Sousa et al. (2017)

September 17, 2020

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  A brief summary of the intervention described by the authors can be found by scrolling about two-thirds of the way down this review.

KEY
ASD = Autism Spectrum Disorder

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer 

SLP = speech-language pathologist

Source: Sousa, M., Trancoso, I., Moniz, H., & Batista, F. (2017, November). Prosodic exercises for children with ASD via virtual therapy. In A. Londral, A. Coffdia de Barros, A. Matos, C. Sousa, L. Garcia, L., & R. Oliveira (Eds.) Atas da Conferência Jornadas Supera 2017 [2017 Conference Proceedings and Minutes] (pp. 59-69).  Sociedade Portuguesa de Engenharia de Reabilitação, Tecnologias de Apoio e Acessibilidade [Portuguese Society for Rehabilitation Engineering, Assistive Technologies and  Accessibility] ARTICLE:  http://supera.org.pt/jornadas2017/wp-content/uploads/sites/2/2017/05/Atas_Jornadas_SUPERA_2017-1.pdf#page=59

Reviewer(s): pmh

Date: September 15, 2020

Overall Assigned Grade: No data provided; therefore, there is no grade.  

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.

Take Away:  The authors detail strategies for developing prosodic assessment and provide ideas for treating affective prosody in children diagnosed with autism spectrum disorder (ASD.) The recommended prosodic intervention was not administered but it does have potential as a model for future development.

1.  Was there a review of the literature supporting components of the intervention?   Yes 

– The type of literature review was a Narrative Review. 

2.  Were the specific procedures/components of the intervention tied to the reviewed literature?  No  

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

4.  Did the author(s) provide a rationale for components of the intervention?  Yes

5.  Description of outcome measures:

  Are outcome measures suggested? Yes 

•  Outcome #1:  Discrimination of nonspeech auditory stimuli that differ only in intonation 

•  Outcome #2:  Discriminate low versus high pitches in single tones

•  Outcome #3:  Discrimination of single words as representing pleasure or displeasure affective states

•  Outcome #4:  Imitation of the intonation of single words represent different affective states.

6.  Was generalization addressed? No

7.  Was maintenance addressed? No  

SUMMARY OF INTERVENTION

PURPOSE: to improve affective prosody

POPULATION: Autism Spectrum Disorders; children

MODALITY TARGETED: receptive and production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affective prosody

MAJOR COMPONENTS:  

–  Some tasks were recommended for achieving the objectives/outcomes. 

•  Outcome #1:  Discrimination of nonspeech auditory stimuli that differ only in intonation 

     ∞ The Participant (P) listens to 2 auditory stimuli and categorizes them as “different “or “equal” (same).

•  Outcome #2:  Discriminate low versus high pitches in single words

     ∞ P listens to a tone and categorizes it as “high” or “low”

     ∞ The Clinician (C) presents, as a model, a low and high tone. Then, P listens to 2 tones and rates them as “high-high”, “low-low”, “high-low or “low-high.”

•  Outcome #3:  Discrimination of single words as representing pleasure or displeasure affective states

     ∞ C presents the image of a common object. 

     ∞ Then the name of the item is presented with prosody signifying pleasure or displeasure. 

     ∞ C selects a symbol representing pleasure (smiley face) or displeasure (frowning face).

•  Outcome #4:  Imitation of the  intonation of single words representing different affective states.

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


Holbrook & Israelsen, 2020

August 28, 2020

SECONDARY REVIEW CRITIQUE

KEY:

ASD = autism spectrum disorders

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: Holbrook, S., & Israelson, M. (2020). Speech prosody interventions for persons with autism spectrum disorders: A systematic review. American Journal of Speech-Language Pathology, 1-17. https://doi.org/10.1044/2020_AJSLP-19-00127

Reviewer(s): pmh

Date: August 27, 2020

Overall Assigned Grade: The highest grade reflecting overall quality of the evidence presented in this investigation is B due to the design of the investigation—Systematic Review with broad criteria. The Overall Assigned Grade does not reflect a judgment of the effectiveness of the treatments described in the investigation; rather, it represents the quality of the evidence provided by the investigators.

Level of Evidence:  B

Take Away: The results of this investigation provide evidence that prosody of speakers with autism spectrum disorders (ASD) may be treated successfully using selected interventions.

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 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:

     – hand searches

     – 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?
  • Did the authors of the secondary research or review teams rate the sources independently? Yes
  • Were interrater reliability data provided? Yes _

– Interrater reliability for inclusion of studies = 92.6%

– Interrater reliability for all coding except effect size and calculation = 93.3%

– Interrater reliability for effect size and calculation = 94.6%

– Disagreements were resolved by consensus.

  • Were assessments of sources sufficiently reliable? Yes
  • 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
  • Were there a sufficient number of sources? Yes

 

  1. Description of outcome measures: (this is a list of the ‘prosody traits’ in one or more of the sources)
  • Outcome #1: Improved overall prosody
  • Outcome #2: Improved intensity
  • Outcome #3: Improved pitch
  • Outcome #4: Improved pauses
  • Outcome #5: Improved rate
  • Outcome #6: Improved contrastive stress
  • Outcome #7: Improved stress
  • Outcome #8: Improved affective intonation

 

  1. Description of results:
  • What measures were used to represent the magnitude of the treatment/effect size?

     – Cohen’s d

     – Hedge’s g

     – Tau U

  • Summary of overall findings of the secondary research: The investigators identified 13 articles that provided adequate (2) or weak (11) evidence of improved prosody in speakers with ASD.
  • Were the results precise? Unclear/Variable
  • 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? Yes
  • Were the results in the same direction? No
  • 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

                                                                                                                   

  1. Were maintenance data reported? Yes

 

  1. Were generalization data reported? Yes

 

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


Morgan & Ferguson (2017)

December 24, 2019

ANALYSIS GUIDELINES

Comparison/Nonintervention Research

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

KEY:

eta =   partial eta squared

HI =  hearing impairment

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

WNL =  within normal limits

YNH = Young Adults with Normal Hearing

YNH1 = Ps from Experiment 1 who were young adults with normal hearing

YNH2 = Ps from Experiment 2 who were young adults with normal hearing

 

SOURCE:  Morgan, S. D., & Ferguson, S. H. (2017). Judgments of emotion in clear and conversational speech by young adults with normal hearing and older adults with hearing impairment. Journal of Speech, Language, and Hearing Research, 60, 2271-2280.

 

REVIEWER(S): pmh

 

DATE:December 17, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  Not graded, this is not an intervention study.  There are 2 experiments in this investigation. The review is concerned only with Experiment 2.

 

TAKE AWAY: Young adults with normal hearing (YNH) and older adults with hearing impairment (OHI) are likely to perceive Clear Speech as signaling angry or disgusted emotions, although YNH listeners were even more likely to perceive sentences negatively than OHI listeners. Nevertheless, those counseling friends and family of those with hearing impairment (HI) should monitor the prosody of their communications, especially when speakers are attempting to use Clear Speech.

 

 

  1. What type of evidence was identified?
  • What was the type of design? Comparison Research; Prospective, Nonrandomized Group Design with
  • 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, the categories of YNH and OHI cannot be randomly assigned.
  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? No _______

                                                                    

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

 

  1. Were the groups adequately described? Yes

–   How many participants were involved in the study?

  • total # of Ps: 48  (but only 30 Ps were in Experiment 2—Ps from Experiment 1 were included in some of the statistical analysis)
  • # of groups: 2 groups, although the Young Adults with Normal Hearing comprised 2 subgroups:  YNH1 = participants (Ps) from Experiment 1 and YNH2 = Ps from Experiment 2
  • List names of groups and the number of Ps in each group:

     –  YNH total =  28

∞  YHN1 = 19 initially reduced to 18 due to late disclosure

∞  YNH 2 = 13 initially reduced to 10 due to software problems and late disclosures

–  OHI =  20

  • Did all groups maintain membership throughout the investigation? No, as noted 3 YNH2 Ps were removed from the study.

 

CONTROLLED CHARACTERISTICS                                                   

  • age:

     –  YNH =  likely over 18 years, less than 35 years

     –  OHI =  greater than 65 years

 

  • cognitive skills:

     –  YNH =  within normal limits (WNL

     –  OHI = 

  • native language:

     –  YNH =  all native speakers of American English

     –  OHI =  all native speakers of American English

  • Socio-economic status:

     –  YNH

     –  OHI

  • educational level of clients:

     –  YNH

     –  OHI =  students in a University Psychology Participant Pool

  • speech or language disorders:

     –  YNH = no history

     –  OHI = no history

  • speech or language therapy:

     –  YNH = no history

     –  OHI = no history

  • Word recognition skills:

     –  OHI =  greater than 80% 

  • Hearing:

     –  YNH =   WNL by self report

     –  OHI =   in at least one ear a mild to moderately severe sloping sensorineural hearing loss

 

–  DESCRIBED CHARACTERISTICS

  • age:

     –  YNH1  = 18 to 33 years

     –  YNH2  = 18 to 30 years

     –  OHI =  65 – 78 years

  • Word recognition skills:

     –  YNH  =  average was 93%

 

–  Were the groups similar?  No

                                                         

–  Were the communication problems adequately described?

Yes ___      No  _x__      Unclear ____   NA ____x___

 

  • disorder type: Hearing Impaired  

 

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

–  YNH listeners

–  OHI listeners

 

  • Conditions?Yes

–  Sentences (14)

–  Speaking Style (Conversation, Clear Speech)

–  Talkers (8; 4 male 4 female; 4 Good Clear Speech Talkers, 4 Poor Clear Speech Talkers)

 

*  Criterion/Descriptive Conditions?  No 

 

  1. Were the groups controlled acceptably?  Yes

 

  1. Was the dependent measure appropriate and meaningful? Yes
  • OUTCOME #1: Listener judgment of perceived emotion
  • The dependent measure was subjective.
  • The dependent measure was NOT objective.

 

 

  1. Were reliability measures provided?
  • Interobserver for analyzers?
  • Intraobserver for analyzers?
  • Treatment or test administration fidelity for investigators?No, however,  the protocol was administered on a computer.

 

  1. Description ofdesign:
  • Clear Speech is a speaking style often directed to listeners with HI; in fact, communicative partners are often counseled to use Clear Speech when talking with individuals with HI. The purpose of this investigation is to determine if this modification speaking style unintentionally conveys negative emotions.

 

  • The Ps were OHI and YNH. The OHI Ps were investigated to explore emotions perceived when listening to Clear Speech. The YNH Ps were included as norms.

