Diehl et al. (2009)

November 16, 2021

ANALYSIS GUIDELINES

Comparison/Nonintervention Research 

KEY:

ADOS = Autism Diagnostic Observation Schedule

ASD = autism spectrum disorder

eta = partial eta squared

F0 = fundamental frequency 

HFA = high-functioning autism

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SD =standard deviation (SD) 

SLP = speech-language pathologist

WNL = within normal limits 

SOURCE:  Diehl, J. J., Watson, D., Bennetto, L., Mcdonough, J., & Gunlogson, C. (2009). An acoustic analysis of prosody in high-functioning autism. Applied Psycholinguistics, 30, 385-404.

REVIEWER(S): pmh

DATE: November 7, 2021  

ASSIGNED GRADE FOR OVERALL QUALITY:  Not Applicable (NA)—This investigation is not concerned with treatment

TAKE AWAY:  In two studies investigating prosody, participants (Ps) displayed increased fundamental frequency (F0) variability in narratives. This variability is not diagnostic because there was overlap between the high functioning autism (HFA) and the Control groups and not all HFA) Ps produced speech that was highly variable. In addition, the findings for adolescents with HFA (in Study 1) revealed an association between clinical ratings of prosody and the F0 measurements. This association was not noted in Study 2, with younger children.

STUDY 1

1.  What type of evidence was identified? 

• What was the type of design?  Comparison Research

• What was the focus of the research? Clinically Related

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

2.  Group membership determination: 

 If there were groups, were participants randomly assigned to groups? No

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

3.  Were experimental conditions concealed?

•  from participants? No 

•  from administrators of experimental conditions? No

•  from analyzers/judges? No 

4.  Were the groups adequately described?  Yes 

–   How many participants were involved in the study? 

•  total # of Ps: 42 

•  # of groups: 2

     ∞ Ps with high-functioning autism (HFA) = 21

     ∞ Neurotypical control Ps (C) = 21

•  Did all groups maintain membership throughout the investigation? Yes  

CONTROLLED CHARACTERISTICS                                                      

•  age:  

    ∞ HFA = 10-18 years

     ∞ C = 10-18 years

•  gender:  the number of each gender in the Control group was matched to the number in the HFA group

     ∞ HFA = 19 males; 2 females

     ∞ C = 19 males; 2 females

•  diagnosis:

     ∞ HFA = all Ps met diagnostic criteria for autism spectrum disorder (ASD) but no Ps met diagnostic criteria for Asperger syndrome.

     ∞ C = free from the following diagnoses: ASD, learning disabilities, mental retardation, language disabilities, or other psychiatric conditions

•  diagnoses of first and second degree relatives:

∞ C = free from diagnoses of ASD

DESCRIBED CHARACTERISTICS

•  age:  

     ∞ HFA = mean 13.58

     ∞ C = mean 13.24

•  gender: 

     ∞ HFA = 19 males; 2 females

     ∞ C = 19 males; 2 females

•  cognitive skills:  

     ∞ HFA 

     Full Scale = 118.25 (mean)

     Verbal IQ = 117.0 (mean)

     Performance IQ = 116.05 (mean)

     ∞ C = 

     Full Scale = 116.81 (mean)

     Verbal IQ = 116.62 (mean)

     Performance IQ = 112.76 (mean)

•  receptive language (PPVT- III): 

     ∞ HFA = 115.33 (mean)

     ∞ C = 116.90 (mean)

–  Were the groups similar? Yes. HFA and Control groups were matched on gender, Full scale IQ (FSIQ), Verbal IQ (VIQ), and Peabody Picture Vocabulary Test- III (PPVT III).

–  Were the communication problems adequately described? No

•  disorder type:  (List)  Ps with HFA were described as preforming at or above average on standardized language tests but exhibiting social-communication challenges.

5.  What were the different conditions for this research?

•  Subject (Classification) Groups? Yes 

     – HFA 

     – C

•  Experimental Conditions? NA

•  Criterion/Descriptive Conditions? NA

6.   Were the groups controlled acceptably? Yes

7.  Were dependent measures appropriate and meaningful? Yes 

•  OUTCOME #1: average standard deviation (SD) of the fundamental frequency (F0) for each 250 ms segmnt

•  OUTCOME #2: average F0 across the entire narrative

•  OUTCOME #3: average number of clauses for the entire narrative

– The dependent measure that was subjective

     •  OUTCOME #3: average number of clauses

– The dependent/ outcome measures that were objective

     •  OUTCOME #1: average SD of the F0 

     •  OUTCOME #2: average F0

8.  Were reliability measures provided?

–  Interobserver for analyzers? No  

  Intraobserver for analyzers?  No 

–  Treatment or test administration fidelity for investigators?  No 

9.  Description of design: 

• The Ps individually viewed a cartoon in which, for the most part, the characters were nonverbal. In a few instances, however, characters produced an exclamation.

• Ps viewed one-third of the cartoon and then immediately retold it to a person who reportedly had not viewed the cartoon.

• The samples were recorded, digitalized, and then acoustically analyzed. Each sample was divided into 250 ms portions. The metrics derived across the samples were

     – the average of the SDs of the F0 across each 250 ms P’s sample

     – the average F0 across each P’s 3 samples

     – the average number of clauses 

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

– Comparisons that are listed as significant achieved p ≤ 0.05):

•  OUTCOME #1: average standard deviation (SD) of the fundamental frequency (F0)  for each 250 ms segment

     – Ps in the HFA group produced significantly larger SDs than the Control group. That is, HFA pitch ranges were significantly wider than Controls. 

•  OUTCOME #2: average F0 across the entire narrative

     – There were no significant differences in the comparisons between the HFA and Control groups. 

•  OUTCOME #3: average number of clauses for the entire narrative

     – The HFA group produced significantly shorter P(i.e., fewer clauses) narratives than the Control group.

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

–  Were effect sizes provided?  Yes. Interpretation Hints for partial eta squared (eta):  .01 small effect, .06 is medium effect, and .14 is large effect.

     •  OUTCOME #1: average standard deviation (SD) of the fundamental frequency (F0)  for each 250 ms segment; Partial Eta squared (Eta) =  0.11 (medium effect)

     •  OUTCOME #2: average F0 across the entire narrative; Eta = 0.05 (small effect)

     •  OUTCOME #3: average number of clauses for the entire narrative; Eta = 0.10 (medium effect)

  Were confidence interval (CI) provided?  No

11.  Summary of correlational results:  

•  OUTCOME #1: average SD of the F0 for each 250 ms segment was correlated with performance on the Autism Diagnostic Observation Schedule (ADOS) Communication factor score. The results indicated that there was a significant (p ≤ 0.05) correlation between the 2 measures (r = 0.43).

12.  Summary of descriptive results:  Qualitative research. NA

13.  Brief summary of clinically relevant results:  

• As a group, the adolescent Ps with HFA produced significantly wider pitch ranges than Controls. The investigators, however, warn that these findings are not conclusive because there was considerable overlap between the SDs of the 2 groups.

• For the HFA group, the SDs of the F0s was correlated with clinical judgments of communication skill (i.e., performance on the ADOS).

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  NA

STUDY 2

1.  What type of evidence was identified? 

• What was the type of design?  Comparison Research

• What was the focus of the research? Clinically Related

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

2.  Group membership determination: 

• If there were groups, were participants randomly assigned to groups? 

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

3.  Were experimental conditions concealed?

•  from participants? No 

•  from administrators of experimental conditions? No 

•  from analyzers/judges? No

4.  Were the groups adequately described? Yes

–   How many participants were involved in the study? 

•  total # of Ps: 34

•  # of groups: 

     – HFA = 17

     – Control = 17

•  Did all groups maintain membership throughout the investigation? 

CONTROLLED CHARACTERISTICS                                                      

•  age: Ps were younger than Study 1 between the ages of 6 to 14

•  cognitive skills: Although Ps cognitive skills were still within normal limits (WNL) they were lower than Study 1

• diagnosis: ASD or Asperger syndrome

DESCRIBED CHARACTERISTICS

•  age:  

     – HFA = 8.81 (mean)

     – Control = 9.49 (mean)

•  gender: 

     – HFA =  13 males, 4 females

     – Control = 12 males; 5 females

•  cognitive skills:  

     – HFA = Composite IQ = 104 (mean); verbal reasoning = 104.8 (mean)

     – Control = Composite IQ = 107.71 (mean); verbal reasoning = 105 (mean)

•  expressive language:  

     – HFA = 100.47 (mean)

     – Control = 102.35 (mean)

•  receptive language: 

     – HFA = 103.35 (mean)

     – Control = 102.12 (mean)

•  diagnosis: 

     – HFA = 15 Ps diagnosed as ASD; 2 diagnosed as Asperger syndrome

     – Control = neurotypical; no history of mental retardation, learning disability, language delay, psychiatric disorders; no history of ASD in first and second degree family members

– Were the groups similar? Yes Matched HFA and Control groups on age, gender, expressive and receptive language scores, composite and verbal reasoning on cognitive tests.

