild and moderate stages and

– problems with the production and imitation of emotional prosody are minimal during the early stages of AD but during the moderate stage of AD, significant problems with the production and imitation of emotional prosody begin to emerge.

  • In this case study of an adult Italian speaking male diagnosed being in the early stages of early onset AD, the participant (P) displayed significant impairment in the production and comprehension of emotional prosody.
  • The investigators recommend that clinicians (C) should carefully monitor the emotional prosody skills of Ps with AD and consider emotional prosody skills when working with AD individuals and their families.

 

 

  1. What type of evidence was identified? Case Study
  1. Group membership determination:
  • If there were groups of participants were members of groups matched? Not Applicable (NA), there was only one P.
  1. Was participant’s communication status concealed?
  • from participant? No
  • from assessment administrators? No
  • from data analyzers? No

                                                                    

 

  1. Was the participant adequately described? Yes. I would have liked more information but to be fair to the investigators I rated this question as “yes” because this was a letter to the Editor and was only 3 pages long.

 

How many participants were involved in the study? 1

The following variables were described:

  • age: 55 years
  • gender: male
  • cognitive skills: 29/30 on the Mini-Mental State Exam; within normal limits (WNL)
  • neurological exam: WNL
  • diagnosis: early onset AD
  • MRI results: cortical/subcortical atrophy of fronto-parietal areas
  • PET scan results: hypometabolism in the right frontal-temporal-parietal areas, left posterior parietal areas, and basal ganglia
  • results of neuropsychological testing:

– widespread, mild cognitive impairment,

     – more impaired on tasks sensitive for both right-hemisphere and executive function

  • educational level of P: may be 14 years

 

– Were the communication problems adequately described? No

  • disorder type: AD

 

 

  1. What were the different conditions for this research?

                                                                                                             

– Subject (Classification) Groups? No. There was only 1 P. ____

If yes, list:

Experimental Conditions? No

 

– Criterion/Descriptive Conditions? Yes

  • Experimental Protocol –Melodic Alternation [previously administered to a group of neurotypical (NT) adults: 10 Ps; same gender; mean age = 54.5; mean education: 14 years]

– Task 1: Auditory Verbal Task: P listened and identified the same neutral sentence produced with sad, happy, angry, surprised, and neutral prosody

– Task 2: Visual Task: P viewed facial expressions depicting sad, happy, angry, surprised, and neutral emotions and identified each

– Task 3: Repetition Task: using the sentences from Task 1, P imitated the same sentence using the emotional prosody modeled in the sentence. Independent judges listened to the models and the imitation to judge accuracy.

– Task 4: Production Task: The investigators presented P with a sentence and directed him/her to produce the sentence with sad, happy, angry, surprised, and neutral intonations.

 

  1. Were the groups controlled acceptably? NA

 

 

  1. Were dependent measures appropriate and meaningful? Yes

 

–   The dependent measures were

  • Dependent Measure #1: Performance on Task 1: Auditory Verbal Task
  • Dependent Measure #2: Performance on Task 1: Visual Task
  • Dependent Measure #3: Performance on Task 1: Repetition Task
  • Dependent Measure #4: Performance on Task 1: Production Task

 

All the dependent measures were subjective.

 

None of the dependent/ outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

  • Dependent Measure #3: Performance on Task 1: Repetition Task—K index = 0.86
  • Dependent Measure #4: Performance on Task 1: Production Task—-K index = 0.93

 

Intraobserver for analyzers? No

 

– Treatment/Procedural fidelity for investigators? No

 

  1. Description of design:
  • In this case study, a 55-year-old Italian male, who had been diagnosed as being in the early stages of early-onset AD, was administered 4 tasks to assess his emotional prosody skills.
  • The 4 tasks were

– Task 1: Auditory Verbal Task: P listened to and identified the same neutral sentence produced with sad, happy, angry, surprised, and neutral prosody

– Task 2: Visual Task: P viewed facial expressions depicting sad, happy, angry, surprised, and neutral emotions and identified each

– Task 3: Repetition Task: using the sentences from Task 1, P imitated the same sentence using the emotional prosody modeled in the sentence. Independent judges listened to the models and the imitation to judge accuracy.