 

  • All Ps listened to recordings of 224 sentences (multiple recordings of 14 different semantically neutral sentences) which were recorded by 8 speakers (4 male, 4 female; 2 good speakers of Clear Speech and 2 poor speakers of Clear Speech.) The prerecorded sentences were selected from the Ferguson Clear Speech Database. Half of the sentences were in Conversational Style and half were in Clear Speech Style. The intent of the talkers was to produce a neutral affect.

 

  • Prior to being administered the experimental stimuli, the investigators were familiarized with the procedures.

 

  • Ps listened to each sentence and categorized the emotion represented in the sentence as

–  anger,

–  fear,

–  disgust,

–  sadness,

–  happiness, or

–  neutral.

 

  1. What were the results of the statistical testing?
  • OUTCOME #1: Listener judgment of perceived emotion

     –  Overall, when listening to Clear Speech, listeners were more likely to judge the emotions as “anger” or “disgust” and less likely to select “fear”, “happiness”, “sadness”, and “neutral than when listening to Conversational Speech.

–  OHI listeners chose the following emotions less often than YHI listeners:

∞ anger

∞  fear

∞  sadness

∞  happiness

–  OHI listeners chose the neutral emotion more often than YHI listeners.

–  OHI listeners chose angry less frequently than YNH listeners for both Conversational Speech and Clear Speech.

–  Overall talkers’ skill in using Clear Speech influenced judgments about emotions with Good Talkers of Clear Speech more likely to be judged as “angry” or “fearful” than Poor Talkers of Clear Speech.

–  YNH listeners were more likely than OHI listeners to judge Good Talkers of Clear Speech as angry or fearful but YNI and OHI listeners were similar in their judgment of angry or fearful for Poor Talkers of Clear Speech.

(add additional outcomes as appropriate)

 

  • What was the statistical test used to determine significance? Linear mixed-effects modeling:

 

  • Were effect sizes provided?No____

 

  • Were confidence interval (CI) provided?No

 

  1. Summary of correlational results:  NA

 

  1. Summary of descriptive results: Qualitative research  NA

 

  1. Brief summary of clinically relevant results:
  • Those counseling friends and family of people with HI should remind the speakers to monitor the prosody of their communications, especially when they are attempting to use Clear Speech

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: Not graded


Fairbanks (1960, Ch. 11., Pitch Variability)

October 16, 2019

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

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, Pitch Variability)  Voice and articulation drillbook.  New York: Harper & Row.  (pp. 129-132)

 

Reviewer(s):  pmh

 

Date:  October 9, 2019

 

Overall Assigned Grade:  Not Graded.  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.

 

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) /shifts comprise pitch; this review, however, is only concerned with Pitch Variability. Several strategies for treating pitch variability are presented in this part of Chapter 11.

 

 

  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 authors provide a rationale for components of the intervention? Variable

 

  1. Description of outcome measures:

 Are outcome measures suggested? Yes

 

  • Outcome #1: Producing speech with the best pitch level and variability
  • Outcome #2: Producing speech with the pitch level and variability that is appropriate to the emotion of the speaker

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

 

PURPOSE: To produce speech using appropriate pitch variability

 

POPULATION:  Adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch variability, affective prosody

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  rate, pitch level, pitch range

 

DOSAGE: NA

 

ADMINISTRATOR:  The book is written so that a layperson 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, Pitch Variability, pp. 129-132) defines several terms used in this section of the chapter. He also notes that there is not a sharp dividing line between male and female speakers. That is, the high pitches for men and low pitches for women often overlap. In treatment, speakers should target producing

–  a difference of about 2 octaves between the highest and lowest pitches,

–  the number of the pitches above and below the most frequent (modal) pitch gradually decrease as the pitch level moves from modal to above/below modal, and

–  more productions below modal than above.

 

  • Fairbanks notes that if the Participant/Patient (P) has a limited ability to produce a typical total pitch range, attention should be directed to improving the typical total pitch range. However, pitch variability can improve even for Ps with limited total pitch ranges.

 

TREATMENT IDEAS

 

  • The clinician (C) directs P to read aloud the first passage on page 130 four different ways using the best pitch level:

– chanting using a monotone,

–  a narrow range,

– an average range, and

–  a wide range.

The P should be careful to have more than just a few productions of high or low pitches when trying to produce variable pitches.

 

  • P rereads the first passage on page 130 four different ways using the a high pitch level:

– chanting using a monotone,

–  a narrow range,

– an average range, and

–  a wide range.

 

  • P rereads the first passage on page 130 four different ways using the a low pitch level:

– chanting using a monotone,

–  a narrow range,

– an average range, and

–  a wide range.

 

  • P reads the first passage on page 131 at the best pitch level and then increases the pitch variability until P produces a very wide pitch range.

 

  • P rereads the first passage on page 131 at the best pitch level and increasing the pitch variability until P or C judges it to be optimal.

 

  • P rereads the first passage on page 131 at the best pitch level and with very wide variability then decreases pitch variability until P or C judges it to be optimal.

 

  • C provides a passage of factual prose for P to read aloud. The target is

–  best pitch level and

–  optimal variability.

 

  • P gives a short impromptu speech. The target is

–  best pitch level and

–  optimal variability.

 

  • C directs P to read aloud the second passage on page 131 (at the bottom of the page) expressing different emotions using variations of rate, pitch level, and pitch variation:

–  Anger (fast rate, high pitch level, wide range for variability)

–  Fear (fast rate, high pitch level, medium range for variability)

–  Indifference (fast rate, low pitch level, narrow range for variability)

–  Grief (slow rate, low pitch level, narrow range for variability)

–  Contempt (slow rate, low pitch level, wide range for variability)

 

———————————————————————

 


Hutchinson (2015)

October 17, 2018

EBP THERAPY ANALYSIS

Single Case Design

NOTE:  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 Disorders

C =  Clinician

EBP =  evidence-based practice

F0=  Fundamental frequency (F0)

HFA =  High Functioning Autism

NA =  not applicable

P =  Patient or Participant

pmh =  Patricia Hargrove, blog developer

PVSP =  Prosody Voice Screening Profile (PVSP)

SLP =  speech–language pathologist

WNL =  within normal limits

 

SOURCE:  Hutchison, A. K. (2015).  Aprosodia therapy: The impact on affective prosody in a child with High Functioning Autism. Thesis from the Arkansas State University  December 2015.  ProQuest Dissertations Publishing, 2015.Retrieved from https://search.proquest.com/openview/2cfdd684ebaf87963fb69a1012b3e7ac/1?pq-origsite=gscholar&cbl=18750&diss=y

 

REVIEWER(S):  pmh

 

DATE:  October 9, 2018

 

ASSIGNED OVERALL GRADE: D (The highest Assigned Overall Grade is based on the design of the investigation. In this case, the design was a Single Case investigation with the highest possible grade being D+.  The Assigned Overall Grade in not a judgment about the quality of the intervention; it is an evaluation of the quality of the evidence supporting the intervention.)

 

TAKE AWAY:  This single case investigation provides support for the use of an imitative approach to improve the expressive affective prosody of a 14-year-old male who had been diagnosed with High Functioning Autism.  Outcomes associated with the participant’s (P’s) production of fundamental frequency (f0) did not change significantly. Outcomes associated with P’s production of duration and intensity changed significantly for the signaling of Anger and Sadness but not Happiness. Subjective Outcomes associated with the production of Phrasing, Rate, and Stress significantly improved.

 

 

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

 

 

  1. What type of evidence was identified?
  • Whattype of single subject design was used?  Case Study:  Description with Pre and Post Test Results
  • What was the level of support associated with the type of evidence?

Level =  D     

 

 

  1. Was phase of treatment concealed?
  • from participants? No
  • from clinicians?No
  • from data analyzers?No

 

 

  1. Was the participant (P) adequately described? Yes

–  How many Ps were involved in the study? 1

 

 CONTROLLED CHARACTERISTICS

  • age:between the ages of 8 years and 15 years
  • language:verbal and nonverbal skills within normal limits (WNL)
  • cognitive skills:WNL
  • diagnosis:Autism Spectrum Disorder (ASD) but not Asperger syndrome:
  • physical or sensory impairment:none
  • prosody:disturbance noted

 

–  DESCRIBED CHARACTERISTICS

  • age:14 years
  • gender:male
  • cognitive skills:WNL
  • language skills:WNL
  • hearing acuity:WNL
  • oral-peripheral skills:WNL

 

– Were the communication problems adequately described?  Yes

  • Disorder type:ASD, High Functioning Autism (HFA)
  • Other aspects of communication that were described:

–  stereotypical behaviors

–  communication problems

–  social interaction problems

–  prosodic problems:

  • phrasing (slight)
  • rate (slight)
  • stress

–  prosodic strengths

  • pitch
  • loudness
  • voice

 

 

  1. Was membership in treatment maintained throughout the study?Yes, there was only one P.
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No, this was a case study
  • Were preintervention data collected on all behaviors?Yes
  • Did preintervention data include untrained stimuli?Yes
  • Did preintervention data include trained stimuli?Yes
  • Was the data collection continuous? No
  • Were different treatment counterbalanced or randomized? Not Applicable (NA), there was only one treatment.

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

ACOUSTIC MEASURES

  • OUTCOME #1:Fundamental frequency (F0) of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #2:F0of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #3: F0of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #4: Duration of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #5: Duration of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #6: Duration of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #7: Duration of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #8: Duration of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #9:Duration of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #10: Duration of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #11: Duration of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #12:Duration of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #13: Intensity of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #14: Intensity of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #15:Intensity of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #16:Intensity of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #17: Intensity of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #198: Intensity of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

PERCEPTUAL MEASURES

  • OUTCOME #19: Changes in the judgment of Phrasing of 25 spontaneous utterances on the Prosody Voice Screening Profile (PVSP) from preintervention to post intervention
  • OUTCOME #20:Changes in the judgment of Rate of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #21:Changes in the judgment of Stress of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #22:Changes in the judgment of Quality of 25 spontaneous utterances on the PVSP from preintervention to post intervention – 100% at preintervention
  • OUTCOME #23: Changes in the judgment of Pitch of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention
  • OUTCOME #24:Changes in the judgment of Loudness of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention

 

 

–  The subjective outcomes are

  • OUTCOME #19: Changes in the judgment of Phrasing of 25 spontaneous utterances on the Prosody Voice Screening Profile (PVSP) from preintervention to post intervention
  • OUTCOME #20:Changes in the judgment of Rate of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #21:Changes in the judgment of Stress of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #22:Changes in the judgment of Quality of 25 spontaneous utterances on the PVSP from preintervention to post intervention – 100% at preintervention
  • OUTCOME #23: Changes in the judgment of Pitch of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention
  • OUTCOME #24:Changes in the judgment of Loudness of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention

 

–  The objective outcomes are

  • OUTCOME #1:Fundamental frequency (F0) of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #2:F0of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #3: Fundamental frequency (F0) of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #4: Duration of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #5: Duration of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #6: Duration of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #7: Duration of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #8: Duration of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #9:Duration of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #10: Duration of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #11: Duration of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #12:Duration of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #13: Intensity of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #14: Intensity of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #15:Intensity of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #16:Intensity of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #17: Intensity of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #18: Intensity of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

–  Reliability Data:

  • The investigator provided some intraobserver (but not interobserver) reliability data. The metric involved remeasuring 10% of the samples for fo. duration, and stress. The investigator then noted the difference in the original and the reliability measurements

∞  F0differed by 0.97 Hz (Outcomes 1 to 3)

∞  Duration of full sentences differed by 20 ms (Outcomes 4-6)

∞  Duration of unstressed syllables differed by 4.96 ms (Outcomes 7-9)

∞  Duration of stressed syllables differed by 2.67 ms  (Outcomes 10-12)

∞  Intensity of unstressed syllables differed by 0.02 volts (Outcomes 13-15)

∞  Intensity of stressed syllables differed by 0.013 volts (Outcomes 16-18)

 

 

  1. Results:

–  Did the target behavior(s) improve when treated? Yes, for the most part, although the fooutcomes did not improve significantly.

