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


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

 

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


Patel et al. (2020)

March 28, 2020

 

ANALYSIS

Comparison Research

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

KEY:

ADOS = Autism Diagnostic Observation Scale

BAP = Broad Autism Phenotype

eta = partial eta squared

f = female

F0 = fundamental frequency

m = male

MLU = mean length of utterance

MPAS = Modified Personality Assessment Schedule (MPAS)

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

PSA = Pragmatic Rating Scale

PSA-SA = Pragmatic Rating Scale-School Age

SD = standard deviation

SLP = speech-language pathologist

 

SOURCE:  Patel, S. P., Nayer, K., Martin, G. E., Franich, K., Crawford, S., Diehl, J. J., & Losh, M. (2020). An acoustic characterization of prosodic differences in autism spectrum disorder and first-degree relatives. Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-020-04392-9

REVIEWER(S):  pmh

 

DATE:  March 19, 2020

 

ASSIGNED GRADE FOR OVERALL QUALITY:  Not Applicable (NA). No grade was assigned because this investigation did not deal with intervention.

 

TAKE AWAY:  This investigation explored the acoustic characteristics of communication of children with autism spectrum disorders (ASD) and their parents by comparing them to neurotypical peers and their parents. Significantly slower speaking rate was observed in both the participants with ASD and their parents.

 

  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 = C+

                                                                                                           

  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?  Unclear

     –  The chronological age of the children with ASD and their neurotypical peers was not significantly different. However, there were significant difference for the following measures

∞ Full scale IQ

∞ Verbal IQ

∞ Performance IQ

∞ male to female ratio

–  The ASD parent group and the Parent control group differed significantly on the following measures

∞ Chronological age (the ASD parent group was older)

∞ Verbal IQ

                                                                    

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

                                                                    

  1. Were the groups adequately described? Yes

   How many participants were involved in the study?

  • total # of Ps: 238
  • # of groups: 4
  • List names of groups and the number of Ps in each group:

     – ASD Group = 55

– ASD Control Group (neurotypical) = 39

– ASD Parent Group = 96

– Parent Control Group = 48

  • Did all groups maintain membership throughout the investigation? Yes, but data from one adolescent and one parent were discarded due to poor quality of the recordings.

 

CONTROLLED CHARACTERISTICS                                                     

  • Diagnosis:

     – ASD Group = all diagnosed with ASD and confirmed

     – ASD Control Group and Parent Control Group = ASD ruled out for all Ps and no family history (1stand 2nd degree relatives) of ASD or related genetic disorders, dyslexia,

  • Other Diagnoses:

     – All Ps = no history of brain injury, major psychiatric disorders, genetic disorders, neurotypical development

 

DESCRIBED CHARACTERISTICS

  • age:

     – ASD Group:  mean = 16.6

     – ASD Control Group:  mean = 19

     – ASD Parent Group:  mean = 46.7

     – Control Parent Group:  mean = 43

  • gender:

    – ASD Group:  45m; 10f

     – ASD Control Group: 19m; 20f

     – ASD Parent Group:  38m; 58f

     – Control Parent Group: 20m; 28f

  • cognitive skills:

     – ASD Group:

∞ mean Full scale IQ = 104.2

∞ mean Verbal IQ = 105.1

∞ mean Performance IQ =  102.9

     – ASD Control Group:

∞ mean Full scale IQ = 115.5

∞ mean Verbal IQ = 117.5

∞ mean Performance IQ = 111.1

     – ASD Parent Group:

∞ mean Full scale IQ = 111.1

∞ mean Verbal IQ = 109.4

∞ mean Performance IQ = 110.4

     – Control Parent Group:

∞ mean Full scale IQ = 114.8

∞ mean Verbal IQ = 111.2

∞ mean Performance IQ = 115.1

 

  • Were the groups similar?Unclear  
  • Were the communication problems adequately described?No 
  • disorder type: Autism Spectrum Disorder (ASD)

 

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

     – ASD Group:

     – ASD Control Group:

     – ASD Parent Group:

     – Control Parent Group:

