Patel et al. (2020)

March 28, 2020

 

ANALYSIS

Comparison Research

 NOTE: This is not an intervention investigation. Accordingly, no summary of intervention is included in the review.

KEY:

ADOS = Autism Diagnostic Observation Scale

BAP = Broad Autism Phenotype

eta = partial eta squared

f = female

F0 = fundamental frequency

m = male

MLU = mean length of utterance

MPAS = Modified Personality Assessment Schedule (MPAS)

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

PSA = Pragmatic Rating Scale

PSA-SA = Pragmatic Rating Scale-School Age

SD = standard deviation

SLP = speech-language pathologist

 

SOURCE:  Patel, S. P., Nayer, K., Martin, G. E., Franich, K., Crawford, S., Diehl, J. J., & Losh, M. (2020). An acoustic characterization of prosodic differences in autism spectrum disorder and first-degree relatives. Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-020-04392-9

REVIEWER(S):  pmh

 

DATE:  March 19, 2020

 

ASSIGNED GRADE FOR OVERALL QUALITY:  Not Applicable (NA). No grade was assigned because this investigation did not deal with intervention.

 

TAKE AWAY:  This investigation explored the acoustic characteristics of communication of children with autism spectrum disorders (ASD) and their parents by comparing them to neurotypical peers and their parents. Significantly slower speaking rate was observed in both the participants with ASD and their parents.

 

  1. What type of evidence was identified?
  • What was the type of design?Comparison Research
  • What was the focus of the research? Clinically Related
  • What was the level of support associated with the type of evidence? Level = C+

                                                                                                           

  1. Group membership determination:
  • . If there were groups, were participants randomly assigned to groups? No
  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched?  Unclear

     –  The chronological age of the children with ASD and their neurotypical peers was not significantly different. However, there were significant difference for the following measures

∞ Full scale IQ

∞ Verbal IQ

∞ Performance IQ

∞ male to female ratio

–  The ASD parent group and the Parent control group differed significantly on the following measures

∞ Chronological age (the ASD parent group was older)

∞ Verbal IQ

                                                                    

  1. Were conditions/groups concealed?
  • from participants?Yes
  • from administrators of experimental conditions? No
  • from analyzers/judges? Yes

                                                                    

  1. Were the groups adequately described? Yes

   How many participants were involved in the study?

  • total # of Ps: 238
  • # of groups: 4
  • List names of groups and the number of Ps in each group:

     – ASD Group = 55

– ASD Control Group (neurotypical) = 39

– ASD Parent Group = 96

– Parent Control Group = 48

  • Did all groups maintain membership throughout the investigation? Yes, but data from one adolescent and one parent were discarded due to poor quality of the recordings.

 

CONTROLLED CHARACTERISTICS                                                     

  • Diagnosis:

     – ASD Group = all diagnosed with ASD and confirmed

     – ASD Control Group and Parent Control Group = ASD ruled out for all Ps and no family history (1stand 2nd degree relatives) of ASD or related genetic disorders, dyslexia,

  • Other Diagnoses:

     – All Ps = no history of brain injury, major psychiatric disorders, genetic disorders, neurotypical development

 

DESCRIBED CHARACTERISTICS

  • age:

     – ASD Group:  mean = 16.6

     – ASD Control Group:  mean = 19

     – ASD Parent Group:  mean = 46.7

     – Control Parent Group:  mean = 43

  • gender:

    – ASD Group:  45m; 10f

     – ASD Control Group: 19m; 20f

     – ASD Parent Group:  38m; 58f

     – Control Parent Group: 20m; 28f

  • cognitive skills:

     – ASD Group:

∞ mean Full scale IQ = 104.2

∞ mean Verbal IQ = 105.1

∞ mean Performance IQ =  102.9

     – ASD Control Group:

∞ mean Full scale IQ = 115.5

∞ mean Verbal IQ = 117.5

∞ mean Performance IQ = 111.1

     – ASD Parent Group:

