Hoque (2008)

September 8, 2016

ANALYSIS GUIDELINES

Comparison Research

 

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

 

KEY:

 

ASD = Autism Spectrum Disorder

DS = Down syndrome

EI = early intervention

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

SOURCE: Hoque, M. E. (2008). Analysis of speech properties of neurotypicals and individuals diagnosed with autism and Down syndrome. Proceedings of the 10th International ACM SIGACCESS Conference on Computers and Accessibility (Assets ’08). ACM, New York, NY, USA, 311-312. ARTICLE: DOI=http://dx.doi.org/10.1145/1414471.1414554

 

REVIEWER(S): pmh

 

DATE: August 28, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: Not graded; this investigation was concerned with the nature of prosodic impairments in individuals diagnosed with Autism Spectrum Disorder (ASD) or Down syndrome (DS.)

 

TAKE AWAY: This brief report in conference proceedings of an investigation involving a small number of participants provides preliminary support for differential use of prosody among NT Ps, ASD Ps, and DS Ps. NT Ps exhibited longer speaking turns than ASD and DS peers and they were most likely to produce pause features that corresponded to typical pause strategies. DS Ps produced speech with higher energy values than DS or NT peers. In addition, ASD (but not DS Ps) and NT Ps produced the same number of rising and falling edges in conversation. However, both the ASD and DS Ps differed from the NT peers in their execution of rising and falling edges with NT Ps producing higher maximum. Interestingly, the DS Ps productions of edges also were higher than the ASD Ps.

 

 

  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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there were groups, were participants randomly assigned to groups? Not Applicable (NA)

 

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants (Ps)? NA

                                                                    

  • from administrators of experimental conditions? NA

                                                                    

  • from analyzers/judges? NA

                                                                    

 

  1. Were the groups adequately described? No

 

–   How many participants were involved in the study?

  • total # of Ps: 6
  • # of groups: 3
  • List names of groups and the number of Ps in each group:

     – Autism Spectrum Disorder (ASD) = 3

– Down syndrome (DS) = 1

– Neurotypical (NT) = 2

 

  • Did all groups maintain membership throughout the investigation? Yes, there was only one session.

                                                                                

– CONTROLLED CHARACTERISTICS—none described                 

 

– DESCRIBED CHARACTERISTICS

  • education of Ps: All ASD and DS Ps attended a nonprofit school that provided early intervention (EI) services to children with disabilities
  • severity of ASD: mild or moderate

 

– Were the groups similar? Unclear

                                                         

– Were the communication problems adequately described?

 

 

  1. What were the different conditions for this research?

                                                                                                             

– Subject (Classification) Groups? Yes

  • ASD
  • DS
  • NT

                                                               

– Experimental Conditions? No

 

–  Criterion/Descriptive Conditions? No

 

 

  1. Were the groups controlled acceptably?

 

 

  1. Were dependent measures appropriate and meaningful? Yes

                                                                                                             

– DEPENDENT MEASURES:

 

NOTE: The investigator noted that more than 50 features associated with segmental and suprasegmental aspects of speech were analyzed but only the following prosody related features are listed here

 

PITCH FEATURES

  • OUTCOME #1: Minimum pitch
  • OUTCOME #2: Maximum pitch
  • OUTCOME #3: Mean pitch
  • OUTCOME #4: Pitch standard deviation
  • OUTCOME #5: Absolute value of pitch
  • OUTCOME #6: Quantiles (pitch)
  • OUTCOME #7: Ratio between voiced and unvoiced frames

 

INTENSITY FEATURES

  • OUTCOME #8: Minimum intensity
  • OUTCOME #9: Maximum intensity
  • OUTCOME #10: Mean intensity
  • OUTCOME #11: Intensity standard deviation
  • OUTCOME #12: Quantiles (intensity)

 

RATE FEATURE

  • OUTCOME #13: Speaking rate

 

PAUSE FEATURES

  • OUTCOME #14: Number of pauses in an utterance
  • OUTCOME #15: Percent of Unvoiced Frames
  • OUTCOME #16: Number of voice breaks
  • OUTCOME #17: Maximum duration of pauses
  • OUTCOME #18: Average duration of pauses
  • OUTCOME #19: Total duration of pauses

 

DURATION FEATURE

  • OUTCOME #20: Average duration per turn

 

None of the dependent measures were subjective.