– Task 4: Production Task: The investigators presented P with a sentence and directed him to produce the sentence with sad, happy, angry, surprised, and neutral intonations. Independent judges listened to the production to judge accuracy.

  • The 4 tasks, Melodic Alternation, had previously been administered to a group of neurotypical (NT) adults: 10 Ps; same gender; mean age = 54.5; mean education: 14 years. This provided comparison data.

 

 

  1. What were the results of the inferential statistical testing? NA

 

  1. What were the results of the correlational statistical testing? Correlational statistics were presented only of the reliability data for measures #3 and #4. (See item #8.)

 

  1. What were the results of the descriptive analysis?
  • Dependent Measure #1: Performance on Task 1: Auditory Verbal Task—P correctly identified 31 of 60 trials (NT control group identified 58/60.) The emotional states that exhibited most errors were neutral, happy, and sad. The P also frequently confused these 3 states.

 

  • Dependent Measure #2: Performance on Task 1: Visual Task—P correctly identified 73% of the trials (NT control group identified correctly 92%. The emotional states that exhibited most problems were neutral and sad.

 

  • Dependent Measure #3: Performance on Task 1: Repetition Task—Overall, P incorrectly imitated prosody 33% of the time. The poorest imitation rate was for happiness (83% errors); the best imitation rates were for surprise (no errors) and neutral.

 

  • Dependent Measure #4: Performance on Task 1: Production Task—All the production trails were associated with some failure. Happy (100% error rate) and angry (83% error rate) were the most challenging emotions to produce acceptably.

 


Samuelsson et al. (2011)

June 10, 2015

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

 

NA = not applicable

P = Participant

pmh = Patricia Hargrove, blog developer

SLI = Specific Language Impairment

TD = Typically Developing

 

 

SOURCE: Samuelsson, C., Reuterskiöld, C., Nettelblatt, U., & Sahlén, B. (2011.) Production and perception of metrical patterns in Swedish children with language impairment. Logopedics Phonatrics Vocology, 36, 1-11.

 

REVIEWER(S): pmh

 

DATE: June 6, 2015

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

 

POPULATION: Specific Language Impairment (SLI), Swedish; Children

 

PURPOSE: To investigate the perception and production of metrical patterns in Swedish children diagnosed with language impairment.

 

INSIGHTS ABOUT PROSODY:

  • Swedish children with SLI more frequently omitted unstressed syllable than TD peers.
  • There may be 3 subgroups of prosody among children with SLI:

– stronger perception/comprehension than production/imitation,

– stronger production/imitation than perception/comprehension, and

– equivalent production/imitation and perception/comprehension.

 

 

  1. What type of evidence was identified? Prospective, Nonrandomized Group Comparison Design
  1. Group membership determination:
  • If there were groups of participants, were members of groups matched? Yes
  • The matching strategy involved selecting participants in the two groups were close in age (preschoolers.)
  1. Was participants’ communication status concealed?
  • from participants? No
  • from assessment administrators? Unclear
  • from data analyzers? Unclear

                                                                    

 

  1. Were the groups/participants adequately described? Yes

How many participants (Ps) were involved in the study?

  • total # of participants: 52
  • was group membership maintained throughout the experiment? Yes
  • # of groups: 2
  • List names of groups: SLI and typically developing (TD)
  • # of participants in each group: SLI = 27 (but see genders- p.4, reported 28 Ps); TD = 25

           

– The following variables controlled:              

  • cognitive skills: at least 78 nonverbal IQ (SLI); teacher reported normal development (TD)
  • language skills: SLI Ps were diagnosed with language impairment by a Swedish speech-language pathologist (SLP)
  • educational level of clients: Preschool
  • hearing: both groups passed a pure tone screening (25dB at 500, 1000, 2000, and 4000 Hz)

– The following variables were described:

  • age: mean age = 4:10 (TD); mean age = 5:4 (SLI)
  • gender: 10f; 18m (SLI); TD not reported

 

– Were the communication problems adequately described? Yes

  • disorder type:

     – 50% of the SLI group was diagnosed with severe language impairment in all domains of language

– 25% of the SLI group was diagnosed with moderate, expressive language impairment, particularly with respect to grammar and phonology

– 25% of the SLI group was diagnosed with mild phonological impairment

 