–  Were the communication problems adequately described? No  

5.  What were the different conditions for this research?

  Subject (Classification) Groups? 

     – HFA

     – Control 

  Experimental Conditions? No 

•  Criterion/Descriptive Conditions? No  

6.   Were the groups controlled acceptably? Yes 

7.  Were dependent measures appropriate and meaningful? Yes           

•  OUTCOME #1: average SD of the F0) for each 250 ms segment

•  OUTCOME #2: average F0 across the entire narrative

•  OUTCOME #3: average number of clauses for the entire narrative

– The dependent measure that was subjective was

•  OUTCOME #3: average number of clauses for the entire narrative

 The dependent/ outcome measures that were objective were

•  OUTCOME #1: average standard deviation (SD) of the fundamental frequency (F0) for each 250 ms segment

•  OUTCOME #2: average F0 across the entire narrative

8.  Were reliability measures provided?

 Interobserver for analyzers? No

• Intraobserver for analyzers? No  

• Treatment or test administration fidelity for investigators? No

9.  Description of design: 

• The Ps individually viewed and listened to a recorded reading of the picture book Frog Where Are You?

• The investigators instructed the Ps to listen to the story while they were out of the room and to be prepared to retell the story when the investigator returned. 

• The samples were recorded, digitalized, and then acoustically analyzed. Each sample was divided into 250 ms portions. The metrics derived across the samples were

     – the average of the standard deviations (SD)s of the fundamental frequencies (F0) across each 250 ms P’s sample

     – the average F0 across each P’s 3 samples

     – the average number of clauses 

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

– Comparisons listed as significant achieved p ≤ 0.05

     •  OUTCOME #1: average standard deviation (SD) of the fundamental frequency (F0)  for each 250 ms segment—The Ps in the HFA groups produced significantly larger SD than the Control group Ps. That is, the variability of the F0 of the Ps in the HFA group was significantly larger.

     •  OUTCOME #2: average F0 across the entire narrative—There was not a significant difference in the productions of the HFA and Control groups.

     •  OUTCOME #3: average number of clauses for the entire narrative– There was not a significant difference in the productions of the HFA and Control groups.

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

– Were effect sizes provided?   Yes 

Interpretation Hints: 

–  Cohen’s (1988) guidelines for interpreting partial eta squared (eta):  .01 small, .06  medium, and .14 large.

     •  OUTCOME #1: average SD of the F0 for each 250 ms segment; Eta =  0.18 (large effect)

     •  OUTCOME #2: average F0 across the entire narrative; Eta = 0.004 (negligible effect)

     •  OUTCOME #3: average number of clauses for the entire narrative; Eta = 0.08 (medium effect)

–  Were confidence interval (CI) provided? No

11.  Summary of correlational results:  

•  OUTCOME #1: average SD of the F0 for each 250 ms segment was correlated with performance on the Autism Diagnostic Observation Schedule (ADOS) Communication factor score. The results indicated that there was not a significant correlation between the 2 measures (r = 0.16).

12.  Summary of descriptive results:  Qualitative research. NA

13.  Brief summary of clinically relevant results:  

 The findings of this investigation support previous reports that young children with HFA produce more variation in F0 than neurotypical peers. This variability is not diagnostic because there was overlap between the HFA and the Control groups and not all HFA participants produced speech that was highly variable. 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  NA

ANALYSIS GUIDELINES

Comparison/Nonintervention Research 

KEY:

ADOS = Autism Diagnostic Observation Schedule

ASD = autism spectrum disorder

eta = partial eta squared

F0 = fundamental frequency 

HFA = high-functioning autism

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SD =standard deviation (SD) 

SLP = speech-language pathologist

WNL = within normal limits 

SOURCE:  Diehl, J. J., Watson, D., Bennetto, L., Mcdonough, J., & Gunlogson, C. (2009). An acoustic analysis of prosody in high-functioning autism. Applied Psycholinguistics, 30, 385-404.

REVIEWER(S): pmh

DATE: November 7, 2021  

ASSIGNED GRADE FOR OVERALL QUALITY:  Not Applicable (NA)—This investigation is not concerned with treatment

TAKE AWAY:  In two studies investigating prosody, participants (Ps) displayed increased fundamental frequency (F0) variability in narratives. This variability is not diagnostic because there was overlap between the high functioning autism (HFA) and the Control groups and not all HFA) Ps produced speech that was highly variable. In addition, the findings for adolescents with HFA (in Study 1) revealed an association between clinical ratings of prosody and the F0 measurements. This association was not noted in Study 2, with younger children.

STUDY 1

1.  What type of evidence was identified? 

• What was the type of design?  Comparison Research

• What was the focus of the research? Clinically Related

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

2.  Group membership determination: 

 If there were groups, were participants randomly assigned to groups? No

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

3.  Were experimental conditions concealed?

•  from participants? No 

•  from administrators of experimental conditions? No

•  from analyzers/judges? No 

4.  Were the groups adequately described?  Yes 

–   How many participants were involved in the study? 

•  total # of Ps: 42 

•  # of groups: 2

     ∞ Ps with high-functioning autism (HFA) = 21

     ∞ Neurotypical control Ps (C) = 21

•  Did all groups maintain membership throughout the investigation? Yes  

CONTROLLED CHARACTERISTICS                                                      

•  age:  

    ∞ HFA = 10-18 years

     ∞ C = 10-18 years

•  gender:  the number of each gender in the Control group was matched to the number in the HFA group

     ∞ HFA = 19 males; 2 females

     ∞ C = 19 males; 2 females

•  diagnosis:

     ∞ HFA = all Ps met diagnostic criteria for autism spectrum disorder (ASD) but no Ps met diagnostic criteria for Asperger syndrome.

     ∞ C = free from the following diagnoses: ASD, learning disabilities, mental retardation, language disabilities, or other psychiatric conditions

•  diagnoses of first and second degree relatives:

∞ C = free from diagnoses of ASD

DESCRIBED CHARACTERISTICS

•  age:  

     ∞ HFA = mean 13.58

     ∞ C = mean 13.24

•  gender: 

     ∞ HFA = 19 males; 2 females

     ∞ C = 19 males; 2 females

•  cognitive skills:  

     ∞ HFA 

     Full Scale = 118.25 (mean)

     Verbal IQ = 117.0 (mean)

     Performance IQ = 116.05 (mean)

     ∞ C = 

     Full Scale = 116.81 (mean)

     Verbal IQ = 116.62 (mean)

     Performance IQ = 112.76 (mean)

•  receptive language (PPVT- III): 

     ∞ HFA = 115.33 (mean)

     ∞ C = 116.90 (mean)

–  Were the groups similar? Yes. HFA and Control groups were matched on gender, Full scale IQ (FSIQ), Verbal IQ (VIQ), and Peabody Picture Vocabulary Test- III (PPVT III).

–  Were the communication problems adequately described? No

•  disorder type:  (List)  Ps with HFA were described as preforming at or above average on standardized language tests but exhibiting social-communication challenges.

5.  What were the different conditions for this research?

•  Subject (Classification) Groups? Yes 

     – HFA 

     – C

•  Experimental Conditions? NA

•  Criterion/Descriptive Conditions? NA

6.   Were the groups controlled acceptably? Yes

7.  Were dependent measures appropriate and meaningful? Yes 

•  OUTCOME #1: average standard deviation (SD) of the fundamental frequency (F0) for each 250 ms segmnt

•  OUTCOME #2: average F0 across the entire narrative

•  OUTCOME #3: average number of clauses for the entire narrative

– The dependent measure that was subjective

     •  OUTCOME #3: average number of clauses

– The dependent/ outcome measures that were objective

     •  OUTCOME #1: average SD of the F0 

     •  OUTCOME #2: average F0

8.  Were reliability measures provided?

–  Interobserver for analyzers? No  

  Intraobserver for analyzers?  No 

–  Treatment or test administration fidelity for investigators?  No 

9.  Description of design: 

• The Ps individually viewed a cartoon in which, for the most part, the characters were nonverbal. In a few instances, however, characters produced an exclamation.

• Ps viewed one-third of the cartoon and then immediately retold it to a person who reportedly had not viewed the cartoon.