  • Experimental Conditions? No  x_____     Unclear ____, there was only one condition in which the speech samples were elicited– Narratives
  • Criterion/Descriptive Conditions?Yes

Acoustic Measures: mean, standard deviation (SD), and range of the fundamental frequency (F0) for each utterance, utterance final F0 excursion size (F0 range of the final word0 of each utterance; rate (syllables per second including within utterance pauses); Normalized Pairwise Variability Index (nPVI, for rhythm)

     –  Clinical Behaviors (for Correlations):

–  Broad Autism Phenotype (BAP) Characteristics—Modified Personality Assessment Schedule (MPAS)

–  Pragmatic Language Ability — Pragmatic Rating Scale (PSA) Pragmatic Rating Scale-School Age (PSA-SA)

–  Perceptual Judgments: rating on a 11-point Likert Scale for each of the following

–  Intonation

–  Rate

–  Rhythm

–  Likelihood the speaker had ASD

 

  1. Were the groups controlled acceptably?  Yes

 

  1. Were dependent measures appropriate and meaningful? Yes

 

ACOUSTIC MEASURES

  • OUTCOME #1: Mean F0 for each utterance selected from a narrative sample
  • OUTCOME #2: Mean utterance final F0 excursion size for each utterance selected from a narrative sample
  • OUTCOME #3: SD of the F0 for each utterance selected from a narrative sample
  • OUTCOME #4: Range of the F0 for each utterance selected from a narrative sample
  • OUTCOME #5: Speech rate from a narrative sample
  • OUTCOME #6: nPVI from a narrative sample

 

CLINICAL BEHAVIORAL MEASURES

  • OUTCOME #7: Rating as BAP+ or BAP- on the basis of P performance on the MPAS scales of Social, Rigid, or Untactful Traits
  • OUTCOME #8: Performance on the Autism Diagnostic Observation Scale (ADOS)
  • OUTCOME #9: Performance on the Pragmatic Rating Scale (PSA) or the Pragmatic Rating Scale-School Age (PSA-SA)

 

PERCEPTUAL MEASURES

  • OUTCOME #10: Rating of intonation of utterances selected from the narrative
  • OUTCOME #11: Rating of rhythm of utterances selected from the narrative
  • OUTCOME #12: Rating of rate of utterances selected from the narrative
  • OUTCOME #13: Rating of likelihood the speaker had been diagnosed with ASD

 

LANGUAGE MEASURE

  • OUTCOME #14: Utterance length (number of syllables per utterance)

 

—  The following outcomes measures are subjective:

CLINICAL BEHAVIORAL MEASURES

  • OUTCOME #7: Rating as BAP+ or BAP- on the basis of P performance on the MPAS scales of Social, Rigid, or Untactful Traits
  • OUTCOME #8: Performance on the Autism Diagnostic Observation Scale (ADOS)
  • OUTCOME #9: Performance on the Pragmatic Rating Scale (PSA) or the Pragmatic Rating Scale-School Age (PSA-SA)

 

PERCEPTUAL MEASURES

  • OUTCOME #10: Rating of intonation of utterances selected from the narrative
  • OUTCOME #11: Rating of rhythm of utterances selected from the narrative
  • OUTCOME #12: Rating of rate of utterances selected from the narrative
  • OUTCOME #13: Rating of likelihood the speaker had been diagnosed with ASD

 

LANGUAGE MEASURES

  • OUTCOME #14: Utterance length (number of syllables per utterance)

 

–  The following outcomes are objective measures:

ACOUSTIC MEASURES

  • OUTCOME #1: Mean F0 for each utterance selected from a narrative sample
  • OUTCOME #2: Mean utterance final F0 excursion size for each utterance selected from a narrative sample
  • OUTCOME #3: SD of the F0 for each utterance selected from a narrative sample
  • OUTCOME #4: Range of the F0 for each utterance selected from a narrative sample
  • OUTCOME #5: Speech rate from a narrative sample
  • OUTCOME #6: nPVI from a narrative sample

 

  1. Were reliability measures provided?

   Interobserver for analyzers?  Yes _x__     No  ___      Unclear  ____

CLINICAL BEHAVIORAL MEASURES

  • OUTCOME #7:Rating as BAP+ or BAP- on the basis of P performance on the MPAS scales of Social, Rigid, or Untactful Traits—Inter-rater reliability 81%
  • OUTCOME #8:Performance on the Autism Diagnostic Observation Scale (ADOS)
  • OUTCOME #9: Performance on the Pragmatic Rating Scale (PSA) or the Pragmatic Rating Scale-School Age (PSA-SA) —Inter-rater reliability 86% and 76%, respectively

 

–  Intraobserver for analyzers?

