Johanson (2011)

SECONDARY REVIEW CRITIQUE

KEY:

ASD = autism spectrum disorder

C = clinician

DSLM = Developmental Speech and Language Training through Music

EOWPVT = Expressive One-Word Picture Vocabulary Test 

f = female

m = male

NA = not applicable

P = patient or participant

PPVT = Peabody Picture Vocabulary Test 

SLP = speech-language pathologist

SR = Systematic Review

Source: Johanson, J. K. (2011). Utilizing music in speech and language therapy for preschool children and children with autism: A systematic review [Unpublished master’s thesis]. Minnesota State University, Mankato.

Reviewer: pmh

Date: January 10, 2021

Overall Assigned Grade:  B-  The highest possible grade for this thesis is B based on its design (Systematic Review with Broad Criteria). The Overall Assigned Grade is not a reflection of the quality of the thesis or the interventions analyzed in the thesis. Rather, it reflects the quality of the evidence supporting the findings.

Level of Evidence: B

Take Away: 😦Note: the reviewer for this Systematic Review was the advisor for the thesis.)  This narrative Systematic Review (SR), which included less than rigorous research designs, explored the use of music in two groups: (a) speech and language therapy of preschoolers and (b)school-aged children with autism spectrum disorder (ASD). Nine sources met criteria for analysis. The findings reveal that there is evidence for the use of music with both subject groups, but the support must be tempered by the design of the sources that had been identified at the time of the completion of the SR. 

What type of secondary review? Narrative Systematic Review 

1.  Were the results valid? Yes 

•  Was the review based on a clinically sound clinical question? Yes 

•  Did the author clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? Yes

•  The author of the secondary research noted that they reviewed the following resources: 

     – internet based databases  

     – references from identified literature

•  Did the sources involve only English language publications? Yes 

•  Did the sources include unpublished studies? Yes 

•  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? Yes

•  Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? Yes 

  Was there evidence that a specific, predetermined strategy was used to evaluate the sources? Yes

•  Did the authors of the secondary research or review teams rate the sources independently? Yes

•  Were interrater reliability data provided? No

•  If there were no interrater reliability data, was an alternate means to insure reliability described? Yes, following independent reviews of the sources, the author and her advisor discussed their finding and resolved differences by consensus.

•  Were assessments of sources sufficiently reliable? Unclear/Variable

•  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? No

•  Were there a sufficient number of sources?  No  

2.  Description of outcome measures:

OUTCOMES ASSOCIATED WITH PRESCHOOLERS RECEIVING SPEECH-LANGUAGE THERAPY

•  Outcome #1: Improved performance on the speech and hearing portion of a test (Aldridge et al., 1995)

•  Outcome #2: Improved performance on the personal-social portion of a test (Aldridge et al., 1995)

•  Outcome #3: Improved performance on the practical reasoning portion of a test (Aldridge et al., 1995)

•  Outcome #4: Improved generation of morphological rules (Gross et al., 2010)

•  Outcome #5: Improved memory for word sequences (Gross et al., 2010)

•  Outcome #6: Improved phonological memory for nonwords (Gross et al., 2010)

•  Outcome #7: Improved understanding of sentences (Gross et al., 2010)

•  Outcome #8: Improved memory for sentences (Gross et al., 2010)

•  Outcome #9: Improved performance on the Peabody Picture Vocabulary Test (Hoskins, 1988; Seaman 2008)

•  Outcome #10: Improved performance on the Expressive One-Word Picture Vocabulary Test (Hoskins, 1988)

•  Outcome #11: Improved comprehension of words (Kouri & Winn, 2006)

•  Outcome #12: Improved production of words  (Kouri & Winn, 2006)

•  Outcome #13: Improved unsolicited imitation of words (Kouri & Winn, 2006) 

•  Outcome #14: Improved production of /m/ (Ross, 1997)

•  Outcome #15: Improved production of /p/ (Ross, 1997)

•  Outcome #16: Improved production of /b/ (Ross, 1997)

•  Outcome #17: Improved performance on the Teacher Rating of Oral Language and Literacy (Seaman, 2008)

OUTCOMES ASSOCIATED WITH CHILDREN WITH ASD RECEIVING SPEECH-LANGUAGE THERAPY

•  Outcome #18: Improved performance on The Checklist of Communicative Responses (Edgerton, 1994)

•  Outcome #19: Improved performance on The Behavior Change Survey (Edgerton, 1994)

•  Outcome #20: Improved performance on verbal production from a researcher designed assessment (Lim, 2010)

•  Outcome #21: Improved eye contact (O’Loughlin, 2000)

•  Outcome #22: Improved looking at stimuli (O’Loughlin, 2000)

•  Outcome #23: Improved pointing to stimuli (O’Loughlin, 2000)

•  Outcome #24: Improved peer engagement (O’Loughlin, 2000)

•  Outcome #25: Improved imitation of talking/singing (O’Loughlin, 2000)

3.  Description of results:            

–  What measures were used to represent the magnitude of the treatment/effect size?