∞ mean Full scale IQ = 111.1

∞ mean Verbal IQ = 109.4

∞ mean Performance IQ = 110.4

     – Control Parent Group:

∞ mean Full scale IQ = 114.8

∞ mean Verbal IQ = 111.2

∞ mean Performance IQ = 115.1

 

  • Were the groups similar?Unclear  
  • Were the communication problems adequately described?No 
  • disorder type: Autism Spectrum Disorder (ASD)

 

  1. What were the different conditions for this research?
  • Subject (Classification) Groups? Yes

     – ASD Group:

     – ASD Control Group:

     – ASD Parent Group:

     – Control Parent Group:

  • Experimental Conditions? No  x_____     Unclear ____, there was only one condition in which the speech samples were elicited– Narratives
  • Criterion/Descriptive Conditions?Yes

Acoustic Measures: mean, standard deviation (SD), and range of the fundamental frequency (F0) for each utterance, utterance final F0 excursion size (F0 range of the final word0 of each utterance; rate (syllables per second including within utterance pauses); Normalized Pairwise Variability Index (nPVI, for rhythm)

     –  Clinical Behaviors (for Correlations):

–  Broad Autism Phenotype (BAP) Characteristics—Modified Personality Assessment Schedule (MPAS)

–  Pragmatic Language Ability — Pragmatic Rating Scale (PSA) Pragmatic Rating Scale-School Age (PSA-SA)

–  Perceptual Judgments: rating on a 11-point Likert Scale for each of the following

–  Intonation

–  Rate

–  Rhythm

–  Likelihood the speaker had ASD

 

  1. Were the groups controlled acceptably?  Yes

 

  1. Were dependent measures appropriate and meaningful? Yes

 

ACOUSTIC MEASURES

  • OUTCOME #1: Mean F0 for each utterance selected from a narrative sample
  • OUTCOME #2: Mean utterance final F0 excursion size for each utterance selected from a narrative sample
  • OUTCOME #3: SD of the F0 for each utterance selected from a narrative sample
  • OUTCOME #4: Range of the F0 for each utterance selected from a narrative sample
  • OUTCOME #5: Speech rate from a narrative sample
  • OUTCOME #6: nPVI from a narrative sample

 

CLINICAL BEHAVIORAL MEASURES

  • OUTCOME #7: Rating as BAP+ or BAP- on the basis of P performance on the MPAS scales of Social, Rigid, or Untactful Traits
  • OUTCOME #8: Performance on the Autism Diagnostic Observation Scale (ADOS)
  • OUTCOME #9: Performance on the Pragmatic Rating Scale (PSA) or the Pragmatic Rating Scale-School Age (PSA-SA)

 

PERCEPTUAL MEASURES

  • OUTCOME #10: Rating of intonation of utterances selected from the narrative
  • OUTCOME #11: Rating of rhythm of utterances selected from the narrative
  • OUTCOME #12: Rating of rate of utterances selected from the narrative
  • OUTCOME #13: Rating of likelihood the speaker had been diagnosed with ASD

 

LANGUAGE MEASURE

  • OUTCOME #14: Utterance length (number of syllables per utterance)

 

—  The following outcomes measures are subjective:

CLINICAL BEHAVIORAL MEASURES

  • OUTCOME #7: Rating as BAP+ or BAP- on the basis of P performance on the MPAS scales of Social, Rigid, or Untactful Traits
  • OUTCOME #8: Performance on the Autism Diagnostic Observation Scale (ADOS)
  • OUTCOME #9: Performance on the Pragmatic Rating Scale (PSA) or the Pragmatic Rating Scale-School Age (PSA-SA)

 

PERCEPTUAL MEASURES

  • OUTCOME #10: Rating of intonation of utterances selected from the narrative
  • OUTCOME #11: Rating of rhythm of utterances selected from the narrative
  • OUTCOME #12: Rating of rate of utterances selected from the narrative
  • OUTCOME #13: Rating of likelihood the speaker had been diagnosed with ASD