• The samples were recorded, digitalized, and then acoustically analyzed. Each sample was divided into 250 ms portions. The metrics derived across the samples were

     – the average of the SDs of the F0 across each 250 ms P’s sample

     – the average F0 across each P’s 3 samples

     – the average number of clauses 

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

– Comparisons that are listed as significant achieved p ≤ 0.05):

•  OUTCOME #1: average standard deviation (SD) of the fundamental frequency (F0)  for each 250 ms segment

     – Ps in the HFA group produced significantly larger SDs than the Control group. That is, HFA pitch ranges were significantly wider than Controls. 

•  OUTCOME #2: average F0 across the entire narrative

     – There were no significant differences in the comparisons between the HFA and Control groups. 

•  OUTCOME #3: average number of clauses for the entire narrative

     – The HFA group produced significantly shorter P(i.e., fewer clauses) narratives than the Control group.

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

–  Were effect sizes provided?  Yes. Interpretation Hints for partial eta squared (eta):  .01 small effect, .06 is medium effect, and .14 is large effect.

     •  OUTCOME #1: average standard deviation (SD) of the fundamental frequency (F0)  for each 250 ms segment; Partial Eta squared (Eta) =  0.11 (medium effect)

     •  OUTCOME #2: average F0 across the entire narrative; Eta = 0.05 (small effect)

     •  OUTCOME #3: average number of clauses for the entire narrative; Eta = 0.10 (medium effect)

  Were confidence interval (CI) provided?  No

11.  Summary of correlational results:  

•  OUTCOME #1: average SD of the F0 for each 250 ms segment was correlated with performance on the Autism Diagnostic Observation Schedule (ADOS) Communication factor score. The results indicated that there was a significant (p ≤ 0.05) correlation between the 2 measures (r = 0.43).

12.  Summary of descriptive results:  Qualitative research. NA

13.  Brief summary of clinically relevant results:  

• As a group, the adolescent Ps with HFA produced significantly wider pitch ranges than Controls. The investigators, however, warn that these findings are not conclusive because there was considerable overlap between the SDs of the 2 groups.

• For the HFA group, the SDs of the F0s was correlated with clinical judgments of communication skill (i.e., performance on the ADOS).

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  NA

STUDY 2

1.  What type of evidence was identified? 

• What was the type of design?  Comparison Research

• What was the focus of the research? Clinically Related

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

2.  Group membership determination: 

• If there were groups, were participants randomly assigned to groups? 

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

3.  Were experimental conditions concealed?

•  from participants? No 

•  from administrators of experimental conditions? No 

•  from analyzers/judges? No

4.  Were the groups adequately described? Yes

–   How many participants were involved in the study? 

•  total # of Ps: 34

•  # of groups: 

     – HFA = 17

     – Control = 17

•  Did all groups maintain membership throughout the investigation? 

CONTROLLED CHARACTERISTICS                                                      

•  age: Ps were younger than Study 1 between the ages of 6 to 14

•  cognitive skills: Although Ps cognitive skills were still within normal limits (WNL) they were lower than Study 1

• diagnosis: ASD or Asperger syndrome

DESCRIBED CHARACTERISTICS

•  age:  

     – HFA = 8.81 (mean)

     – Control = 9.49 (mean)

•  gender: 

     – HFA =  13 males, 4 females

     – Control = 12 males; 5 females

•  cognitive skills:  

     – HFA = Composite IQ = 104 (mean); verbal reasoning = 104.8 (mean)

     – Control = Composite IQ = 107.71 (mean); verbal reasoning = 105 (mean)

•  expressive language:  

     – HFA = 100.47 (mean)

     – Control = 102.35 (mean)

•  receptive language: 

     – HFA = 103.35 (mean)

     – Control = 102.12 (mean)

•  diagnosis: 

     – HFA = 15 Ps diagnosed as ASD; 2 diagnosed as Asperger syndrome

     – Control = neurotypical; no history of mental retardation, learning disability, language delay, psychiatric disorders; no history of ASD in first and second degree family members

– Were the groups similar? Yes Matched HFA and Control groups on age, gender, expressive and receptive language scores, composite and verbal reasoning on cognitive tests.

–  Were the communication problems adequately described? No  

5.  What were the different conditions for this research?

  Subject (Classification) Groups? 

     – HFA

     – Control 

  Experimental Conditions? No 

•  Criterion/Descriptive Conditions? No  

6.   Were the groups controlled acceptably? Yes 

7.  Were dependent measures appropriate and meaningful? Yes           

•  OUTCOME #1: average SD of the F0) for each 250 ms segment

•  OUTCOME #2: average F0 across the entire narrative

•  OUTCOME #3: average number of clauses for the entire narrative

– The dependent measure that was subjective was

•  OUTCOME #3: average number of clauses for the entire narrative

 The dependent/ outcome measures that were objective were

•  OUTCOME #1: average standard deviation (SD) of the fundamental frequency (F0) for each 250 ms segment

•  OUTCOME #2: average F0 across the entire narrative

8.  Were reliability measures provided?

 Interobserver for analyzers? No

• Intraobserver for analyzers? No  

• Treatment or test administration fidelity for investigators? No

9.  Description of design: 

• The Ps individually viewed and listened to a recorded reading of the picture book Frog Where Are You?

• The investigators instructed the Ps to listen to the story while they were out of the room and to be prepared to retell the story when the investigator returned. 

• The samples were recorded, digitalized, and then acoustically analyzed. Each sample was divided into 250 ms portions. The metrics derived across the samples were

     – the average of the standard deviations (SD)s of the fundamental frequencies (F0) across each 250 ms P’s sample

     – the average F0 across each P’s 3 samples

     – the average number of clauses 

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

– Comparisons listed as significant achieved p ≤ 0.05

     •  OUTCOME #1: average standard deviation (SD) of the fundamental frequency (F0)  for each 250 ms segment—The Ps in the HFA groups produced significantly larger SD than the Control group Ps. That is, the variability of the F0 of the Ps in the HFA group was significantly larger.

     •  OUTCOME #2: average F0 across the entire narrative—There was not a significant difference in the productions of the HFA and Control groups.

     •  OUTCOME #3: average number of clauses for the entire narrative– There was not a significant difference in the productions of the HFA and Control groups.

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

– Were effect sizes provided?   Yes 

Interpretation Hints: 

–  Cohen’s (1988) guidelines for interpreting partial eta squared (eta):  .01 small, .06  medium, and .14 large.

     •  OUTCOME #1: average SD of the F0 for each 250 ms segment; Eta =  0.18 (large effect)

     •  OUTCOME #2: average F0 across the entire narrative; Eta = 0.004 (negligible effect)

     •  OUTCOME #3: average number of clauses for the entire narrative; Eta = 0.08 (medium effect)

–  Were confidence interval (CI) provided? No

1

1.  Summary of correlational results:  

•  OUTCOME #1: average SD of the F0 for each 250 ms segment was correlated with performance on the Autism Diagnostic Observation Schedule (ADOS) Communication factor score. The results indicated that there was not a significant correlation between the 2 measures (r = 0.16).

12.  Summary of descriptive results:  Qualitative research. NA

13.  Brief summary of clinically relevant results:  

 The findings of this investigation support previous reports that young children with HFA produce more variation in F0 than neurotypical peers. This variability is not diagnostic because there was overlap between the HFA and the Control groups and not all HFA participants produced speech that was highly variable. 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  NA


Léard-Schneideer & Lévêque (2020)

October 1, 2020

ANALYSIS GUIDELINES

Comparison/Nonintervention Research 

KEY:

eta =   partial eta squared 

f = female

m = male

MBEA = the Montreal Battery of Evaluation of Amusia

MEC = Montreal Evaluation of Communication

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

TBI = traumatic brain injury 

WNL = within normal limits

SOURCE:  Léard-Schneider, L. & Lévêque , Y (2020). Perception of music and speech prosody after traumatic brain injury, PsyArXiv Preprints  https://psyarxiv.com/w7cbf/

REVIEWER(S):  pmh

DATE:  October 1, 2020

ASSIGNED GRADE FOR OVERALL QUALITY:  This is not an intervention study; therefore, there is no Assigned Grade for Overall Quality.

TAKE AWAY:   This investigation compared the performance of French-speaking participants (Ps) with traumatic brain injury (TBI) to a neurotypical peer group or test norms on music and prosody comprehension tasks. The results suggest that Ps with TBI encounter challenges with musical pitch discrimination, rhythm, affective prosody, and linguistic prosody.  

1.  What type of evidence was identified? 

• What was the type of design?  Comparison Research 

• What was the focus of the research? Clinically Related  

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

2.  Group membership determination: 

•  If there were groups, were participants randomly assigned to groups? No, the groups were TBI and Neurotypical Controls. This cannot be randomized.

 • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched?  Yes, the groups reported similar gender distribution, age, and schooling.