–  Treatment or test administration fidelity for investigators?  No

 

  1. Description of design:
  • A total of 238 Ps representing the following groups the ASD Group, ASD Control Group, ASD Parent Group, and Control Parent Group participated in the investigation.
  • The investigators administered the MPAS and the PRS or the PRS-SA to all the Ps. In addition, the investigator elicited narrative language samples from which they measured selected utterances acoustically and perceptually.
  • The data were analyzed using inferential and correlational statistics including regression analysis.

 

 

 

 

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

 

10a  List comparisons that are significant  (e.g.,  p ≤ 0.05).  For each outcome, list any significant difference among comparisons or in the case of the use of descriptive statistics only, list any notable differences or trends. Note if you do not use ≤ 0.05 as your criterion.

 

Start on page BAP GROUP DIFFERENCES. Id bap in description of design

 

 

ACOUSTIC MEASURES

  • OUTCOME #1: Mean F0 for each utterance selected from a narrative sample—ASD Parent Group was significantly lower than Parent Control Group; mothers in the Parent ASD group were significantly lower than mothers in Parent Control Group
  • OUTCOME #2: Mean utterance final F0 excursion size for each utterance selected from a narrative sample—overall ASD Group produced a larger change; male ASD Ps produced a larger change than male ASD Controls
  • OUTCOME #3: SD of the F0 for each utterance selected from a narrative sample
  • OUTCOME #4: Range of the F0 for each utterance selected from a narrative sample—ASD Parent Group was significantly higher than Parent Control Group; mother in ASD Parent Group had significantly larger range than mother in the Parent Control Group
  • OUTCOME #5: Speech rate from a narrative sample —Overall ASD Group produced slower; male ASD Ps produced slower rate than ASD Controls; ASD Parent group showed more slowing as the utterance length increasd (Outcome 14)
  • OUTCOME #6:nPVI from a narrative sample

 

CLINICAL BEHAVIORAL MEASURES

  • OUTCOME #7:Rating as BAP+ or BAP- on the basis of P performance on the MPAS scales of Social, Rigid, or Untactful Traits
  • OUTCOME #8:Performance on the Autism Diagnostic Observation Scale (ADOS)
  • OUTCOME #9: Performance on the Pragmatic Rating Scale (PSA) or the Pragmatic Rating Scale-School Age (PSA-SA)

 

PERCEPTUAL MEASURES

  • OUTCOME #10:Rating of intonation of utterances selected from the narrative—ASD Ps were rated significantly more poorly than the ASD Control Ps;
  • OUTCOME #11:Rating of rhythm of utterances selected from the narrative
  • OUTCOME #12:Rating of rate of utterances selected from the narrative—rate and the likelihood the P had ASD (Outcome 13) most significantly predicted the diagnosis of ASD

 

  • OUTCOME #13:Rating of likelihood the speaker had been diagnosed with ASD—Expert listeners were more likely to accurately identify Ps from the ASD Group as having ASD; nonexpert listeners did not do this; this outcome and rate perception (Outcome 12 ) most significantly predicted the diagnosis of ASD

 

LANGUAGE MEASURES

  • OUTCOME #14:Utterance length (number of syllables per utterance). ASD Parent group showed more slowing (Outcome 5)  as the utterance length increased

 

 

 

 

 

 

  • OUTCOME #1:
  • OUTCOME #2:
  • OUTCOME #3:

 

(add additional outcomes as appropriate)

 

10b  What was the statistical test used to determine significance?  Place xxx after any inferential statistical test used in the investigation.