 

LANGUAGE MEASURES

  • OUTCOME #14: Utterance length (number of syllables per utterance)

 

–  The following outcomes are objective measures:

ACOUSTIC MEASURES

  • OUTCOME #1: Mean F0 for each utterance selected from a narrative sample
  • OUTCOME #2: Mean utterance final F0 excursion size for each utterance selected from a narrative sample
  • OUTCOME #3: SD of the F0 for each utterance selected from a narrative sample
  • OUTCOME #4: Range of the F0 for each utterance selected from a narrative sample
  • OUTCOME #5: Speech rate from a narrative sample
  • OUTCOME #6: nPVI from a narrative sample

 

  1. Were reliability measures provided?

   Interobserver for analyzers?  Yes _x__     No  ___      Unclear  ____

CLINICAL BEHAVIORAL MEASURES

  • OUTCOME #7:Rating as BAP+ or BAP- on the basis of P performance on the MPAS scales of Social, Rigid, or Untactful Traits—Inter-rater reliability 81%
  • OUTCOME #8:Performance on the Autism Diagnostic Observation Scale (ADOS)
  • OUTCOME #9: Performance on the Pragmatic Rating Scale (PSA) or the Pragmatic Rating Scale-School Age (PSA-SA) —Inter-rater reliability 86% and 76%, respectively

 

–  Intraobserver for analyzers?

–  Treatment or test administration fidelity for investigators?  No

 

  1. Description of design:
  • A total of 238 Ps representing the following groups the ASD Group, ASD Control Group, ASD Parent Group, and Control Parent Group participated in the investigation.
  • The investigators administered the MPAS and the PRS or the PRS-SA to all the Ps. In addition, the investigator elicited narrative language samples from which they measured selected utterances acoustically and perceptually.
  • The data were analyzed using inferential and correlational statistics including regression analysis.

 

 

 

 

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

 

10a  List comparisons that are significant  (e.g.,  p ≤ 0.05).  For each outcome, list any significant difference among comparisons or in the case of the use of descriptive statistics only, list any notable differences or trends. Note if you do not use ≤ 0.05 as your criterion.

 

Start on page BAP GROUP DIFFERENCES. Id bap in description of design

 

 

ACOUSTIC MEASURES

  • OUTCOME #1: Mean F0 for each utterance selected from a narrative sample—ASD Parent Group was significantly lower than Parent Control Group; mothers in the Parent ASD group were significantly lower than mothers in Parent Control Group
  • OUTCOME #2: Mean utterance final F0 excursion size for each utterance selected from a narrative sample—overall ASD Group produced a larger change; male ASD Ps produced a larger change than male ASD Controls
  • OUTCOME #3: SD of the F0 for each utterance selected from a narrative sample
  • OUTCOME #4: Range of the F0 for each utterance selected from a narrative sample—ASD Parent Group was significantly higher than Parent Control Group; mother in ASD Parent Group had significantly larger range than mother in the Parent Control Group
  • OUTCOME #5: Speech rate from a narrative sample —Overall ASD Group produced slower; male ASD Ps produced slower rate than ASD Controls; ASD Parent group showed more slowing as the utterance length increasd (Outcome 14)
  • OUTCOME #6:nPVI from a narrative sample

 

CLINICAL BEHAVIORAL MEASURES

  • OUTCOME #7:Rating as BAP+ or BAP- on the basis of P performance on the MPAS scales of Social, Rigid, or Untactful Traits
  • OUTCOME #8:Performance on the Autism Diagnostic Observation Scale (ADOS)
  • OUTCOME #9: Performance on the Pragmatic Rating Scale (PSA) or the Pragmatic Rating Scale-School Age (PSA-SA)

 

PERCEPTUAL MEASURES

  • OUTCOME #10:Rating of intonation of utterances selected from the narrative—ASD Ps were rated significantly more poorly than the ASD Control Ps;
  • OUTCOME #11:Rating of rhythm of utterances selected from the narrative
  • OUTCOME #12:Rating of rate of utterances selected from the narrative—rate and the likelihood the P had ASD (Outcome 13) most significantly predicted the diagnosis of ASD