3.  Were experimental conditions concealed?

•  from participants? No

•  from administrators of experimental conditions? No 

•  from analyzers/judges? No 

4.  Were the groups adequately described?  Yes 

–  How many participants were involved in the study? 

•  total # of Ps:  62

•  # of groups:  2

     Traumatic Brain Injury (TBI) = 31 (of 36 qualified volunteers, 5 were excluded for failing to meet al criteria)

     Neurotypical (NT) = 31 (of 33 qualified volunteers, 2 were omitted because they exhibited possible amusia)

•  Did all groups maintain membership throughout the investigation? Yes, but data was missing for 2 of the TBI group for the Lin Vowel task.         

CONTROLLED CHARACTERISTICS                                                      

•  age: 18 – 60 years

•  cognitive skills:  

•  native language: French

•  short-term memory: all TBI Ps demonstrated sufficient verbal comprehension on a standardized test

•  receptive language: all TBI Ps demonstrated sufficient verbal comprehension on a standardized test

•  severity of TBI: all Ps were rated as having severe TBI

     ∞ NT = none

•  Living Arrangements: only 1 TBI P lived independently

•  Hearing: all Ps within normal limits (WNL)

•  Amusia in NT Ps:  2 of 33 qualified NT volunteers were excluded because meet criterion on tasks identifying amusia.

DESCRIBED CHARACTERISTICS

•  age:  

     ∞ TBI = 38.1 years

     ∞ NT = 37.29 years

•  gender: 

     ∞ TBI = 32% women

     ∞ NT = 32%. women

•  schooling: 

     ∞ TBI = 48% ≤ 11 years

     ∞ NT = 48% ≤ 11 years

•  time post onset (TBI group only):

     ∞ less than 2 years = 25%

     ∞ 2 to 5 years = 23%

     ∞ more than 5 years = 52%

•  musical training (i.e., 3 or mor years of training)

     ∞ TBI = 4 Ps had prior musical training; all had stopped playing their instrument after their TBI.

•  Amusia in NT Ps: 2 of 33 qualified NT volunteers were excluded for failing the Montreal Battery of Evaluation of Amusia (MBEA)

  Were the groups similar? Yes 

•  Were the communication problems adequately described? No 

•  disorder type: Traumatic Brain Injury 

•  functional level:  severe

5.  What were the different conditions for this research?

–  Subject (Classification) Groups? Yes 

      • TBI

      • NT         

–  Experimental Conditions? No  

–  Criterion/Descriptive Conditions? Yes 

     • Performance on Scale portion of the MBEA

     • Performance on Rhythm portion of the MBEA

     • Performance on the Emotional Prosody Understanding portion of the Montreal Evaluation of Communication (MEC)

     • Performance on the Linguistic Prosody Understanding portion of the MEC

     • Performance on Emo Vowel task (accuracy of identifying emotions and the intensity of the emotions)]

     • Performance on Lin Vowel task [accuracy of identifying the intention (question, order, neutral/statement)]  

6.   Were the groups controlled acceptably? Yes 

7.  Were dependent measures appropriate and meaningful? Yes 

• OUTCOME #1: Performance on Scale portion of the Montreal Battery of Evaluation of Amusia (MBEA)

• OUTCOME #2:  Performance on Rhythm portion of the MBEA 

• OUTCOME #3: Performance on the Emotional Prosody Understanding portion of the Montreal Evaluation of Communication (MEC)

• OUTCOME #4:  Performance on the Linguistic Prosody Understanding portion of the MEC

• OUTCOME #5:  Performance on Emo Vowel task (accuracy of identifying emotions and the intensity of the emotions)

• OUTCOME #6:  Performance on Lin Vowel task [accuracy of identifying the intention (question, order, neutral/statement)  

–  All the dependent measures are subjective.

–  None of the dependent/ outcome measures are objective.

8.  Were reliability measures provided?                                   

•  Interobserver for analyzers?  No 

  Intraobserver for analyzers?  No 

•  Treatment or test administration fidelity for investigators?  No

9.  Description of design:  (briefly describe)

• Two groups of French-speaking adult volunteers (TBI and NT) were administered a battery of tests/tasks including those designed to assess musical recognition of pitch and rhythm as well as the comprehension of prosodic affect and linguistic prosody.

• The groups were similar for age, gender, and education.

• The results of correlational and gender analyses as well as results pertaining attitudes toward musi are not summarized in this review.

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

• OUTCOME #1: Performance on Scale (pitch) portion of the MBEA

     ∞ TBI group performed significantly more poorly than the NT

     ∞ 42 % of TBI Ps were classified as pathological

• OUTCOME #2:  Performance on Rhythm portion of the MBEA. 

     ∞ 52 % of TBI Ps were classified as Pathological 

• OUTCOME #3: Performance on the Emotional Prosody Understanding portion of the MEC

     ∞ the TBI and NT groups were not compared because the NT were not administered this task

• OUTCOME #4:  Performance on the Linguistic Prosody Understanding portion of the MEC

     ∞ the TBI and NT groups were not compared because the NT were not administered this task

• OUTCOME #5:  Performance on Emo Vowel task (accuracy of identifying emotions and the intensity of the emotions)

     § accuracy of affective prosody understanding was significantly lower for the TBI group than the NT group. d = 1.11

     § however, the perceived intensity of the emotion in the task was not significantly different for the NT versus the TBI groups

• OUTCOME #6:  Performance on Lin Vowel task [accuracy of identifying the intention (question, order, neutral/statement) 

     § accuracy of linguistic prosody understanding was significantly lower for the TBI group than the NT group. d = 1.11

∞ The descriptive analyses of correct responses for Outcomes 3, 4, 5, and 6 were combined:

     § pathological = equal or below 2 standard deviations below the performance of the NT groups or below cut-off on MBEA or MEC

     § 84% of the TBI groups had one or more of the above 4 Outcomes categorized as impaired/pathological.

     § 42% of the TBI groups had impaired affective and linguistic prosody understanding.

     § Approximately equal proportions of TBI Ps experienced problems with only affective (19%) or linguistic (23%) prosody.

     § Vowel based outcome tasks (i.e., Outcomes 5 and 6) were more of challenge than the sentence based, or MEC, outcome tasks (i.e., Outcomes 3 and 5).

          • for affective prosody, 55% of the Ps had a problem with the Vowel task (Outcome 5) compared to 35% for the sentences (Outcome 3).

          • for linguistic prosody, , 55% of the Ps had a problem with the Vowel task (Outcome 6) compared to 35% for the sentences (Outcome 4).

  What was the statistical test used to determine significance?

• Mann-Whitney U

•  Spearman

∞  Were effect sizes provided?   Yes

• OUTCOME #1: Performance on Scale (pitch) portion of the MBEA

     ∞ d = 1.04 (large effect)

• OUTCOME #5:  Performance on Emo Vowel task (accuracy of identifying emotions and the intensity of the emotions)

     ∞ d = 1.11 (large effect)

• OUTCOME #6:  Performance on Lin Vowel task [accuracy of identifying the intention (question, order, neutral/statement) 

     ∞ d = 1.11 (large effect)

∞  Were confidence interval (CI) provided?  No

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

12.  Summary of descriptive results:  Qualitative research. NA

13.  Brief summary of clinically relevant results:  

• Ps with TBI performed significantly more poorly on tasks measuring amusia as well as comprehension of affective and linguistic prosody.

• Ps with TBI were more likely to exhibit problems understanding affective and/or linguistic prosody than they were to exhibit amusia. That is, prosodic comprehension is more vulnerable than music processing following a TBI.

• Although not all Ps with TBI exhibited pathological music, affective prosody, and linguistic prosody, a large percentage of them did.

• Clinicians should consider assessing affective prosody, linguistic prosody, and music processing in Ps with TBI.

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  NA

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


Sousa et al. (2017)

September 17, 2020

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

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

KEY
ASD = Autism Spectrum Disorder

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer 

SLP = speech-language pathologist

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

Reviewer(s): pmh

Date: September 15, 2020

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

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

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

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

– The type of literature review was a Narrative Review. 

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

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

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

5.  Description of outcome measures:

  Are outcome measures suggested? Yes 

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

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

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

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

6.  Was generalization addressed? No

7.  Was maintenance addressed? No  

SUMMARY OF INTERVENTION

PURPOSE: to improve affective prosody

POPULATION: Autism Spectrum Disorders; children

MODALITY TARGETED: receptive and production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affective prosody

MAJOR COMPONENTS:  

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

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

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

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

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

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

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

     ∞ C presents the image of a common object. 

