Khetrapal (2009)

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  • Did the sources include unpublished studies?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.
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