Grossman et al. (2010)

December 15, 2016

 

ANALYSIS

Comparison Research  

NOTES:

  • A summary of an intervention is not included in the review because this in not an investigation about intervention. 

KEY: 

ASD = autism spectrum disorders

eta =   partial eta squared

HFA = high-functioning autism

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

TD = typically developing

  

SOURCE: Grossman, R. B., Bemis, R. H., Skwerer, D. P., & Tager-Flusberg, H. (2010.) Lexical and affective prosody in children with high-functioning autism. Journal of Speech, Language, and Hearing Research, 53, 778- 793.

 

REVIEWER(S): pmh

 

DATE: December 7, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY:  Not graded, this is an investigation of the nature of prosody within a clinical population; it is not an intervention study.

 

TAKE AWAY: This investigation of lexical and affective prosody in children and adolescents with high functioning autism (HFA) comprises 3 experiments: perception of affective prosody, perception of lexical prosody, and production of lexical prosody. The results indicate that children and adolescents with HFA are similar to TD peers with respect to their perception of affective prosody and lexical stress as well in their ability to mark correctly the stressed syllable in compound words (e.g., greenhouse) and noun phrases (green house.) However, the Ps with HFA differed from their TD peers with respect to how they marked the stressed syllable. Specially, the productions of Ps with HFA were of longer duration which was perceived be slower, more labored, containing longer pauses than TD peers.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of design? Comparison; Prospective, Nonrandomized Group Design with Controls

 

  • What was the focus of the research? Clinically Related

           

  • What was the level of support associated with the type of evidence? B+

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there were groups, were participants randomly assigned to groups? Yes
  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? Yes

                                                                    

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

 

–    How many participants (Ps) were involved in the study?

 

NOTE: The same Ps were involved in all 3 experiments

  • total # of Ps: 31
  • # of groups: 2
  • List names of groups and the number of Ps in each group:

– High-Functioning Autism (HFA) = 16 (except Experiment #3, N = 11 for pitch and intensity analyses

– Typically Developing (TD) = 15 (except Experiment #3, N = 9 for pitch and intensity analyses

 

  • Did all groups maintain membership throughout the investigation? Yes, but data from some Ps were discarded from the pitch and intensity analysis for Experiment #3 due to excessive static on the recordings. This resulted in the following Ns for the 2 groups”

– TD = 9

– HFA = 11

                                                                                

–   CONTROLLED CHARACTERISTICS

                                                                                                                       

  • cognitive skills:

     – HFA = within normal range

     – TD = within normal range

 

  • receptive language:  (performance on the Peabody Picture Vocabulary Test)

     – HFA = within normal range

     – TD = within normal range

 

  • presence of identified genetic disorders: excluded from experiments

 

  • diagnosis of HFA =

     – met criteria in the Diagnostic and Statistical Manual of Mental Disorders; Autism Diagnostic Interview—Revised; Autism Diagnostic Observation Schedule

     – diagnosis noted that the P was in classified as “full range” autism

     – verbal IQ and receive vocabulary were within 2 standard deviations (SD) of the mean but the following challenges still resulted in diagnosis of ASD:

  • social skills
  • communication skills
  • pragmatic skills

     – excluded the following diagnoses:

  • Asperger syndrome
  • Autism, Pervasive Developmental Disorder, not otherwise specified

 

–   DESCRIBED CHARACTERISTICS (* = no significant differences between TD and HFA groups)

 

  • age*:

     HFA = mean – 12;4, range 7;6-17

     TD = mean 12;7, range 7;-18

 

  • gender: Not reported
  • cognitive skills:

HFA =

  • Full range IQ = 106.7 ( mean); 87-123 (range)
  • Verbal IQ* = 101.2 (mean); 83-127 (range)
  • Nonverbal IQ* = 109.6 (mean); 94-127 (range)

     TD =

  • Full range IQ = 108.9 (mean); 87-123 (range)
  • Verbal IQ* = 108.1 (mean); 81-127 (range)
  • Nonverbal IQ* = 106.7 (mean); range 85-116 (range)

 

  • receptive language*: (performance on the Peabody Picture Vocabulary Test)

     HFA = 107.0 (mean); 79-138 (range)

     TD =  111.3 (mean); 79-139 (range)

  • Hearing: Not reported

 

– Were the groups similar? Yes

                                                         

– Were the communication problems adequately described? Unclear.

 

  • disorder type: Ps in the HFA group were described as having social, pragmatic, and communication problems but they were not described. In addition, Ps with HFA were described as “did not at this time exhibit measureable language impairment” (p. 783’)

 

 

NOTE: This study investigated 3 experiments that used the same Ps described in item #4. Items #5 through #13 are presented separately for each of the experiments.

 

EXPERIMENT 1:

Investigation of the perception of affective prosody

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups? Yes

HFA

     – TD          

 

  • Experimental Conditions? Yes

 

CONTENT OF STIMULI

– Unfiltered Condition: 6 Sentences produced for each of 3 forms of affective prosody (happy, sad, neutral.) In each case, the content of the sentence and the prosody of the sentence matched the targeted content. For example, happy affective prosody was paired with the following sentence: “When Mike pets the puppy, it’s wagging its tail” (p.792)

– Filtered Condition: The 18 unfiltered sentences were passed through a low-pass filter deleting speech frequencies that resulted in the removal of semantic content but the retention of prosody.

 

EMOTION REPRESENTED ON STIMULI: (p. 781)

– Sad = lower pitch, slower rate, low tone ending

Happy = higher pitch, faster rate, complex tone ending

Neutral = midrange pitch, accent on the main topic, less complex final tone

 

  • Criterion/Descriptive Conditions? No

 

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

 

– OUTCOMES:

 

  • OUTCOME #1: Percentage of correct identifications of depicted affects in unfiltered and filtered sentence stimuli.

 

–   The outcome was subjective.

 

The outcome measures was not objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No

 

  • Intraobserver for analyzers? No

 

  • Treatment or test administration fidelity for investigators?

 

 

  1. Description of design:
  • Following a training session that involved only unfiltered sentences, Ps listened to sentences and classified the emotions/affect as happy, sad, or neutral.
  • The validity of prerecorded sentence stimuli wasa ascertained by the independent rating of affect by 10 listeners who were not Ps in the investigation.
  • There were 18 sentences each for the unfiltered and filtered sentences. There were 3 versions of each of the sentence types which difference with respect to the order of sentence. The order of sentences was pseudorandomized and counterbalanced.
  • The verbal stimuli are included in an appendix.
  • Sentences were presented on acomputer via speakers. The filtered sentences were administered first; then the unfiltered sentences were administered.
  • Ps signified their choices by selecting the appropriated button.

 

 

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

 

– Results:

 

  • OUTCOME #1: Percentage of correct identifications of depicted affects in unfiltered and filtered sentence stimuli.
  • performance above chance for
  • filtered task: both TD and HFA
  • unfiltered task: both TD and HFA
  • performance was better on unfiltered than filtered for both TD and HFA
  • performance on neutral sentences was significantly poorer for neutral sentences for both TD and HFA
  • there was not an overall significant difference between TD and HFA groups

 

– The statistical tests used to determine significance included t-test; ANOVA: repeated measure 2 (Group—TD, HFA) x 2 (Task—filtered, unfiltered) x 3 (Emotion—happy, sad, neutral); repeated measure 2 (Group) x 3 (Emotion) for each task

 

– Were effect sizes provided? Yes

 

  • OUTCOME #1: Percentage of correct identifications of depicted affects in unfiltered and filtered sentence stimuli.
  • performance was better on unfiltered than filtered for both TD and HFA;
  • HFA – Cohen’s d = 1.04 (large effect)
  • TD – Cohen’s d = 0.76 (moderate effect)

 

– Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results: Not Applicable (NA)

 

 

  1. Summary of descriptive results: Qualitative research NA

 

 

  1. Brief summary of clinically relevant results:

 

  • TD and HFA Ps exhibited similar skills in interpreting affective prosody.
  • Both groups had significantly more difficulty on the filtered task than the unfiltered task. However, they still were able to label emotions above chance in the filtered condition. Therefore, both groups make use of semantic information to interpret affect (in addition to prosody.)
  • Both groups found the neutral affect sentences to be more difficult to interpret.

