Saban-Bezalel & Mashal (2015)

 

EBP THERAPY ANALYSIS

Treatment Groups

 

Note: Scroll about two-thirds of the way down the page to read the summary of the procedure(s).

 

Key:

ASD = Autism Spectrum Disorders

ASD foil = ASD participants randomly assigned to the control group in which a foil treatment was administered

ASD tx = ASD participants randomly assigned to the treatment group

C = Clinician

DVF = divided visual field

EBP = evidence-based practice

LVF/RH = left visual field/ right hemisphere

NA = not applicable

RVF/LH = right visual field/left hemisphere

P = Patient or Participant

SLP = speech–language pathologist

TD = typically developing participants who received a foil treatment

tx = treatment

 

SOURCE: Saban-Bezalel, R., & Mashal, N. (2015). The effects of intervention on the comprehension of irony and on hemispheric processing of irony in adults with ASD. Neuropsychologia,

ARTICLE: http://dx.doi.org/10.1016/j.neuropsychologia.2015.09.004

REVIEWER(S): pmh

 

DATE: September 17, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: B-  (The highest possible grade based on design type was A.)

 

TAKE AWAY: It may be a stretch to include this treatment in the Clinical Prosody Blog because the treatment protocol does not specify that prosodic cues are targeted. Nevertheless this investigation is included because the investigators noted in their review of the literature that prosody is one cue that listeners use to detect irony. The investigators determined that their intervention did improve the irony comprehension of Hebrew-speaking adults with Autism Spectrum Disorders (ASD) as measured by a reading task as well as response and accuracy time in a visual field task.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Nonrandomized Group Design with Controls

                                                                                                           

  • What was the level of support associated with the type of evidence? Level = A

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • Were participants randomly assigned to groups? Yes. The group of participants (P) with Autism Spectrum Disorder (ASD) were randomly assigned into treatment and foil treatment groups.
  • If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched?

Yes ____     No ___     Unclear _x___     N/A _______. Obviously, Ps were not randomly assigned to the typically developing (TD) group. Matching strategies for TD and Ps with ASD were not described by the investigators. Nevertheless, there were no significant differences between the Ps with ASD and the TD group on age, nonverbal IQ, and vocabulary.

                                                                    

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No
  • from clinicians? No
  • from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described?

How many participants were involved in the study?

– total # of participant:   51

– # of groups: 3

– # of participants in each group: 16, 13, 22

– List names of groups:   

– ASD treatment (tx) = 16

– ASD foil control (foil) = 13

– TD = 22

The following variables were described                                  

  • age:

ASD tx = mean 28.16

     ASD foil = mean 24.36

     – TD =  mean 27.45

  • gender:

ASD tx = 9m, 7f

     ASD foil = 11m, 2f

     – TD = 13m, 9f

  • cognitive skills (nonverbal IQ):

ASD tx = mean score 37.06

     ASD foil = mean score 35.31

     – TD = mean score 39.14

  • receptive language: (vocabulary)

ASD tx = mean score 44.56

     ASD foil = mean score 42.69

     – TD =  mean score 47.95

  • educational level of clients: At least 12 years of education
  • neurological problems: None reported
  • handedness: All Ps were right handed
  • vision: Ps were either intact or corrected
  • diagnosis of ASD Ps: PDD-NOS (9Ps), Asperger syndrome (20Ps); according to DSM-IV criteria all would be classified ASD

 

–   Were the groups similar before intervention began? Yes

                                                         

– Were the communication problems adequately described? Yes

  • disorder type:  problem comprehending irony

 

 

  1. Was membership in groups maintained throughout the study?

 

  • Did each of the groups maintain at least 80% of their original members? Yes
  • Were data from outliers removed from the study? No

 

  1. Were the groups controlled acceptably? Yes

 

  • Was there a no intervention group? No

                                   

  • Was there a foil intervention group? Yes (ASD foil)

                                   

  • Was there a comparison group? Yes (TD)
  • Was the time involved in the foil/comparison and the target groups constant? No. The ASD foil and TD groups were involved in a “passive intervention” using the stimuli from the ASD group intervention in small groups that were lead by a speech-language pathologist (SLP.) There was only one session.

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

The outcomes were

  • OUTCOME #1: Percentage of correct responses on an irony questionnaire
  • OUTCOME #2: Improved reaction time to read passages in a divided visual field (DVF) task containing ironic or literal comments at the end.
  • OUTCOME #3: Percentage of correct responses on the DVF task

 

— The outcome measures that are subjective are

  • OUTCOME #1: Percentage of correct responses on an irony questionnaire
  • OUTCOME #3:   Percentage of correct responses on the DVF task

 

— The outcome measure that is objective is

  • OUTCOME #2: Improved reaction time to read passages in a divided visual field (DVF) task containing ironic or literal comments at the end.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? No

 

Intraobserver for analyzers? No

– Treatment fidelity for clinicians? Yes but no data were provided. The lead investigator trained all administrators of the treatment protocol and randomly observed the administrators delivering the protocol. In addition, after each session the administrators completed forms detailing P behavior.

 

 

  1. What were the results of the statistical (inferential) testing?

 

  • OUTCOME #1: Percentage of correct responses on an irony questionnaire

– 2x2x2 (3 way) ANOVA time (pre, post) x passage (ironic, literal) x group (ASD tx, ASD foil) revealed. (NOTE: TD group was not included in this analysis because the group was at ceiling.)

– Overall ironic were less accurate than literal.

– The 3 way interaction was significant revealing:

  • ASD tx group was significantly less accurate before intervention on the ironic passages compared to literal passage but the difference was not significant after treatment.
  • ASD foil group was significantly less accurate before and after intervention on the ironic passages compared to the literal passages.
  • OUTCOME #2: Improved reaction time to read passages in a divided visual field (DVF) task containing ironic or literal comments at the end.

– 2 x 2 x 2 x 3 ANOVA [time (pre, post) x visual field (right, left) x target word (ironic, literal) x group (ASD tx, ASD foil, TD)].

– Overall,

  • the posttest reaction times were significantly faster (i.e., smaller) than the pretest reaction times.
  • Ps reacted significantly faster to stimuli were presented to the left visual field/ right hemisphere (LVF/RH) than to the right visual field/left hemisphere (RVF/LH)
  • The ASD tx group reacted significantly more slowly than TD group.

– There was a significant difference for the time (pre, post) x target word (ironic, literal) but follow up post hoc analyses were not significant.

– There was a significant difference for the time (pre, post) x visual field (right, left) x target word (ironic, literal) x group (ASD tx, ASD foil, TD) interaction. Post hoc analysis revealed the following significant differences:

  • For the ASD tx group, a significant difference between target groups after intervention with faster responses to ironic target words in the ASD tx group
  • Also for the ASD tx group, when Ps were presented the LVF/RH after intervention they responded significantly faster to ironic target words.
  • For the TD group, Ps responded significantly faster to the ironic target words before the control foil intervention and after the intervention they responded significantly faster to the literal words.
  • OUTCOME #3: Percentage of correct responses on the DVF task

– 2 x 2 x 2 x 3 ANOVA [time (pre, post) x visual field (right, left) x target word (ironic, literal) x group (ASD tx, ASD foil, TD].

– Overall,

  • Ps produced more correct responses following intervention than before intervention.
  • Significantly more correct responses occurred when stimuli were presented to LVF/RH than to RVF/LH.
  • The TD group was significantly more accurate than the ASD foil group.
  • Iconic target words were significantly more accurate than literal target words.

– There was a significant interaction for the time (pre, post) x target word (ironic, literal.) Post hoc analyses indicated that

  • Ironic words were significantly more accurate after intervention compared to before intervention

– There was a significant interaction of time (pre, post) x group (ASD tx, ASD foil, TD.) Post hoc analyses revealed that

  • For the ASD tx and the TD group, performance was significantly more accurate after intervention.

– There was a significant interaction for visual field (LVF/RH, RVF/RH) x target word (ironic, literal.) Post hoc analyses indicated that

  • Ironic words were significantly more accurate in the LVF/RH condition compared to the RVF/LH condition.

– The interaction of time (pre, post) x visual field (right, left) x target word (ironic, literal) x group (ASD tx, ASD foil, TD) was significant. Post hoc analyses yielded the following significant differences:

  • For the ASD foil group, after the control intervention LVF/RH was significantly more accurate than RVF/LH but the 2 visual fields were not significantly different before control intervention.
  • The opposite was true for the TD group— before the control intervention LVF/RH was significantly more accurate than RVF/LH but the 2 visual fields were not significantly different after control intervention
  • What were the statistical test used to determine significance?

ANOVA:

– Bonferroni post hoc analysis:

Scheffe post hoc analysis

 

  • Were confidence interval (CI) provided? No

 

                                   

  1. What is the clinical significance?

 

– Measures used: ETA:

NOTE: The investigators provided eta for numerous comparisons. Only significant comparisons concerned with pre and post intervention are noted here.