  • t-test:
  • ANOVA:
  • MANOVA:
  • Tukey: xxxx
  • Mann-Whitney U:
  • Wilcoxan:
  • Regression Analysis xxxx
  • . Kappa Values xxxx

 

10c  Were effect sizes provided?

Yes ____  No__x__

If yes, provide data and interpretation for any outcome with effect size results.

Interpretation Hints:

–  Cohen’s (1988) guidelines for interpreting standardized mean difference: d =  .20 small treatment effect; d = .50 moderate treatment effect; d =  .80 large treatment effect

–  for partial eta squared (eta):  .01 small, .06 is medium, and .14 is large.

 

  • OUTCOME #1:
  • OUTCOME #2:
  • OUTCOME #3:

 

(add additional outcomes as appropriate)

 

10d  Were confidence interval (CI) provided?  Yes ___          No __x__

 

10e  If the answer to 10d was yes, list the dependent measure (from item 7a) associated with the reported confidence interval (CI):

  • 98% CI:
  • 95% CI:
  • 90%
  • Other (List CI%):

 

 

  1. Summary of correlational results: for the most part these appeared to be the Pearson correlations. xxx

  –  For any outcomes associated with correlational statistics, list the following:

  • The name of the correlational test
  • The correlational data
  • The interpretation of the correlation

 

  • The following associations were significantly correlated:

  –  F0 variability [SD of F0 (Outcome 3) and FO utterance final excursion (Outcome 2)] with

     ∞  perceived intonation (Outcome 10)

     ∞  perceived rhythm (Outcome 11)

     ∞  perceived rate (Outcome 12)

  –  range of F0 (Outcome 4) with perceived intonation (Outcome 10)

  –  rate of speech (Outcome 5) with perceived rate (Outcome 12) and perceived

rhythm (Outcome 11)

  –  A subgroup of ASD Parents, labeled BAP+, presented with a significant interaction between speaking rate and utterance length. The BAP+ subgroup of ASD Parents differed significantly from the Parent Control Group. (BAP+ , or Broad Autism Phenotype, was determined by parents’ performance on subtests of the MPAS indicating the presence of the following traits: socially reticent, rigid and untactful.)

 

  –  The following associations between acoustic measures, severity of ASD, and pragmatics were found to be significant:

        ∞  in the ASD Group

  • decreased rate of speech with (1) overall severity, (2) severity of social symptom, (3) greater impairment on the Theory of Mind on the PSA-SA
  • greater impairment on the Theory of Mind on the PSA-SA with (1)  decreased rate of speech, (2) increased F0 range

 

        ∞  in the ASD Control Group

  •   increased F0 ranges with (1) greater impairment on the Theory of Mind on the PSA-SA, (2) greater impairment on suprasegmental on the PSA-SA
  • decreased rate of speech with increased score on the ADOS
  • F0 excursion with (1)  the severity of restrictive and repetitive behaviors, especially in males, (2) increased language impairment as measured by the PSA-SA

 

        ∞  in the ASD Parent Group

  • increased  nPVI was correlated with overall pragmatic violations on the PSA (such as overly detailed, tangential)
  • decreased F0 ranges was correlated with pragmatic violations on the PSA (such as lack of reciprocity, vaguness), especially in mothers

 

 

START WITH ASD PARENTS AND PARENT CONTROL

  1. Summary of descriptive results: Qualitative research.  NA

 

 

DIRECTIONS:

–  Complete this item only if the investigation was solely or primarily Qualitative in nature.

–  List the finding associated with each of the outcomes listed in item 7a.

 

  • OUTCOME #1:
  • OUTCOME #2:
  • OUTCOME #3:

 

(add other outcomes as appropriate)

 

 

  1. Brief summary of clinically relevant results:

 

  • The following acoustic measure may differentiate individuals with ASD and neurotypical peers as well as the subgroup of BAP from the Parent Control Group: the rate of speech (slower).

 

  • Mother of children with ASD who were labelled as BAP displayed mean and range differences in F0:

–  decreased F0 mean

–  wider F0 range

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: ___NA__

 

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

 


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.

