Van Lancker Sidtis & Yang (in press, 2021)



ASD = autism spectrum disorders (ASD)

C = clinician

f = female

LSVT = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = patient or participant

PLVT = Pitch Limiting Voice Treatment

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

Source: Van Lancker Sidtis, D., & Yang, S. (in press, 2021). Pathological Prosody: Overview, assessment, and treatment. In C. Gussenhoven & A. Chen (Eds.), The Oxford handbook of language prosody. Oxford University Press. Prepublication version available at

Reviewer(s):  pmh

Date:  January 20, 2021

Overall Assigned Grade:  Not graded—this narrative review described current and historic perspectives on the nature, assessment, and treatment of prosodic deficits; it did not promote a specific treatment

Level of Evidence: Not Applicable (NA); no supporting data

Take Away: This book chapter is a comprehensive, well-written discussion of the nature, measurement, and interventions for prosodic deficits (pathological prosody). It has value for those beginning to work with prosody or those seeking to update their knowledge base about prosody.

The major focus of the chapter is on the prosody of adults with neurological conditions although some attention is directed to children with autism spectrum disorders (ASD). The authors clearly and consisely explore numerous important issues including the rationale for attending to prosody, prosodic terminology and notation, historic and current views regarding the neurological localization of prosody, functions of prosody, prosodic deficits, assessment of prosody, and the treatment of prosody. The focus of this review is the interventions described in the chapter.

What type of secondary review?  Narrative Review  

1.  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 did not describe their search strategy  

  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∞  Did the sources include unpublished studies?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? No 

∞  Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? No 

∞  Did the authors of the secondary research or review teams rate the sources independently? No

∞  Were interrater reliability data provided? No

  If there were no interrater reliability data, was an alternate means to insure reliability described? NA

∞  Were assessments of sources sufficiently reliable? NA

∞  Was the information provided sufficient for the reader to undertake a replication? NA

∞  Did the sources that were evaluated involve a sufficient number of participants? Unclear/Variable

  Were there a sufficient number of sources? Yes

2.  Description of treatment outcome measures:  The following potential outcome measures were derived from the chapter by the reviewer. The citations following each outcome are the sources cited by the authors of the chapter.

•  Outcome #1: Production of sentences with appropriate affective prosody measured perceptually (Rosenbek et al., 2004; Rosenbek et al., 2006; Russell et al., 2010)

•  Outcome #2: Production of sentences with appropriate affective prosody measured acoustically (Jones et al., 2009; Russell et al., 2010)

•  Outcome #3: Imitation and production of the terminal contour of sentences (authors of the chapter, illustrative case)

•  Outcome #4: Increasing loudness and speech clarity using Lee Silverman Voice Treatment (LSVT; Ramig et al., 2001) or SPEAKOUT (Levitt, 2014) 

•  Outcome #5: Increasing loudness and decreasing pitch using Pitch Limiting Voice Treatment (PLVT, de Swart et al., 2003). 

•  Outcome #6: Resolving timing (rate) abnormalities (van Nuffelen et al., 2009) 

•  Outcome #7: Improved expressive language skills using Melodic Intonation Therapy (MIT; Helm-Estabrooks & Albert, 1991; Hough, 2010; Marshall & Holtzapple, 1976; Stahl & Van Lancker Sidtis, 2015; van der Meulen et al., 2014)

3.  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 were reported.

∞ Summary of Intervention section of the chapter.

– With respect to intervention, the authors of the chapter concluded that the development of models of the nature of prosody (structure and function) will facilitate the development of effective treatment.  

– The authors briefly highlighted several interventions that appeared to be useful when targeting the following outcomes:

•  Outcome #1Production of sentences with appropriate affective prosody measured perceptually— The authors of the chapter reported that there is evidence to support effectiveness claims.

•  Outcome #2Production of sentences with appropriate affective prosody measured acoustically—The authors of the chapter noted that one source reported to support effectiveness while the other source did not support effectiveness.

•  Outcome #3: Imitation and production of the terminal contour of sentences – The authors of the chapter described their own illustrative case that resulted in 80% correct for imitated sentences and 50% correct for elicited (spontaneous) sentences.

•  Outcome  #4: Increasing loudness and speech clarity using LSVT or SPEAKOUT – The authors of the chapter noted that some success was achieved.

•  Outcome #5Increasing loudness and decreasing pitch using PLVT –The authors of the chapter reported some success. 

•  Outcome #6Resolving timing (rate) abnormalities—The authors of the chapter claimed that there was some success associated with this intervention. 

•  Outcome #7: Improved expressive language skills using MIT— The authors of the chapter reported modest improvement.

– The interventions noted in this review included a variety of clinical conditions including

     – Parkinson’s disease (hypophonia)

     – Right Hemisphere damage

     – Expressive dysprosody

     – Expressive language deficits associated with nonfluent aphasia

– Were the results precise? No 

∞  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? No  

∞  For the most part, were the results similar from source to source? Yes

  Were the results in the same direction? Yes, for the most part  

∞  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 


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