The standardized mean difference (d) was reported in 3 of the reviewed sources.

•  number needed to treat  (NNT)

–  Summary overall findings of the secondary research: 

The following outcomes were reported to improve following treatment in at least one of the 9 sources: 

     • unsolicited word production,

     • phonological memory for nonwords, 

     • understanding sentences, 

     • memory for sentences, 

     • scores on the Peabody Picture Vocabulary Test,

     • scores on Expressive and Receptive One Word Picture Vocabulary Test, 

     • production of /m/ and possibly /b/, 

     • hearing and speech tasks on the Griffiths test, 

     • social-personal tasks on the Griffiths test, 

     • improved performance on the Teacher Rating of Oral Language and Literacy

     • verbal production, 

     • performance on the Checklist of Communicative Responses

     • eye contact, and 

     • looking at pictures.

–  Were the results precise? Unclear/Variable  _x__ 

–  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  

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

–  For the most part, were the results similar from source to source? Variable 

  Were the results in the same direction? Variable

–  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  

4.  Were maintenance data reported?  No 

5.  Were generalization data reported? No 

SUMMARY OF INTERVENTION

Source #1: Aldridge et al. (1995)

PopulationDevelopmental delay

Nonprosodic Targets: Performance on the following subtests of the Griffiths test: Hearing and Speech, Personal-Social, and Practical Reasoning

Aspects of Prosody Used in Treatment of Nonprosodic Targets: Music therapy

Description of Procedure/Source #1—not provided

Evidence Supporting Procedure/Source #1

• Significant improvement in the scores of the Hearing and Speech as well as the Personal-Social scores.

Evidence Contraindicating Procedure/Source #1

• Performance on the Practical Reasoning subtest did not improve significantly

————-

Source #2: Gross et al. (2010)

Nonprosodic Targets:  Speech/language skills and cognitive skills (cognitive skills were not summarized in the SR). Specific speech/language skills included

• generation of morphological rules

• memory for word sequences 

• phonological memory for nonwords 

• understanding of sentences 

• memory for sentences 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: Music therapy

Description of Procedure/Source #2

• Procedures were derived from the Nordoff Robbins approach.

• The major components included patient (P) and clinician (C) singing and using the piano and percussion instruments to create music.

Evidence Supporting Procedure/Source #2

The effect size for the following skills was moderate or small

• phonological memory for nonwords 

• understanding of sentences 

• memory for sentences 

Evidence Contraindicating Procedure/Source #2

The effect size for the following skills was negligible for

• generation of morphological rules

• memory for word sequences 

————-

Source #3: Hoskins (1988)

Populationlanguage delayed preschoolers

Nonprosodic Targets: performance on the Peabody Picture Vocabulary Test (PPVT) and performance on the Expressive One-Word Picture Vocabulary Test (EOWPVT)

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music activities

Description of Procedure/Source #3: C presents an object to the group of children and sings a brief (3-5 words) phrase about the object. The group and the C then named the object.

Evidence Supporting Procedure/Source #3:

• The data from the children with delayed language were divided into 3 groups based on level of functioning and age:

     – high functioning

     – moderate functioning

     – low functioning

• The results of the brief intervention revealed all P improved significantly in their performance on the PPVT (spoken and melodic forms) and the EOWPVT

———

Source #4: Kouri & Winn, 2006

PopulationMild developmental delay and specific language impairment (preschoolers)

Nonprosodic Targets: Quick Incidental Learning (comprehension and production) of vocabulary

Aspects of Prosody Used in Treatment of Nonprosodic Targets: singing

Description of Procedure/Source #4

• C presented story scripts with novel words in spoken and sung contexts over 2 sessions to children.