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B

 

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

 

EXPERIMENT 2

Investigate the perception of lexical stress for differentiating noun phrases from compound nouns

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups? Yes

– HFA

     – TD

                                                               

  • Experimental Conditions? Yes

     – Noun Phrases (e.g. green house, wet suit, p. 792)

     – Compound Words (e.g., greenhouse, wetsuit, )

     – Foils (e.g., tree house, headphones, p. 792)

 

  • Criterion/Descriptive Conditions? No

 

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

 

–OUTCOMES:

  • OUTCOME #1: Percentage accuracy of responses to the experimental task

 

– The outcome measure was subjective.

 

 The outcome measure was not objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No

 

  • Intraobserver for analyzers? No _

 

  • Treatment or test administration fidelity for investigators? No

 

  • Validity of the stimuli was supported by

AUDITORY STIMULI:

  • The investigators analyzed the experimental auditory stimuli using Praat to insure that the first syllable was stressed in the compound word (e.g., HOTdog) and the second syllable was stressed in the noun phrase (e.g., hot DOG.)
  • The acoustic criteria the investigators used to identify stressing were

         ¶ longer duration

         ¶ higher pitch

         ¶ greater intensity

  • For the foil items (i.e., stimuli produced with equal stress), acoustic analysis of the 3 above features did not reveal differences between the first and second syllable.
  • Ten judges listened to the auditory stimuli to determine which words could be properly identified as noun phrases or compound words.

 

VISUAL STIMULI:

  • The investigators insured that judges could properly link the auditory stimuli with pictures of the targeted words.

 

 

  1. Description of design:
  • The experimental stimuli included auditory and visual stimuli.

– Every experimental word (compound word or noun phrase) was paired with a picture presenting the target word and the opposite stress pattern. For example, for the target “wetsuit,” the investigator presented a picture of a “wet suit” and a picture of a suit that was wet.

–  Eleven foil words (i.e., compound words without corresponding noun phrases) were also presented auditorily and visually throughout the testing. For example, ne picture presented the target word (e.g., rainbow) and one picture presented the picture of a hair bow.

– The verbal stimuli are included in an appendix.

 

  • Prior to the experimental task, investigators administered a brief training task insuring that the Ps were able to press a button signifying their picture choice. Investigators provided corrective feedback to the Ps.

 

  • The Ps listened to prerecorded auditory stimuli of the compound words or noun phrases in isolation (i.e., not in a contextualizing sentence.)

 

 

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

 

– RESULTS:

 

  • OUTCOME #1: Percentage accuracy of responses to the experimental task
  • All Ps from both groups (TD, HFA) performed at the 80% accuracy level on foil stimuli.
  • All Ps from both groups (TD, HFA) performed at the 80% accuracy level for compound word and noun phrase stimuli.
  • Both groups were significantly more accurate on compound word/first syllable stress targets than noun phrase/second syllable stress target.
  • There was no significant differenceS between TD and HFA groups.

 

– The statistical tests used to determine significance included t-test; ANOVA: 2 (Groups: TD, HFA) x 2 (Stress: compound word/first syllable targets, noun phrase/ second syllable targets)

 

–   Were effect sizes provided? Yes

  • OUTCOME #1: Percentage accuracy of responses to the experimental task
  •  Both groups (TD, HFA) were significantly more accurate on compound word/first syllable stress targets than noun phrase/second syllable stress target.

∞ TD Cohen’s d = 0.80 (moderate effect)

∞ HFA Cohen’s d = 1.2 (large effect)

 

 

  1. Summary of correlational results: NA

 

 

  1. Summary of descriptive results: Qualitative research NA

 

 

  1. Brief summary of clinically relevant results:

 

  • HFA and TD groups performed similarly on the task requiring Ps to demonstrate comprehension of compound words (e.g., Yellowstone) compared to noun phrases (yellow stone.) Thus, Ps with HFA and their TD peers are equally competent on this task.

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   B

 

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

 

EXPERIMENT 3

Investigate the production of lexical prosody

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups? Yes

HFA

     – TD

                                                               

  • Experimental Conditions? Yes

 

    – Lexical type (compound words/first syllable stress; noun phrases/second syllable stress)

 

  • Criterion/Descriptive Conditions? Yes

 

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

                                                                                                             

–  Outcome measures:

 

  • OUTCOME #1: Mean pitch of productions

 

  • OUTCOME #2: Mean intensity of productions

 

  • OUTCOME #3: Mean whole word duration

 

– The Outcome measures are not subjective.

 

All of the outcome measures are objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

 

  • OUTCOME #3: Mean whole word duration—The investigators calculated the mean difference in overall duration length for the original analyzer and a second judge using 15% of the samples. The difference was 4 ms which met the investigators 5 ms or less criterion.

 

– Intraobserver for analyzers? No

 

– Treatment or test administration fidelity for investigators? No

 

 

  1. Description of design:

 

  • Experiment 3 was administered after a break following the administration of Experiments 1 and 2.
  • The investigators used the same picture stimuli as Experiment #2 with Experiment #2 always preceding Experiment #3.
  • In this investigation, there were 27 targets: 11 compound word/first syllable stress, 11 noun phrases/second syllable stress, 5 foils.
  • Scripts of the verbal stimuli are included in an appendix.
  • The investigators taught the procedures of Experiment 3 during a brief training session insuring that P clearly understood the procedures.
  • Investigators read a brief narrative designed to elicit the target word while a picture of that word was displayed.
  • Discarded data due to static on the recordings from the 2 groups resulted in reduced Ns for the intensity and pitch analyses to

– TD = 9

– HFA = 11

 

 

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

 

– RESULTS

 

  • OUTCOME #1: Mean pitch of productions

– No significant difference between groups (TD, HFA) on the production of

  • compound word/first syllable stressed targets
  • noun phrase/second syllable stressed targets

 

  • OUTCOME #2: Mean intensity of productions

– No significant difference between groups (TD, HFA) on the production of

  • compound word/first syllable stressed targets
  • noun phrase/second syllable stressed targets

 

  • OUTCOME #3: Mean whole word duration

     Compound words/first syllable stressed words were significantly shorter than noun phases/second syllable stressed word

– HFA group produced significantly longer utterances than the TD group

 

– What were the statistical tests used to determine significance? t-test; ANOVA: one way ANOVA; 2 (Group: HFA, TD) x 2 (Stress: compound word/first syllable stressed, noun phrase/second syllable stressed)

  • Other: (List the test and the associated outcomes)

 

– Were effect sizes provided? Yes.

 

  • OUTCOME #3: Mean whole word duration

     Compound words/first syllable stressed words were significantly shorter than noun phases/second syllable stressed word– eta = 0.53 (large effect)

  • for HFA the effect size was — Cohen’s d = 0.90 (large effect)
  • for TD the effect size was—Cohen’s d = 0.80 (large effect)

 

– HFA group produced significantly longer utterances than the TD group eta = 0.16 (large effect)

  • for compound words/first syllable stressed targets the effect size was –Cohen’s d = 0.82 (large effect)
  • for noun phrases/second syllable stressed targets the effect size was –Cohen’s d = 0.75 (moderate effect)

 

– 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:

 

  • Ps with HFA were able to differentiate compound words/first syllable stress (e.g., highlight) from noun phrases/second syllable stress (e.g., high light) using duration.

 

  • However, their productions of both types of target words were significantly longer than their TD peers.