 

ACOUSTIC MEASURES

  • OUTCOME #1:Fundamental frequency (F0) of imitative sentences representing the emotion Happiness changes from preintervention to post interventionNo significant difference; ineffective
  • OUTCOME #2:F0of imitative sentences representing the emotion Anger changes from preintervention to post intervention- No significant difference; ineffective
  • OUTCOME #3: Fundamental frequency (F0) of imitative sentences representing the emotion Sadness changes from preintervention to post intervention– No significant difference; ineffective

 

  • OUTCOME #4: Duration of imitative sentences representing the emotion Happiness changes from preintervention to post intervention – Significant Difference;  moderate improvement
  • OUTCOME #5: Duration of imitative sentences representing the emotion Anger changes from preintervention to post intervention – Significant Difference;  moderate improvement
  • OUTCOME #6: duration of imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  moderate improvement

 

  • OUTCOME #7: Duration of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #8: Duration of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #9:Duration of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  moderate

 

  • OUTCOME #10: Duration of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #11:Duration of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention – Significant Difference;  moderate improvement
  • OUTCOME #12:Duration of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  moderate improvement

 

  • OUTCOME #13: Intensity of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #14: Intensity of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention –  Significant Difference;  strong improvement
  • OUTCOME #15:Intensity of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention –  Significant Difference; strong improvement

 

  • OUTCOME #16:Intensity of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #17: Intensity of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention – Significant Difference;  strong improvement
  • OUTCOME #18: Intensity of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  strong improvement

 

PERCEPTUAL MEASURES

  • OUTCOME #19: Changes in the judgment of Phrasing of 25 spontaneous utterances on the Prosody Voice Screening Profile (PVSP) from preintervention to post intervention—preintervention = 12% correct , post intervention = 100% correct; strong improvement
  • OUTCOME #20: Changes in the judgment of Rate of 25 spontaneous utterances on the PVSP from preintervention to post intervention —preintervention = 16% correct , post intervention = 84% correct; moderate improvement  
  • OUTCOME #21:Changes in the judgment of Stress of 25 spontaneous utterances on the PVSP from preintervention to post intervention —preintervention = 56% correct, 84% post intervention =  84% correct; moderate improvement  
  • OUTCOME #22:Changes in the judgment of Quality of 25 spontaneous utterances on the PVSP from preintervention to post intervention – 100% at preintervention; not considered a treatment outcome
  • OUTCOME #23: Changes in the judgment of Pitch of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention; not considered a treatment outcome
  • OUTCOME #24:Changes in the judgment of Loudness of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention; not considered a treatment outcome

 

 

  1. Description of baseline:
  • Were preintervention data provided?Yes. But the  preintervention data for all outcomes  were generated with only one data point.

 

 

  1. What is the clinical significance? NA

 

 

  1. Was information about treatment fidelity adequate? NA

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported?Yes
  • Performance on the PVSP (see item 8b- Perceptual Measures) could be considered generalization data because the PVSP was derived from spontaneous samples and spontaneous speech was not the focus of the intervention.
  • Changes in the 3 PVSP outcomes that were used in the pre- and post- intervention comparisons ranged from moderate to strong improvement. (NOTE: The three other PVSP outcomes were not included in the pre-and post- intervention comparisons because preintervention performance was 100% correct. )

 

 

  1. Brief description of the design:
  • A single P, who was diagnosed as having High Functioning Autism, was administered 10 weeks of therapy.
  • Prior to (preintervention) and after (post intervention), the investigator collected the same measurements from the P.
  • For the most part, the investigator compared the measures using the parametric statistic the paired sample t-test.

 

 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  D-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To improve the production of affective prosody.

 

POPULATION:   ASD (HFA); children

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affect, stress, intensity, fo, duration/rate, phrasing

 

DOSAGE:   1 hour sessions; 1 time a week; 10 weeks

 

ADMINISTRATOR:  Graduate Student in SLP

 

MAJOR COMPONENTS:

 

  • The intervention (The Imitative Approach) contained 6 steps in which the clinician (C) initially provided maximal cues and gradually faded the cues.
  • Three consecutive correct responses were required to move from one step to the next.

 

STEP 1:

  • C identifies target affect (happy, sad, angry, or neutral) and the P’s task.
  • C directs P to listen and she models a written sentence using the target emotion.
  • C and P repeat the target sentence with the targeted emotion together (in unison.),

 

STEP 2:

  • C models the target written sentence with the appropriate prosody and facial expression.
  • C directs P to produce the modeled sentence and affect.
  • Correct response = correct sentence and prosody (appropriate facial expression is not required).

 

STEP 3:

  • C models the target written sentence with the appropriate prosody.C covers his/her face thus obstructing the P’s view of her facial expression.

 

STEP 4:

  • C presents a sentence with a neutral prosody and directs the P to imitate the sentence with a targeted prosody (i.e., happy, sad, or angry).

 

STEP 5:

  • C asks a question designed to elicit the target written sentence with a specific affect.
  • For example, to elicit a happy(or sad or angry) affect for the target written sentence “The fair starts tomorrow,“ C asks “Why are you so happy (or sad or angry?”)

 

STEP 6:

  • Using the same target written sentence, the C directs a role playing task in which the P shares a targeted affective/ emotional state with a family member.

 

 

 


Sousa (2017)

June 1, 2018

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  A summary of the intervention can be found by scrolling about one-half of the way down this page.

KEY

ASD =  autism spectrum disorder

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist 

Source:  Sousa, M. S. S. (2017).  Prosodic exercises for children with ASD via virtual therapy. Thesis in Electrical and Computer Engineering, Técnico Lisboa (Portugal).  Retrieved from Semantic Scholar (https://www.semanticscholar.org/paper/Prosodic-exercises-for-children-with-ASD-via-Sousa-Trancoso/800334b2054586baaa055b01f08c2932df93eb77) 

Reviewer(s):  pmh

Date:  May 31.2018 

Overall Assigned Grade for Evidence (because there are no supporting data, the highest grade will be F, ):  The grade of F should not be interpreted as an evaluation of the intervention described in this paper or the quality of the paper itself. It merely reflects the quality of the support for the intervention. Because there were no data, the grade is F.

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.

Take Away:  The author detailed the strategies for developing a mobile phone-based prosodic intervention for young Portuguese speaking children diagnosed with autism spectrum disorder (ASD.) The author described methods for assessing the quality of the auditory stimuli used in the treatment and for evaluating acoustically imitations produced during the intervention by the children with ASD. The author consulted the existing literature as well as “therapists”  to identify important learning strategies and targets. Although this mobile-phone prosodic intervention was not administered, it does have potential as a model for future development.

  1. Was there a review of the literature supporting components of the intervention?Yes
  • Narrative Review

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes

  

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

 

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

 

  1. Description of outcome measures:

–  Are outcome measures suggested?  Yes

  • Outcome #1: Discrimination of same and different using visual stimuli

 

  • Outcome #2: Discrimination of nonspeech auditory stimuli (affirmation versus question; pleasure versus displeasure) that differ only in intonation

 

  • Outcome #3: Discrimination of single words as representing pleasure or displeasure affective states

 

  • Outcome #4: Discriminate low versus high pitches in single words

 

  • Outcome #5: Identification of the direction of the pitches of 2 syllable productions

 

  • Outcome #6: Imitate intonation of single words

  

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

  

SUMMARY OF INTERVENTION

 

PURPOSE: to develop an Android application for teaching the comprehension and production of intonation

POPULATION:  Autism Spectrum Disorder; children

MODALITY TARGETED: comprehension, production (imitation)

 ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, intonation

OTHER TARGETS:  concepts of same/different

DOSAGE: not applicable because the program was not administered

ADMINISTRATOR:  mobile phones? (this is virtual therapy)

MAJOR COMPONENTS:

  • This intervention was developed to fulfill the thesis requirement for the Master of Science in Electrical and Computer Engineering at Ténico Lisboa (Portugal.)

 

  • Several tasks were developed for nonreading children to use on Android phones including

–  2 activities to teach the concept of same/different

– one activity to teach the discrimination of single words as being same or different when they could differ only by intonation patterns representing question/affirmation  or pleasure/displeasure.

–  one activity to teach the imitation of single words that differed only by intonation patterns representing question/affirmation  or pleasure/displeasure.

– one activity to teach the identification of pleasure/displeasure affective states of single words.

– one activity to teach the identification of high versus low pitches on auditory stimuli (initially nonspeech sounds, moving to speech sounds)

– one activity to teach the identification of sequences of pitches produced on sounds (e.g., high-high, low-low, high-low, etc.)

 

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

 


Akbari & Davis (2018)

April 3, 2018

EBP THERAPY ANALYSIS for

Single Case 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

F0 =  fundamental frequency

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PVSP =  Perceived performance on the Prosody-Voice Screening Profile

SLP = speech–language pathologist

WNL = within normal limits

 

SOURCE:  Akbari, C. C., & Davis. A. H. (2018).  Treating expressive affective prosody in Autism Spectrum Disorder: A case study.  Communication Disorders Quarterly. Article first published online: February 27, 2018 DOI; 10.1177/1525740118755669  cdq.sagepub.com

 

REVIEWER(S):  pmh

 

DATE: March 22, 2018

 

ASSIGNED OVERALL GRADE:  D-  The highest possible grade for this investigation is D+. This grade is based on the design of the investigation, a single case study. This grade does not represent a judgment regarding the quality of the investigation nor the quality of the intervention. It solely represents the level of the support for the intervention in this investigation.