 

  1. What were the different conditions for this research?
  • Subject (Classification) Groups? Yes, there were 2 groups: SLI and TD
  • Experimental Conditions? No
  • Criterion/Descriptive Conditions? Yes, there were 3 tasks, all of them were in Swedish:
  • Imitation of phrases that differed on the placement of stress on the verb particle or on the prepositional phrase (iambic vs trochaic stress.) The examiner provided pictures to support the different sentences.
  • Comprehension task in which the participant (P) hears a direction and points to the appropriate picture of a set of 3 (2 contrasting sentences and a foil). The directions were identical sentences that differed only in the placement of stress on the verb particle or on the prepositional phrase (iambic vs trochaic stress.)
  • Imitation of phrases with an indefinite article (before the stressed syllable) or a definite form of a noun (after the stressed syllable. This contrasted differed iambic vs trochaic stress. The examiner provided pictures to support the different sentences.

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes
  • The dependent measures were

Dependent Measure #1: Overall number of unstressed syllables omitted across all tasks

Dependent Measure #2: Proportion of prestressed syllables omitted in content words versus the proportion of omitted copulas

Dependent Measure #3: Comparing the same morpheme in different positions (stressed versus unstressed) and with different functions (verb particle versus preposition)

Dependent Measure #4: Relative strength of performance on imitated versus comprehension tasks concerned with phrasal stress.

Dependent Measure #5: Performance of Groups from measure 4 on

  • imitation of total unstressed syllables
  • perception of total unstressed syllables
  • imitation of prestressed syllables

Dependent Measure #6: Relationship between linguistic variables and nonverbal IQ among SLI Ps

  • All the dependent measures were subjective:.

 

  • None of the dependent/ outcome measures were objective?

                                         

 

  1. Were reliability measures provided?

 

  • Interobserver for analyzers? Yes. Overall inter-rater reliability for imitated/production tasks was 95%. Differences between raters were resolved by consensus.

 

  •  Intraobserver for analyzers? No

 

  • Treatment/Procedural fidelity for investigators? No

 

 

  1. Description of design:
  • The investigators administered 3 tasks to two groups of Swedish speaking children (SLI and TD groups.)
  • Prior to the administration of the tasks, the SLI Ps had been assessed using the Swedish Test of Language Comprehension, T.R.O.G. (a comprehension test), Lund Test of Phonology and Grammar (expressive), ORIS (oral motor skills), and a test of nonverbal IQ.
  • The 3 tasks were

– Imitation of phrases that differed on the placement of stress on the verb particle or on the prepositional phrase (iambic versus trochaic stress.) The examiner provided pictures to support the different sentences.

– Comprehension task in which the participant (P) hears a direction and points to the appropriate picture of a set of 3 (2 contrasting sentences and a foil). The directions were identical sentences that differed only in the placement of stress on the verb particle or on the prepositional phrase (iambic versus trochaic stress.)

– Imitation of phrases with an indefinite article (before the stressed syllable) or a definite form of a noun (after the stressed syllable. This contrasted differed iambic versus trochaic stress. The examiner provided pictures to support the different sentences.

  • The investigators used inferential (nonparametric) and correlational statistics to analyze the data.

 

  1. What were the results of the inferential statistical testing
  • Significant comparisons are p ≤ 0.05.

Dependent Measure #1: Overall number of unstressed syllables omitted across all tasks- Ps with SLI omitted significantly more unstressed syllables and TD Ps.

Dependent Measure #2: Proportion of prestressed syllables omitted in content words versus the proportion of omitted copulas by SLI group—no significant differences

Dependent Measure #3: Comparing the same morpheme in different positions (stressed versus unstressed) and with different functions (verb particle versus preposition) by the SLI group—no significant difference

Dependent Measure #4: Relative strength of performance on imitated versus comprehension tasks concerned with phrasal stress— not analyzed statistically. See descriptive analysis Item #12 in which 3 groups (A, B, C) of Ps with SLI were identified.

Dependent Measure #5: Performance of Groups from measure 4 (see also item #12) on

  • imitation of total unstressed syllables: Group A significantly poorer than other groups.
  • perception of total unstressed syllables: Group B significantly poorer than other groups.
  • imitation of prestressed syllables: Group A significantly poorer than other groups.