 

  • The investigators described their perceptions of Ps with HFA longer productions as being labored and slow with exaggerated pauses between syllables. The TD Ps productions, on the other hand, were perceived to be shorter, not labored, with smoother transitions between syllables.

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: __B-___

 


Ploog et al. (2013)

March 28, 2016

SECONDARY REVIEW CRITIQUE

 

 

KEY:

 

AS = Asperger Syndrome

ASD = autism spectrum disorders

C = clinician

CAT = computer-assisted technologies

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

TD = typically developing

 

 

Source: Ploog, B. O., Scharf, A., Nelson, D., & Brooks, P. J. (2013). Use of computer-assisted technologies (CAT) to enhance social, communicative, and language development in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 301 – 322.

 

Reviewer(s): pmh

 

Date: March 20, 2016

 

Overall Assigned Grade: B- (Highest possible grade was B based on the design of the investigation.)

 

Level of Evidence: B (Narrative Systematic Review with Broad Criteria)

 

Take Away: Computer-assisted technologies (CAT) have potential to improve comprehension of prosodic affect and sarcasm/metaphors in individuals with autism spectrum disorders (ASD) but it is not clear that it is more effective than conventional interventions.

 

What type of secondary review? Narrative Systematic Review

 

  1. Were the results valid? Yes

 

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

 

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

 

  • The authors of the secondary research noted that they reviewed the following resources: Not Applicable (NA), the resources for identifying existing publications were not listed.

 

  • Did the sources involve only English language publications? Yes

 

  • Did the sources include unpublished studies? No

 

  • Was the time frame for the publication of the sources sufficient? Yes

 

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

 

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

 

  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources? Yes. Although the investigators did not describe the strategy, it was clear from their techniques they had a strategy. However, it is not clear whether or not the strategy was predetermined.

 

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

 

  • Were interrater reliability data provided? No

 

  • If the authors of the secondary research provided interrater reliability data, list the data here: NA

 

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

 

  • Were assessments of sources sufficiently reliable? Unclear

 

  • Was the information provided sufficient for the reader to undertake a replication? Yes

 

  • Did the sources that were evaluated involve a sufficient number of participants? Yes, for Communication Disorders intervention research the overall numbers were acceptable.

 

  • Were there a sufficient number of sources? Variable. Yes, for the overall investigation; No, for this review’s focus.

 

 

  1. Description of outcome measures:

NOTE: There were 5 outcomes. Only one of the (Outcome #1) was concerned with prosody. Although the other outcomes are listed, their results will not be presented and they will not be summarized.

 

  • Outcome #1: Improved recognition of prosodic affect
  • Outcome #2: Improve recognition of facial emotion
  • Outcome #3: Improved expressive and receptive language skill, including literacy skills
  • Outcome #4: Improved performance on Theory of Mind tasks
  • Outcome #5: Improved social skills

 

 

  1. Description of results:

 

– What measures were used to represent the magnitude of the treatment/effect size? No measure of the magnitude of the treatment effect/effect size was reported

 

– Summarize overall findings of the secondary research:

 

[NOTE: There were 5 outcomes. Only one of the (Outcome #1) was concerned with prosody and only its findings will be summarized.]

 

Outcome #1: Improved recognition of prosodic affect

 

  • LaCava et al. (2007): using “‘Mind Reading” software with 8 children with Asperger Syndrome, the investigators detected significant improvement in pre and post tests.

 

  • LaCava et al. (2010) using “Mind Reading” software with 4 boys with ASD, the investigators reported significant improvement. However, “Mind Reading” software did not appear to be more effective than intervention that did not use CAT.

 

  • Golan and Baron-Cohen (2006) compared the use of “Mind Reading” software to a no intervention condition in 54 adults with AS or ASD and determined that the “Mind Reading” software yielded a significant improvement on a test of interpreting prosody (“Reading the Voice in Mind”, p. 313.)

 

  • Grynszpan et al. (2008)- The investigators treated were 2 groups of 10 Ps each and that included both children diagnosed with ASD and typically developing (TD) children. Generalization of the intervention was assessed using two versions of the game “Intruder” (text only and a combination of facial cues, text, and synthetic voice, p. 317) designed to measure the ability to comprehend sarcasm or metaphor. The results revealed that the TD Ps improved in the text only and the combined versions of the Intruder. However, the Ps with ASD improved in the text only version of the Intruder measure but not in the combined measure. The investigators attributed this to attention problems associated with ASD.

 

Were the results precise? Unclear, no data were presented related to this question.

 

– If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? NA, the investigators did not provide confidence intervals.

 

– Were the results of individual studies clearly presented? Yes, for the most part.

 

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

 

– Were the results in the same direction? Yes

 

– Did a forest plot indicate homogeneity? NA

 

– Was heterogeneity of results explored? No

 

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

– Were negative outcomes noted? Yes

 

                                                                                                                   

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Only Grynszpan et al. (2008) reported generalization data using the CAT game “Intruder.” The results revealed that the TD Ps improved in the text only and the combined versions of the Intruder but the Ps with ASD improved only improved in the text only version. The investigators attributed this to attention problems associated with ASD.

 

 

SUMMARY OF INTERVENTIONS

 

NOTE:

[Reviewers should only complete this section if sufficient information is provided in the review to describe treatment procedure(s).]

 

Population: Autism Spectrum Disorders, Asperger Syndrome; Adults, Adolescents, Children

 

Prosodic Targets: prosodic affect and sarcasm/metaphors

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: prosodic affect

 

Description of Procedure #1— Mind Reading Software

 

  • CAT involving voice, facial cues, and photos.

 

Evidence Supporting Procedure #1—Mind Reading Software

 

  • LaCava et al. (2007, 2010) as well as Golan and Baron-Cohen (2006) reported significant improvement in the interpretation of affective prosody in Ps with AS and ASD.

 

Description of Procedure/Source #2— What to Choose

 

  • The CAT presented a dialogue in virtual reality in which one speaker in a conversation uttered a sarcastic statement. The audio was accompanied by a picture of a virtual reality character whose face appropriate to the sarcastic remark.

 

  • P selected one of three possible interpretations of the sarcastic remark by clicking on it.

 

  • Feedback was provided to the P.

 

Evidence Supporting Procedure/Source #2—What to Choose

 

  • Grynszpan et al. (2008) — Generalization was assessed using two versions (text only and a combination of facial cues, text, and synthetic voice) of the game “Intruder” (p. 317) designed to measure the ability to comprehend sarcasm or metaphor. The results reveals that

– the TD Ps improved in the text only and the combined versions of the Intruder and

– the Ps with ASD improved only improved in the text only version.

 

Evidence Contraindicating Procedure/Source #2 — What to Choose

 

  • Grynszpan et al. (2008) attributed this the failure of the ASD group to improve in the combined version of the Intruder game to attention problems associated with ASD.

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.

 

________________________


Raymer et al. (2001)

September 9, 2015

 

EBP THERAPY ANALYSIS for

Single Subject Designs

 

Note: The summary of the intervention procedure can be viewed by scrolling about two-thirds of the way down on this page.

 

Key:

BNT = Boston Naming Test

C = Clinician

EBP = evidence-based practice

m = male

NA = not applicable

P = Patient or Participant

PND = percentage of nonoverlapping data

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WAB = Western Aphasia Battery

WPM = words per minute

 

 

SOURCE: Raymer, A. M., Bandy, D., Adair, J. C., Schwartz, R. L., David J.G. Williamson, D. J. G., Gonzalez Rothi, L. J. ,& Heilman, K. M. (2001). Effects of Bromocriptine in a patient with crossed nonfluent aphasia: A case report. Archives of Physical Medicine and Rehabilitation, 82, 139 -144.