 

TAKE AWAY:  This single case study revealed that an adaptation of an intervention used with adults with aphasia to improve expressive affective prosody was used effectively with an adolescent with Autism Spectrum Disorder. The outcomes were acoustic and perceptual measures of features used to expressive affective prosody.

                                                                                                           

 

  1. What was the focus of the research? Clinical

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used?  Case Study– Description with Pre and Post Test Results
  • What was the level of support associated with the type of evidence?

Level = D+   

                                                                                                           

 

  1. Was phase of treatment concealed?
  • from participants?No
  • from clinicians? No
  • from data analyzers? No

 

 

  1. Was the participant (P) adequately described? Yes

 

–  How many Ps were involved in the study?  1

 

–  DESCRIBED CHARACTERISTICS

  • age:14 years
  • gender:male                               
  • cognitive skills:within normal limits (WNL)
  • language scores:WNL
  • oral peripheral status: WNL
  • diagnosis:Autism Spectrum Disorder (ASD)
  • hearing: WNL

 

–  Were the communication problems adequately described?  Yes

  • The disorder type(s):ASD
  • Other aspects of communication that were described:

–  Problems in the following aspects of prosody

         ∞  phrasing

         ∞  rate

         ∞  stress

    –   Voice quality was WNL.

 

                                                                                                                       

  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? Not applicable (NA) 
  • Were any data removed from the study? No 

 

 

  1. Did the design include appropriate controls? No, it was a single case study.

                                                                      

  • Were preintervention data collected on all behaviors? Yes
  • Did pre and post intervention data include untrained stimuli? Yes
  • Did pre and post intervention data include trained stimuli? No
  • Was the data collection continuous? No
  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes, but I did not see an outcome targeting the accuracy of listeners’ interpretation of the expressive affect.

 

OUTCOMES

 

  • OUTCOME #1: Perceived performance on the Prosody-Voice Screening Profile (PVSP): Phrasing
  • OUTCOME #2:Perceived performance on the PVSP: Rate
  • OUTCOME #3: Perceived performance on the PVSP: Stress
  • OUTCOME #4: Perceived performance on the PVSP: Loudness
  • OUTCOME #5:Perceived performance on the PVSP: Pitch
  • OUTCOME #6: Perceived performance on the PVSP: Quality
  • OUTCOME #7: Production of duration of full sentences representing happiness
  • OUTCOME #8:Production of duration of full sentences representing anger
  • OUTCOME #9: Production of duration of full sentences representing sadness
  • OUTCOME #10: Production of fundamental frequency (F0) in sentences representing happiness
  • OUTCOME #11: Production of F0 in sentences representing anger
  • OUTCOME #12: Production of F0 in sentences representing sadness
  • OUTCOME #13: Production of duration of unstressed syllables in sentences representing happiness
  • OUTCOME #14: Production of duration of unstressed syllables in sentences representing anger
  • OUTCOME #15: Production of duration of unstressed syllables in sentences representing sadness
  • OUTCOME #16: Production of duration of stressed syllables in sentences representing happiness
  • OUTCOME #147: Production of duration of stressed syllables in sentences representing anger
  • OUTCOME #18: Production of duration of stressed syllables in sentences representing sadness
  • OUTCOME #19: Production of intensity of unstressed syllables in sentences representing happiness
  • OUTCOME #21:Production of intensity of unstressed syllables in sentences representing anger
  • OUTCOME #22: Production of intensity of unstressed syllables in sentences representing sadness
  • OUTCOME #23: Production of intensity of stressed syllables in sentences representing happiness
  • OUTCOME #24: Production of intensity of stressed syllables in sentences representing anger
  • OUTCOME #25: Production of intensity of stressed syllables in sentences representing sadness

 

SUBJECTIVE OUTCOMES

  • OUTCOME #1: Perceived performance on the Prosody-Voice Screening Profile (PVSP): Phrasing
  • OUTCOME #2: Perceived performance on the PVSP: Rate
  • OUTCOME #3: Perceived performance on the PVSP: Stress
  • OUTCOME #4: Perceived performance on the PVSP: Loudness
  • OUTCOME #5:Perceived performance on the PVSP: Pitch
  • OUTCOME #6: Perceived performance on the PVSP: Quality

 

OBJECTIVE OUTCOMES

  • OUTCOME #7: Production of duration of full sentences representing happiness
  • OUTCOME #8:Production of duration of full sentences representing anger
  • OUTCOME #9: Production of duration of full sentences representing sadness
  • OUTCOME #10: Production of fundamental frequency (F0) in sentences representing happiness
  • OUTCOME #11:Production of F0 in sentences representing anger
  • OUTCOME #12: Production of F0 in sentences representing sadness
  • OUTCOME #13: Production of duration of unstressed syllables in sentences representing happiness
  • OUTCOME #14 Production of duration of unstressed syllables in sentences representing anger
  • OUTCOME #15: Production of duration of unstressed syllables in sentences representing sadness
  • OUTCOME #16: Production of duration of stressed syllables in sentences representing happiness
  • OUTCOME #147: Production of duration of stressed syllables in sentences representing anger
  • OUTCOME #18: Production of duration of stressed syllables in sentences representing sadness
  • OUTCOME #19: Production of intensity of unstressed syllables in sentences representing happiness
  • OUTCOME #21: Production of intensity of unstressed syllables in sentences representing anger
  • OUTCOME #22: Production of intensity of unstressed syllables in sentences representing sadness
  • OUTCOME #23: Production of intensity of stressed syllables in sentences representing happiness

 

 

–  Reliability data

 

  • Intra rater reliability of acoustic measurement:Authors claim little variation in the following measures:

–  F0

–  stressed syllable duration

– unstressed syllable duration

– stressed syllable intensity

– unstressed syllable intensity

 

 

  1. Results:

 

–  Did the target behavior(s) improve when treated?  Yes, for the most part

 

  • OUTCOME #1: Perceived performance on the Prosody-Voice Screening Profile (PVSP): Phrasing — WNL for both pre and post testing

 

  • OUTCOME #2: Perceived performance on the PVSP: Rate —WNL for both pre and post testing

 

  • OUTCOME #3: Perceived performance on the PVSP: Stress– pretest =  approximately 44% correct; post test = approximately 84% correct

 

  • OUTCOME #4: Perceived performance on the PVSP: Loudness-WNL for both pre and post testing

 

  • OUTCOME #5: Perceived performance on the PVSP: Pitch — WNL for both pre and post testing

 

  • OUTCOME #6: Perceived performance on the PVSP: Quality  — WNL for both pre and post testing

 

  • OUTCOME #7: Production of duration of full sentences representing happiness —Significantly longer following post testing

 

  • OUTCOME #8: Production of duration of full sentences representing anger  —Significantly longer following post testing

 

  • OUTCOME #9: Production of duration of full sentences representing sadness  Significantly longer following post testing

 

  • OUTCOME #10:Production of fundamental frequency (F0) in sentences representing happiness  —No significant differences between pre and post testing

 

  • OUTCOME #11: Production of F0 in sentences representing anger  —No significant differences between pre and post testing

 

  • OUTCOME #12: Production of F0 in sentences representing sadness —No significant differences between pre and post testing 

 

  • OUTCOME #13: Production of duration of unstressed syllables in sentences representing happiness —No significant differences between pre and post testing

 

  • OUTCOME #14: Production of duration of unstressed syllables in sentences representing anger  —No significant differences between pre and post testing

 

  • OUTCOME #15: Production of duration of unstressed syllables in sentences representing sadness  —Significantly longer following post testing

 

  • OUTCOME #16: Production of duration of stressed syllables in sentences representing happiness anger  —No significant differences between pre and post testing

 

  • OUTCOME #147: Production of duration of stressed syllables in sentences representing anger  —Significantly shorter following post testing

 

  • OUTCOME #18: Production of duration of stressed syllables in sentences representing sadness —Significantly longer following post testing

 

  • OUTCOME #19: Production of intensity of unstressed syllables in sentences representing happiness  —No significant differences between pre and post testing

 

  • OUTCOME #21: Production of intensity of unstressed syllables in sentences representing anger– Significantly reduced following post testing

 

  • OUTCOME #22: Production of intensity of unstressed syllables in sentences representing sadness — Significantly reduced following post testing

 

  • OUTCOME #23:Production of intensity of stressed syllables in sentences representing happiness —No significant differences between pre and post testing

 

  • OUTCOME #24: Production of intensity of stressed syllables in sentences representing anger —Significantly reduced following post testing

 

  • OUTCOME #25: Production of intensity of stressed syllables in sentences representing sadness — Significantly reduced following post testing

 

 

  1. Description of baseline:
  • Were baseline data provided? No,but there was pretesting for all measures

numbering as needed)

 

 

  1. What is the clinical significanceNo data provided.

 

  1. Was information about treatment fidelity adequate? No

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported?Yes. The sentences used in the pre- and post-testing differed from the sentences usedin the intervention

 

 

  1. Brief description of the design:
  • This was a single case study.
  • The second investigator served as the clinician (C) and as the pre and post intervention assessor.
  • Pre and post testing comprised

          – 24 spontaneous utterances

–  12 sentences (4 sentences representing each of 3 emotions) read aloud

  • The C used 24 sentences during intervention that differed from the pre-and post-testing sentences.
  • All testing and intervention sentences were provided in the appendixes.

 

 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: D-

 

SUMMARY OF INTERVENTION

 

PURPOSE: To explore the effectiveness of an intervention designed for adults with aphasia in improving the expressive affective prosody of an adolescent with ASD

 

POPULATION:  ASD; Children (Adolescence)

 

MODALITY TARGETED:  Expressive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:intensity, duration, F0, loudness, pitch, stress, rate,

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  voice quality

 

DOSAGE:  individual sessions, 1 hour per week, for 10 weeks

 

ADMINISTRATOR:  the second author

 

MAJOR COMPONENTS:

 

  • The intervention was an adaptation of a six step program designed to improve the expressive affective prosody of Ps with aphasia.

 

  • The investigators included all the treatment (practice) and testing (assessment targets) in the appendices.

 

  • The steps of the intervention are outlined in Appendix B. Treatment involves providing maximum cueing and fading to minimal or no cueing.

 

  • To move from one step to the next, P needed to produce 3 consecutive correct response.