Evidence Supporting Procedure/Source #4

• Unsolicited imitation of the novel words improved over the 2 sessions

Evidence Contraindicating Procedure/Source #4

• The production and comprehension of the novel words did not improve over the 2 sessions

————-

Source #5: Ross (1997)

Populationchildren with severe speech impairment

Nonprosodic Targets: production of speech sounds (/b/, /p/, and /m/)

Aspects of Prosody Used in Treatment of Nonprosodic Targets: singing and music

Description of Procedure/Source #5:

• sixteen 30-minute music therapy sessions.

• The each session included 

     – hello song, 

     – an instrumental activity, 

     – a cognitive activity, 

     – the song intervention activity, 

     – a group movement activity, and 

     – a goodbye song.

Evidence Supporting Procedure/Source #5

• Treatment resulted some improvement each of the participants (Ps)

•  Improved production of /m/: highly effective (2 Ps), 1fairly effective (1 P)

•  Improved production of /p/: highly effective (1 P), ineffective (2 Ps)

•  Improved production of /b/: highly effective (1 P), 1fairly effective, ineffective (1 P)

Evidence Contraindicating Procedure/Source #5—(provide title)

•  Some of the targets did not improve

•  Treatment of /p/ was ineffective for 2 P

•  Treatment of /b/ was ineffective for 1 P

————-

Source#6: Seaman (2008)

Populationpreschool children identified as special needs or at-risk

Nonprosodic Targets:

•  Performance on the Peabody Picture Vocabulary Test 

•  Performance on the Teacher Rating of Oral Language and Literacy 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music

Description of Procedure/Source #5

• This was a master’s thesis and its author provided extensive information about the 10 week intervention provided in the form of music education.

• The author of this SR did not provide a summary of the intervention.

Evidence Supporting Procedure/Source #5:

•  Overall performance on the Peabody Picture Vocabulary Test increased 21.18%

•  Overall performance on the Teacher Rating of Oral Language and Literacy increased 34.67%

————-

Source#7: Edgerton (1994)

Populationautism spectrum disorder (ASD)

Nonprosodic Targets:

•  Outcome #18: Improved performance on The Checklist of Communicative Responses 

•  Outcome #19: Improved performance on The Behavior Change Survey 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music  

Description of Procedure/Source #7

• The author of the source implemented the Nordoff Robbin approach (music therapy)

• Children attended one 30-minute treatment per week for 10 weeks

• Treatment involved music activities designed to match each child’s needs.

Evidence Supporting Procedure/Source #7

• Performance on The Checklist of Communicative Responses increased significantly for the group.

Evidence Contraindicating Procedure/Source #7

• Performance of individual children on The Behavior Change Survey did not improve or improved slightly

————-

Source#8: Lim (2010)

Populationchildren with ASD; preschoolers

Prosodic Targets: 

• Outcome#22: Improved performance on verbal production from a researcher designed assessment

Aspects of Prosody Used in Treatment of Nonprosodic Targets: singing

Description of Procedure/Source #8

• The intervention was entitled Developmental Speech and Language Training through Music (DSLM) in which the clinician (C) presented in song, the 36 target words.

• The sessions were 9 minutes long and they were administered twice a day for 6 weeks.

Evidence Supporting Procedure/Source #8

• The group of  children who received DSLM and a group of children who received speech therapy both improved significantly on the researcher-designed assessment with strong effect size.

Evidence Contraindicating Procedure/Source #8

• Although the children in the DSLM and the speech therapy groups improved approximately the same amount, the DSLM sessions were more than 50% longer than the speech therapy session. This suggests that DSLM is not as effective as traditional speech therapy.

————-

Source#9: O’Loughlin, 2000

Populationautism spectrum disorders; children and adults

Prosodic Targets: 

•  Outcome #25: Improved imitation of talking/singing 

Nonprosodic Targets: the following prelinguistic behaviors:

•  Outcome #21: Improved eye contact 

•  Outcome #22: Improved looking at stimuli 

•  Outcome #23: Improved pointing to stimuli 

•  Outcome #24: Improved peer engagement 

•  Outcome #25: Improved imitation of talking/singing

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music

Description of Procedure/Source #9:

• The intervention involved music and speech therapy but the procedures were not fully described in the SR.

Evidence Supporting Procedure/Source #9:

• Significant improvement in frequency of eye contact (Outcome#21) and looking at stimuli (Outcome#22)

Evidence Contraindicating Procedure/Source #9

• Apparently there was not a significant improvement in the following outcomes:

     –  Outcome #23: Improved pointing to stimuli 

     –  Outcome #24: Improved peer engagement 

     –  Outcome #25: Improved imitation of talking/singing 

————-

One Response to Johanson (2011)

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: