Persicke et al. (2013)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

NOTES:

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

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Persicke, A., Tarbox, J., Ranick, J., St. Clair, M. (2013). Teaching children with autism to detect and respond to sarcasm. Research in Autism Spectrum Disorders, 7, 193-198.

 

REVIEWER(S): pmh

 

DATE: December 12, 2015

 

ASSIGNED OVERALL GRADE: B (Based on the design, the highest possible grade was A-. )

 

TAKE AWAY: This single subject experimental design investigation provides good support of an intervention teaching children with Autism Spectrum Disorders (ASD) to comprehend sarcasm.

                                                                                                                       

 

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

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Single Subject Experimental Design with Specific Client Multiple ABA designs

                                                                                                           

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

                                                                                                           

 

  1. Was phase of treatment concealed? (answer Yes, No, or Unclear to each of the questions)
  • from participants? No
  • from clinicians? No
  • from data analyzers? Unclear

 

 

  1. Were the participants (Ps) adequately described? No

 

  • How many Ps were involved in the study? 3

 

— The CONTROLLED characteristics included

  • diagnosis: Autism

 

— The DESCRIBED characteristics included

  • age: 6 and 7 years old
  • gender: based on names they were males
  • parental involvement: improved understanding of sarcasm was a priority with parents and supervisors
  • current therapy: 2 to 10 hours a week of behavioral therapy; sarcasm was not targeted outside the investigation’s interventions
  • previous therapy: had been receiving behavioral in-home for 3 to 4 years; no direct work on sarcasm but all participants (Ps) had received training on the following skills (p. 195)

     – prosody

     – body language

     – facial expression

     – physical context of conversation

     – conversational audience

     – desires

     – emotions

     – sensory perspective taking

     – cause and effect

     – preferences

     – knowing

     – beliefs

     – intentions                                

                                                 

  • Were the communication problems adequately described? No
  • The disorder type was Communication Disorder associated with Autism Spectrum Disorder (ASD)

 

                                                                                                                       

  1. 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? No

 

 

  1. Did the design include appropriate controls? Yes

 

  • Were baseline/preintervention data collected on all behaviors? Yes

 

  • Did probes/intervention data include untrained stimuli? Yes

 

  • Did probes/intervention data include trained stimuli? No

 

  • Was the data collection continuous? Yes

 

  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– The outcome/dependent variable was

 

OUTCOME: Increased accuracy in responding to sarcastic comments in conversation

 

– The outcome was subjective.

                                                       

– The outcome was NOT objective                                                         

 

  • The reliability data for the outcome (Increased accuracy in responding to sarcastic comments in conversation) was

     – averaged across 36% of the sessions;

     – interobserver reliability was 99.4%;

     – the lowest interobserver reliability for a session was 97%.

 

 

  1. Results:

 

Did the target behavior(s) improve when treated? Yes

 

– The overall quality of improvement for the outcome (Increased accuracy in responding to sarcastic comments in conversation) strong.

 

 

  1. Description of baseline:

 

Were baseline data provided? Yes

  • OUTCOME: Increased accuracy in responding to sarcastic comments in conversation

Reggie had 3 baseline sessions

     – Hans had 4 baseline sessions

     – Kevin had 5 baseline sessions

 

Was baseline low and stable? Baseline was low and stable for all 2 Ps. One of the Ps display minimal variability.

 

Was the percentage of nonoverlapping data (PND) provided? No. However, this reviewer calculated PND

 

– What was the PND and what level of effectiveness does it suggest?

 

  • OUTCOME: Increased accuracy in responding to sarcastic comments in conversation

Reggie – PND = 100% — highly effective

     – Hans – PND = 90% — highly effective

     – Kevin – PND = 100%– highly effective

 

 

  1. What is the clinical significanceNA. Not provided.

 

  1. Was information about treatment fidelity adequate? No. The investigators reported that treatment fidelity was monitored but no data were provided.

 

 

  1. Were maintenance data reported? Yes
  • For 2 of the Ps, follow-up assessments were administered 1, 2, and 3 months after the post therapy phase. Both Ps maintained accurate performances.

 

 

  1. Were generalization data reported? Yes
  • All Ps were assessed using untrained stimuli, in untrained contexts, and with interacters who were not present during intervention. In each case, the Ps produced correct responses at a rate similar to trained cases.

 

 

  1. Brief description of the design:
  • Three boys diagnosed with ASD were subjects in a single subject experimental design investigation.
  • The investigation involved a staggered ABA design in which the Ps were administered 3, 4, or 5 sessions of preintervention (baseline) assessment.
  • The intervention consisted of 11 or 12 session administered by C.
  • The postintervention phase involved 7 post therapy sessions for all the Ps and an additional 3 session of follow-up assessment for 2 of the Ps. The postintervention phase involved procedures similar to the preintervention phase as well as generalization tasks.
  • The assessment for the pre and post intervention phases involved observing Ps’ reactions to sarcastic comments made by the clinician (C) during conversation.

 

 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: B

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of a program designed to increase the comprehension of sarcastic remarks in conversation

 

POPULATION: Autism Spectrum Disorders

 

MODALITY TARGETED: comprehension

 

ELEMENTS OF PROSODY USED AS INTERVENTION: overall intonation (specific elements of intonation were not identified)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: sarcasm

 

DOSAGE: 30 min per session, 2 to 3 times a week for a total of 11-12 sessions.

 

ADMINISTRATOR: “therapist” or parent (during Phase II)

 

MAJOR COMPONENTS:

 

  • Intervention progressed from contrived activities to conversation. It included generalization to untrained stimuli and contexts.

 

  • Treatment, for the most part, occurred in the home, although generalization activities could occur in the community

 

  • Treatment sessions lasted about 30 minutes. Pre-and Post – intervention sessions lasted about an hour.

 

PHASE 1—Rules and Videos

 

  • The clinician (C) provided

– rules

– models

– examples

– leading questions

– feedback (praise for correct responses; leading questions for incorrect responses)

– exaggerated cues (intense intonation and facial cues)

– brief videos of sarcastic remarks in context

 

  • C asked questions after the viewing of the videos focusing on cues P might use to determine if the comment was sarcastic and to provide P with a repertoire of questions to ask himself when determining if a comment was sarcastic or sincere.

 

  • C gradually faded the exaggerated intonation and facial cues.

 

  • Criterion = 80% for 3 sessions (2 Ps achieved criterion in 3 session; 1 P achieved criterion in 1 session.)

 

  • The investigators noted that it was not clear that this phase was essential due to the high rate of achieving criterion.

 

PHASE II – In Vivo Training

 

  • Each session involved 10 – 12 trials

 

  • At the beginning of each session, C stated the rule and directed P to restate it.

 

  • C produced sarcastic comments during conversation.

 

  • If P responded appropriately to the sarcasm, C praised him. If he was incorrect, C asked leading questions as in Phase I.

 

  • P’s intonation and facial expression were exaggerated in the first session, faded in the second session, and eliminated in the third session.

 

  • In each session, one -half the sarcastic stimuli were novel sentences and one-half had been used previously.

 

  • Intervention was administered in the home, in a park (for generalization), or in a coffeehouse (for generalization).

 

  • Administrators during this phase were therapists and parents/nannies. Parents and nannies were reported to be trained by the therapists.

 

  • Criterion = 80% for 3 sessions (2 Ps achieved criterion in 3 session; 1 P achieved criterion in 1 session.)

 

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