 

  • A summary of the 6 steps of the intervention:

 

  1. C reads aloud a practice sentence with one of the 3 targeted prosodic affects and identified the targeted affect to the P. C and P produce the sentence in unison.
  2. C models the practice sentence with the targeted prosodic affect and facial expression then directs P to imitate her.
  3. C models the practice sentence with the targeted prosodic affect but not with facial expression then directs P to imitate her prosody.
  4. C produces the practice sentence with a neutral affect and directs P to reproduce with but to include the targeted affective prosody.
  5. C asks a question designed to elicit the targeted emotion and P answers with the practice sentence and the targeted prosodic affect.
  6. C engages in role-playing in which P produces the practice sentence with the targeted affective prosody.

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


Radice-Neumann et al. (2009)

February 13, 2016

 

EBP THERAPY ANALYSIS

Treatment Groups

 

 

Note: Scroll about two-thirds of the way down the page to read the summary of the procedure(s).

 

Key:

C = Clinician

d = Standardized Mean Difference

EBP = evidence-based practice

f = female

FAR = Facial affect recognition training

m = male

N = number

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SEI = Stories of emotional inference training

SLP = speech–language pathologist

 

 

SOURCE: Radice-Neumann, D., Zupan, B., Tomita, M., & Willer, B. (2009). Training emotional processing in persons with brain injury. Journal of Head Trauma Rehabilitation, 24, 313-323.

 

REVIEWER(S):  pmh

 

DATE: February 11, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: A-   (The highest possible grade based on the design of the investigation was A. )

 

TAKE AWAY: Participants (Ps) with acquired brain injury (ABI) improved facial recognition of affect and/or the ability to infer affect and/or their social-emotional behavior following the administration of one of two affect interventions that did not focus of prosodic affect. However, the Ps’ recognition of affective prosody did not improve following either of the two interventions. The findings suggest that affective prosody needs to be directly treated.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Randomized Group Design with Controls

                                                                                                           

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

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Yes

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No
  • from clinicians? No
  • from analyzers? No

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many Ps were involved in the study?

 

  • total # of Ps: 21
  • # of groups: 2
  • List names of groups and the # of participants in each group:
  • Facial affect recognition training (FAR) = 11 (data from one P was removed from the investigation, so the final number, N, was 10)
  • Stories of emotional inference training (SEI) = 10 (one P dropped out of the investigation so the final N was 9.)

 

– The following characteristic were CONTROLLED

  • age: between the ages of 18 and 65
  • severity of brain injury: Severe (Glasgow Coma Scale ≤ 8)
  • time post injury: at least 1 year
  • expressive language: no “substantial” problems (p. 315)
  • receptive language: comprehended short paragraphs and the emotion words used in the investigation; no “substantial” problems (p. 315)
  • facial recognition skills: at least one standard deviation below the mean
  • social-emotional status: with the exception of depression no psychiatric comorbidity
  • hearing status: hearing loss was corrected
  • visual status: impairment was correct
  • Other: no current abuse of alcohol or drug

 

– The following P characteristics were DESCRIBED

  • age: (statistical test revealed no significant difference)

     – FAR = 47 years

     – SEI = 38 years

  • gender:

     – FAR = 9m, 2f

     – SEI = 3m, 6f

  • residence

     – FAR = Western New York (US) – 7; Ontario (Canada) – 4

     – SEI = Western New York (US) – 6; Ontario (Canada) – 3

  • race

     – FAR = white-9; African American – 1; Native American – 1;

     – SEI = white-8; Asian – 1

  • cause of brain injury

     – FAR = motor vehicle – 9; fall – 2

     – SEI = motor vehicle – 6; fall – 1; other – 2

  • years post Injury: (statistical test revealed significant difference)

     – FAR = 16 years

     – SEI = 8 years

  • Glasgow Coma Scale Score;

     – FAR = 3.6

     – SEI = 4.6

  • Brock Adaptive Functioning Questionnaire: (test of executive function, statistical testing revealed no significant difference)

     – FAR = 61

     – SEI = 56

  • receptive language: (statistical testing revealed no significant difference)

     – FAR = 6.9

     – SEI = 6.2

  • Beck Depression Inventory: (statistical testing did not reveal significant difference)

     – FAR = 17

     – SEI = 20

  • DANVA2-Faces: (statistical testing did not reveal a significant difference)

     – FAR = 14

     – SEI = 15.9

 

–   Were the groups similar before intervention began? Yes, for the most part

 

Were the communication problems adequately described?

 

  •  disorder type: Normal functioning on the test that measured the ability to recognized affective prosody was a score of 14-21, with a highest possible score of 24. The pretest scores for the two groups were

– FAR: mean = 13.25; standard deviation = 2.37

– SEI: mean = 14.72; standard deviation = 3.40. (Prior to intervention, some of the Ps of both groups apparently were functioning below normal limits and some were functioning within normal limits. The investigators did not provide individual scores but it is unlikely any of the Ps performed at the test ceiling.)

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? Yes, however, one SEI P dropped out of the investigation.

                                                               

  • Were data from outliers removed from the study? Yes, the investigators removed the data for one FAR P from the investigation.

 

 

  1. Were the groups controlled acceptably?

                                                                                                             

  • Was there a no intervention group? No
  • Was there a foil intervention group? No
  • Was there a comparison group? Yes
  • Was the time involved in the comparison and the target groups constant? Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– The outcomes were

NOTE: All of the outcomes are listed, although the focus of this analysis will be on the outcome (OUTCOME #1) concerned with prosody.

 

  • OUTCOME #1: Improved performance on test of the recognition of prosodic affect—DANVA2-AP (NOTE: The investigators had NOT expected transference to this outcome.)
  • OUTCOME #2 –Improved to infer how they (the Ps) would feel in the described situations—LEAS-Self
  • OUTCOME #3: Improved to infer how others would feel in the described situations—LEAS-Others
  • OUTCOME #4: Improved performance on a test of the recognition of facial affect—DANVA2-AF
  • OUTCOME #5: Improved ability to recognize affect from short videos which included facial, prosodic, gestural, and postural cues–EET
  • OUTCOME #6: Improved social-emotional functioning—BAFQ

 

–  List the outcome measures (using outcome numbers from item 7a) that are subjective: ALL

 

 List the outcome measures (using outcome numbers form item 7a) that are objective? NONE

 

                                         

 

  1. Were reliability measures provided?

NOTE: The reliability measures are reports of previously reported data.

                                                                                                            

  • Interobserver for analyzers? Yes

– OUTCOME #2 –Improved to infer how they (the Ps) would feel in the described situations—LEAS-Self: a minimum of 0.84

– OUTCOME #3: Improved to infer how others would feel in the described situations—LEAS-Others: a minimum of 0.84

 

  • Intraobserver for analyzers? No

 

  • Treatment fidelity for clinicians?

 

  • Test-retest reliability? Yes

OUTCOME #1: Improved performance on test of the recognition of prosodic affect—DANVA2-AP: 0.73 to 0.93

– OUTCOME #4: Improved performance on a test of the recognition of facial affect—DANVA2-AF: 0.81

 

 

  1. What were the results of the statistical (inferential) testing and/or the description of the results?

 

  • Summary Of Important Results

 

— What level of significance was required to claim significance? p = 0.05 (0.05 was the level listed in Table 3. The prose reports a lower level was used for most comparisons to correct for multiple comparisons.)

 

 

PRE AND POST TREATMENT

 

NOTES:

  1. Although there were 2 groups of Ps, the investigators did not present the results of statistical comparisons of the 2 intervention groups
  2. * = although the p value was ≤ 0.05, correction for multiple comparisons indicated the difference was not significant

 

  • OUTCOME #1: Improved performance on test of the recognition of prosodic affect—DANVA2-AP

– FAR results:

  • pretest compared to posttest–no significant difference
  • pretest to follow-up– no significant difference

 

– SEI results:

  • pretest compared to posttest– no significant difference
  • pretest to follow-up– no significant difference

 

  • OUTCOME #2 –Improved to infer how they (the Ps) would feel in the described situations—LEAS-Self

– FAR results:

  • pretest compared to posttest- post test is significantly higher
  • pretest to follow-up– no significant difference

 

– SEI results:

  • pretest compared to posttest– no significant difference
  • pretest to follow-up – post test is significantly higher

 

  • OUTCOME #3: Improved to infer how others would feel in the described situations—LEAS-Others

– FAR results:

  • pretest compared to posttest– post test is significantly higher
  • pretest to follow-up– no significant difference
  • posttest to follow-up – no significant difference

 

– SEI results:

  • pretest compared to posttest– no significant difference
  • pretest to follow-up– no significant difference

 

  • OUTCOME #4: Improved performance on a test of the recognition of facial affect—DANVA2-AF

– FAR results:

  • pretest #1 compared to posttest– post test is significantly higher
  • pretest #2 compared to posttest– post test is significantly higher
  • pretest #1 and #2 to follow-up– follow up is significantly higher
  • posttest to follow up—significant difference *

 

– SEI results:

  • pretest #1 compared to posttest– post test is significantly higher*
  • pretest #2 compared to posttest– post test is significantly higher*
  • pretest #1 to follow-up– follow up is significantly higher *
  • pretest #2 to follow-up– no significant difference

 

 

  • OUTCOME #5: Improved ability to recognize affect from short videos which included facial, prosodic, gestural, and postural cues—EET

– FAR results:

  • pretest compared to posttest– no significant difference
  • pretest to follow-up– no significant difference

 

– SEI results:

  • pretest compared to posttest- no significant difference
  • pretest to follow-up– no significant difference

 

  • OUTCOME #6: Improved social-emotional functioning—BAFQ

– FAR results:

  • pretest compared to posttest– post test is significantly better (lower scores reflect improvement)

 

– SEI results:

  • pretest compared to posttest– no significant difference

 

 

– What was the statistical test used to determine significance? t-test; ANOVA

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

– The investigators provided the following evidence-based EBP measure: Standardized Mean Difference- (d)

 

– Results of EBP testing and the interpretation

 

  • OUTCOME #1: Improved performance on test of the recognition of prosodic affect—DANVA2-AP

– FAR results:

  • pretest compared to posttest— d = 0.02   very small

 

– SEI results:

  • pretest compared to posttest– d = 0.07 very small

 

  • OUTCOME #2 –Improved to infer how they (the Ps) would feel in the described situations—LEAS-Self

– FAR results:

  • pretest compared to posttest    d = 0.81 large

 

– SEI results:

  • pretest compared to posttest d = 0.37 small to medium

 

  • OUTCOME #3: Improved to infer how others would feel in the described situations—LEAS-Others

– FAR results:

  • pretest compared to posttest   d = 1.37   very large

 

– SEI results:

  • pretest compared to posttest   d = 0.14 small

 

  • OUTCOME #4: Improved performance on a test of the recognition of facial affect—DANVA2-AF

– FAR results:

  • pretest #1 compared to posttest: d = 2.07   very large

 

– SEI results:

  • pretest #2 compared to posttest: d = 0.33   small

 

  • OUTCOME #5: Improved ability to recognize affect from short videos which included facial, prosodic, gestural, and postural cues—EET

– FAR results:

  • pretest compared to posttest d = 0.44 medium

 

– SEI results:

  • pretest compared to posttest d = 0.57 medium

 

  • OUTCOME #6: Improved social-emotional functioning—BAFQ

– FAR results:

  • pretest compared to posttest   d = 0.24 small

 

– SEI results:

  • pretest compared to posttest   d = 0.09 very small

 

 

  1. Were maintenance data reported? Yes. With the exception of OUTCOME #6 (Improved social-emotional functioning—BAFQ), all of the outcomes were tested at a follow-up session, administered 2 weeks after the termination of therapy. For the most part, gains made in treatment were maintained or at least improved from the pretest.