 

REVIEWER(S): pmh

 

DATE: September 4, 2015

ASSIGNED OVERALL GRADE: B (Based on the design of the investigation, the highest possible grade was A-.)

 

TAKE AWAY: This investigation involved the administration of Bromocriptine to a patient (P) with crossed nonfluent aphasia using a single-subject experimental design. The P’s number of words per minute in conversation and the number of words named beginning with a specified letter improved markedly but there were no changes in the percentage of correct production of targeted affective prosody nor were there changes in the relative proportion of word classes.

 

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

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Single Subject Experimental Design with Specific Client – ABABA (A= no drug; B = drug )

– Alternating Treatment

                                                                                                           

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

                                                                                                           

  1. Was phase of treatment concealed?
  2. from participants? No
  3. from clinicians? No
  4. from data analyzers? No

 

 

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

 How many participants were involved in the study?            1

–   The following P characteristics were described:

  • age: 50
  • gender: m
  • cognitive skills
  • handedness:   right handed
  • educational level of P: 15 years
  • lesion: involvement of right dorsolateral frontal cortex and some subcortical white matter
  • etiology: right hemisphere infarction
  • results of infarction: left hemiparesis, neglect of left space, severe limb apraxia, nonfluent aphasia, emotional aprosodia

                                                 

– Were the communication problems adequately described? Yes

  • The disorder types were crossed nonfluent aphasia, transcortial aphasia, emotional aprosodia, moderate anomia
  • Other aspects of communication that were described:

– Western Aphasia Battery (WAB) one month after stroke

  • Aphasia Quotient 79.8/100
  • challenges – fluency, naming
  • strengths – comprehension and repetition

– Boston Naming Test (BNT)

  • 33/60 (poorer than expected)

– Controlled Oral Word Association Test (COWAT) letters F, A, S

  • 7 words in 3 minute (standard 12 words per minute)

– Expressive Language

  • reduced initiations
  • reduced elaborations
  • reduced verbal output
  • no phonologic errors
  • no agrammatism

– Florida Apraxia Screening Test—Revised

  • 9/30 with right arm (no hemiparesis in right arm)

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes, but there was only 1 P.
  • If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? Yes
  • Were baseline/preintervention data collected on all behaviors? Yes
  • Did probes/intervention data include untrained data? Yes
  • Did probes/intervention data include trained data? No, there were no trained behaviors because this was a drug study.
  • Were different treatment counterbalanced or randomized? Not Applicable

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– The outcomes were

ABABA MEASURES:

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected)

OUTCOME #2: Increased words per minute (WPM) in a conversational task

OUTCOME #3: Increased proportion of nouns in a conversational task

OUTCOME #4: Increased proportion of verbs in a conversational task

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task

OUTCOME #6: Increased proportion of function words in a conversational task

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences

PRE/POST INTERVENTION MEASURES

OUTCOME #9: Improved performance on the WAB

OUTCOME #10: Improved performance on the BNT

All the outcomes were subjective.

None of the outcomes were objective.

None of the outcome measures were associated with reliability data.

 

  1. Results:
  • Did the target behavior improve when it was treated? Inconsistent. Some of the targeted ABAB measures (i.e., not the control measure) improved and the Pre/Post Intervention measures consistently did NOT improve.
  • The overall quality of improvement

– There were two types of outcome measures: ABABS and Pre/Post Intervention.

ABABS MEASURES:

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected)— ineffective

OUTCOME #2: Increased words per minute (WPM) in a conversational task–strong

OUTCOME #3: Increased proportion of nouns in a conversational task—ineffective

OUTCOME #4: Increased proportion of verbs in a conversational task— ineffective

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task— ineffective

OUTCOME #6: Increased proportion of function words in a conversational task— ineffective

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute— strong

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences—ineffective

PRE/POST INTERVENTION MEASURES

OUTCOME #9: Improved performance on the WAB—ineffective (descriptive data only)

OUTCOME #10: Improved performance on the BNT—ineffective (descriptive data only)

  1. Description of baseline:

 

  • Were baseline data provided?

– For all the ABAB measures, the initial baseline (A1) lasted five sessions.

 

  • Was baseline low and stable?

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected—low and stable

OUTCOME #2: Increased words per minute (WPM) in a conversational task—low and moderately stable

OUTCOME #3: Increased proportion of nouns in a conversational task—low and moderately stable

OUTCOME #4: Increased proportion of verbs in a conversational task—low and stable

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task—low and stable

OUTCOME #6: Increased proportion of function words in a conversational task—moderate and unstable

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute—low and stable

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences)—moderate and unstable

  • What was the percentage of nonoverlapping data (PND)? The authors did not use PND to measure change, rather they used the C statistic (pertaining to slope) which will be reported here.

ABABA MEASURES:

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected)—C statistic (changes in slope) not reported but graph represents no change.

OUTCOME #2: Increased words per minute (WPM) in a conversational task—in both treatment phases (B1, B2), P showed significant improvement (C = 0.72, C = 0.476) and even during the second withdrawal phase (C = 0.633)

OUTCOME #3: Increased proportion of nouns in a conversational task–no

OUTCOME #4: Increased proportion of verbs in a conversational task–no

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task— no

OUTCOME #6: Increased proportion of function words in a conversational task–no

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute— significant improvement in B1 (C= 0.895)

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences—greatest improvement was C= 0.49, not significant

 

 

  1. What was the magnitude of the treatment effect? The investigators did not report classic evidence-based practice metrics. However, they did provide z scores which are reported here:

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected)

– measure calculated: not provided

OUTCOME #2: Increased words per minute (WPM) in a conversational task

– measure calculated: z scores for B1 (z = 2.769), A2 (z = 2.14), B2 = 1.98

OUTCOME #3: Increased proportion of nouns in a conversational task

– measure calculated: not provided

OUTCOME #4: Increased proportion of verbs in a conversational task

– measure calculated: not provided

 

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task

– measure calculated: not provided

 

OUTCOME #6: Increased proportion of function words in a conversational task

– measure calculated: not provided

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute

– measure calculated: z score for B1 = 3.496

– interpretation: significant

 

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences

– measure calculated: largest z score for final A was 1.59

– interpretation: not significant

 

  1. Was information about treatment fidelity adequate? No, since the treatment was a daily single dose of medication, treatment fidelity is not necessary.

 

 

  1. Were maintenance data reported? Yes. The final phase (A3) could be considered maintenance. For the following measures, improvement was maintained or continued: emotional prosody, words per minute, number of words named beginning with selected letters.

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:

 

  • The investigation was an ABABA single-subject experimental design. The A phases involved no drug treatment or withdrawal from the drug and the B phases involved the administration of the drug Bromocriptine.
  • There were two types of outcome measures: ABABA and Pre/Post Intervention.
  • The investigators administered the probes for A phases in the 5 separate sessions for each of the 3 no drug treatment phases. The probes for the B phases were also administered 5 times but the number of B phases was only 2. During the B phases, P received 20mg of the drug Bromocriptine each day. As P was transitioning from treatment (B1, B2) to nontreatment phases (A2, A3) there was a gradual reduction in the drug dosage and a period of time when P did not receive the drug.
  • Although the number of probes was constant (5 for each phase), the amount of time devoted to each phase differed:

– A1= unclear

– B1 = 3 weeks

– A2 = 2 months

– B2 = 6 weeks

– A3 = 2 months

  • The ABABA measures comprised measures assessing gesture to command (a control measure for which no progress was expected), several measures of discourse (words per minute and the proportion of nouns, verbs, adjectives/adverbs, and function words), and a measure of expressive affective prosody.
  • The Pre/Post Intervention measures were administered before and after the ABABA investigation and consisted of the WAB and the BNT.