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

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

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

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


Holbrook & Israelsen, 2020

August 28, 2020

SECONDARY REVIEW CRITIQUE

KEY:

ASD = autism spectrum disorders

C = clinician

f =  female

m =  male

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

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

Reviewer(s): pmh

Date: August 27, 2020

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

Level of Evidence:  B

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

What type of secondary review?  Narrative Systematic Review

  1. Were the results valid? Yes
  • Was the review based on a clinically sound clinical question? Yes
  • Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? Yes
  • The authors of the secondary research noted that they reviewed the following resources:

     – hand searches

     – internet based databases

     – references from identified literature

  • Did the sources involve only English language publications? Yes
  • Did the sources include unpublished studies? Yes
  • Was the time frame for the publication of the sources sufficient? Yes
  • Did the authors of the secondary research identify the level of evidence of the sources? Yes
  • Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? Yes
  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources?
  • Did the authors of the secondary research or review teams rate the sources independently? Yes
  • Were interrater reliability data provided? Yes _

– Interrater reliability for inclusion of studies = 92.6%

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

– Interrater reliability for effect size and calculation = 94.6%

– Disagreements were resolved by consensus.

  • Were assessments of sources sufficiently reliable? Yes
  • Was the information provided sufficient for the reader to undertake a replication? Yes
  • Did the sources that were evaluated involve a sufficient number of participants? Yes
  • Were there a sufficient number of sources? Yes

 

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

 

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

     – Cohen’s d

     – Hedge’s g

     – Tau U

  • Summary of overall findings of the secondary research: The investigators identified 13 articles that provided adequate (2) or weak (11) evidence of improved prosody in speakers with ASD.
  • Were the results precise? Unclear/Variable
  • If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? NA
  • Were the results of individual studies clearly displayed/presented? Yes
  • For the most part, were the results similar from source to source? Yes
  • Were the results in the same direction? No
  • Did a forest plot indicate homogeneity? NA
  • Was heterogeneity of results explored? No
  • Were the findings reasonable in view of the current literature? Yes
  • Were negative outcomes noted? Yes

                                                                                                                   

  1. Were maintenance data reported? Yes

 

  1. Were generalization data reported? Yes

 

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


Dalhberg et al. (2018)

August 20, 2019

ANALYSIS GUIDELINES

Comparison Research

NOTE:  This research focuses on a clinical disorder, not on an intervention. Accordingly, no summary of intervention is included in the review.

KEY:

ADD =  attention deficit disorder

ADHD =  attention deficit/hyperactivity disorder

ASD = autism spectrum disorder(s)

c2v/second =  consonant-to-vowel transitions per second

eta =  partial eta squared

fo = fundamental frequency

Hz =  Hertz

MLU = mean length of utterance

NA = Not Applicable

NAP =  Narrative Assessment Profile

P = participant or patient

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

WLN = within normal limits

 

SOURCE:  Dahlberg, S., Sandberg, A. D., Strömbergsson, S., Wenhov, L., Råstam, M, & Nettelbladt, U. (2018). Prosodic traits in speech produced by children with autism spectrum disorders—Perceptual and acoustic measurements. Autism & Developmental Language Impairments, 3, 1- 10.

 

REVIEWER(S): pmh

 

DATE:  August 12, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B-  (Based on the design of the investigation, the highest possible grade is B+.)

 

TAKE AWAY: This investigation explored the productive prosody of 11 Swedish children diagnosed with high functioning autism spectrum disorder (ASD group) and 11 Swedish children judged to the typically developing (TDC group). Perceptual and acoustic analyses of one-minute speech samples extracted from each child’s narratives revealed only one significantly different measure:  the ASD group produced significantly longer utterances than their TDC peers despite the fact that the TDC group had significantly more advanced receptive language scores.

 

  1. What type of evidence was identified?

–  What was the type of design? Comparison Research; Prospective Nonrandomized Group Design with Controls

–  What was the focus of the research?  Clinically Related  xxx

–  What was the level of support associated with the type of evidence?  Level = B+

 

                                                                                                           

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

                                                                    

 

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

                                                                    

 

  1. Were the groups adequately described? Yes

   How many participants were involved in the study?

  • total # of Ps:22
  • # of groups:2
  • List names of groups and the number of Ps in each group:

     –  Autism Spectrum Disorders (ASD)  = 11

–  Typically Developing Children (TDC) = 11

  • Did all groups maintain membership throughout the investigation? Yes

 

–  CONTROLLED CHARACTERISTICS                                                  

  • cognitive skills:all participants were within normal limits (WLN)
  • diagnosis:

     – ASD group = diagnosis of ASD

     – TDC group = no diagnosis of ASD; no history of assessment or treatment with a speech-language pathologist (SLP) or a psychologist

 

DESCRIBED CHARACTERISTICS  (* = a significant difference between groups)

  • age:

     – ASD group =   11.1. years  (9.2 to 12.9)

     – TDC group =   11.1 years  (10.5. to 12.1)

  • gender:

     – ASD group =  10 males; 1 female

     – TDC group =  6 males; 1 female

  • receptive vocabulary*:

     – ASD group =  4.8 scaled score

     – TDC group =  9.6 scaled score

  • receptive linguistic age*:

     – ASD group =  10.4 years

     – TDC group =  14.7 years

  • Narrative Assessment Profile (NAP; maximum score 18; production):

     – ASD group =  14.9

     – TDC group =   16.1

  • additional diagnoses:

     – ASD group = in addition to ASD, there were the following diagnoses

         –  4 Ps = attention deficit/hyperactivity disorder (ADHD)

          –  1 P = attention deficit disorder (ADD)

     – TDC group =  no diagnoses

 

– Were the groups similar?  Yes on most variables, but there were significant differences in receptive language age and receptive vocabulary.

                                                         

–  Were the communication problems adequately described?  Unclear

  • disorder type: High Functioning ASD

 

 

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

     – ASD

     – TDC       

  • Experimental Conditions? No 
  • Criterion/Descriptive Conditions?No 

 

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

 

ACOUSTIC MEASURES

  • OUTCOME #1:fundamental frequency (f0) average in Hertz (Hz)
  • OUTCOME #2:f0range in semitones
  • OUTCOME #3:f0 variation in semitones
  • OUTCOME #4:speech rate as represented by syllables per second which operationally was defined as consonant-to-vowel transitions per second (c2v/second)
  • OUTCOME #5:utterance length orwords per utterance

 

PERCEPTUAL MEASURES

  • OUTCOME #6:Rating of Pitch from 1 to 4 with 4 indicating the highest deviancy from typical development.
  • OUTCOME #7:Rating of Intonation from 1 to 4 with 4 indicating the highest deviancy from typical development.
  • OUTCOME #8:Rating of Speech Rate from 1 to 4 with 4 indicating the highest deviancy from typical development.
  • OUTCOME #9:Rating of Length of Utterance from 1 to 4 with 4 indicating the highest deviancy from typical development.
  • OUTCOME #10:Rating of Intensity from 1 to 4 with 4 indicating the highest deviancy from typical development.
  • OUTCOME #11:Rating of Timbre from 1 to 4 with 4 indicating the highest deviancy from typical development.
  • OUTCOME #12:Rating of Fluency from 1 to 4 with 4 indicating the highest deviancy from typical development.
  • OUTCOME #13:Rating of Nasality with indications of deviancy or no deviancy
  • OUTCOME #14:Rating of overall impression of Prosody as adequate, atypical, or very atypical.
  • OUTCOME #15:Categorization of P as having a diagnosis or ASD or not from the speech samples.

 

POST HOC ANALYSES MEASURES

  • OUTCOME #16: Comparison on all measures of the 3 Ps from the ASD group who had been correctly identified by listeners as having ASD versus the remaining 8 Ps in the ASD group

 

–  The perceptual measures were subjective.

–  The acoustic measures were objective.

 

 

  1. Were reliability measures provided?
  • Interobserver for analyzers? No.  However, the raters, 3 SLPs with a specialization in voice, discussed their ratings of each P and came to a consensus.
  • Intraobserver for analyzers? No
  • Treatment or test administration fidelity for investigators?NA

 

 

  1. Description ofdesign:
  • Eleven Swedish children diagnosed with ASD and 11 matched typically developing Swedish peers were recorded telling a narrative about the beach.

 

  • The investigators removed 1 minute samples from each narrative and subjected them to acoustic and perceptual analyses.

 

  • Raters for the perceptual measures listened to the speech samples which were presented in a random order with respect to group and gender.

 

  • Because none of the TDC group and only 3 Ps from the ASD group were judged to be ASD speakers, the investigators sought to identify if the 3 identified Ps were different from their ASD peers. (I have labeled this the Post Hoc Analysis.)

 

 

  1. What were the results of the statistical (inferential) testing?
  • There was only significant difference among all the acoustic and perceptual measures:

–  OUTCOME #5: utterance length orwords per utterance

 

  • The Post Hoc analysis identified the differences between the 3 Ps from the ASD group who had been judged to be ASD speakers from their 1 minute samples and the rest of the ASD group. The analysis yielded the following significant differences:

–  The 3 Ps identified as ASD

∞ performed significantly more poorly on the NAP from the descriptive characteristics.