 

 

  1. Were generalization data reported? Yes.
  • Affective prosody was not directly treated in either intervention; there was not generalization to affective prosody.
  • FAR intervention did not include training in the interpretation of short video stories but OUTCOME #5 (Improved ability to recognize affect from short videos which included facial, prosodic, gestural, and postural cues) assessed this skill. Neither intervention yielded significant improvement on this outcome.
  • SEI intervention was not concerned with inferring emotions. OUTCOME #2 (Improved to infer how Ps would feel in the described situations—LEAS-Self) and

OUTCOME #3 (Improved to infer how others would feel in the described situations—LEAS-Others) assessed inference. The SEI group did not improve significantly on these outcomes although FAR improved significantly.

 

 

  1. Describe briefly the experimental design of the investigation.
  • The investigators randomly assigned Ps with ABI to one of 2 treatment groups: FAR and SEI.
  • For the most part, the Ps in the 2 groups displayed similar characteristics prior to intervention.
  • The investigators assessed the Ps 3 times: pretests (2 weeks before intervention and immediately before the initiation of therapy), posttest (within 3 days of the end of therapy), and follow-up (2 weeks after the termination of therapy.) One outcome (#6) was only measured at the pre- and post-test assessments.
  • For most part, there was not a significant difference between the first and second pretests, accordingly the pre- and post- test scores of most outcomes were combined for statistical analysis.
  • Therapy sessions were individual, 1 hour long, 3 sessions a week, for 2 to 3 weeks. The average number of sessions per P for both groups was 6.5.
  • The statistical comparisons compared

– pretests vs posttest,

– pretests vs follow up,

– posttest vs follow up, and

– pretest #1 vs pretest #2.

  • The investigators did not report the results of comparisons of the 2 different treatment groups (Far vs SEI.)

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: A-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To compare the effectiveness of interventions to improve affective recognition.

 

POPULATION: Traumatic Brain Injury

 

MODALITY TARGETED: comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: prosodic affect

 

OTHER TARGETS: facial affect, social-emotional function, recognition of affect, inference of affect. (NOTE: These outcomes are not cross referenced because it was not clear that prosody was used to treat these targets.)

 

DOSAGE: individual, 1 hour sessions, 3 times a week for 2-3 weeks.

 

ADMINISTRATOR: “therapist” but the type of therapist is unclear

 

MAJOR COMPONENTS:

 

There were 2 intervention: FAR and SEI

 

FAR

 

  • FAR focused on helping Ps attend to their own affect and inferring the affect of others by attending to facial cues.

 

  • The investigators provided an Appendix detailing the intervention.

 

  • FAR comprised 2 phases: facial recognition and recognition of P’s own affect

 

  • Phase 1

 

– The clinician (C) used a computer program to present facial cues associated with selected affects.

– C and P discussed each of the emotions and applied them to Ps’ experiences.

– C provided feedback to P.

– The difficulty of the task of identifying the emotion increased and the cues for attending to facial representations of affect decreased as P progressed.

– Criterion for each of the exercises in this Phase was 85% correct.

 

Phase 2

 

– P described the physical reactions he/she expected to experience with each of the targeted emotions.

– C selected exemplars/events from the P’s discussions of his/her experiences associated with emotions/affects noted in the previous phase.

– For each of the events, C asked P to

  • provide details about the event
  • describe the context preceding the event
  • describe how he/she felt about the event including physical responses to the emotion
  • suggest why he/she felt the way he/she did
  • describe how he/she responded to the event
  • note the consequences

 

 

SEI

 

  • SEI focused on interpreting social stories and inferring affect from the context.

 

  • C presented 20 social stories focusing on

– attention to cues to emotions of characters

– relating the social story to the P’s life experiences

 

  • The C presented the social stories visually and orally using a computer.

 

  • Key words and cues about emotional status were highlighted in the social story texts on the computer.

 

  • C directed P to read the story and then answer questions about the emotional status of the characters.

 

  • C provided feedback as well as directed P to reread portions of the text, as necessary.

 

  • Following a correct answer, P asked C

– why he/she thought the answer was correct

– how he/she would have felt in a similar context

– if he/she had experienced a similar situation

– if he/she had experience a similar emotion

 

  • Criterion for advancement was 80% correct.

 

________________________


Ramdoss et al. (2012)

May 3, 2015

SECONDARY REVIEW CRITIQUE

Key:

 

ASD = Autism Spectrum Disorders

d = standardized mean difference

CBI = computer-based interventions

NA = not applicable

NAP = Non-overlapping of All Pairs

P = participant

pmh = Patricia Hargrove, blog developer

SR = systematic review

Source: Ramdoss, S., Machalicek, W., Rispoli, M., Mulloy, A. Russell Lang, R., & O’Reilly, M. (2012). Computer-based interventions to improve social and emotional skills in individuals with autism spectrum disorders: A systematic review. Developmental Neurorehabilitation , 15, 119-135.

 

Reviewer(s): pmh

 

Date: April 30, 2015

 

Overall Assigned Grade: B   (Highest possible grade, based on the design of the paper, is B.)

 

Level of Evidence: B

 

Take Away: Ramdoss et al. (2012) focused on a variety of outcomes and treatment procedures, only outcomes and treatment procedures concerned with prosody will be discussed in this review. The systematic review (SR) summarized and analyzed the literature pertaining to the use of computer-based interventions (CBI) to treat social and emotional outcomes for children, adolescents, and adults with Autism Spectrum Disorders. All the direct treatments of recognition of prosodic emotion employed Mind Reading software. Gains were moderate to large.

 

What type of secondary review? Narrative Systematic Review

  • Classic Systematic 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)? Yes

 

– Authors noted that they reviewed the following resources:

  • electronic based databases
  • references from identified literature

 

– 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 reviewers identify the level of evidence of the sources? Yes. They classified each of the sources as either suggestive, preponderant, or conclusive.

– Did the reviewers 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 reviewers or review teams rate the sources independently? Yes

– Were interrater reliability data provided? Yes. In addition, the discussed disagreements and came to a consensus on all disagreements.

– If the reviewers provided interrater reliability data, list them: Not Applicable

 

– If there were no interrater reliability data, was an alternate means to insure reliability described? Not Applicable

 

– Were assessments of sources sufficiently reliable? Yes

– 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? Variable. Numbers of participants (P) in the sources ranged from 4 to 79 with a mean of 28 Ps.

 

– Were there a sufficient number of sources? Yes. The overall number of sources was 11 and there were 12 experiments. The number of sources concerned with some aspect of prosody was 6.

  1. Description of outcome measures:

NOTE: Only procedures concerned with prosody as an outcome or as a means to treating other outcomes will be described here.

The outcome measures were

  • Outcomes Associated with Procedure #1 (Beaumont & Sofronoff, 2008; prosody was part of the intervention, not an outcome): improved reciprocal positive interaction, social responsiveness, initiating and maintaining conversations, interactive play, interpreting facial expressions and body postures, knowledge of anger and anxiety management strategies.
  • Outcome Associated with Procedure #2 (Golan & Baron-Cohen, 2006; Experiment 1): improved comprehension/recognition of complex emotions as represented in prosody and in facial representations
  • Outcome Associated with Procedure #3 (Golan & Baron-Cohen, 2006; Experiment 2): improved comprehension/recognition of complex emotions as represented in prosody and in facial representations

 

  • Outcome Associated with Procedure #4 (Lacava et al., 2007): improved comprehension/recognition of complex emotions as represented in prosody and in facial representations
  • Outcomes Associated with Procedure #5 (Lacava et al., 2010): improved comprehension/recognition of complex emotions as represented in facial representations and positive social interaction

 

  • Outcome Associated with Procedure #6 (Silver & Oakes, 2001; the intervention is likely to have involved prosody because the authors noted that one of the components of the treatment consisted of interpreting emotions from narratives): improved recognition of emotions from photographs of faces and from cartoons. NOTE: I am assuming that the narratives were presented outloud. If they were written, this would not be a prosody related intervention (pmh.)

 

  1. Description of results: (information is found in tables and in the prose; be sure to review both)

– What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size?

  • standardized mean difference (d) effect size for group analyses
  • Non-overlapping of All Pairs (NAP) for single case studies
  • Following the calculation of the measures, the authors sorted the experiments on the basis of design/methodology as

– suggestive

– preponderant

– conclusive (see p. 122 for criteria for categorization)

– Summarization overall findings of the secondary review:

  • There was only one conclusive experiment (the authors’ highest level of evidence) from the 12 possible experiments. That investigation was not concerned with prosody and will not be discussed here.
  • For the investigations concerned with prosody/voice representations of emotion, improvement across the relevant investigations was in a positive direction with small to moderate improvement.
  • The authors noted that while there is as yet insufficient evidence to support the overall use of CBI to teach social/emotional skills to students with ASD, the research provides helpful guidelines:

– Golan & Baron-Cohen (2006) determined that there were no significant differences between CBI and face-to-face interventions. This should be considered to be positive support for the use of CBI to improve emotion recognition.

– Some of the research indicated that progress in emotion recognition was correlated with the number of intervention sessions.