Dependent Measure #6: Relationship between linguistic variables and nonverbal IQ among SLI Ps: This measure was analyzed inferentially and correlationally. See item #11 for the correlational analysis.

     – There were no significant differences among the 3 SLI groups (i.e., Groups A, B, and C) with respect to linguistic and nonlinguistic measure.

– What were the statistical test used to determine significance?

  • Mann-Whitney U
  • Kruskal-Wallis
  • Post-hoc analysis by Siegel and Castellan

 

Were evidence-based measures provided: No

– Were confidence intervals provided? No

 

 

  1. What were the results of the correlational statistical testing?

 

– Correlations that od p ≤ 0.05) are considered significant:

 

  • Dependent Measure #6: Relationship between linguistic variables and nonverbal IQ among SLI Ps: This measure was analyzed inferentially and correlationally. See item #10 for the inferential analysis.

     – Overall SLI (i.e., combined Groups A, B, and C) as well as Groups A and B individually—no significant correlation between perception and imitation of stress patterns

     – For Group C there was a significant correlation between perception and imitation of stress patterns (r = 0.85.)

correlationally. See item #10 for the inferential analysis.

     – Overall SLI (i.e., combined Groups A, B, and C), there were no significant correlations for the number of unstressed free morphemes and oral motor skills.

     – Overall SLI (i.e., combined Groups A, B, and C), there was a significant correlation for the number of unstressed free morphemes and receptive language (r = 0. 37.)

 

  1. What were the results of the descriptive analysis?

Dependent Measure #4: Relative strength of performance on imitated versus comprehension tasks concerned with phrasal stress:

  • The investigators identified 3 subgroups within the SLI group.
  • NOTE : throughout the manuscript the investigator used the term “production” instead of “imitation.” I will continue with the term “imitation” because it is more specific. Also, some of the information provided here was found in the results or discussion section.

– GROUP A: Ps who were stronger on the perception/comprehension tasks than on the imitative task. (Criterion: 2 points better on perception/ comprehension tasks than on the imitation task.) These Ps had problems with all aspects of expressive language performance. This also was the smallest group.

– GROUP B: Ps who were stronger on the imitative task than on the perception/comprehension tasks (Criterion: 2 points better on the imitation task than on the perception/ comprehension tasks.) These Ps had more trouble with overall language comprehension than the other 2 groups.

– GROUP C: Ps whose performance on the perception/comprehension tasks and the imitative task were similar. (Criterion: Scores on the perception/ comprehension tasks and the imitative task were the same or within one point of one another.) Although all these Ps had nonverbal IQs of at least 78, as a group their nonverbal IQs were lower than the o


Khetrapal (2009)

June 2, 2015

SECONDARY REVIEW CRITIQUE

 

Note: To read a summary of intervention procedures presented in this article, scroll down the page about 2/3 of the way.

 

 

KEY:

ASD = Autism Spectrum Disorder

NA = not applicable

P = Participant(s)

pmh = Patricia Hargrove

 

Source: Khetrapal, N. (2009). Why does music therapy help in autism? Empirical Musicology Review, 4 (1), 11-18. Article: https://kb.osu.edu/dspace/bitstream/handle/1811/36602/EMR000065a_Khetrapal.pdf?sequence=1

 

 

Reviewer(s): pmh

 

Date: May 28, 2015

 

Overall Assigned Grade: D- (Based on the design, the highest possible grade was D.)

 

Level of Evidence: D

 

Take Away: This expository article logically supports the use of music therapy using a narrative review of the literature. The author presents a rationale for the use of music therapy (MT) in the treatment of individuals diagnosed with autism spectrum disorder (ASD) based in a link between tonal pitch and prosodic emotional recognition. The author presents research indicating that while people with ASD may experience difficulty interpreting emotional prosody, their (musical) tonal pitch tends to be intact and suggests that MT interventions may use this intact skill to improve emotional prosody comprehension. No specific procedures were recommended but the author encouraged additional research.

 

 

What type of secondary review?  Narrative Review

 

 

  1. Were the results valid? Yes

 

  • Was the review based on a clinically sound clinical question? Yes

 

  • Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? No

 

  • Authors noted that they reviewed the following resources: (place X next to the appropriate resources). Not applicable (NA), the author did not note which resources were reviewed.