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: B

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of Bromocriptine on selected aspects of language and prosody for a P with crossed nonfluent aphasia

POPULATION: Aphasia, Crossed Nonfluent Aphasia; Adult

 

MODALITY TARGETED: expressive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: affective prosody

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: WPM, nouns, verbs, adjectives/adverbs, function words, ability to name words beginning with a specified letter

 

OTHER TARGETS: gesture to command (this was a control task in which improved performance was not expected)

 

DOSAGE: daily doses of 20mg of Bromocriptine

 

ADMINISTRATOR: medical care provider

 

MAJOR COMPONENTS:

 

  • This is not a speech-language pathology treatment. It involves the administration of a drug.

Diehl & Paul (2013)

July 18, 2015

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

 

ASD = Autism spectrum disorders

CA = chronological age

LD = Learning disability

NA = not applicable

P = participant(s)

PEPS-C = Profiling Elements of Prosodic Systems in Children

pmh = Patricia Hargrove, blog developer

SD = standard deviation

SS = Standard Score

TD = typically developing

 

 

SOURCE: Diehl, J. J., & Paul, R. (2013). Acoustic and perceptual measurements of prosody production on the Profiling Elements of Prosodic Systems in Children by children with autism spectrum disorders. Applied Psycholinguistics, 34, 135-161.

 

REVIEWER(S): pmh

 

DATE: July 11, 2015

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

 

POPULATION: Autism spectrum disorders (ASD); Learning disability (LD)

 

PURPOSE: To investigate the prosody production (and to a lesser extent comprehension) of children with ASD, children with LD, and typically developing (TD) children using acoustic and perceptual measures of prosody.

 

INSIGHTS ABOUT PROSODY:

  • Comparisons of participant (P) groups on the subtests of the Profiling Elements of Prosodic Systems in Children (PEPS-C) revealed that the Ps with ASD and LD struggled with prosodic comprehension of affect, turn ends/terminal contour, and focus/stress but not chunking/phrasing. In addition, Ps with LD struggled with the production of accurate chunking/phrasing. The specific results are listed below:

– For the comprehension of affect subtest, the TD Ps performed significantly better than Ps with ASD or LD.

– For the production of affect subtest, the scores did not differ significantly for the 3 groups (ASD, LD, TD.)

– For the comprehension of turn ends/terminal contour subtest, TD Ps performed significantly better than Ps with ASD or LD.

– For the production of turn ends/terminal contour subtest, the scores did not differ significantly for the 3 groups.

– For the comprehension of chunking/phrasing subtest, the scores did not differ significantly for the 3 groups.

– For the production of chunking/phrasing subtest, the Ps with LD performed significantly more poorly than the Ps with ASD and the TD peers.

– For the comprehension of focus/stress subtest, the TD Ps performed significantly better than Ps with ASD or LD.

– For the production of focus/stress subtest, the scores did not differ significantly for the 3 groups (ASD, LD, TD.)

  • The prosodic productions of the Ps also were measured acoustically.

– As a group, the Ps with ASD displayed significant differences from the TD on the following:

  • longer duration of utterances for affect (conveying dislike) and turn-end/terminal contour tasks.
  • louder intensity for stress/focus task.
  • wider average f0 range for focus/stress task
  • larger SD of f0 during focus/stress task
  • On several expressive prosodic tasks, the Ps with LD produced prosody that differed significantly from the TD peers:
  • lower average f0 for turn ends/terminal contour, chunking/phrasing, and focus/stress tasks.
  • longer duration for turn-end/terminal contour
  • Because the intent of Ps and ASD were regularly interpreted by judges as correct, the findings may be interpreted as indicating that most Ps with ASD or LD can convey meaning using prosody. However, at times their productions are atypical.

 

 

  1. What type of evidence was identified? Prospective, Nonrandomized Group Comparison Design
  1. Group membership determination:

 

  • If there were groups of participants were members of groups matched? Yes

                                                                    

  • The matching strategy involved

The TD group and ASD and LD groups were matched on chronological age (CA).

–  The participants (Ps) with LD and ASD were matched on CA, nonverbal IQ, CELF-4 core, and receptive language scores,

  1. Was participants’ communication status concealed?
  • from participants? No
  • from assessment administrators? No
  • from data analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

How many participants were involved in the study?

  • total # of participants: 62
  • was group membership maintained throughout the experiment? Yes
  • # of groups: 3
  • List names of groups:

– TD (Typically developing)

– LD (Learning disability)

– ASD (Autism spectrum disorder)

  • # of participants in each group:

– TD = 22

– LD = 16

– ASD = 24

 

The following variables were CONTROLLED

 

  • neurological status: neurological problems excluded
  • vision: visual loss excluded, if uncorrected
  • hearing: hearing loss excluded
  • diagnosis:

All ASD Ps had been diagnosed with ASD (autism, Asperger’s syndrome, or PPD-NOS);

     – All LD Ps showed no sign of ASD and there were no reports of first degree family members with ASD;

     – For the TD group, the parents reported typical development; there were no reports of first degree family members with ASD or no previous diagnoses of development disability; and TD Ps were in the appropriate grade in school

– The following variables were DESCRIBED

  • age: mean age ASD group = 12.31; mean age LD group = 12.99; mean age TD group = 12.21
  • gender: ASD = 16m, 8f; LD = 12m, 4f; TD = 15m, 7f
  • nonverbal IQ: ASD = 103.61; LD = 96.85 (difference was not significant); TD—not reported
  • core language on CELF-4: ASD = 97.21; LD = 88.94: TD—not reported
  • expressive language on CELF-4: ASD = 100.54; LD = 90.00 (difference was significant); TD not reported
  • receptive language: ASD = 93.67; LD = 88.73; (difference was significant); TD not reported
  • learning disability: based on parent report of the LD group—5 Ps with reading disability, 11 Ps with language-based learning disability
  • Were the communication problems adequately described? Yes

– Communication disorder descriptions:

 

ASD

     – The Standard Score (SS) for the Core CELF-4 for the ASD group

  • ranged from 67-132
  • mean was 97.21

     – The SS for the Receptive Language CELF-4 for the ASD group

  • ranged from 58-121
  • mean was 93.67

– The SS for the Expressive Language CELF-4 for the ASD group

  • ranged from 75-126
  • mean was 100.54
  • This was significantly higher than the LD group.

LD

     – The SS for the Core CELF-4 for the LD group

  • ranged from 60-117
  • mean was 88.94

     – The Standard SS for the Receptive Language CELF-4 for the LD group

  • ranged from 58-119
  • mean was 88.73

– The SS for the Expressive Language CELF-4 for the LD group

  • ranged from 65-114
  • mean was 90.00
  • This was significantly lower than the ASD group.

 

  1. What were the different conditions for this research?

                                                                                                             

– Subject (Classification) Groups? Yes

  • There were 3 subject groups:

     – ASD

     – LD

     – TD

                                                               

– Experimental Conditions? No

 Criterion/Descriptive Conditions? Yes. Performance on the Profiling Elements of Prosodic Systems in Children (PEPS-C)

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

 

The dependent measures were

  • Dependent Measure #1: To comprehend affect signaled by prosody (number correct)

 

  • Dependent Measure #2: To express correctly affect using prosody (number correct perceptually)

 

  • Dependent Measure #3: Expression of prosodic affect of all liking food items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

  • Dependent Measure #4: Expression of prosodic affect of all not liking food items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

  • Dependent Measure #5: Expression of prosodic affect of all and correct only liking food items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #6: Expression of prosodic affect of correct not liking food items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

  • Dependent Measure #7: To comprehend when sentences contained prosody signifying question asking (correct responses)

 

  • Dependent Measure #8: To express statements and questions using prosody (perceptually measured)

 

  • Dependent Measure #9: Prosodic expression of all questions as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

  • Dependent Measure #10: Prosodic expression of correct questions as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

  • Dependent Measure #11: Prosodic expression of all statements as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

  • Dependent Measure #12: Prosodic expression of correct statements as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #13: To comprehend prosodic chunking (correct responses)

 

  • Dependent Measure #14: To produce accurate prosodic chunking (correct responses)

 

  • Dependent Measure #15: Prosodic expression of chunking of all subtest items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

  • Dependent Measure #16: Prosodic expression of chunking of correct subtest items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

  • Dependent Measure #17: To comprehend prosodic stress/focus (correct responses)

 

  • Dependent Measure #18: To express stress/focus prosodically (correct responses)
  • Dependent Measure #19: Prosodic expression of stress/focus of all subtest items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

  • Dependent Measure #20: Prosodic expression of stress/focus of correct subtest items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

The dependent measures that were subjective were

  • Dependent Measure #1: To comprehend samples of prosodic affect (number correct)
  • Dependent Measure #2: To express correctly affect using prosody (number correct perceptually)
  • Dependent Measure #7: To comprehend when sentences contained prosody signifying question asking (correct responses)
  • Dependent Measure #8: To express statements and questions using prosody (perceptually measured)
  • Dependent Measure #13: To comprehend prosodic chunking (correct responses)
  • Dependent Measure #14: To produce accurate prosodic chunking (correct responses)
  • Dependent Measure #17: To comprehend prosodic stress/focus (correct responses)
  • Dependent Measure #18: To express stress/focus prosodically (correct responses)

–   The dependent/ outcome measures that were objective are

 

  • Dependent Measure #3: Expression of prosodic affect of all liking food items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #4: Expression of prosodic affect of all not liking food items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #5: Expression of prosodic affect of all and correct only liking food items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #6: Expression of prosodic affect of correct not liking food items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #9: Prosodic expression of all questions as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #10: Prosodic expression of correct questions as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #11: Prosodic expression of all statements as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #12: Prosodic expression of correct statements as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #15: Prosodic expression of chunking of all subtest items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #16: Prosodic expression of chunking of correct subtest items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #19: Prosodic expression of stress/focus of all subtest items as measured by

– average f0

– f0 variability/range

– f0 standard deviation

– intensity of utterance

– duration of utterance

  • Dependent Measure #20: Prosodic expression of stress/focus of correct subtest items as measured by

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

  • Average overall interrater reliability for combined combined Dependent Measures #2 was 0.88. (As a reminder, Dependent Measures #2 is listed below.)

– Dependent Measure #2: To express correctly affect using prosody (number correct perceptually)

 Intraobserver for analyzers? No

 

– Treatment/Procedural fidelity for investigators? No

 

 

  1. Description of design:
  • This investigation involved a prospective, nonrandom comparison design.
  • There were 3 groups of Ps:

– ASD

– LD

– TD

  • All 3 groups were administered the PEPS-C.
  • The dependent measures involved

– perceptual judgments of correction on and production subtests of the PEPS-C

– acoustic analysis of the production subtests.

  • The acoustic analyses comprised:

– average f0

– standard deviation of f0

– f0 range

– utterance duration

– utterance intensity

 

  1. What were the results of the inferential statistical testing?

– The comparisons are significant presented with p ≤ 0.05.

  • Dependent Measure #1: To comprehend affect using prosody (number correct): TD was significantly better than ASD and LD
  • Dependent Measure #2: To express correctly affect using prosody (number correct perceptually): No significant differences
  • Dependent Measure #3: Expression of prosodic affect of all liking food items as measured by the 5 variables: No significant differences
  • Dependent Measure #4: Expression of prosodic affect of all not liking food items as measured by the 5 variables: No significant differences
  • Dependent Measure #5: Expression of prosodic affect of all and correct liking food items as measured by the 5 variables: No significant differences
  • Dependent Measure #6: Expression of prosodic affect of correct not liking food items as measured by

– average f0

– f0 standard deviation:

– f0 variability/range

– intensity of utterance

– duration of utterance: The ASD group produced significantly longer utterances than the LD group and the TD group.

  • Dependent Measure #7: To comprehend when sentences contained prosody signifying question asking (correct responses): TD was significantly better than ASD and LD
  • Dependent Measure #8: To express statements and questions using prosody (perceptually measured): No significant differences:
  • Dependent Measure #9: Prosodic expression of all questions as measured by

– average f0: The LD group produced significantly lower average f0 and the TD group

– f0 standard deviation:

– f0 variability/range:

– intensity of utterance

– duration of utterance: The Ps with ASD produced significantly longer utterances than the TD peers.

  • Dependent Measure #10: Prosodic expression of correct questions as measured by

– average f0: : The LD group produced significantly lower average f0 and the TD group

– f0 standard deviation:

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #11: Prosodic expression of all statements as measured by

– average f0

– f0 standard deviation:

– f0 variability/range

– intensity of utterance

– duration of utterance: Ps with ASD produced significantly longer utterances than Ps with LD and those with TD. The Ps with LD produced significantly longer utterances than TD peers.

  • Dependent Measure #12: Prosodic expression of correct statements as measured by

– average f0: The LD group produced significantly lower average f0 and the TD group

– f0 standard deviation:

– f0 variability/range

– intensity of utterance

– duration of utterance: Ps with ASD produced significantly longer utterances than Ps with LD and those with TD. The Ps with LD produced significantly longer utterances than TD peers.

  • Dependent Measure #13: To comprehend prosodic chunking/phrasing (correct responses) No significant differences
  • Dependent Measure #14: To produce accurate prosodic chunking/phasing (correct responses): The Ps with LD displayed significantly lower scores than Ps with ASD and the TD peers.
  • Dependent Measure #15: Prosodic expression of chunking of all subtest items as measured by

– average f0: Ps with LD produced significantly lower f0 than TD peers and Ps with ASD.

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #16: Prosodic expression of chunking of correct subtest items as measured by

– average f0: Ps with LD produced significantly lower f0 than TD peers and Ps with ASD.

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

  • Dependent Measure #17: To comprehend prosodic stress/focus (correct responses): The TD group exhibited significantly higher scores than the ASD and LD groups.
  • Dependent Measure #18: To express stress/focus prosodically (correct responses): No significant differences
  • Dependent Measure #19: Prosodic expression of stress/focus of all subtest items as measured by

– average f0: The LD group was significantly lower than the TD and ASD groups

– f0 standard deviation: The ASD and LD groups were significantly larger than the TF group

– f0 variability/range: Ps with ASD used a significantly wider range than TD.

– intensity of utterance

– duration of utterance

  • Dependent Measure #20: Prosodic expression of stress/focus of correct subtest items as measured by

– average f0: The LD group was significantly lower than the TD and ASD groups

– f0 standard deviation: The f0 SD was significantly smaller for the TD group than for the ASD group.

– f0 variability/range: The range of the ASD group was significantly larger range than the TD group.

– intensity of utterance: The Ps with ASD were significantly louder than the Ps with LD.

– duration of utterance

 

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

–   Were effect sizes provided? Yes. The effect sizes for significant comparisons ranged from 0.05 (small) to 0.25 (large).

– Were confidence intervals (CI) provided? No

 

 

  1. What were the results of the correlational statistical testing? There was no correlational analysis.

 

  1. What were the results of the descriptive analysis? The descriptive analysis was secondary to the inferential analysis.

 


Tosto et al. (2011)

June 18, 2015

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

 

AD = Altzheimer’s disease

NA = not applicable

NT = neurotypical

P = participant

pmh = Patricia Hargrove, blog developer

WNL = within normal limits

 

 

SOURCE: Tosto, G., Gasparini, M., G.L. Lenzi, G. L., & Bruno, G. (2011). Prosodic impairment in Altzheimer’s disease: Assessment and clinical relevance. Journal of Neuropsychiatry and Clinical Neuroscience, 23 (2), E21-E23.

Journal Address: http://neuro.psychiatryonline.org

REVIEWER(S): pmh

 

DATE: June 13, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: D (Based on the case study design, the highest possible grade was D+.)