  • The effect sizes/NAPs were categorized as ineffective, small, moderate, or large. The overall effect sizes for the outcomes or treatments associated with improving prosody/voice emotion recognition were small and moderate. The quality of improvement and the level of evidence for the Outcomes Associated with the different prosody related (treating prosody or using prosody to treat another aspect of communication) experiments is listed below:
  • Outcomes Associated with Procedure #1 (Beaumont & Sofronoff, 2008; prosody was part of the intervention, not an outcome): improved reciprocal positive interaction, social responsiveness, initiating and maintaining conversations, interactive play, interpreting facial expressions and body postures, knowledge of anger and anxiety management strategies: Large effect for social outcomes; [Certainty of evidence = preponderant]

 

  • Outcome Associated with Procedure #2 (Golan & Baron-Cohen, 2006; Experiment 1): improved comprehension/recognition of complex emotions as represented in prosody and in facial representations: Moderate effect for faces and voices outcomes; No significant differences on reading the mind tasks [Certainty of evidence = suggestive]
  • Outcome Associated with Procedure #3 (Golan & Baron-Cohen, 2006; Experiment 2): improved comprehension/recognition of complex emotions as represented in prosody and in facial representations: No significant between 2 treatment groups (CBI vs face-to face treatment) [Certainty of evidence = suggestive]

 

  • Outcome Associated with Procedure #4 (Lacava et al., 2007): improved comprehension/recognition of complex emotions as represented in prosody and in facial representations: Moderate effect size for Faces and Voices (prosody) subtests [Certainty of evidence = preponderant]

 

  • Outcomes Associated with Procedure #5 (Lacava et al., 2010): improved comprehension/recognition of complex emotions as represented in facial representations and positive social interaction: Small effect for social interaction outcomes; Large effects for Faces and Voices subtests [Certainty of evidence = preponderant]

 

  • Outcome Associated with Procedure #6 (Silver & Oakes, 2001; the intervention is likely to have involved prosody because the authors noted that one of the components of the treatment consisted of interpreting emotions from narratives): improved recognition of emotions from photographs of faces and from cartoons. Large effects [Certainty of evidence = suggestive] NOTE: I am assuming that the narratives were presented outloud. If they were written, this would not be a prosody related intervention (pmh).

 

– Were the results precise? Unclear

– 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? Not Applicable

 

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

– For the most part, were the results similar from source to source? Yes, all the research concerned with prosodic recognition of emotion was in the positive direction.

–  Were the results in the same direction? Yes

–  Did a forest plot indicate homogeneity? Not Applicable

 

  1. Was heterogeneity of results explored? Yes
  1. Were the findings reasonable in view of the current literature? Yes
  2. Were negative outcomes noted? Yes

           

                                                                                                                   

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? Yes. The investigations also were concerned with skills other than the prosodic recognition. These could be considered generalizations. The will not be discussed here.

 

 

SUMMARY OF INTERVENTION

 

Population:   ASD; children, adolescents, adults

 

Prosodic Targets: affect recognition (comprehension/receptive) as noted in Outcomes #2, 3, 4, and 5.

Nonprosodic Targets: A variety of social interaction skill and facial (Outcomes #1 and 6) and body posture recognition of emotions (Outcome #1)

Aspects of Prosody Used in Treatment of Nonprosodic Targets: Affective prosody (Outcome #1) and overall prosody in narratives (Outcome #6)

Description of Procedure/Source #1—Outcomes Associated with Procedure #1 (Beaumont & Sofronoff, 2008; prosody was part of the intervention, not an outcome): improved reciprocal positive interaction, social responsiveness, initiating and maintaining conversations, interactive play, interpreting facial expressions and body postures, knowledge of anger and anxiety management strategies

PROCEDURE #1

  • The investigators used Junior Detective Training Program software
  • The intervention comprised 2 phases:

– Phase 1: Using computer animation, Ps learned to interpret facial expression, body postures, and prosody of human characters

– Phase 2: Using cartoon characters, Ps learned to interpret emotions in a variety of contexts using nonverbal (including prosody?) and environmental cues.

EVIDENCE SUPPORTING PROCEDURE/SOURCE #1

  • Large improvements on measures of social interaction and emotion management.

EVIDENCE CONTRAINDICATING PROCEDURE/SOURCE #1

  • Measures of recognition of facial and body posture representations of emotion did not improve significantly.

Description of Procedure/Source #2— Outcome Associated with Procedure #2 (Golan & Baron-Cohen, 2006; Experiment 1): improved comprehension/recognition of complex emotions as represented in prosody and in facial representations

PROCEDURE #2

  • Investigators used Mind Reading software
  • Ps used the software at home for about 2 hours a week for 10-15 weeks.
  • The software contained a emotion library, games, and instructional logs. The software represented 24 emotion groups at 4 developmental levels.

EVIDENCE SUPPORTING PROCEDURE/SOURCE #2

  • Moderate, significant improvement on interpreting facial expression

EVIDENCE CONTRAINDICATING PROCEDURE/SOURCE #2

  • No significant improvements in reading the mind in eyes, voices, or films

Description of Procedure/Source #3— Outcome Associated with Procedure #3 (Golan & Baron-Cohen, 2006; Experiment 2): improved comprehension/recognition of complex emotions as represented in prosody and in facial representation

PROCEDURE #3

  • Two sets of procedures were compared: face-to-face social skills teaching procedures and CBI plus social skill course procedures. (The nature of the control group is confusing. In the prose it is referenced as tutoring and in Table 1, it is referenced as a social skills course.)
  • The authors of the SR only described the CBI procedures: the used the same Mind Reading Software and procedures as Golan & Baron-Cohen (2006), Experiment 1.

EVIDENCE SUPPORTING PROCEDURE/SOURCE #3

  • There were no significant differences in the outcomes of the CBI plus adult tutors procedures and face-to-face social skills teaching groups.

Description of Procedure/Source #4— Outcome Associated with Procedure #4 (Lacava et al., 2007): improved comprehension/recognition of complex emotions as represented in prosody and in facial representations

PROCEDURE #4

  • The investigators used Mind Reading software.
  • The software contains an emotions library, a learning center, and games. Ps were restricted in their use of games to 33% of the time they were engaged with the software.

 

EVIDENCE SUPPORTING PROCEDURE/SOURCE #4

  • The results indicated significant and moderate effect sizes for Faces and Voices (prosody) subtests of a measure of emotion recognition.

EVIDENCE CONTRAINDICATING PROCEDURE/SOURCE #4

  • The group size was small and the group assignment was not random.

Description of Procedure/Source #5— Outcomes Associated with Procedure #5 (Lacava et al., 2010): improved comprehension/recognition of complex emotions as represented in facial representations and positive social interaction

PROCEDURE #5

  • The investigators used Mind Reading Software.
  • Adult tutors who sat next to the Ps during the use of the software. The tutors prompted Ps and discussed emotions encountered in daily living.

EVIDENCE SUPPORTING PROCEDURE/SOURCE #5

  • Small, significant effect for social interaction outcomes.
  • Large, significant effects for Faces and Voices subtests for recognizing emotion.

EVIDENCE CONTRAINDICATING PROCEDURE/SOURCE #5

  • Small N.

Description of Procedure/Source #6— Outcome Associated with Procedure #6 (Silver & Oakes, 2001; the intervention is likely to have involved prosody because the authors noted that one of the components of the treatment consisted of interpreting emotions from narratives): improved recognition of emotions from photographs of faces and from cartoons

PROCEDURE #6—

  • The investigators used Emotion Trainer software.
  • Ps used Emotion Trainer software to interpret emotions from photos, physical situations (?), and narratives.
  • NOTE: I am assuming that the narratives were presented outloud. If they were written, this would not be a prosody related intervention (pmh).
  • Ps selected the represented emotion from 4 possibilities and was reinforced with the written message “well done” when correct.

EVIDENCE SUPPORTING PROCEDURE/SOURCE #6

  • Large, significant effects for recognizing mental/emotional states in narratives and cartoons

EVIDENCE CONTRAINDICATING PROCEDURE/SOURCE #6

  • No significant effect for recognizing emotion from facial expression.

Bornhofen & McDonald (2008b)

March 10, 2015

EBP THERAPY ANALYSIS
Treatment Groups

Note: Scroll about two-thirds of the way down the page to read the summary of the procedure(s).

Key:
C = Clinician
EBP = evidence-based practice
NA = not applicable
P = Patient or Participant
pmh = Patricia Hargrove, blog developer
SLP = speech–language pathologist
TBI = traumatic brain injury
WNL = within normal limits

SOURCE: Bornhofen, C., & McDonald, S. (2008b). Treating deficits in emotion perception following traumatic brain injury. Neuropsychological Rehabilitation, 8 (1), 22-44.

REVIEWER(S): pmh

DATE: March 5, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: B (The highest possible grade was A.)

TAKE AWAY: This investigation is reviewed despite the fact that one cannot parse out the improvement in prosodic affects, because the measures and intervention treated emotion perception holistically. Overall, the intervention yielded positive changes that were maintained for at least a month.

1. What type of evidence was identified?
• What was the type of evidence? Prospective, Randomized Group Design with Controls
• What was the level of support associated with the type of evidence? Level = A

2. Group membership determination:
• If there was more than one group, were participants randomly assigned to groups? Yes

3. Was administration of intervention status concealed?
• from participants? No
• from clinicians? No
• from analyzers? No

4. Were the groups adequately described? Yes

– How many participants were involved in the study?
• total # of participant: 12
• # of groups: 2
• # of participants in each group: initially 6, 6; during experimental/treatment phase 5 ,6; post test after initial experimental treatment 5, 5
• List names of groups:
– treatment
– waitlist

– The following variables were CONTROLLED:
• age: at least 18 years
• social skills: Participant (P) displays one or more of the following characteristics:
– chronic social isolation
– awkward social interactions
– inattention to social cues
– inappropriate social responses (p. 25)
• premorbid cognitive functioning: Within normal limits (WNL)
• emotional/psychiatric status: excluded if any reported problems psychosis or severe depression
• length of time post onset: at least 9 months

– The following variables were DESCRIBED:
• age: mean = 35.83; range 20 -57 years
• gender: 11m; 1f
• residence: Sydney, Australia vicinity
• length of time post onset: mean = 93.6 months; range = 17 months to 207 months
• educational level of clients: mean years of education = 11.1; range = 10 to 15 years
• number of days with post traumatic amnesia: 58 to 210 days; Unknown (3Ps)
• age at referral
• performance on Benton facial Recognition Test:
– Treatment Group: mean = 42.4; range = 36- 47 (1P was moderately impaired; 1P was severely impaired)
– Waitlist Group: mean = 42.4; range = 34-49 47 (1P was moderately impaired; 1P was severely impaired)
• performance on Logical Memory Test I (Standard Score; SS):
– Treatment Group: range = 4 -11
– Waitlist Group: range = 4-15
• performance on Logical Memory Test II (SS):
– Treatment Group: range = 2-10
– Waitlist Group: range = 5-15
• performance on Weschler Test of Adult Reading (SS): (used as measure of pre TBI cognitive skills)
– Treatment Group: mean = 94.8; range = 83-103
– Waitlist Group: mean = 97.4; range = 83- 119

• Were the groups similar before intervention began? Yes

• Were the communication problems adequately described?
• disorder type: not specified
• functional level: inclusion criteria noted that at least one of the following characteristics were evidenced:
– chronic social isolation
– awkward social interactions
– inattention to social cues
– inappropriate social responses (p. 25)

5. Was membership in groups maintained throughout the study?
• Did each of the groups maintain at least 80% of their original members? Yes

• Were data from outliers removed from the study? No

6. Were the groups controlled acceptably? Yes

• Was there a no intervention group? Yes. One of the groups was waitlisted.