∞ produced significantly more atypical fluency in the 1- minute samples

∞ produced significantly more atypical speaking rates in the 1- minute samples

 

  • What was the statistical test used to determine significance?ANOVA and Mann-Whitney U

 

  • Were effect sizes provided?Yes, for one Outcome

     –  OUTCOME #5:  Utterance length or words per utterance  (Cohen’s d was 0.99 which is considered to be a large 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:
  • SLP judges were not able to differentiate ASD and TDC speakers listening to 1 minute narrative speech samples.

 

  • Only one measure, words per utterance, differentiated the ASD group from the TDC group. (The ASD group was labeled as high functioning.)

 

  • The Ps who were correctly identified as having ASD had

– significantly poorer narrative skills

–  significantly more atypical fluency

– significantly more atypical speaking rate

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B-


Vaiouli & Andrews (2018)

February 13, 2019

SECONDARY REVIEW CRITIQUE

KEY:

ASD =  Autism Spectrum Disorder

C =  clinician

f =  female

m =  male

MT =  music therapy

NA =  not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP =  speech-language pathologist

SR =  Systematic Review

 

Source:  Vaiouli, P., & Andreou, G. (2018). Communication and language of young children with autism: A review of the research in music. Communication Disorders Quarterly, 39(2), 323-329.

Reviewer(s):  pmh

Date:  February 10, 2019

Overall Assigned Grade: B-    The highest possible grade based on the level of evidence is B.  The overall grade should be interpreted as a rating of the quality of the evidence supporting the investigation’s findings. It is not a judgment about the quality or effectiveness of the music therapy. 

Level of Evidence:  B

Take Away:  The purpose of this review was to investigate the use of music therapy (MT) for improving communication development of children (ages 0 to 8 years) diagnosed with Autism Spectrum Disorder (ASD). The investigators identified 3 uses of music in the improvement of speech, language, and communication targets:  (1) to facilitate preverbal communication by using music to engage the children, (2) to improve receptive language, and (3) to improve expressive language (i.e., the production of speech and language.)

 

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)?
  • The authors of the secondary research noted that they reviewed the following resource:internet based databases
  • 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?
  • Did the authors of the secondary research identify the level of evidence of the sources? No, but they identified the design of the investigations.        
  • Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources?Yes
  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources?
  • Did the authors of the secondary research or review teams rate the sources independently? Unclear
  • Were interrater reliability data provided?No
  • 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(on the average)
  • Were there a sufficient number of sources?No

 

  1. Description of outcome measures:

 

  • The investigation was not concerned about outcomes, rather the focus was on describing the nature of MT associated with language and communication development for children with ASD.

 

  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 were reported because the focus of the investigation was not treatment effectiveness.
  • Summary overall findings of the secondary research: The investigators described 3 uses of music:

–  To facilitate preverbal communication by using music to engage the children

–  To improve receptive language

–  To improve expressive language (i.e., the production of speech and

language

  • Were the results precise? Not Applicable (NA)
  • Were the results of individual studies clearly displayed/presented?Yes
  • Were the findings reasonable in view of the current literature? Yes

                                                                                                                   

  1. Were maintenance data reported?NA

 

  1. Were generalization data reported?NA

 

SUMMARY OF INTERVENTION

 

Population:  Autism Spectrum Disorder; Children

Purpose:  To identify how music is used when targeting speech, language, and communication improvement in children with ASD

Nonprosodic Targets:  preverbal communication, receptive language, expressive language (speech and language production)

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (pitch rhythm, loudness, duration)

 

  • The investigators identified 9 sources that met inclusion and exclusion criteria.

 

  • From the 9 sources, the investigators described 3 uses of music:

–  To facilitate preverbal communication by using music to engage the children

–  To improve receptive language

–  To improve expressive language (i.e., the production of speech and

language

 

TO FACILITATE PREVERBAL COMMUNICATION BY USING MUSIC TO ENGAGE THE CHILDREN

 

  • Number of studies: 2
  • Total Number of Participants (Ps):4
  • Music Techniques:  Songs, familiar melodies, sung directives

 

TO IMPROVE RECEPTIVE LANGUAGE

 

  • Number of studies: 3
  • Total Number of Ps:35
  • Music Techniques:  Songs and precomposed sngs

 

TO IMPROVE EXPRESSIVE LANGUAGE (I.E., THE PRODUCTION OF SPEECH AND  LANGUAGE

 

  • Number of studies: 4
  • Total Number of Ps:90
  • Music Techniques:  Songs, familiar melodies, singing, tapping

 

————————————————————————————————————

 


Hutchinson (2015)

October 17, 2018

EBP THERAPY ANALYSIS

Single Case Design

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

Key:

ASD =  Autism Spectrum Disorders

C =  Clinician

EBP =  evidence-based practice

F0=  Fundamental frequency (F0)

HFA =  High Functioning Autism

NA =  not applicable

P =  Patient or Participant

pmh =  Patricia Hargrove, blog developer

PVSP =  Prosody Voice Screening Profile (PVSP)

SLP =  speech–language pathologist

WNL =  within normal limits

 

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

 

REVIEWER(S):  pmh

 

DATE:  October 9, 2018

 

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

 

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

 

 

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

 

 

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

Level =  D     

 

 

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

 

 

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

–  How many Ps were involved in the study? 1

 

 CONTROLLED CHARACTERISTICS

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

 

–  DESCRIBED CHARACTERISTICS

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

 

– Were the communication problems adequately described?  Yes

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

–  stereotypical behaviors

–  communication problems

–  social interaction problems

–  prosodic problems:

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

–  prosodic strengths

  • pitch
  • loudness
  • voice

 

 

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

 

 

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

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

ACOUSTIC MEASURES

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

 

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

 

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

 

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

 

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

 

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

 

PERCEPTUAL MEASURES

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

 

 

–  The subjective outcomes are

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

 

–  The objective outcomes are

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

 

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

 

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

 

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

 

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

 

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

 

–  Reliability Data:

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

∞  F0differed by 0.97 Hz (Outcomes 1 to 3)

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

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

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

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

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

 

 

  1. Results:

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

 

ACOUSTIC MEASURES

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

 

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

 

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

 

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

 

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

 

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

 

PERCEPTUAL MEASURES

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

 

 

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

 

 

  1. What is the clinical significance? NA

 

 

  1. Was information about treatment fidelity adequate? NA

 

 

  1. Were maintenance data reported?No

 

 

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

 

 

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

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To improve the production of affective prosody.

 

POPULATION:   ASD (HFA); children

 

MODALITY TARGETED:  production

 

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

 

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

 

ADMINISTRATOR:  Graduate Student in SLP

 

MAJOR COMPONENTS:

 

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

 

STEP 1:

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

 

STEP 2:

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

 

STEP 3:

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

 

STEP 4:

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

 

STEP 5:

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

 

STEP 6:

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

 

 

 


Sousa (2017)

June 1, 2018

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

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

KEY

ASD =  autism spectrum disorder

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist 

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

Reviewer(s):  pmh

Date:  May 31.2018 

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

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

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

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

 

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

  

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

 

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

 

  1. Description of outcome measures:

–  Are outcome measures suggested?  Yes

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

 

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

 

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

 

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

 

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

 

  • Outcome #6: Imitate intonation of single words

  

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

  

SUMMARY OF INTERVENTION

 

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

POPULATION:  Autism Spectrum Disorder; children

MODALITY TARGETED: comprehension, production (imitation)

 ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, intonation

OTHER TARGETS:  concepts of same/different

DOSAGE: not applicable because the program was not administered

ADMINISTRATOR:  mobile phones? (this is virtual therapy)

MAJOR COMPONENTS:

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

 

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

–  2 activities to teach the concept of same/different

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

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

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

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

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

 

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

 


Chenausky & Schlag (2018)

April 29, 2018

EBP THERAPY ANALYSIS

Treatment Groups 

Note: Scroll about 80% of the way down the page to read the summary of the procedure.