 

– All of the dependent measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers?  No

 

  • Intraobserver for analyzers? No

 

  • Treatment or administration fidelity for investigators? No

 

 

  1. Description of design:

 

  • Pairs of Ps engaged in a conversation while seated across from one another a table. Each conversational pair comprised one NT P and either one P with ASD or one P with DS. Each member of the pair was recorded separately.

 

  • The NT P selected a topic and each P’s speech was recorded onto its own channel.

 

  • More than 50 segmental and suprasegmental features were calculated from each of the recorded samples.

 

  • The investigator analyzed the data using feature mining algorithms. These algorithms were used to identify similarities and differences among the three P groups (ASD, DS, NT.)

 

  1. What were the results of the statistical testing?

 

– OUTCOMES (For the most part, the results are reported in feature grouping. The outcomes associated with each feature group are provided to assist in comprehensibility.)

 

PITCH FEATURES—Ps with ASD exhibited lower maximum falling and rising edges than the P with DS or the NT Ps.

  • OUTCOME #1: Minimum pitch
  • OUTCOME #2: Maximum pitch
  • OUTCOME #3: Mean pitch
  • OUTCOME #4: Pitch standard deviation
  • OUTCOME #5: Absolute value of pitch
  • OUTCOME #6: Quantiles (pitch)
  • OUTCOME #7: Ratio between voiced and unvoiced frames

 

INTENSITY FEATURES— Ps with DS exhibited higher intensity features than Ps with ASD or NT Ps.

  • OUTCOME #8: Minimum intensity
  • OUTCOME #9: Maximum intensity
  • OUTCOME #10: Mean intensity
  • OUTCOME #11: Intensity standard deviation
  • OUTCOME #12: Quantiles (intensity)

 

RATE FEATURE

  • OUTCOME #13: Speaking rate

 

PAUSE FEATURES—NT Ps used pauses more appropriately than Ps with either ASD or DS but ASD Ps produced a similar number of pauses as NT peers.

  • OUTCOME #14: Number of pauses in an utterance
  • OUTCOME #15: Percent of Unvoiced Frames
  • OUTCOME #16: Number of voice breaks
  • OUTCOME #17: Maximum duration of pauses
  • OUTCOME #18: Average duration of pauses
  • OUTCOME #19: Total duration of pauses

 

DURATION FEATURE

  • OUTCOME #20: Average duration per turn—The utterance durations of Ps with NT were longer than the durations of Ps with either ASD or DS.

 

PROSODIC FEATURES THAT WERE SIMILAR ACROSS THE GROUPS:

  • Speaking rate
  • Number of pauses per turn
  • Maximum duration of pauses

 

PROSODIC FEATURES THAT WERE DISSIMILAR ACROSS THE GROUPS:

  • Minimum pitch
  • Mean pitch
  • Maximum pitch
  • Mean intensity
  • Maximum intensity
  • Minimum intensity
  • Energy

 

(add additional outcomes as appropriate)

 

– What was the statistical test used to determine significance? Feature Mining Algorithm—Waikato Environment for Knowledge Analysis (WEKA)

 

– Were effect sizes provided? No

 

– Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results:  NA

 

 

  1. Summary of descriptive results: Qualitative research— NA

 

 

  1. Brief summary of clinically relevant results:
  • On average in conversations, NT Ps exhibited longer speaking turns than ASD and DS peers. The investigator noted that is supports the view that NT speakers tend to dominate conversations with ASD and DS partners.

 

  • NT speakers were most likely to produce pause features that corresponded to typical pause strategies.

 

  • On average in conversations, DS Ps produced speech with higher energy values than DS or NT peers. The investigators posited that this supports characterizations of DS speakers as being easily excited.

 

  • On average in conversations, ASD (but not DS Ps) and NT Ps produced the same number of rising and falling edges in conversation.

 

  • However, both the ASD and DS Ps differed from the NT peers in their execution of rising and falling edges with NT Ps producing higher maximum edges. Interestingly, the DS Ps also were higher than the ASD Ps. This corresponds with previous characterizations of ASD Ps.