 

POPULATION: Altzheimer’s disease (AD); Adult

 

PURPOSE: To describe comprehension and production of emotional prosody in an Italian male with mild, early onset AD.

 

INSIGHTS ABOUT PROSODY:

  • This case study diverges from the clinical literature on prosody in dementia in which the expectation is that

– problems with the comprehension of emotional prosody appear in the early stages of AD and then remain stable throughout the mild and moderate stages and

– problems with the production and imitation of emotional prosody are minimal during the early stages of AD but during the moderate stage of AD, significant problems with the production and imitation of emotional prosody begin to emerge.

  • In this case study of an adult Italian speaking male diagnosed being in the early stages of early onset AD, the participant (P) displayed significant impairment in the production and comprehension of emotional prosody.
  • The investigators recommend that clinicians (C) should carefully monitor the emotional prosody skills of Ps with AD and consider emotional prosody skills when working with AD individuals and their families.

 

 

  1. What type of evidence was identified? Case Study
  1. Group membership determination:
  • If there were groups of participants were members of groups matched? Not Applicable (NA), there was only one P.
  1. Was participant’s communication status concealed?
  • from participant? No
  • from assessment administrators? No
  • from data analyzers? No

                                                                    

 

  1. Was the participant adequately described? Yes. I would have liked more information but to be fair to the investigators I rated this question as “yes” because this was a letter to the Editor and was only 3 pages long.

 

How many participants were involved in the study? 1

The following variables were described:

  • age: 55 years
  • gender: male
  • cognitive skills: 29/30 on the Mini-Mental State Exam; within normal limits (WNL)
  • neurological exam: WNL
  • diagnosis: early onset AD
  • MRI results: cortical/subcortical atrophy of fronto-parietal areas
  • PET scan results: hypometabolism in the right frontal-temporal-parietal areas, left posterior parietal areas, and basal ganglia
  • results of neuropsychological testing:

– widespread, mild cognitive impairment,

     – more impaired on tasks sensitive for both right-hemisphere and executive function

  • educational level of P: may be 14 years

 

– Were the communication problems adequately described? No

  • disorder type: AD

 

 

  1. What were the different conditions for this research?

                                                                                                             

– Subject (Classification) Groups? No. There was only 1 P. ____

If yes, list:

Experimental Conditions? No

 

– Criterion/Descriptive Conditions? Yes

  • Experimental Protocol –Melodic Alternation [previously administered to a group of neurotypical (NT) adults: 10 Ps; same gender; mean age = 54.5; mean education: 14 years]

– Task 1: Auditory Verbal Task: P listened and identified the same neutral sentence produced with sad, happy, angry, surprised, and neutral prosody

– Task 2: Visual Task: P viewed facial expressions depicting sad, happy, angry, surprised, and neutral emotions and identified each

– Task 3: Repetition Task: using the sentences from Task 1, P imitated the same sentence using the emotional prosody modeled in the sentence. Independent judges listened to the models and the imitation to judge accuracy.

– Task 4: Production Task: The investigators presented P with a sentence and directed him/her to produce the sentence with sad, happy, angry, surprised, and neutral intonations.

 

  1. Were the groups controlled acceptably? NA

 

 

  1. Were dependent measures appropriate and meaningful? Yes

 

–   The dependent measures were

  • Dependent Measure #1: Performance on Task 1: Auditory Verbal Task
  • Dependent Measure #2: Performance on Task 1: Visual Task
  • Dependent Measure #3: Performance on Task 1: Repetition Task
  • Dependent Measure #4: Performance on Task 1: Production Task

 

All the dependent measures were subjective.

 

None of the dependent/ outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

  • Dependent Measure #3: Performance on Task 1: Repetition Task—K index = 0.86
  • Dependent Measure #4: Performance on Task 1: Production Task—-K index = 0.93

 

Intraobserver for analyzers? No

 

– Treatment/Procedural fidelity for investigators? No

 

  1. Description of design:
  • In this case study, a 55-year-old Italian male, who had been diagnosed as being in the early stages of early-onset AD, was administered 4 tasks to assess his emotional prosody skills.
  • The 4 tasks were

– Task 1: Auditory Verbal Task: P listened to and identified the same neutral sentence produced with sad, happy, angry, surprised, and neutral prosody

– Task 2: Visual Task: P viewed facial expressions depicting sad, happy, angry, surprised, and neutral emotions and identified each

– Task 3: Repetition Task: using the sentences from Task 1, P imitated the same sentence using the emotional prosody modeled in the sentence. Independent judges listened to the models and the imitation to judge accuracy.

– Task 4: Production Task: The investigators presented P with a sentence and directed him to produce the sentence with sad, happy, angry, surprised, and neutral intonations. Independent judges listened to the production to judge accuracy.

  • The 4 tasks, Melodic Alternation, had previously been administered to a group of neurotypical (NT) adults: 10 Ps; same gender; mean age = 54.5; mean education: 14 years. This provided comparison data.

 

 

  1. What were the results of the inferential statistical testing? NA

 

  1. What were the results of the correlational statistical testing? Correlational statistics were presented only of the reliability data for measures #3 and #4. (See item #8.)

 

  1. What were the results of the descriptive analysis?
  • Dependent Measure #1: Performance on Task 1: Auditory Verbal Task—P correctly identified 31 of 60 trials (NT control group identified 58/60.) The emotional states that exhibited most errors were neutral, happy, and sad. The P also frequently confused these 3 states.

 

  • Dependent Measure #2: Performance on Task 1: Visual Task—P correctly identified 73% of the trials (NT control group identified correctly 92%. The emotional states that exhibited most problems were neutral and sad.

 

  • Dependent Measure #3: Performance on Task 1: Repetition Task—Overall, P incorrectly imitated prosody 33% of the time. The poorest imitation rate was for happiness (83% errors); the best imitation rates were for surprise (no errors) and neutral.

 

  • Dependent Measure #4: Performance on Task 1: Production Task—All the production trails were associated with some failure. Happy (100% error rate) and angry (83% error rate) were the most challenging emotions to produce acceptably.

 


Khetrapal (2009)

June 2, 2015

SECONDARY REVIEW CRITIQUE

 

Note: To read a summary of intervention procedures presented in this article, scroll down the page about 2/3 of the way.

 

 

KEY:

ASD = Autism Spectrum Disorder

NA = not applicable

P = Participant(s)

pmh = Patricia Hargrove

 

Source: Khetrapal, N. (2009). Why does music therapy help in autism? Empirical Musicology Review, 4 (1), 11-18. Article: https://kb.osu.edu/dspace/bitstream/handle/1811/36602/EMR000065a_Khetrapal.pdf?sequence=1

 

 

Reviewer(s): pmh

 

Date: May 28, 2015

 

Overall Assigned Grade: D- (Based on the design, the highest possible grade was D.)

 

Level of Evidence: D

 

Take Away: This expository article logically supports the use of music therapy using a narrative review of the literature. The author presents a rationale for the use of music therapy (MT) in the treatment of individuals diagnosed with autism spectrum disorder (ASD) based in a link between tonal pitch and prosodic emotional recognition. The author presents research indicating that while people with ASD may experience difficulty interpreting emotional prosody, their (musical) tonal pitch tends to be intact and suggests that MT interventions may use this intact skill to improve emotional prosody comprehension. No specific procedures were recommended but the author encouraged additional research.

 

 

What type of secondary review?  Narrative Review

 

 

  1. Were the results valid? Yes

 

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

 

  • Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? No

 

  • Authors noted that they reviewed the following resources: (place X next to the appropriate resources). Not applicable (NA), the author did not note which resources were reviewed.