 

  • OUTCOME #13:Rating of likelihood the speaker had been diagnosed with ASD—Expert listeners were more likely to accurately identify Ps from the ASD Group as having ASD; nonexpert listeners did not do this; this outcome and rate perception (Outcome 12 ) most significantly predicted the diagnosis of ASD

 

LANGUAGE MEASURES

  • OUTCOME #14:Utterance length (number of syllables per utterance). ASD Parent group showed more slowing (Outcome 5)  as the utterance length increased

 

 

 

 

 

 

  • OUTCOME #1:
  • OUTCOME #2:
  • OUTCOME #3:

 

(add additional outcomes as appropriate)

 

10b  What was the statistical test used to determine significance?  Place xxx after any inferential statistical test used in the investigation.

  • t-test:
  • ANOVA:
  • MANOVA:
  • Tukey: xxxx
  • Mann-Whitney U:
  • Wilcoxan:
  • Regression Analysis xxxx
  • . Kappa Values xxxx

 

10c  Were effect sizes provided?

Yes ____  No__x__

If yes, provide data and interpretation for any outcome with effect size results.

Interpretation Hints:

–  Cohen’s (1988) guidelines for interpreting standardized mean difference: d =  .20 small treatment effect; d = .50 moderate treatment effect; d =  .80 large treatment effect

–  for partial eta squared (eta):  .01 small, .06 is medium, and .14 is large.

 

  • OUTCOME #1:
  • OUTCOME #2:
  • OUTCOME #3:

 

(add additional outcomes as appropriate)

 

10d  Were confidence interval (CI) provided?  Yes ___          No __x__

 

10e  If the answer to 10d was yes, list the dependent measure (from item 7a) associated with the reported confidence interval (CI):

  • 98% CI:
  • 95% CI:
  • 90%
  • Other (List CI%):

 

 

  1. Summary of correlational results: for the most part these appeared to be the Pearson correlations. xxx

  –  For any outcomes associated with correlational statistics, list the following:

  • The name of the correlational test
  • The correlational data
  • The interpretation of the correlation

 

  • The following associations were significantly correlated:

  –  F0 variability [SD of F0 (Outcome 3) and FO utterance final excursion (Outcome 2)] with

     ∞  perceived intonation (Outcome 10)

     ∞  perceived rhythm (Outcome 11)

     ∞  perceived rate (Outcome 12)

  –  range of F0 (Outcome 4) with perceived intonation (Outcome 10)

  –  rate of speech (Outcome 5) with perceived rate (Outcome 12) and perceived

rhythm (Outcome 11)

  –  A subgroup of ASD Parents, labeled BAP+, presented with a significant interaction between speaking rate and utterance length. The BAP+ subgroup of ASD Parents differed significantly from the Parent Control Group. (BAP+ , or Broad Autism Phenotype, was determined by parents’ performance on subtests of the MPAS indicating the presence of the following traits: socially reticent, rigid and untactful.)

 

  –  The following associations between acoustic measures, severity of ASD, and pragmatics were found to be significant:

        ∞  in the ASD Group

  • decreased rate of speech with (1) overall severity, (2) severity of social symptom, (3) greater impairment on the Theory of Mind on the PSA-SA
  • greater impairment on the Theory of Mind on the PSA-SA with (1)  decreased rate of speech, (2) increased F0 range

 

        ∞  in the ASD Control Group

  •   increased F0 ranges with (1) greater impairment on the Theory of Mind on the PSA-SA, (2) greater impairment on suprasegmental on the PSA-SA
  • decreased rate of speech with increased score on the ADOS
  • F0 excursion with (1)  the severity of restrictive and repetitive behaviors, especially in males, (2) increased language impairment as measured by the PSA-SA

 

        ∞  in the ASD Parent Group

  • increased  nPVI was correlated with overall pragmatic violations on the PSA (such as overly detailed, tangential)
  • decreased F0 ranges was correlated with pragmatic violations on the PSA (such as lack of reciprocity, vaguness), especially in mothers

 

 

START WITH ASD PARENTS AND PARENT CONTROL

  1. Summary of descriptive results: Qualitative research.  NA

 

 

DIRECTIONS:

–  Complete this item only if the investigation was solely or primarily Qualitative in nature.