 


Kargas et al. (2016)

August 9, 2016

ANALYSIS

Comparison Research

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

KEY:

 ADOS = Autism Diagnostic Observation Scale

ASD = autism spectrum disorders

eta =   partial eta squared

f = female

m = male

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

TD = typically developing

 

 

SOURCE: Kargas, N., López, B., Morris, P., & Reddy, V. (2016). Relations among detection of syllable stress, speech abnormalities, and communicative ability in adults with autism spectrum disorders. Journal of Speech, Language, and Hearing Research, 59, 206-215.

 

REVIEWER(S): pmh

 

DATE: August 4, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: No grade assigned. This investigation is concerned with aspects of prosody in a clinical population. Nevertheless, it has application to the clinical practice.

 

TAKE AWAY: The investigators compared adults diagnosed with autism spectrum disorders to typical peers on a task tapping the perception of syllable stress (primary speech perception). The results revealed that adults with ASD have significantly lower scores on the Syllable Stress Perception Task compared to TD peers, although perception varied markedly within the ASD group. Also, within the ASD group, poor stress perception was associated with increased speech production (i.e., stress, intonation, rate) problems but not communication/language problems.

 

 

  1. What type of evidence was identified?
  • What was the type of design? Comparison Research — Prospective, Nonrandomized Group Design

 

  • What was the focus of the research? Clinically Related

                                                                                                           

  • 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 experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? Yes, the Ps responses were collected on the computer.

 

 

  1. Were the groups adequately described? Variable

 

– How many participants were involved in the study?

 

  • total # of Ps:  42
  • # of groups: 2
  • List names of groups and the number of Ps in each group:

     – Autism Spectrum Disorders (ASD) = 21

– Typically Developing (TD) = 21

  • Did all groups maintain membership throughout the investigation? Yes, there was only one session

                                                                                

– CONTROLLED CHARACTERISTICS                                                  

  • age: adults
  • gender: 18m; 3f in each group
  • diagnosis of Ps with ASD: Asperger’s syndrome using Autism Diagnostic Observation Scale (ADOS)
  • psychiatric or developmental diagnosis of the TD group: Self report of no diagnosis of either of these problems.
  • Hearing: within normal limits based on audiometric testing

 

== DESCRIBED CHARACTERISTICS

  • age:

     – ASD = mean 30.3 years

     – TD = mean 29.5 years

  • gender:
  • cognitive skills:

     – ASD

  • mean Full range IQ = 109.5
  • mean Verbal IQ = 109.8
  • mean Performance IQ 107.2

     – TD

  • mean Full range IQ = 115.9
  • mean Verbal IQ = 113.9
  • mean Performance IQ = 114.2

 

– Were the groups similar? Yes

 

– Were the communication problems adequately described? No

 

 

  1. What were the different conditions for this research?

                                                                                                             

— Subject (Classification) Groups? Yes

  • Diagnosis (ASD, TD)

                                                               

— Experimental Conditions? Yes

  • performance of the Syllable Stress Perception Task (described below in item #9)

 

— Criterion/Descriptive Conditions? Yes

  • performance on Language and Communication Measure of the ADOS

 

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Was the dependent measure appropriate and meaningful? Yes

 

  • OUTCOME #1: The accuracy of responses on the Syllable Stress Perception Task

 

  • The dependent measure was NOT subjective.

 

  • The dependent measure WAS objective? Ps entered their responses into the computer

 

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? No _

 

Intraobserver for analyzers? No

 

– Treatment or test administration fidelity for investigators? No

 

 

  1. Description of design:

 

  • Testing for each Ps was accomplished during 3 hour individual sessions.
  • Prior to the Experimental Phase of the testing, an IQ test and the ADOS were administered.
  • The Experimental Phase included:

– tests were administered in a quiet room.

– practice with the Experimental Task.

– the administration of the Experimental Task — Syllable Stress Perception Task in which the P pressed a button via the computer indicating whether the words were same or different

  • The Syllable Stress Perception Task involved

– Ps individually listening to word pairs in which the same 4 syllable word was presented 2 times in one of the 4 following sets:

  • first syllable stressed for both versions (same)
  • first syllable stressed for 1 version, second syllable stressed for the other version (different)
  • second syllable stressed for both versions (same)
  • second syllable stressed for 1 version, first syllable stressed for the other version (different)

 

  • Statistical analyses controlled for overall IQ, Verbal IQ, and Performance IQ.