 Key:

AMMT =  Auditory-motor mapping training

approximately correct =  P produced consonant bisyllable target with 2 of 3

features (manner, place, voicing)  of an adult form of the consonant AND the

vowel portion of the bisyllable target was of the same class (i.e., same height

and degree of backness)

ASD =  Autism Spectrum Disorder

C = Clinician

EBP = evidence-based practice

f = female

m = male

MV =  Minimally Verbal

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

SRT =  Speech Repetition Therapy

 

 

SOURCE: Chenausky, K. V., & Schlaug, G. (2018). From intuition to intervention: Developing an intonation-based treatment for autism.  Annals of the New York Academy of Sciences, 1-13. doi: 10.1111/nyas. 13609 (Early Online Version before inclusion in an issue)

 

 

REVIEWER(S):  pmh

 

DATE:   April 24, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY: 

– Proof of Concept Study =  C-

– Replication Study =  C-

– Comparison Study =  B-

 

TAKE AWAY: Although the article provides information that could be used as a summary of stages of program assessment, the focus of this review is limited to the evidence for the effective of a music-based intervention: Auditory-motor mapping training (AMMT.) Three studies were reported in this investigation:  Proof of Concept, Replication, and Comparison. Some participants’ data were used in more than one investigation. Each of the studies is reviewed separately and indicate that AMMT has potential for success.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence?

     – Prospective, Nonrandomized Group Design with Controls?   Comparison Study

– Prospective, Single Group with Pre- and Post-Testing  Proof of Concept Study, Replication Study

 

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

     – Proof of Concept Level = C+

     – Replication Level = C+

     – Comparison Level = B+

 

PROOF OF CONCEPT STUDY

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups?Not Applicable

 

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

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

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

                                                                    

 

  1. Was the group adequately described? No

 

–  How many  Ps were involved in the study?

  • total # of Ps:   6
  • # of groups:  1

 

–  CONTROLLED CHARACTERISTICS

  • expressive vocabulary:less than 20 words
  • imitation skills: able to imitate at least 2 sounds
  • diagnosis:Minimally Verbal (MV) Autism Spectrum Disorder (ASD)
  • other diagnoses:excluded sensorineural disorders (e.g., deafness, Down syndrome)

 

–  DESCRIBED CHARACTERISTICS

  • age:5 years 9 months to  8 years 9 months (mean = 6 years 7 months)
  • gender: 1f; 5m

 

–   Were the groups similar before intervention began? NA, there was only one group.

                                                         

–  Were the communication problems adequately described?  No

  • disorder type:  MV ASD
  • functional level:  baseline phonetic inventory =  7.9 (+/- 5.3)

 

 

  1. Was membership in the group maintained throughout the study?

                                                                                                             

  • Did the group maintain at least 80% of their original members? Yes
  • Were data from outliers removed from the study? No 

 

 

  1. Was the group controlled acceptably?  No, this was a single group study.

 

 

  1. Was the outcome measure appropriate and meaningful? Yes

 

  • OUTCOME #1:Percentage of “syllables approximately correct” (p. 4)  from a list of 30 bisyllable words/phrases

 

NOTE:  approximately correct =  P produced consonant bisyllable target with 2 of 3 features (manner, place, voicing)  of an adult form of the consonant AND the vowel portion of the bisyllable target was of the same class (i.e., same height and degree of backness)

 

  • The outcome measures was subjective.

 

*  The outcome measure was NOTobjective.

                                         

 

  1. Were reliability measures provided?

                                                                                                             

  • Interobserver for analyzers?Yes

    –  OUTCOME #1:  Percentage of “syllables approximately correct” (p. 4)  from a list  of 30 bisyllable words/phrases

–  for the measure “approximately correct”

            ∞ percent of interobserver agreement was 68%

            ∞ difference in from change agreement–  Cohen’s K = 0.55 (p <

                0.0005)

            ∞ investigators claimed these measures were “favorable” (p. 5) and

                 “at least ‘moderate’ or ‘good’)

 

  • Intraobserver for analyzers?No 

 

  • Treatment fidelity for clinicians? No , but the investigators developed a manual describing treatment procedures.

 

 

  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

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

 

  • OUTCOME #1:Percentage of “syllables approximately correct” (p. 4)  from a list of 30 bisyllable words/phrases:  Ps scores were significantly better following treatment compared to pretreatment data

 

  • What was the statistical test used to determine significance?

–  t-test

     –  binominal test of significant

 

  • Were confidence interval (CI) provided?Yes

     –  95% CI:  xxx, investigators reported that the Ps pretreatment scores were beyond the 95% CI for the post intervention scores.

 

 

  1. What is the clinical significanceNo EBP data provided but investigators claim clinical significance by describing the increase of percentage of approximately correct bisyllables.

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported?No, but the outcome measure included trained and untrained stimuli but the trained/untrained data were not presented separately.

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Six Ps were selected to determine if AMMT regularly resulted in improvements in the outcome.

 

  • The 6 Ps each participated in 40 treatment sessions and served as his/her control.

 

  • The investigators performed multiple baseline assessment of the outcome and used the best performance of each P as his/her baseline.

 

  • Following the 10thsession and every 5 sessions after the 10th, the investigators performed an assessment or probe session. Probe sessions were similar to the treatment session except they included both trained and untrained (generalization) stimuli.

 

  • Each Ps’ clinician (C) administered the probes but the ratings of correct/incorrect were performed by a blinded rater.

 

 

GRADE= C-

 

 

REPLICATION STUDY

 

 

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Not Applicable (NA), there was only one group.

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

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

                                                                    

 

  1. Was the group adequately described? No

 

– How many  Ps were involved in the study?

  • total # of Ps: 17
  • # of groups:1

 

–  CONTROLLED CHARACTERISTICS

  • expressive vocabulary:less than 20 words
  • imitation skills: able to imitate at least 2 sounds
  • diagnosis:Minimally Verbal (MV) Autism Spectrum Disorder (ASD)
  • other diagnoses:excluded sensorineural disorders (e.g., deafness, Down syndrome)

 

–  DESCRIBED CHARACTERISTICS

  • age:3 years; 5 months to 9 years; 8 months (mean =6 years; 6 months)
  • gender:2f; 15m

 

–   Were the groups similar before intervention began? NA , there was only one group.

                                                         

–  Were the communication problems adequately described?  No

  • disorder type: MV ASD
  • functional level: baseline phonetic inventory:  mean = 7.2 (+/- 4.3)

 

 

  1. Was membership in the group maintained throughout the study?

                                                                                                             

  • Did the group maintain at least 80% of their original members? Yes
  • Were data from outliers removed from the study?No 

 

 

  1. Were the groups controlled acceptably?  NA, there was only a single group.

 

 

  1. Was the outcome measure appropriate and meaningful? Yes

 

  • OUTCOME #1:Percentage of “syllables approximately correct” (p. 4)  from a list of 30 bisyllable words/phrases

 

  • The outcome measures was subjective.
  • The outcome measure was NOTobjective.

                                         

 

  1. Were reliability measures provided?

                                                                                                             

  • Interobserver for analyzers?No, but see the results for interobserver reliability for the Proof of Concept study.

 

  • Intraobserver for analyzers?No 

 

  • Treatment fidelity for clinicians?Yes

–  All of the reviewed sessions included the major AMMT components (intoned speech) and drums.

 

 

  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

 

PRE AND POST TREATMENT ONLY ANALYSES

 

OUTCOME #1:  Percentage of “syllables approximately correct” (p. 4)  from a list  of 30 bisyllable words/phrases imitated

  • There post treatment scores were significantly better than thepretreatment score.
  • The investigators compared the results of the Replication Group and the Proof of Concept Group at 25 sessions and determined

∞  that there was no significant difference between the groups,

∞  that their combined outcomes were significantly better after treatment, and

∞  that the trajectories of their improvement were similar

∞  overall the number of correct syllables in the combined groups was about 15 at baseline and 27 following 25 sessions.

 

 

—  What was the statistical test used to determine significance?

  • t-test
  • ANOVA

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significance(List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.) No 

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported?No, treated bisyllables were included in the assessment data but they were not described separately.

 

 

  1. Describe briefly the experimental design of the investigation.
  • Seventeen Ps were selected to determine to replicate the finding of the Proof of Concept study with a larger group.

 

  • The 17 Ps each participated in 25 treatment sessions and served as his/her control. The 25 sessions dosage is markedly reduced from the Proof of Concept study but was used because of the burden of 40 sessions for families. The decision also was made to use 25 sessions because almost 90% of the change in the Proof of Concept study had been achieved by session 25.

 

  • The investigators performed multiple initial preintervention assessments of the outcome and used the best performance of each P as his/her baseline.

 

  • Following the 10thsession and every 5 sessions after the 10th, the investigators performed an assessment or probe session. Probe sessions were similar to the treatment sessions except they included both trained and untrained (generalization) stimuli. Each Ps’ clinician (C) administered the probes but the ratings of correct/incorrect were performed by a blinded rater.

 

  • The investigators combinedthe data from the Ps in the Proof of Concept and the Replication studies because the performance of the 2 groups was similar.