 


Kuschke et al. (2016)

January 31, 2017

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 disoders

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PVS = Prosodically Varied Speech

SLP = speech–language pathologist

 

SOURCE: Kuschke, S., Vinck, B. & Geertsema, S. (2016.) A combined prosodic and linguistic treatment approach for language-communication skills in children with autism spectrum disorders: A proof-of-concept study. South African Journal of Childhood Education, 6(1), a290. http://dx.doi. org/10.4102/sajce.v6i1.290

 

REVIEWER(S): pmh

 

DATE: January 28, 2016

 

ASSIGNED OVERALL GRADE: D (This grade is not a judgment of the quality of the intervention. Rather, this grade reflects the quality of the evidence supporting the intervention. For this investigation, the highest possible grade associated with the design, Case Studies, is a D+.)

 

TAKE AWAY: This preliminary investigation into the effectiveness of a linguistic-prosodic intervention with South African children diagnosed with autism spectrum disorders (ADS) revealed that a short dose of therapy was associated with improvement in listening, pragmatic, and social interaction outcomes.

                                                                                                                       

 

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

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Case Studie – 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. Were the participants (Ps) adequately described? Yes

 

–  How many Ps were involved in the study? 3

 

–  CONTROLLED CHARACTERISTICS:

  • age: 6:0 to 8:11
  • diagnosis of ASD: based on APA (1994)
  • primary language: English or Afrikaans
  • receptive language: evidence of problems with listening
  • communication status: at least some functional speech; evidence of problems with pragmatic/discourse and social interaction skills
  • educational status participants: all enrolled in school
  • hearing: “minimal hyperhearing”
  • current speech-language therapy: not to be enrolled concurrent with the investigation

 

– DESCRIBED CHARACTERISTICS:

  • age: 6:7 to 8:4
  • gender: all male
  • age at diagnosis of ASD: 3:2 to 6:1
  • severity of ASD: moderate (2); severe (1)
  • home language: Afrikaans (1); English (2)
  • expressive language:

– 2 word utterances (1)

     – 1 word utterances (1)

     – sentence (1)

                                                 

– Were the communication problems adequately described? Unclear

                                                                                                             

–   The types of communication disorders included

     – listening problems,

     – pragmatic skill problems;

     – social interaction problems,

     – limited functional communication,

     – hyperhearing (limited)

 

                                                                                                                       

  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? Yes

 

  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No, these were case studies

                                                                      

  • Were baseline/preintervention data collected on all behaviors? Yes

 

  • Did probes/intervention data include untrained stimuli? Yes

 

  • Did probes/intervention data include trained stimuli? No

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? Not Applicable (NA)

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– The outcomes were

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist
  • OUTCOME #3: Improved social interaction performance on the Autism Index on the Gilliam Autism Rating Scale

 

All the outcomes were subjective.

 

None of the outcomes were objective.

 

– There was some interobserver reliability data:

  • Combining scores from all 3 outcomes, 98.3% agreement

 

 

  1. Results:

 

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

 

The overall quality of improvement for each of the outcomes was

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist: strong (2Ps); moderate 1P
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist strong (2Ps); limited 1P
  • OUTCOME #3: Improved social interaction performance on the Autism Index on the Gilliam Autism Rating Scale—strong (2Ps); ineffective 1P

 

 

  1. Description of baseline:

 

— Were baseline data provided? Yes

 

– The number of data points for each of the outcomes was

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist – 3 probes
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist – 3 probes
  • OUTCOME #3: Improved performance on the Autism Index on the Gilliam Autism Rating Scale – 3 probes

 

 

– Was baseline low (or high, as appropriate) and stable?

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist—baseline was low but since the data across the 3 sessions were averaged, stability can not be determined.

 

  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist baseline was low but since the data across the 3 sessions were averaged, stability can not be determined.

 

  • OUTCOME #3: Improved social interaction performance on the Autism Index (Gilliam Autism Rating Scale) baseline was high (which indicates more characteristics associated with ASD) but since the data across the 3 sessions were averaged, stability can not be determined.

                                                       

– Was the percentage of nonoverlapping data (PND) provided?