–  List the finding associated with each of the outcomes listed in item 7a.

 

  • OUTCOME #1:
  • OUTCOME #2:
  • OUTCOME #3:

 

(add other outcomes as appropriate)

 

 

  1. Brief summary of clinically relevant results:

 

  • The following acoustic measure may differentiate individuals with ASD and neurotypical peers as well as the subgroup of BAP from the Parent Control Group: the rate of speech (slower).

 

  • Mother of children with ASD who were labelled as BAP displayed mean and range differences in F0:

–  decreased F0 mean

–  wider F0 range

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: ___NA__

 

============================================================

 


Boutsen & Dvorak (2017)

March 18, 2020

 

SECONDARY REVIEW CRITIQUE

 

NOTE: The article reviewed here does not address intervention, rather it is a critical evaluation of writings about prosody as they pertain to motor speech disorders.

 

KEY:

C = clinician

f =  female

m =  male

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

 

Source:  Boutsen, F., & Dvorak, J. (2017). Prosody and. Motor speech disorders: A retrospective review of a merger that is imminent. Lingua, 199, 50-59.

 

Reviewer(s):  pmh

 

Date:  March 16, 2020

 

Overall Assigned Grade:  No grade assigned. This is not an intervention paper. Rather, it provides background information pertaining to the application of a theoretical framework to clinical issues associated with the prosody and motor speech disorders.

 

Level of Evidence:  Not Applicable.

 

Take Away:  This analysis of history of scholarship exploring the relationship between prosody and motor speech disorders can serve as an aid to readers who wish to track the evolution of thought about prosody and the diagnosis of motor speech disorders. Moreover, it explores current and historic terminology and strategies used to describe atypical prosody.

 

What type of secondary review?   Narrative Review

 

  • 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

– The authors of the secondary research noted that they reviewed the following resources:  NA

–  Did the sources involve only English language publications? No

–  Did the sources include unpublished studies?  No

 

– Was the time frame for the publication of the sources sufficient?  NA

–  Did the authors of the secondary research identify the level of evidence of the sources?   No

–  Were there a sufficient number of sources?  Yes

 

  • Description of outcome measures: NA,  this is not an intervention article.

 

  • Description of findings:

–  Historically, scholars have linked prosody and motor speech disorders. Only relatively recently has there emerged a coherent merger between prosodic scholarship (especially rhythm and intonational analysis) and motor speech disorders research. The authors described some acoustic metrics that may be reasonably associated with perceptions of motor speech disorders, although research needs to continue in this area.

–  Were the results of individual studies clearly displayed/presented?  Yes

–  Were the findings reasonable in view of the current literature?  Yes 

 

  • Were maintenance data reported? NA

 

  • Were generalization data reported? Yes

______________________________________________________________


Fairbanks (1960, Ch 11, Infections/Shifts)

March 5, 2020

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  To view the summary of the intervention, scroll about two-thirds of the way down this post.

KEY

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

Source:  Fairbanks, G. (1960, Ch. 11, Inflections and Shifts)  Voice and articulation drillbook.  New York: Harper & Row.  (pp. 132-134)

 

Reviewer(s):  pmh

 

Date:  March 3, 2020

 

Overall Assigned Grade (because there are no supporting data, there is not a grade)  The Assigned Overall Grade reflects the quality of the evidence supporting the intervention and does not represent a judgment regarding the quality of the intervention.

 

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention. Several strategies for treating pitch variability are presented in this part of Chapter 11.