 

  • Did the sources involve only English language publications? Yes

 

  • Did the sources include unpublished studies? No
  • Was the time frame for the publication of the sources sufficient? Yes
  • Did the reviewers identify the level of evidence of the sources? No
  • Did the reviewers describe procedures used to evaluate the validity of each of the sources? No
  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources? No
  • Did the reviewers or review teams rate the sources independently? No
  • Were interrater reliability data provided? No
  • If the reviewers provided interrater reliability data, list them: NA

 

  • If there were no interrater reliability data, was an alternate means to insure reliability described? No

 

  • Were assessments of sources sufficiently reliable? Unclear
  • Was the information provided sufficient for the reader to undertake a replication? No
  • Did the sources that were evaluated involve a sufficient number of participants? Unclear

 

  • Were there a sufficient number of sources? Yes
  1. Description of outcome measures:

Outcome measures that the author used to support the contention that MT improves communication include

  • Outcomes Associated with Source #1: Improved musical and nonmusical communication (Edgerton, 1994)
  • Outcome Associated with Source #2: Increased number of correctly imitated signed and spoken words (Buday, 1995)
  • Outcome Associated with Source #3: Decreased off task behavior and improved task related behavior (Burlesson et al., 1989)
  • Outcome Associated with Source #4: Decreased rate of problem behaviors in the classroom (Orr et al., 1998)
  • Outcomes Associated with Source #5: Improved eye contact, social acknowledgement, and initiation (Wimpory et al., 1995)
  • Outcome Associated with Source #6: Modifying behaviors (Brownell, 2002)
  • Outcome Associated with Source #7: Distinguish happy /sad emotions using pitch variations and rhythmic variation (Khalfa et al., 2008)
  • Outcome Associated with Source #8: Detecting pitch in music (Mottron et al., 2000)
  • Outcomes Associated with Source #9: Detecting emotion in music (Heaton et al., 1999)
  • Outcome Associated with Source #10: Identifying regions of the brain activated during music and language processing (Peretz & Coltheart, 2003)
  • Outcome Associated with Source #11: Identifying emotions (Thompson et al., 2004)

 

 

  1. Description of results:
  • 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) Not provided
  • Summary of the overall findings of the secondary review:

This traditional narrative of literature included only brief summaries of research results supporting the author’s argument. It is not known what sources were omitted nor the quality of the sources analyzed. Nevertheless, the author presented a clear rationale for researching the effectiveness of music therapy with individuals with ASD diagnosis.

Briefly, the rationale was that tonal pitch and the ability to distinguish music emotion is preserved in most individuals with ASD. [Tonal pitch is important to the ability to distinguish emotions in speech (at least the happy-sad difference.)] In addition, although music and language both use pitch and rhythm for meaning, processing of music and language appear to be processed in different locations in the brain. Therefore, MT may be useful when trying to teach students with ASD to distinguish emotions in speech by moving from an area of strength (musical emotional meaning) to an area of apparent weakness (speech emotional meaning.)

  • Were the results precise? No
  • 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

 

  • Were the results of individual studies clearly displayed/presented? Variable, the summaries of the results were brief.
  • For the most part, were the results similar from source to source? Yes, the author only reported positive results
  • Were the results in the same direction? No, the author only reported positive results
  • Did a forest plot indicate homogeneity? Not Applicable
  • Was heterogeneity of results explored? No
  • Were the findings reasonable in view of the current literature? Yes

 

  1. Were negative outcomes noted? No

           

                                                                                                                   

  1. Were maintenance data reported? No. For the most part, no maintenance results were reported. There was one exception in which the targeted outcome was maintained for 2 years (Outcome #5, Wimpory et al., 1995.)

 

 

  1. Were generalization data reported? No

 

 

SUMMARY OF INTERVENTION

Population: Autism Spectrum Disorders

 

Prosodic Targets: Affective Prosody

Description of Procedure—Music Therapy

  • Different MT procedures were used in sources cited by Khetrapal. The following is a listing of the procedures that were summarized by Khatrapal.