 

  • 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? No
  • Did the reviewers describe procedures used to evaluate the validity of each of the sources? No
  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources? No
  • Did the reviewers or review teams rate the sources independently? No
  • Were interrater reliability data provided? No
  • If the reviewers provided interrater reliability data, list them: NA

 

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

 

  • Were assessments of sources sufficiently reliable? Unclear
  • Was the information provided sufficient for the reader to undertake a replication? No
  • Did the sources that were evaluated involve a sufficient number of participants? Unclear

 

  • Were there a sufficient number of sources? Yes
  1. Description of outcome measures:

Outcome measures that the author used to support the contention that MT improves communication include

  • Outcomes Associated with Source #1: Improved musical and nonmusical communication (Edgerton, 1994)
  • Outcome Associated with Source #2: Increased number of correctly imitated signed and spoken words (Buday, 1995)
  • Outcome Associated with Source #3: Decreased off task behavior and improved task related behavior (Burlesson et al., 1989)
  • Outcome Associated with Source #4: Decreased rate of problem behaviors in the classroom (Orr et al., 1998)
  • Outcomes Associated with Source #5: Improved eye contact, social acknowledgement, and initiation (Wimpory et al., 1995)
  • Outcome Associated with Source #6: Modifying behaviors (Brownell, 2002)
  • Outcome Associated with Source #7: Distinguish happy /sad emotions using pitch variations and rhythmic variation (Khalfa et al., 2008)
  • Outcome Associated with Source #8: Detecting pitch in music (Mottron et al., 2000)
  • Outcomes Associated with Source #9: Detecting emotion in music (Heaton et al., 1999)
  • Outcome Associated with Source #10: Identifying regions of the brain activated during music and language processing (Peretz & Coltheart, 2003)
  • Outcome Associated with Source #11: Identifying emotions (Thompson et al., 2004)

 

 

  1. Description of results:
  • What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? (Place an X next to all that apply) Not provided
  • Summary of the overall findings of the secondary review:

This traditional narrative of literature included only brief summaries of research results supporting the author’s argument. It is not known what sources were omitted nor the quality of the sources analyzed. Nevertheless, the author presented a clear rationale for researching the effectiveness of music therapy with individuals with ASD diagnosis.

Briefly, the rationale was that tonal pitch and the ability to distinguish music emotion is preserved in most individuals with ASD. [Tonal pitch is important to the ability to distinguish emotions in speech (at least the happy-sad difference.)] In addition, although music and language both use pitch and rhythm for meaning, processing of music and language appear to be processed in different locations in the brain. Therefore, MT may be useful when trying to teach students with ASD to distinguish emotions in speech by moving from an area of strength (musical emotional meaning) to an area of apparent weakness (speech emotional meaning.)

  • Were the results precise? No
  • If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? Not Applicable

 

  • Were the results of individual studies clearly displayed/presented? Variable, the summaries of the results were brief.
  • For the most part, were the results similar from source to source? Yes, the author only reported positive results
  • Were the results in the same direction? No, the author only reported positive results
  • Did a forest plot indicate homogeneity? Not Applicable
  • Was heterogeneity of results explored? No
  • Were the findings reasonable in view of the current literature? Yes

 

  1. Were negative outcomes noted? No

           

                                                                                                                   

  1. Were maintenance data reported? No. For the most part, no maintenance results were reported. There was one exception in which the targeted outcome was maintained for 2 years (Outcome #5, Wimpory et al., 1995.)

 

 

  1. Were generalization data reported? No

 

 

SUMMARY OF INTERVENTION

Population: Autism Spectrum Disorders

 

Prosodic Targets: Affective Prosody

Description of Procedure—Music Therapy

  • Different MT procedures were used in sources cited by Khetrapal. The following is a listing of the procedures that were summarized by Khatrapal.

 

  • Outcomes Associated with Source #1: Improved musical and nonmusical communication (Edgerton, 1994) – Improvisational MT
  • Outcome Associated with Source #2: Increased number of correctly imitated signed and spoken words (Buday, 1995)—Sung text
  • Outcome Associated with Source #3: Decreased off task behavior and improved task related behavior (Burlesson et al., 1989)—Background music
  • Outcome Associated with Source #4: Decreased rate of problem behaviors in the classroom (Orr et al., 1998)—Rhythmic entrainment
  • Outcomes Associated with Source #5: Improved eye contact, social acknowledgement, and initiation (Wimpory et al., 1995)—Music Interaction Therapy
  • Outcome Associated with Source #6: Modifying behaviors (Brownell, 2002) –Musically presented social stories
  • Outcome Associated with Source #7: Distinguish happy /sad emotions using pitch variations and rhythmic variation (Khalfa et al., 2008)—this was not an intervention study
  • Outcome Associated with Source #8: Detecting pitch in music (Mottron et al., 2000)—this was not an intervention investigation
  • Outcomes Associated with Source #9: Detecting emotion in music (Heaton et al., 1999)—this was not an intervention investigation
  • Outcome Associated with Source #10: Identifying regions of the brain activated during music and language processing (Peretz & Coltheart, 2003)—this was not an intervention investigation
  • Outcome Associated with Source #11: Identifying emotions (Thompson et al., 2004)—this is not an intervention investigation

 

Evidence Supporting MT

  • Outcomes Associated with Source #1: Improved musical and nonmusical communication (Edgerton, 1994) –Khetrapal (2009) reported that Edgerton’s Ps improved in musical and nonmusical communication
  • Outcome Associated with Source #2: Increased number of correctly imitated signed and spoken words (Buday, 1995)– Khetrapal (2009) reported that Ps with ASD were more likely to imitate signs and spoken words in sung as opposed to spoken contexts.
  • Outcome Associated with Source #3: Decreased off task behavior and improved task related behavior (Burlesson et al., 1989)– Khetrapal (2009) reported that decreased off-task behavior and improved task related behavior occurred in the presence of background music
  • Outcome Associated with Source #4: Decreased rate of problem behaviors in the classroom (Orr et al., 1998)– Khetrapal (2009) reported that in a case study of a P with ASD, problem behaviors were reduced using rhythmic entrainment.
  • Outcomes Associated with Source #5: Improved eye contact, social acknowledgement, and initiation (Wimpory et al., 1995)– Khetrapal (2009) reported that a child with ASD improved in these outcomes during interactions with her mother and maintained the improvement 2 years later.
  • Outcome Associated with Source #6: Modifying behaviors (Brownell, 2002)—Khetrapal (2009) reported that behaviors were more likely to improve with sung social stories as opposed to spoken social storied.
  • Outcome Associated with Source #7: Distinguish happy /sad emotions using pitch variations and rhythmic variation (Khalfa et al., 2008)— Khetrapal (2009) reported that listeners rely on pitch variation to distinguish happy and sad prosodic affect.
  • Outcome Associated with Source #8: Detecting pitch in music (Mottron et al., 2000)— Khetrapal (2009) reported that Ps with ASD are generally capable of detecting pitch in music
  • Outcomes Associated with Source #9: Detecting emotion in music (Heaton et al., 1999)— Khetrapal (2009) reported that Heaton et al (1999), among others, determined that Ps with ASD do not experience difficulty distinguishing emotion in music.
  • Outcome Associated with Source #10: Identifying regions of the brain activated during music and language processing (Peretz & Coltheart, 2003)– Khetrapal (2009) reported that music and language are not processed in the same areas of the brain, for the most part.
  • Outcome Associated with Source #11: Identifying emotions (Thompson et al., 2004)– Khetrapal (2009) reported that knowledge of words or verbal comprehension are not needed to identify emotions from speech.

 

 

Evidence Contraindicating MT

  • Khetrapal did not provide contradictory information for the contention that MT might be useful in improving the prosodic recognition of emotion. However, the research that was summarized in Khetrapal was brief and incomplete. Little information was provided about the number of Ps, communication status of the Ps use of randomization, treatment procedures, specific outcome measures, and statistical results.