• Was there a foil intervention group? No

• Was there a comparison group? No

7. Were the outcomes measure appropriate and meaningful? Yes

OUTCOMES THAT CONTAIN PROSODY AS A COMPONENT OF EMOTION PERCEPTION
• OUTCOME #1: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in a video that provided facial, vocal, and body language cue to the emotion on The Awareness of Social Inference, Part 1 (TASIT, Part 1)
• OUTCOME #2: Improved performance on a task requiring the P to discriminate between sarcastic and sincere comments in a video from The Awareness of Social Inference, Part 2 (TASIT, Part 2)
• OUTCOME #3: Improved performance on a task requiring the P to discriminate between sarcasm and lies in a video from The Awareness of Social Inference, Part 3 (TASIT, Part 3)

OUTCOMES CONCERNED WITH EMOTION PERCEPTION BUT DO NOT HAVE PROSODY AS A COMPONENT OF THE MEASURE
• OUTCOME #4: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in photos portraying emotions on The Facial Expression Naming Task
• OUTCOME #5: Improved performance on a task requiring the P to choose which of four photos matches the emotion of a targeted photo on The Facial Matching Task

GENERALIZATION OUTCOME
• OUTCOME #6: Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings

— All of the outcome measures were subjective.

— None of the outcomes were objective.

8. Were reliability measures provided?

– Interobserver for analyzers? No

– Intraobserver for analyzers?

– Treatment fidelity for clinicians? No

– Test-retest reliability on alternate forms of the test? Yes. The investigators reported extant data.

OUTCOMES THAT CONTAIN PROSODY AS A COMPONENT OF EMOTION PERCEPTION
• OUTCOME #1: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in a video that provided facial, vocal, and body language cue to the emotion on The Awareness of Social Inference, Part 1 (TASIT, Part 1); r = 0.83
• OUTCOME #2: Improved performance on a task requiring the P to discriminate between sarcastic and sincere comments in a video from The Awareness of Social Inference, Part 2 (TASIT, Part 2); r = 0.62
• OUTCOME #3: Improved performance on a task requiring the P to discriminate between sarcasm and lies in a video from The Awareness of Social Inference, Part 3 (TASIT, Part 3); r = 0.78

OUTCOMES CONCERNED WITH EMOTION PERCEPTION BUT DO NOT HAVE PROSODY AS A COMPONENT OF THE MEASURE
• OUTCOME #4: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in photos portraying emotions on The Facial Expression Naming Task; r = 0.75
• OUTCOME #5: Improved performance on a task requiring the P to choose which of four photos matches the emotion of a targeted photo on The Facial Matching Task; r = 0.67

GENERALIZATION OUTCOME
• OUTCOME #6: Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings; r = 0. 90

9. What were the results of the statistical (inferential) testing?

• The investigators provided group comparisons and analyses of individual performances.

TREATMENT/ WAITLIST GROUP COMPARISONS

— There were no significant differences between the treatment and waitlist groups on the pretest measures for 5 of the 6 outcomes.

–Pretest, the treatment group rated themselves significantly lower than the waitlist group on the self-perception of function outcome. (OUTCOME #6: Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings)

— Post treatment there were significant differences on several outcomes. In all cases, the treatment group was the significantly better group.

OUTCOMES THAT CONTAIN PROSODY AS A COMPONENT OF EMOTION PERCEPTION

• OUTCOME #1: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in a video that provided facial, vocal, and body language cue to the emotion on The Awareness of Social Inference, Part 1 (TASIT, Part 1)—significantly better than waitlist on both forms of the test (A and B)

• OUTCOME #2: Improved performance on a task requiring the P to discriminate between sarcastic and sincere comments in a video from The Awareness of Social Inference, Part 2 (TASIT, Part 2)— not significantly better than waitlist on either form of the test (A, B)

• OUTCOME #3: Improved performance on a task requiring the P to discriminate between sarcasm and lies in a video from The Awareness of Social Inference, Part 3 (TASIT, Part 3)– significantly better than waitlist on both forms of the test (A and B)

OUTCOMES CONCERNED WITH EMOTION PERCEPTION BUT DO NOT HAVE PROSODY AS A COMPONENT OF THE MEASURE

• OUTCOME #4: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in photos portraying emotions on The Facial Expression Naming Task–)— not significantly better than waitlist on either form of the test (A, B)

• OUTCOME #5: Improved performance on a task requiring the P to choose which of four photos matches the emotion of a targeted photo on The Facial Matching Task–—significantly better than waitlist on one form (B) of the test

GENERALIZATION OUTCOME

• OUTCOME #6: Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings–)— not significantly better than waitlist on either form of the test (A, B)

INDIVIDUAL COMPARISONS

– Overall all for the treatment group, outcomes for 26 of a possible 55 measures (i.e., 47.2%) changes were unusually large (expected less than 5% of the time without treatment.)
– Overall all for the waitlist group outcomes for 8 of a possible 66 measures (i.e., 12.1%) there were unusually large (expected less than 5% of the time without treatment) changes.

OUTCOMES THAT CONTAIN PROSODY AS A COMPONENT OF EMOTION PERCEPTION
• OUTCOME #1: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in a video that provided facial, vocal, and body language cue to the emotion on The Awareness of Social Inference, Part 1 (TASIT, Part 1)– 4 of 5 Ps from the treatment presented with unusually large improvements on at least one of the forms

• OUTCOME #2: Improved performance on a task requiring the P to discriminate between sarcastic and sincere comments in a video from The Awareness of Social Inference, Part 2 (TASIT, Part 2) —3 of 5 Ps from the treatment presented with unusually large improvements on at least one of the forms

• OUTCOME #3: Improved performance on a task requiring the P to discriminate between sarcasm and lies in a video from The Awareness of Social Inference, Part 3 (TASIT, Part 3) )— 4 of 5 Ps from the treatment presented with unusually large improvements on at least one of the forms

– For the treatment group’s prosodic outcomes for 13 of a possible 30 measures (i.e., 43.3%) there were unusually large (expected less than 5% of the time without treatment) changes.
– For the waitlist group’s prosodic outcomes for 5 of a possible 636 measures (i.e., 12.1%) there were unusually large (expected less than 13.9% of the time without treatment) changes.

OUTCOMES CONCERNED WITH EMOTION PERCEPTION BUT DO NOT HAVE PROSODY AS A COMPONENT OF THE MEASURE
• OUTCOME #4: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in photos portraying emotions on The Facial Expression Naming Task–3 of 5 Ps from the treatment presented with unusually large improvements on at least one of the forms

• OUTCOME #5: Improved performance on a task requiring the P to choose which of four photos matches the emotion of a targeted photo on The Facial Matching Task—All 5 Ps from the treatment presented with unusually large improvements on at least one of the forms

GENERALIZATION OUTCOME
• OUTCOME #6: Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings–2 of 5 Ps from the treatment presented with unusually large improvements on at least one of the forms

– What was the statistical test used to determine significance?
• ANOVA: Group comparisons
• Ley’s procedure for unusual changes (expected less than 5% of the time in a no treatment condition): Individual comparisons

– Were confidence interval (CI) provided? No

10. What is the clinical significance?
• Results of EBP testing—Standardized Mean Difference

OUTCOME #1: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in a video that provided facial, vocal, and body language cue to the emotion on The Awareness of Social Inference, Part 1 (TASIT, Part 1)—-form A: d = 1.95; form B: d = 1.09; both are considered large effects
OUTCOME #2: Improved performance on a task requiring the P to discriminate between sarcastic and sincere comments in a video from The Awareness of Social Inference, Part 2 (TASIT, Part 2) — not provided
OUTCOME #3: Improved performance on a task requiring the P to discriminate between sarcasm and lies in a video from The Awareness of Social Inference, Part 3 (TASIT, Part 3) —-form A: d = 4.8; form B: d = 3.97; both are considered large effects

OUTCOMES CONCERNED WITH EMOTION PERCEPTION BUT DO NOT HAVE PROSODY AS A COMPONENT OF THE MEASURE
OUTCOME #4: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in photos portraying emotions on The Facial Expression Naming Task—not provided
OUTCOME #5: Improved performance on a task requiring the P to choose which of four photos matches the emotion of a targeted photo on The Facial Matching Task—- form B: d = 4.63; considered to be a large effect

GENERALIZATION OUTCOME
OUTCOME #6: Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings—not provided

11. Were maintenance data reported? Yes. The investigators compared performance from baseline until 1 month after the cessation of therapy for the treatment group. With the exception of Outcome 6 which was concerned with self-perception, all outcomes were significantly higher at the one month follow-up.

12. Were generalization data reported? Yes . Outcome #6 (Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings) was used as a measure of generalization. There were no significant changes in Outcome #6 ratings.

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B

SUMMARY OF INTERVENTION

PURPOSE: To investigate the effectiveness of a program to improve the perception of emotion.

POPULATION: Traumatic Brain Injury

MODALITY TARGETED: comprehension

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: prosodic affect

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: affect

DOSAGE: small groups [2 or 3Ps with one clinician (C)], 8 weeks, 1.5 hours per session, administered “biweekly.” The dictionaries I (pmh) consulted indicated that biweekly is an ambiguous term that means once every two weeks or two times a week.

ADMINISTRATOR: Clinicians in a brain injury unit of a hospital, possibly psychologists

STIMULI: auditory, visual

MAJOR COMPONENTS:

• The intervention was designed to gradually increase completely of tasks. The focus was on attending to cues (i.e., prosodic, facial, gestures, body posture) of others’ emotions. The amount of support for P was gradually reduced throughout the intervention.

• Tasks included group activities, use of notebooks, and practice at home.

• Cs used different stimuli in treatment compared to assessment.

• The content of the intervention was based on the procedures in the literature that are cited on page 29 including recognizing prosody, facial movements, postures, and movements associated with specific emotions.

• The hierarchy of objectives was
– linking emotion to context by focusing on emotions associated with common activities and experiences
– interpreting line drawings and photographs representing emotions
– focusing on the interpretation of one type of cue at a time and then integrating the different type of cues.
– making inferences about the speaker’s intent (e.g., lies or sarcasm)

• Intervention activities included board games such as Monopoly, with simplified rules, to motivate Ps.

• Intervention techniques included
– errorless learning
– self-instruction training
– C modeling
– video viewing and analysis
– role playing
– massed and distributed practice
– rehearsal (mirror work, role play, games)
– positive reinforcement
– cumulative review