 

 

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

 

  • OUTCOME #1: The accuracy of responses on the Syllable Stress Perception Task

– Ps with ASD performed significantly more poorly on the Syllable Stress Perception Task than the TD Ps. The response was stable irrespective of whether the stress was on the first or second syllable.

– Response bias for providing “Same” or “Different” response was similar for the Ps with ASD and the TD group.

– The investigators explored whether there were previously unrecognized subgroups within the 2 major groups (ASD, TD.) They determined that the ASD group had significantly more poor performers (2 standard deviations below the group mean) than the TD group (33% vs 10.5%)

 

  • What statistical tests were used to determine significance? t-test, ANOVA, Chi square

 

  • Were effect sizes provided? No, for the most part.

 

  • Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results:

 

  • OUTCOME #1: The accuracy of responses on the Syllable Stress Perception Task

– Correlation between accuracy and communication quality:

  • Significant correlation between syllable stress perception accuracy and Speech Abnormalities score on the ADOS (i.e., atypical production of rate, stress, intonation; higher scores signify more problems) — r = – 0.75
  • The correlation between syllable stress perception accuracy and language communication score on the ADOS was not significant

 

 

  1. Summary of descriptive results: Qualitative research NA

 

 

  1. Brief summary of clinically relevant results:
  • Adults with ASD have significantly lower scores on the Syllable Stress Perception Task compared to TD peers, although perception varied markedly within the ASD group.
  • Within the ASD group, poor stress perception was associated with and increased speech production (i.e., stress, intonation, rate) problems.

 

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B

 

 

 

 

 


Ploog et al. (2013)

March 28, 2016

SECONDARY REVIEW CRITIQUE

 

 

KEY:

 

AS = Asperger Syndrome

ASD = autism spectrum disorders

C = clinician

CAT = computer-assisted technologies

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

TD = typically developing

 

 

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

 

Reviewer(s): pmh

 

Date: March 20, 2016

 

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

 

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

 

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

 

What type of secondary review? Narrative Systematic Review

 

  1. Were the results valid? Yes

 

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

 

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

 

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

 

  • Did the sources involve only English language publications? Yes

 

  • Did the sources include unpublished studies? No

 

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

 

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

 

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

 

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

 

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

 

  • Were interrater reliability data provided? No

 

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

 

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

 

  • Were assessments of sources sufficiently reliable? Unclear

 

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

 

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

 

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

 

 

  1. Description of outcome measures:

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

 

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

 

 

  1. Description of results:

 

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

 

– Summarize overall findings of the secondary research:

 

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

 

Outcome #1: Improved recognition of prosodic affect

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

– Were the results in the same direction? Yes

 

– Did a forest plot indicate homogeneity? NA

 

– Was heterogeneity of results explored? No

 

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

– Were negative outcomes noted? Yes

 

                                                                                                                   

  1. Were maintenance data reported? No

 

 

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

 

 

SUMMARY OF INTERVENTIONS

 

NOTE:

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

 

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

 

Prosodic Targets: prosodic affect and sarcasm/metaphors

 

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

 

Description of Procedure #1— Mind Reading Software

 

  • CAT involving voice, facial cues, and photos.

 

Evidence Supporting Procedure #1—Mind Reading Software

 

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

 

Description of Procedure/Source #2— What to Choose

 

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

 

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

 

  • Feedback was provided to the P.

 

Evidence Supporting Procedure/Source #2—What to Choose

 

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

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

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

 

Evidence Contraindicating Procedure/Source #2 — What to Choose

 

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

Yashim et al. (2015)

February 5, 2016

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

 

NOTE: To view the Summary section, scroll down about ½ way.

 

ANALYSIS

 

KEY
C = clinician

Mobile app = mobile application

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

Source: Yashim, N. M. K. M., Mustafa/Dain, W. B., Isa, R., & Manaf. N. R. (2015). Mobile application can be treated authistic (sic) children. Paper: DOI: 10.13140/RG2.1.3041.6085   or https://www.researchgate.net/publication/283205478_MOBILE_APPLICATION_CAN_TREATED_AUTHISTIC_CHILDREN

 

Reviewer(s):  pmh

 

Date: February 5, 2016

 

Overall Assigned Grade :  No Grade.  This is expert opinion; the authors did not claim to provide evidence.