 

GRADE C-

 

 

COMPARISON STUDY

 

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? No 

 

  • If there were groups andthe Ps were not randomly assigned to groups, were members of groups carefully matched?  Yes
  • -Seven Ps from the original Ps in the Replication study were matched to 7 Ps who were to be assigned to the control group, Speech Repetition Therapy (SRT.)

     –  The Ps were matched on the basis of

∞  chronological age

∞  mental age

∞  baseline phonemic (phonetic) repetition ability

                                                                    

 

  1. Was administration of intervention status concealed?

                                                                                                           

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

                                                                    

 

  1. Were the groups adequately described? No

 

–  How many  Ps were involved in the study?

  • total # of Ps: probably
  • # of groups:2
  • List names of groups and the # of participants in each group:

     –  AMMT = 7  (a subgroup of Ps from the AMMT treated Replication study)

–  SRT = 7

 

–  CONTROLLED CHARACTERISTICS

  • expressive vocabulary:less than 20 words
  • imitation skills: able to imitate at least 2 sounds
  • diagnosis:Minimally Verbal (MV) Autism Spectrum Disorder (ASD)
  • other diagnoses:excluded sensorineural disorders (e.g., deafness, Down syndrome)

 

–  DESCRIBED CHARACTERISTICS

  • age:

     –  AMMT = 3 years; 5 months to 8 years; 11 months (mean =  6 years, 1 month)

     –  SRT =  3 years; 9  months to 8 years; 5 months (means = 5 years; 8 months)

  • gender:

     –  AMMT = 7m

     –  SRT = 2f; 5m

 

–   Were the groups similar before intervention began? Yes

                                                         

–  Were the communication problems adequately described?  No 

  • disorder type: (List) MV  ASD
  • functional level: baseline phonetic inventory

– AMMT =  7.1 (+/- 3.4)

– SRT =  8.9 (+/- 5.4)

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? Yes

                                                               

  • Were data from outliers removed from the study? No 

 

 

  1. Were the groups controlled acceptably? Yes

                                                                                                             

  • 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 foil/comparison and the target groups constant? Yes

 

 

  1. Was the outcome measure appropriate and meaningful? Yes

                                                                                                             

  • OUTCOME #1:Percentage of “syllables approximately correct” (p. 4)  from a list of 30 bisyllable words/phrases

 

  • The outcome measure was subjective.
  • The outcome measure was NOT objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                             

  • Interobserver for analyzers?No, but see the results for interobserver reliability for the Proof of Concept study.

 

  • Intraobserver for analyzers?No 

 

  • Treatment fidelity for clinicians?Yes

     – Every AMMT reviewed trial reviewed contained the 2 major components of AMMT:  intoned speech and drumming.

     – None of the SRT  trials reviewed contained the 2 major components of AMMT: intoned speech and drumming.

 

 

  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

 

TREATMENT AND FOIL/COMPARISON/NO TREATMENT GROUP ANALYSES

 

  • OUTCOME #1:  Percentage of “syllables approximately correct” (p. 4)  from a list  of 30 bisyllable words/phrases

–  Overall, both the AMMT and the SRT groups improved significantly from baseline to the end of treatment.

     –  The 2 groups (AMMT, SRT) scores were not significantly different from one another over the 4 testing periods.

 

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

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported? Yes  __x__  No ______
  • Improvements following treatment of 25 weeks were maintained 4 and 8 weeks post treatment.(That is, there no significant difference between outcomes immediately after treatment and 4 and 8 weeks post treatment.

 

  • There were no significantly different outcome scores for the 2 groups .

 

 

  1. Were generalization data reported?Yes

 

  • Trained stimuli were significantlymore likely to be correct than untrained stimuli.

 

  • There were no significantly different outcome scores for the 2 groups .

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigators matched 7 of the Ps from the Replication study to a group of Ps who received SRT.

 

  • The 14 Ps each participated in 25 treatment sessions and served as his/her control.

 

  • The investigators compared the outcomes of the AMMT and SRT groups following 25 sessions and analyzed the data.

 

  • For the maintenance analysis, the investigators then selected 10 AMMT Ps for the Replication study and the 7 SRT Ps from this Comparison study and compared their performance 4 and 8 weeks following the termination of treatment.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if a music-based intervention (AMMT), based on Melodic Intonation Therapy, warrants additional research

 

POPULATION:  ASD

 

MODALITY TARGETED:  production

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  music (rhythm, intonation, pitch), rate.

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: Articulation

 

DOSAGE:  45 minute individual sessions for 40 (Proof of Concept study) or 25 sessions (Replication study or Comparison study)

 

ADMINISTRATOR:  probably SLP

 

 

MAJOR COMPONENTS:

 

  • Two treatments were described in the article:AMMT and SRT

 

 

AUDITORY-MOTOR MAPPING TRAINING (AMMT)

 

  • AMMT is derived from Melodic Intonation Therapy.

 

  • The main objective of AMMT is to increase speech sound accuracy and intelligibility.

 

  • AMMT involves scaffolding, massed practice, spaced practice, and several behavioral management techniques.

 

  • Clinicians (Cs) model intoned bisyllables at 1 syllable per second using 2 pitch levels that corresponded to naturalspeech. The C accompanied the production of the intoned bisyllables with tapping of an electronic drum using the same pitches as the intoned modeled bisyllables. Again, the rate is one tap per second.

 

  • There are 5 hierarchical steps in AMMT:

–  Listening:  The C produces a model of the bisyllable target word at the end of a sentence. Example: “It is fun to blow bubbles” (p. 6.)  The target was intoned using the 2 pitches and the intoning was accompanied the tapping of an electronic drum.

 

–  Unison: C and P produce the bisyllable target word together. Example:  C says: “Let’s say it together:  bubbles” (p. 6.) The target was intoned using the 2 pitches and the intoning was accompanied the tapping of an electronic drum.

 

–  Unison Fade: C says the first syllable of the bisyllable target word, cuing P to produce the whole target. Example:  C says: Again:  bu….”   (p. 6.) The target was intoned using the 2 pitches and the intoning was accompanied the tapping of an electronic drum.

 

–  Imitation: C models the target word and directs P to imitate. The target was intoned using the 2 pitches and the intoning was accompanied the tapping of an electronic drum. Example:

∞  C says: “My turn: bubbles.” (p. 6)

∞  C says: “You turn …..”  (p. 6)

 

–  Cloze: C elicits the independent production of the bisyllable target from P. Example: “Last time It’s fun to blow …..” (p. 6.).

 

  • Each session involved 15 bisyllable target words in which each was practiced 5 times before moving to the next target.

 

 

SPEECH REPETITION THERAPY  (SRT)

 

  • SRT used the same procedures at AMMT without the intoning and drumming.

 


Akbari & Davis (2018)

April 3, 2018

EBP THERAPY ANALYSIS for

Single Case Designs

NOTES: 

  • The summary of the intervention procedure(s) can be viewed by scrolling about two-thirds of the way down on this page. 

Key:

ASD =  Autism Spectrum Disorder

C = Clinician

EBP = evidence-based practice

F0 =  fundamental frequency

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PVSP =  Perceived performance on the Prosody-Voice Screening Profile

SLP = speech–language pathologist

WNL = within normal limits

 

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

 

REVIEWER(S):  pmh

 

DATE: March 22, 2018

 

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

 

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

                                                                                                           

 

  1. What was the focus of the research? Clinical

 

 

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

Level = D+   

                                                                                                           

 

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

 

 

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

 

–  How many Ps were involved in the study?  1

 

–  DESCRIBED CHARACTERISTICS

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

 

–  Were the communication problems adequately described?  Yes

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

–  Problems in the following aspects of prosody

         ∞  phrasing

         ∞  rate

         ∞  stress

    –   Voice quality was WNL.

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes

                

  • If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable (NA) 
  • Were any data removed from the study? No 

 

 

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

                                                                      

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

 

 

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

 

OUTCOMES

 

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

 

SUBJECTIVE OUTCOMES

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

 

OBJECTIVE OUTCOMES

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

 

 

–  Reliability data

 

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

–  F0

–  stressed syllable duration

– unstressed syllable duration

– stressed syllable intensity

– unstressed syllable intensity

 

 

  1. Results:

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

 

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

numbering as needed)

 

 

  1. What is the clinical significanceNo data provided.

 

  1. Was information about treatment fidelity adequate? No

 

 

  1. Were maintenance data reported?No

 

 

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

 

 

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

          – 24 spontaneous utterances

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

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

 

 

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

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION:  ASD; Children (Adolescence)

 

MODALITY TARGETED:  Expressive

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  voice quality

 

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

 

ADMINISTRATOR:  the second author

 

MAJOR COMPONENTS:

 

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

 

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

 

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

 

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

 

  • A summary of the 6 steps of the intervention:

 

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

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