 

Take Away:  This chapter of Fairbanks (1960) is concerned with the production of Pitch. Fairbanks notes that pitch level, pitch variability (pitch range), and inflection (pitch modulation within an utterance) and shifts (pitch modulation from the end of a phonation to the beginning of the next phonation) comprise pitch. This post, however, is only concerned with Inflections and Shifts.

 

  1. Was there a review of the literature supporting components of the intervention? No

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Not Applicable (NA)

 

  1. Was the intervention based on clinically sound clinical procedures? Yes

 

  1. Did the author(s) provide a rationale for components of the intervention? Variable

 

  1. Description of outcome measures:

–  Are outcome measures suggested? Yes

  • Outcome #1: Producing speech with a variety of pitch inflections
  • Outcome #2: Producing speech with a variety of pitch shifts

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To produce speech using appropriate pitch inflection and pitch shifts

 

POPULATION:  Adults

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch inflections and pitch shifts (onset), pitch direction, pitch range (extent), pitch slope (duration of pitch), affective prosody

 

DOSAGE:  NA

 

ADMINISTRATOR:  The book is written so that a lay person could use it as a self-help book. Historically, I know of many speech-language pathologists who have used the techniques and the materials in their therapy sessions.

 

MAJOR COMPONENTS:

 

  • Fairbanks (1960, Ch 11, Inflections and Shifts) defines several terms used in this section of the chapter.

 

Step 1:  P reads the words from wordlist the (paired with recommended intentions/meaning) on page132 with the designated inflections (rising or falling). C recommends that the inflections be exaggerated.

 

Step 2:  P revises the intentions/meanings associated with each of the words on the wordlist from Step 1 so that pitch directions are in the opposite direction. P then attempts to read aloud the new wordlist with the new recommended inflections.

 

Step 3: C presents a new word list with new words (from #3, Fairbanks, 1960, (p. 132-133). P writes phrases for a meaning that would be associated with a falling (downward) inflection for each word and then assigns meanings that would be associated with a rising (upward) inflection for the same single words. P speaks the words, exaggerating the inflection.

 

Step 4:  Using the words from Step 3, P explores different meaning associated with rising or falling pitch directions (inflections) that occur when a speaker varies pitch range. That is, P determines the different meanings of words associated with a falling (or rising) pitch direction associated with a narrow, average, or wide range of pitches. P speaks the words, exaggerating the inflection.

 

Step 5:  C explains that the slope of the pitch change/modulation (rate/duration of the change in inflection) can change the meaning of a single word message. P produces each word from Step 3 using a wide falling inflection

  • with wide slope (slow rate of inflectional change),
  • then with a narrow slope (fast rate of inflectional change.)

C and P discuss the different meanings.

 

Step 6:  C and P repeat Step 5 using a wide rising (upward) inflection.

 

Step 7:  P reads each word from Step 3, attempting to convey the following emotions:

  • uncertainty,
  • confidence,
  • impatience, and
  • boredom.

 

Step 8:  C presents a list of 2-word sentences to P (Fairbanks, 1960, p. 133, #8). For each sentence, C directs P to

  • read aloud the first word,
  • pause briefly, and
  • produce a wide rising pitch change (shift) at the beginning of the second word.

 

Step 9:  C and P repeat Step 8 using a wide falling pitch change at the beginning of the second word.

 

Step 10:  C presents a list of sentences (Fairbanks, 1960, p. 133-134, #10) with symbols indicating a pause and rising (upward) shift, falling (downward), or no shift following a pause within a sentence. P reads aloud the sentence, exaggerating the shifts.

 

Step 11:  C presents a list of sentences (Fairbanks, 1960, p. 134, #11) with a symbol indicating a pause but a blank space for directions indicating rising (upward) shift, falling (downward), or no shift following a pause within a sentence. P reads aloud the sentences and adds different shifts that are appropriate to the meaning. P then marks a preferred shift and reads aloud the sentences, exaggerating the shift.