 

Level of Evidence:  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 provide a brief description of SpeechPrompts™ which is a mobile app that can be used in speech therapy and in treating prosody.

 

 

  1. Was there a review of the literature supporting components of the intervention? Yes. Narrative Review and brief summaries of 3 mobile applications (mobile apps.)

 

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Not Applicable (NA)

 

 

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

 

 

  1. Did the author(s) provide a rationale for components of the intervention? Yes. The review led the readers to a brief discussion of the the feasibility of mobile apps.

 

  1. Description of outcome measures:

 

  • Are outcome measures suggested? No. The discussion was general rather than specific in nature.

 

 

  1. Was generalization addressed? No

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

NOTE:  The authors briefly summarized the nature and history of autism and several interventions. They then summarized but did not critique three mobile apps that have can be used with children diagnosed with autism spectrum disorders (ASD.) The authors’ summaries included prosody in only one of the 3 apps (iPrompts® PRO.) It will be described below.

 

 

PURPOSE: To improve prosody

 

POPULATION:  ASD; Children

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: Prosody– general

 

ELEMENTS OF PROSODY USED AS INTERVENTION (list only if prosody is being used as a treatment technique with a nonprosodic outcome):

 

MAJOR COMPONENTS:

 

  • The authors summarized (but did not critique) 3 mobile apps that have potential for use with children with ASD:

– Look at Me

– iPrompts®Pro

– AAC Speech Buddy

 

  • In the summaries, the authors only noted that iPrompts®Pro included prosody as a focus. Therefore, only iPrompts®Pro will be summarized below.

 

iPrompts®Pro

 

  • This app contains 3 separate apps. Again, only one of the 3 apps is directly concerned with prosody

 

– iPrompts®Pro — potential for developing schedules, video modeling

– StoryMaker™ — for developing Social Stories™

– SpeechPrompts™ — for speech therapy, including prosody

 

Although the authors did not provide a no critique of SpeechPrompts™, their summary alerts clinicians to an app that is concerned with prosody intervention.

 

 


Diehl & Paul (2013)

July 18, 2015

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

 

ASD = Autism spectrum disorders

CA = chronological age

LD = Learning disability

NA = not applicable

P = participant(s)

PEPS-C = Profiling Elements of Prosodic Systems in Children

pmh = Patricia Hargrove, blog developer

SD = standard deviation

SS = Standard Score

TD = typically developing

 

 

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

 

REVIEWER(S): pmh

 

DATE: July 11, 2015

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

 

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

 

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

 

INSIGHTS ABOUT PROSODY:

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

 

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

                                                                    

  • The matching strategy involved

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

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

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

                                                                    

 

  1. Were the groups adequately described? Yes

How many participants were involved in the study?

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

– TD (Typically developing)

– LD (Learning disability)

– ASD (Autism spectrum disorder)

  • # of participants in each group:

– TD = 22

– LD = 16

– ASD = 24

 

The following variables were CONTROLLED

 

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

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

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

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

– The following variables were DESCRIBED

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

– Communication disorder descriptions:

 

ASD

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

  • ranged from 67-132
  • mean was 97.21

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

  • ranged from 58-121
  • mean was 93.67

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

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

LD

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

  • ranged from 60-117
  • mean was 88.94

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

  • ranged from 58-119
  • mean was 88.73

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

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

 

  1. What were the different conditions for this research?

                                                                                                             

– Subject (Classification) Groups? Yes

  • There were 3 subject groups:

     – ASD

     – LD

     – TD

                                                               

– Experimental Conditions? No

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

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

 

The dependent measures were

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

 

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

 

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

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

 

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

 

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

 

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

 

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

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

 

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

 

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

The dependent measures that were subjective were

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

–   The dependent/ outcome measures that were objective are

 

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

– average f0

– f0 variability/range

– f0 standard deviation

– intensity of utterance

– duration of utterance

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

– average f0

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

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

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

 Intraobserver for analyzers? No

 

– Treatment/Procedural fidelity for investigators? No

 

 

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

– ASD

– LD

– TD

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

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

– acoustic analysis of the production subtests.