 

  • Outcomes Associated with Source #1: Improved musical and nonmusical communication (Edgerton, 1994) – Improvisational MT
  • Outcome Associated with Source #2: Increased number of correctly imitated signed and spoken words (Buday, 1995)—Sung text
  • Outcome Associated with Source #3: Decreased off task behavior and improved task related behavior (Burlesson et al., 1989)—Background music
  • Outcome Associated with Source #4: Decreased rate of problem behaviors in the classroom (Orr et al., 1998)—Rhythmic entrainment
  • Outcomes Associated with Source #5: Improved eye contact, social acknowledgement, and initiation (Wimpory et al., 1995)—Music Interaction Therapy
  • Outcome Associated with Source #6: Modifying behaviors (Brownell, 2002) –Musically presented social stories
  • Outcome Associated with Source #7: Distinguish happy /sad emotions using pitch variations and rhythmic variation (Khalfa et al., 2008)—this was not an intervention study
  • Outcome Associated with Source #8: Detecting pitch in music (Mottron et al., 2000)—this was not an intervention investigation
  • Outcomes Associated with Source #9: Detecting emotion in music (Heaton et al., 1999)—this was not an intervention investigation
  • Outcome Associated with Source #10: Identifying regions of the brain activated during music and language processing (Peretz & Coltheart, 2003)—this was not an intervention investigation
  • Outcome Associated with Source #11: Identifying emotions (Thompson et al., 2004)—this is not an intervention investigation

 

Evidence Supporting MT

  • Outcomes Associated with Source #1: Improved musical and nonmusical communication (Edgerton, 1994) –Khetrapal (2009) reported that Edgerton’s Ps improved in musical and nonmusical communication
  • Outcome Associated with Source #2: Increased number of correctly imitated signed and spoken words (Buday, 1995)– Khetrapal (2009) reported that Ps with ASD were more likely to imitate signs and spoken words in sung as opposed to spoken contexts.
  • Outcome Associated with Source #3: Decreased off task behavior and improved task related behavior (Burlesson et al., 1989)– Khetrapal (2009) reported that decreased off-task behavior and improved task related behavior occurred in the presence of background music
  • Outcome Associated with Source #4: Decreased rate of problem behaviors in the classroom (Orr et al., 1998)– Khetrapal (2009) reported that in a case study of a P with ASD, problem behaviors were reduced using rhythmic entrainment.
  • Outcomes Associated with Source #5: Improved eye contact, social acknowledgement, and initiation (Wimpory et al., 1995)– Khetrapal (2009) reported that a child with ASD improved in these outcomes during interactions with her mother and maintained the improvement 2 years later.
  • Outcome Associated with Source #6: Modifying behaviors (Brownell, 2002)—Khetrapal (2009) reported that behaviors were more likely to improve with sung social stories as opposed to spoken social storied.
  • Outcome Associated with Source #7: Distinguish happy /sad emotions using pitch variations and rhythmic variation (Khalfa et al., 2008)— Khetrapal (2009) reported that listeners rely on pitch variation to distinguish happy and sad prosodic affect.
  • Outcome Associated with Source #8: Detecting pitch in music (Mottron et al., 2000)— Khetrapal (2009) reported that Ps with ASD are generally capable of detecting pitch in music
  • Outcomes Associated with Source #9: Detecting emotion in music (Heaton et al., 1999)— Khetrapal (2009) reported that Heaton et al (1999), among others, determined that Ps with ASD do not experience difficulty distinguishing emotion in music.
  • Outcome Associated with Source #10: Identifying regions of the brain activated during music and language processing (Peretz & Coltheart, 2003)– Khetrapal (2009) reported that music and language are not processed in the same areas of the brain, for the most part.
  • Outcome Associated with Source #11: Identifying emotions (Thompson et al., 2004)– Khetrapal (2009) reported that knowledge of words or verbal comprehension are not needed to identify emotions from speech.

 

 

Evidence Contraindicating MT

  • Khetrapal did not provide contradictory information for the contention that MT might be useful in improving the prosodic recognition of emotion. However, the research that was summarized in Khetrapal was brief and incomplete. Little information was provided about the number of Ps, communication status of the Ps use of randomization, treatment procedures, specific outcome measures, and statistical results.