  • OUTCOME #1: Percentage of correct responses on an irony questionnaire

– The eta time x passage x group interaction was 0.17 (moderate.) Post hoc analysis indicated that

  • for the ASD tx group, before intervention ironic targets were less accurate than literal targets but after intervention ironic and literal targets were similar (no EBP data provided.)
  • for the ASD foil group, both before and after intervention, ironic targets were less accurate (no EBP data provided.)
  • OUTCOME #2: Improved reaction time to read passages in a divided visual field (DVF) task containing ironic or literal comments at the end.

– Reaction times were faster after intervention than before (eta = 0.54, strong)

– Eta for the time x target x group interaction was 0.13. Post hoc analyses revealed that

  • for the ASD tx group, the response time for ironic and literal targets did not differ before intervention but that literal targets were significantly faster after intervention. (No EBP data were provided.)

– Eta for the time x visual field x target x group interaction was 0.12 (moderate.)

  • OUTCOME #3: Percentage of correct responses on the DVF task

– There was greater accuracy on the DVF after intervention compared to before intervention (eta = 0.23, moderate.)

– The eta for the interaction in the time x target analysis was 0.19 (moderate.) The post hoc analysis indicated that

  • For ironic words, performance was significantly stronger after intervention compared to before intervention. (No EBP data were provided.)

– The eta for the interaction in the time x group analysis was 0.12. The post hoc analysis indicated that

  • Both ASD tx and TD groups improved from pre to post intervention. (No EBP data were provided.)

– The eta for the interaction in the time x visual field x group analysis was 0.12 (moderate.) The post hoc analysis indicated that

  • For the TD group, responses were better to LVF/RH stimuli than to RVF/LH stimuli before intervention but not after passive intervention.
  • For the ASD foil group, responses were better to LVF/RH stimuli than to RVF/LH stimuli after intervention but not after before intervention.

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

           

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an intervention designed to improve the comprehension of irony.

POPULATION: ASD; adults

 

MODALITY TARGETED: comprehension

 

ELEMENTS OF PROSODY USED AS INTERVENTION: prosodic cues to irony

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: irony

DOSAGE:

– ASD tx group: small groups, 30 – 45 minute sessions, 1 time a week, 5 weeks

– ASD foil: small group, one session

– TD: small group, one session

 

ADMINISTRATOR:

– ASD tx group: 1 SLP and 6 teachers

– ASD foil: SLP

– TD: SLP

 

STIMULI: auditory, visual

– ASD tx group: video clips (20, derived from movies and television), comic strips (13, investigator developed), short stories (5, investigator developed)

– ASD foil: video clips

– TD: video clips

 

MAJOR COMPONENTS: (The Appendix provides a more thorough presentation of the ASD tx procedures.)

 

– ASD tx group

  • SESSION 1: The Clinician (C), who could be the SLP or a teacher,

– explained the concept of figurative language and irony

– focused on its purpose the social context

– presented cues to identify irony

– asked Ps to identify irony in the video clips and written stories

  • SESSION 2:

– Ps viewed and analyzed 4 different video clips

– Ps identified cues to irony from the videos.

– Ps discussed speaker intention.

– Ps created ironic or literal responses to short stories.

  • SESSION 3:

– Ps viewed and analyzed 4 different video clips

– Ps identified cues to irony from the videos.

– Ps discussed speaker intention

– Ps created ironic or literal responses to short stories.

– Ps also created ironic or literal responses to comic strips.

  • SESSION 4:

– Ps viewed 4 different video clips

– Ps identified cues to irony from the videos.

– Ps discussed speaker intention.

– Ps created ironic or literal responses to short stories.

– Ps created ironic or literal responses to comic strips.

– Ps also described contexts in which they have noted irony in daily living.

  • SESSION 5:

– Ps viewed 4 different video clips

– Ps identified cues to irony from the videos.

– Ps discussed speaker intention.

– Ps created ironic or literal responses to short stories.

– Ps created ironic or literal responses to comic strips.

– Ps described contexts in which they have noted irony in daily living.

– C summarized the use of irony.

– C provided examples of irony in the press.

– ASD foil

  • this was a passive intervention in which the SLP presented the videos and Ps were asked to rate the level of enjoyment and the understandability of the 20 videos

– TD

  • this was a passive intervention in which the SLP presented the videos and Ps were asked to rate their level of enjoyment and understandability .

 

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