  • The acoustic analyses comprised:

– average f0

– standard deviation of f0

– f0 range

– utterance duration

– utterance intensity

 

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

– The comparisons are significant presented with p ≤ 0.05.

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

– average f0

– f0 standard deviation:

– f0 variability/range

– intensity of utterance

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

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

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

– f0 standard deviation:

– f0 variability/range:

– intensity of utterance

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

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

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

– f0 standard deviation:

– f0 variability/range

– intensity of utterance

– duration of utterance

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

– average f0

– f0 standard deviation:

– f0 variability/range

– intensity of utterance

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

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

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

– f0 standard deviation:

– f0 variability/range

– intensity of utterance

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

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

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

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

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

– f0 standard deviation

– f0 variability/range

– intensity of utterance

– duration of utterance

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

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

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

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

– intensity of utterance

– duration of utterance

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

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

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

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

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

– duration of utterance

 

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

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

– Were confidence intervals (CI) provided? No

 

 

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

 

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

 


Russo et al. (2008)

June 30, 2015

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

 

ASD = Autism spectrum disorders

fo = fundamental frequency

H2 = second harmonic

NA = not applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

TD = typically developing

WNL = within normal limits

 

 

SOURCE:  Russo. N. M., E. Skoe, E., Trommer, B., Nicol, T., Zecker, S., Bradlow, N., Kraus, N. (2008). Deficient brainstem encoding of pitch in children with Autism Spectrum Disorders. Clinical Neurophysiology, 119, 1730-1731.

 

REVIEWER(S): pmh

 

DATE: June 21, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: B+ (The highest grade for this investigation, based on its design, is B+.)

 

POPULATION: Autism Spectrum Disorders (ASD)

 

PURPOSE: To investigate the subcortical responsiveness to prosody in children with ASD.

 

INSIGHTS ABOUT PROSODY:

  • The ability of children with ASD to encode pitch less was accurate/preserved and less robust than typically developing (TD) peers.
  • However, subgroup analysis of the ASD group revealed that a small group of children with ASD (i.e., ASD OUT) accounted for the poor pitch encoding scores.
  • The ASD OUT group included 5 Ps (about 20% of the overall ASD group) and they exhibited more Frequency and Slope errors as well as reduced pitch locking.

 

 

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

 

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

                                                                    

  • The participants (Ps) were matched by age.
  1. Was participants’ communication status concealed?

                                                                                                           

  • from participants? No
  • from assessment administrators? No
  • from data analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

– How many participants were involved in the study?

  • total # of participants: originally there were 48 Ps but 6 Ps with ASD were eliminated due to abnormal brainstem responses (click evoked brainstem responses –atypical Wave V latency), noncompliance, parental choice, and/or relocation; the working total of Ps was 42
  • was group membership maintained throughout the experiment? 6 Ps withdrew/were eliminated from the investigation, as noted above
  • # of groups: 2
  • List names of groups: Autism Spectrum Disorders (ASD), typically developing (TD)
  • # of participants in each group: ASD = 21; TD = 21

                                                                                

– Characteristics of Ps:

CONTROLLED                                                                                           

  • age: 7 to 13 years
  • cognitive skills: Full scale IQ In which with the confidence intervals, the value is >80
  • hearing: within normal limits (WNL)
  • diagnosis: for the Ps with ASD, diagnosis by neurologist/psychologist and actively followed
  • neurological problems: lack of confounding neurological problems

 

DESCRIBED

  • age: mean age ASD = 9.9; mean age TD = 9.95 (no significant difference)
  • gender: ASD = 19m, 2f; TD = 13m, 8f
  • cognitive skills: for both groups the mean was WNL, although TD Ps scored significantly higher
  • expressive language: mean scores on the core portion of the Clinical Evaluation of Language Fundamentals were WNL, although TD Ps scored significantly higher
  • receptive language: mean scores on the receptive portion of the Clinical Evaluation of Language Fundamentals were WNL, although TD Ps scored significantly higher
  • overall language skills: mean scores of the core Clinical Evaluation of Language Fundamentals were WNL, although TD Ps scored significantly higher
  • diagnoses of Ps with ASD: parent reported the following specific diagnoses– autism, Asperger Disorder, PDD-NOS, combined diagnoses
  • supplemental observations by investigators of Ps with ASD: Ps displayed some or all of the following

   – limited eye contact

   – limited reciprocity

   – restricting range of topics in conversation

   – use of restricted or idiosyncratic language

   – abnormal prosody

   – echolalia or scripted speech

   – stereotyped movements

 

Were the communication problems adequately described? Yes, but I would have liked to see a description of the communication scores of ASD OUT versus ASD IN Ps.