 

 

  1. What is the clinical significanceNA, data concerned with the magnitude of the change were not reported.

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? Yes
  • Each of the outcomes was probed in a single session 4 weeks after the termination of therapy. The investigators did not report the maintenance data but , in the Discussion, noted that there was a “marked decline.”

 

 

  1. Were generalization data reported? Yes
  • All the outcomes could be considered to be generalizations because they were not directly targeted during the intervention.

 

 

  1. Brief description of the design:
  • There were 4 phases in the design of this investigation:

– Phase 1: 1 week in which the 3 outcomes were measured on 3 separate occasions

– Phase 2: 3 weeks of treatment for a total of 6 sessions

– Phase 3: 1 week after the termination of intervention, during the post-intervention phase, the 3 outcomes were measured 2 time

– Phase 4: 3 weeks after the post tests, the 3 outcomes were measured one more time to ascertain maintenance

 

  • The clinician (C) treated each P individually in 30 minute sessions, 2 times a week for 3 weeks.

 

  • Treatment aims, procedures, and rationales were clearly described in a table and in the appendix.

 

  • Analysis of the data was descriptive.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if an intervention involving traditional language therapy paired with prosodically varied speech has potential to improve listening, pragmatic, and social interaction skills.

 

POPULATION: Autism Spectrum Disorders; Children

 

MODALITY TARGETED: production, comprehension

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable: pitch, stress, rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: listening, pragmatics, social interaction

 

 

DOSAGE: 30 minute sessions, 2 times a week, for 3 weeks

 

ADMINISTRATOR: SLP

 

 

MAJOR COMPONENTS:

 

  • The investigators described the intervention as traditional language therapy paired with prosodically varied speech.

 

  • The investigators provided a thorough description of the intervention in Table 2 and in the Appendix.

 

  • For selected treatment activities, P employed Prosodically Varied Speech (PVS) that uses 2 aspects of prosody (2 pitches and stress) while intoning a phrase.

 

  • Each session included several activities. C explained the procedures for each treatment activity as it was introduced to P.

 

  • The treatment activities included

 

– Facilitation of Whole Body Listening: C used a toy to encourage listening.

 

– Development of Routine (e.g., greeting, joint attention, eye contact): C modeled a song with variations in pitch and P imitateed C phrase by phrase.

 

– Object Naming: If P did not respond appropriately to a naming request, C modeled the phrase “This is a …..” using PVS and P imitated the C..

 

– Nonverbal Imitation and Turn-Taking: C beat a rhythm on an empty coffee can and P imitated C’s rhythm.

 

– Following One-Step Instructions: C named the color of a block using PVS and then, still using PVS directed P to complete an action using PVS.

 

– Picture Description: C provided art materials to P (e.g., crayons, pencils, stencils.)   C modeled a sentence describing the artwork and then C asked questions about the artwork using PVS.

 

– Categorization: Using PVS, C identified an item (“This is an apple”) and then directed P to “Give the red fruit” or asked P to find all the apples among an array of fruits.

 

– Requesting Behavior: C showed an item of potential interest (e.g., bubbles) to P. If P did not spontaneously request it, C (using PVS) asked P if he would like the item.

 

– Role Playing and Object Function: C constructed a play scenario with P (e.g., tending to a sick toy animal.) C verbally described the steps in caring for the toy and then questioned P about the steps.

 

– Redirection: When P’s attention wandered, C redirected him to the task by singing a familiar song. The task was initiated by C describing the steps in the task (C models song, unison singing, P singing alone.)


Simmons et al. (2016)

December 28, 2016

EBP THERAPY ANALYSIS

Treatment Groups

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

Key:

C = Clinician

EBP = evidence-based practice

f = female

G = grade level

m = male

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

Ss = students who were enrolled in speech-language therapy

SLPs = speech–language pathologists

 

 

SOURCE:  Simmons, E. S., Paul, R., & Shic, F. (2016.) A mobile application to treat prosodic deficits in autism spectrum disorder and other communication impairments. Journal of Autism and Developmental Disorders, 46, 320-327.

