SECONDARY REVIEW CRITIQUE
AS = Asperger Syndrome
ASD = autism spectrum disorders
C = clinician
CAT = computer-assisted technologies
NA = not applicable
P = patient or participant
pmh = Patricia Hargrove, blog developer
SLP = speech-language pathologist
SR = Systematic Review
TD = typically developing
Source: Ploog, B. O., Scharf, A., Nelson, D., & Brooks, P. J. (2013). Use of computer-assisted technologies (CAT) to enhance social, communicative, and language development in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 301 – 322.
Date: March 20, 2016
Overall Assigned Grade: B- (Highest possible grade was B based on the design of the investigation.)
Level of Evidence: B (Narrative Systematic Review with Broad Criteria)
Take Away: Computer-assisted technologies (CAT) have potential to improve comprehension of prosodic affect and sarcasm/metaphors in individuals with autism spectrum disorders (ASD) but it is not clear that it is more effective than conventional interventions.
What type of secondary review? Narrative Systematic Review
- Were the results valid? Yes
- Was the review based on a clinically sound clinical question?
- Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? Yes
- The authors of the secondary research noted that they reviewed the following resources: Not Applicable (NA), the resources for identifying existing publications were not listed.
- 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- Did the sources include unpublished studies?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 authors of the secondary research identify the level of evidence of the sources? No
- Did the authors of the secondary research 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? Yes. Although the investigators did not describe the strategy, it was clear from their techniques they had a strategy. However, it is not clear whether or not the strategy was predetermined.
- Did the authors of the secondary research or review teams rate the sources independently? No
- Were interrater reliability data provided? No
- If the authors of the secondary research provided interrater reliability data, list the data here: 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? Yes
- Did the sources that were evaluated involve a sufficient number of participants? Yes, for Communication Disorders intervention research the overall numbers were acceptable.
- Were there a sufficient number of sources? Variable. Yes, for the overall investigation; No, for this review’s focus.
- Description of outcome measures:
NOTE: There were 5 outcomes. Only one of the (Outcome #1) was concerned with prosody. Although the other outcomes are listed, their results will not be presented and they will not be summarized.
- Outcome #1: Improved recognition of prosodic affect
- Outcome #2: Improve recognition of facial emotion
- Outcome #3: Improved expressive and receptive language skill, including literacy skills
- Outcome #4: Improved performance on Theory of Mind tasks
- Outcome #5: Improved social skills
- Description of results:
– What measures were used to represent the magnitude of the treatment/effect size? No measure of the magnitude of the treatment effect/effect size was reported
– Summarize overall findings of the secondary research:
[NOTE: There were 5 outcomes. Only one of the (Outcome #1) was concerned with prosody and only its findings will be summarized.]
Outcome #1: Improved recognition of prosodic affect
- LaCava et al. (2007): using “‘Mind Reading” software with 8 children with Asperger Syndrome, the investigators detected significant improvement in pre and post tests.
- LaCava et al. (2010) using “Mind Reading” software with 4 boys with ASD, the investigators reported significant improvement. However, “Mind Reading” software did not appear to be more effective than intervention that did not use CAT.
- Golan and Baron-Cohen (2006) compared the use of “Mind Reading” software to a no intervention condition in 54 adults with AS or ASD and determined that the “Mind Reading” software yielded a significant improvement on a test of interpreting prosody (“Reading the Voice in Mind”, p. 313.)
- Grynszpan et al. (2008)- The investigators treated were 2 groups of 10 Ps each and that included both children diagnosed with ASD and typically developing (TD) children. Generalization of the intervention was assessed using two versions of the game “Intruder” (text only and a combination of facial cues, text, and synthetic voice, p. 317) designed to measure the ability to comprehend sarcasm or metaphor. The results revealed that the TD Ps improved in the text only and the combined versions of the Intruder. However, the Ps with ASD improved in the text only version of the Intruder measure but not in the combined measure. The investigators attributed this to attention problems associated with ASD.
– Were the results precise? Unclear, no data were presented related to this question.
– 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? NA, the investigators did not provide confidence intervals.
– Were the results of individual studies clearly presented? Yes, for the most part.
– For the most part, were the results similar from source to source? Yes
– Were the results in the same direction? Yes
– Did a forest plot indicate homogeneity? NA
– Was heterogeneity of results explored? No
– Were the findings reasonable in view of the current literature? Yes
– Were negative outcomes noted? Yes
- Were maintenance data reported? No
- Were generalization data reported? Only Grynszpan et al. (2008) reported generalization data using the CAT game “Intruder.” The results revealed that the TD Ps improved in the text only and the combined versions of the Intruder but the Ps with ASD improved only improved in the text only version. The investigators attributed this to attention problems associated with ASD.
SUMMARY OF INTERVENTIONS
[Reviewers should only complete this section if sufficient information is provided in the review to describe treatment procedure(s).]
Population: Autism Spectrum Disorders, Asperger Syndrome; Adults, Adolescents, Children
Prosodic Targets: prosodic affect and sarcasm/metaphors
Aspects of Prosody Used in Treatment of Nonprosodic Targets: prosodic affect
Description of Procedure #1— Mind Reading Software
- CAT involving voice, facial cues, and photos.
Evidence Supporting Procedure #1—Mind Reading Software
- LaCava et al. (2007, 2010) as well as Golan and Baron-Cohen (2006) reported significant improvement in the interpretation of affective prosody in Ps with AS and ASD.
Description of Procedure/Source #2— What to Choose
- The CAT presented a dialogue in virtual reality in which one speaker in a conversation uttered a sarcastic statement. The audio was accompanied by a picture of a virtual reality character whose face appropriate to the sarcastic remark.
- P selected one of three possible interpretations of the sarcastic remark by clicking on it.
- Feedback was provided to the P.
Evidence Supporting Procedure/Source #2—What to Choose
- Grynszpan et al. (2008) — Generalization was assessed using two versions (text only and a combination of facial cues, text, and synthetic voice) of the game “Intruder” (p. 317) designed to measure the ability to comprehend sarcasm or metaphor. The results reveals that
– the TD Ps improved in the text only and the combined versions of the Intruder and
– the Ps with ASD improved only improved in the text only version.
Evidence Contraindicating Procedure/Source #2 — What to Choose
- Grynszpan et al. (2008) attributed this the failure of the ASD group to improve in the combined version of the Intruder game to attention problems associated with ASD.