  • disorder type: ASD
  • functional level: observations by investigators of Ps with ASD revealed that Ps displayed some or all of the following:

– limited eye contact

– limited reciprocity

– restricting range of topics in conversation

– use of restricted or idiosyncratic language

– abnormal prosody

– echolalia or scripted speech

 

  1. What were the different conditions for this research?
  • Subject (Classification) Groups? Yes: ASD, TD
  • Experimental Conditions? No
  • Criterion/Descriptive Conditions? Yes: passively evoked brainstem responses to

     – click evoked brainstem responses

     – speech evoked brainstem responses– speech syllables with descending and ascending pitch contours

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

– The dependent measures were

  • Dependent Measure #1: Wave V latency within the normal range (this was actually an exclusionary criterion; 2 Ps with ASD were excluded from the original 48 Ps)
  • Dependent Measure #2: Rate of frequency errors (an accuracy measure of encoding) for fo (fundamental frequency) and H2 (second harmonic)
  • Dependent Measure #3: Rate of slope error (a measure of preservation of the pitch contour) for fo (fundamental frequency) and H2 (second harmonic)
  • Dependent Measure #4: Rate of pitch strength (a measure of periodicity) for fo (fundamental frequency)
  • Dependent Measure #5: Composite score of overall pitch tracking (frequency errors of fo plus frequency errors and pitch strength of H2)
  • Dependent Measure #6: Relationship of age, sex, and intelligence on brainstem responses

None of the dependent measures that were subjective.

 

– All of the dependent/ outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No
  • Intraobserver for analyzers? No
  • Treatment/Procedural fidelity for investigators? No
  • Test/Retest Reliability? Yes. Six Ps with ASD were retested. There were no significant differences in the first and second administrations of the protocol using nonparametric statistical analysis. Accordingly, the Ps responses were judged to be stable and reliable.

 

 

  1. Brief description of design:
  • The investigators compared Ps with ASD and TD peers on series of measures representing the subcortical processing of prosody using passively evoked brainstem responses.
  • Ps watched a video of their choice as the experimental stimuli were delivered to the right ear. The investigators instructed the Ps to ignore the sounds in their right ear.
  • Two sets of stimuli were presented:

– clicks (these were part of the exclusion criteria. Ps with abnormal Wave V latency were excluded from the investigation)

– speech (a single syllable [ya] with ascending and descending pitch contours)

  • The investigators compared the TD and ASD groups on the dependent measures using parametric statistics.
  • They then performed follow up with an statistical analysis of the ASD group (using nonparametrics) in which they identified two subgroups: ASD OUT and ASD IN.

 

 

  1. What were the results of the inferential statistical testing

 

– The comparisons that are significant are p ≤ 0.05.

NOTE: For several of the dependent measure, there were 2 sets of comparisons:

  • ASD vs TD and
  • a subgroup analysis for the ASD Ps — ASD OUT (n = 5) vs ASD IN (n = 16.)

The subgroups of ASD were classified on the basis of performance on the composite score (Dependent measure #5.) The ASD OUT group (i.e., deficient pitch trackers) had composite scores that were <1.65 standard deviations from the overall ASD mean composite score. The ASD OUT group comprised

– 3 Ps with Asperger Disorder

– 1 P with PDD-NOS

– 1 P with ASD with Sensory Integration Disorder

  • Dependent Measure #1: Wave V latency within the normal range (this was actually an exclusionary criterion)— no significant differences between ASD and TD groups, although 2 Ps with were eliminated from the investigation;

 

  • Dependent Measure #2: Rate of frequency errors (an accuracy measure of encoding) for fo (fundamental frequency) and H2 (second harmonic)

For fo, the overall ASD group was significantly less accurate than the TD group.

     — For H2, the overall ASD group was significantly less accurate than the TD group.