 

REVIEWER(S): pmh

 

DATE: December 21, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible overall quality grade for this investigation was C+, Prospective Single Group with Pre and Post Testing)

 

TAKE AWAY: This preliminary investigation explores whether a software program (SpeechPrompts) has potential for treating prosodic problems in children and adolescents. Basic issues (e.g., student engagement, use pattern, perceive improvement, ease of use) about the intervention were investigated and it was determined that speech-language pathologists (SLPs) found SpeechPrompts enjoyable and easy to use in a school setting and they perceived that it resulted in perceived improvements in the Ss’ ability to produce stress, loudness, and intonation, but not speaking rate. These improvements were reported despite a low dose of the intervention over an 8 week period.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing

                                                                                                          

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

 

                                                                                                           

  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 (Ps)? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? No

                                                                    

 

  1. Were the groups adequately described? Yes

 

–           How many Ps were involved in the study?

 

  • total # of Ps: 40 students (Ss); 10 speech language pathologists (SLPs) [The 2 major questions involved different sets of participants: students who were enrolled in speech-language therapy; SLPs]
  • # of groups: 3 groups:

∞ treatment group (consisting of participants with a range of diagnosis, although most had the diagnosis of ASD);

∞ a subset of the treatment group with the diagnosis of ASD who the investigators had permission to link their diagnosis with their performance on the investigation task

∞ SLPs

  • List names of groups and the # of participants in each group:

     ∞ SLPs (speech-language pathologists) = 10

     ∞ Ss (students receiving treatment) = 40

  • Autism Spectrum Disorder (ASD) Subset = 12 (for this group of participants, the investigators were able to link their data and their diagnoses)

 

– List the P characteristics that are controlled (i.e., inclusion/exclusion criteria) or described. Provide data for each characteristic.

 

SLPs

 

CONTROLLED:

  • Licensure: All SLPs were licensed by the State of Connecticut
  • Certification: All SLPs were certified by the American Speech-Language-Hearing Association
  • caseload: All SLPs had students on their caseload with prosodic deficits.

 

DESCRIBED

  • caseload: (NOTE: The total is more than 10 because some SLPs worked in more than 1 setting)

– Preschool = 3

     – Elementary School = 8

     – Middle School = 4

     – High School = 2

  • years in current position:

– 0 to 5 years: 2

     – 6 – 10 years: 4

     – 11-15 years: 2

     – 16-20 years: 0

     – 21 or more years : 2

  • experience with iPads:

– minimal: 2

     – some experience: 2

     – significant experience: 60

 

Ss

CONTROLLED

  • expressive language:

All Ss spoke in full sentences.

     – All Ss exhibited prosodic problems

  • enrollment in speech-language therapy

– All Ss were enrolled in speech-language therapy as part of special education

 

DESCRIBED:

  • age: 5 years to 19 years (mean = 9.63)
  • gender: 31m, 9f
  • educational level of students (Ss):

– Elementary (PreK to Grade 4, G4) = 22

     – Middle School (G5 to G8) = 13

     – High School (G9 to G12) = 5

  • diagnosis:

– Autism Spectrum Disorder = 67.5% (27 Ss)

     – Speech and language impairment = 17.5% (7 Ss)

     – Intellectual disability = 7.5% (3 Ss)

     – Multiple disabilities = 2.5% (1 S)

     – Traumatic brain injury = 2.5% (1 S)

     – Other health problems = 2.5% (1 S)

 

ASD Subset

(investigators had permission to link diagnosis and task performance)

CONTROLLED

  • expressive language:

All Ss spoke in full sentences.

     – All Ss exhibited prosodic problems

  • enrollment in speech-language therapy

– All Ss were enrolled in speech-language therapy as part of special education

  • diagnosis: All ASD Subset Ps were diagnosed with ASD and the investigators were able to link their data with them

 

DESCRIBED:

  • age: 6 to 12 years; mean = 8.25
  • gender: 11m; 1f

 

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

                                                         

– Were the communication problems adequately described? No

 

  • disorder type: (only prosodic disorders described; some of the Ss had problems in multiple domains)

– Rate/Rhythm = 27

– Stress = 29

– Volume = 28

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did the group maintain at least 80% of it original members? Yes, but 20% of the Ss were removed from data analysis because of absenteeism, SLP errors, or technical difficulties.