   — Reanalysis of the data with the ASD subgroups revealed that for fo and for H2, the ASD IN performed similarly to the TD group but that the ASD OUT group differed significantly more poorly than the TD group and the ASD IN subgroup.

 

  • Dependent Measure #3: Rate of slope error (a measure of preservation of the pitch contour) for fo (fundamental frequency) and H2 (second harmonic)

— For fo, no significant differences between ASD and TD groups.

   — For H2, no significant differences between ASD and TD groups.

  • Dependent Measure #4: Rate of pitch strength (a measure of periodicity) for fo (fundamental frequency)

For fo, the ASD group yielded significantly higher scores than the TD group.

   — Reanalysis of the data with the ASD subgroups revealed that for fo, the ASD IN performed similarly to the TD group but that the ASD OUT group differed significantly from TD and the ASD IN subgroup.

  • Dependent Measure #5: Composite score of overall pitch tracking (frequency errors of fo plus frequency errors and pitch strength of H2)

— Overall, the TD group was significantly better than the ASD group.

 

  • Dependent Measure #6: Relationship of age, sex, and intelligence on brainstem responses

— Overall, Ps in the ASD group had significantly poorer scores than the TD group on measures of language skills (CELF) and most measures of intelligence with the exception of performance mental skills.

     — For the ASD subgroups, there were no significant differences on the measures of language and intelligence.

– What were the statistical tests used to determine significance? MANOVA, Mann-Whitney U, Kruskal-Wallis, and Chi square.

– Were effect sizes provided? Yes, but only for some of the measures. If an effect size is not listed for a dependent measure, it was not provided in the paper.

  • Dependent Measure #2: Rate of frequency errors (an accuracy measure of encoding) for fo (fundamental frequency) and H2 (second harmonic)

— For fo, the effect size for ASD vs TD scores was d = 0.61 (moderate)

     — For H2, the effect size for ASD vs TD scores was d = 0.73 (moderate)

  • Dependent Measure #4: Rate of pitch strength (a measure of periodicity) for fo (fundamental frequency)

— For fo, the effect size for ASD vs TD scores was d = 0.56 (moderate)

  • Dependent Measure #5: Composite score of overall pitch tracking (frequency errors of fo plus frequency errors and pitch strength of H2)

– Were confidence interval (CI) provided? No

 

 

  1. What were the results of the correlational statistical testing?
  • Dependent Measure #6: Relationship of age, sex, and intelligence on brainstem responses

– For the overall ASD group and the ASD IN subgroup, significant differences were not noted for the following

  • pitch tracking and measures of intelligence
  • pitch tracking and language measures (CELF)

     – Correlational analysis could not be performed with the data for the ASD OUT subgroup due to the small n.

  • What was the statistical test used to determine correlation? Pearson Product

Khetrapal (2009)

June 2, 2015

SECONDARY REVIEW CRITIQUE

 

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

 

 

KEY:

ASD = Autism Spectrum Disorder

NA = not applicable

P = Participant(s)

pmh = Patricia Hargrove

 

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

 

 

Reviewer(s): pmh

 

Date: May 28, 2015

 

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

 

Level of Evidence: D

 

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

 

 

What type of secondary review?  Narrative Review

 

 

  1. Were the results valid? Yes

 

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

 

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

 

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

 

  • Did the sources involve only English language publications? Yes

 

  • Did the sources include unpublished studies? No
  • Was the time frame for the publication of the sources sufficient? Yes
  • Did the reviewers identify the level of evidence of the sources? No
  • Did the reviewers describe procedures used to evaluate the validity of each of the sources? No
  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources? No
  • Did the reviewers or review teams rate the sources independently? No
  • Were interrater reliability data provided? No
  • If the reviewers provided interrater reliability data, list them: NA

 

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

 

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

 

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

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

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

 

 

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

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

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

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

 

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

 

  1. Were negative outcomes noted? No

           

                                                                                                                   

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

 

 

  1. Were generalization data reported? No

 

 

SUMMARY OF INTERVENTION

Population: Autism Spectrum Disorders

 

Prosodic Targets: Affective Prosody

Description of Procedure—Music Therapy

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

 

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

 

Evidence Supporting MT

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

 

 

Evidence Contraindicating MT

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