                                                               

  • Were data from outliers removed from the study? No

 

 

6 Were the groups controlled acceptably? NA, there was only one group.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– OUTCOMES

 

PROSODIC PERFORMANCE OUTCOMES (3 point scale; 0 = typical prosody; 1 = mildly atypical prosody, 2 = clearly atypical prosody; p 323; lower mean score signifies improvement)

 

  • OUTCOME #1: SLP Ranking of the quality of speaking rate in a 5 minute speech sample
  • OUTCOME #2: SLP Ranking of the quality of lexical stress in a 5 minute speech sample
  • OUTCOME #3: SLP Ranking of the quality of sentence stress in a 5 minute speech sample
  • OUTCOME #4: SLP Ranking of the quality of intensity in a 5 minute speech sample
  • OUTCOME #5: SLP Ranking of global intonation in a 5 speech minute sample

 

SOFTWARE USE OUTCOMES

  • OUTCOME #6: Number of times the SLP used the software
  • OUTCOME #7: Length of treatment sessions

 

STUDENT ENGAGEMENT OUTCOMES (ranked on a 5 point scale 1 = strong agreement/engagement, 5 = strong disagreement/no engagement)

 

  • OUTCOME #8: SLP’s ranking of student’s enjoyment
  • OUTCOME #9: SLP’s ranking of student’s attention maintenance
  • OUTCOME #10: SLP’s ranking of student’s consistency of responses
  • OUTCOME #11: SLP’s ranking of the student’s lack maladaptive behavior during treatment

 

SLP OUTCOMES

  • OUTCOME #12: SLP ranking of whether the software was enjoyable
  • OUTCOME #13: SLP ranking of ease of use of the software
  • OUTCOME #14: SLP ranking of function of the software
  • OUTCOME #15: SLP ranking of positive changes

 

All outcome measures that were subjective.

 

– None of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes, for some of the Prosodic Performance Outcomes:

 

  • OUTCOMES #1 through #4 (SLP Ranking of the quality of speaking rate, lexical stress, sentence stress, and in intensity in a 5 minute sample)—Cohen’s Kappa coefficient = 0.68.

 

  • Intraobserver for analyzers? No

 

  • Treatment fidelity for clinicians? No. Although no data were provided, SLPs were involved in a 20 minutes training session in which they were instructed about the treatment program (SpeechPrompts.)

 

 

  1. What were the results of the inferential, correlational, and descriptive analyses ?

 

— Summary Of Important Results

  •  What level of significance was required to claim statistical significance? p = 0.05

 

PRE AND POST TREATMENT ONLY ANALYSES:

descriptive data, correlational data, inferential data

 

 

PROSODIC PERFORMANCE OUTCOMES (3 point scale; 0 = typical prosody; 1 = mildly atypical prosody, 2 = clearly atypical prosody; p 323; lower mean score signifies improvement)

 

  • OUTCOME #1: (SLP Ranking of the quality of speaking rate in a 5 minute sample)

     – All Ss: no significant difference between pre- and post- intervention rankings

     – ASD subgroup: no significant difference between pre- and post- intervention rankings

 

  • OUTCOME #2: (SLP Ranking of the quality of lexical stress in a 5-minute sample)

All Ss: significantly lower post intervention scores

     – ASD subgroup: no significant difference between pre- and post- intervention rankings

 

  • OUTCOME #3: (SLP Ranking of the quality of sentence stress in a 5-minute sample)

All Ss: significantly lower post intervention scores

ASD subgroup: significantly lower post intervention scores

 

  • OUTCOME #4: (SLP Ranking of the quality of intensity in a 5 minute sample)

     – All Ss: significantly lower post intervention scores

ASD subgroup: significantly lower post intervention scores

 

  • OUTCOME #5: (SLP Ranking of global intonation in a 5-minute sample)

     – All Ss: significantly lower post intervention scores; no significant correlation between global intonation and the number of treatment minutes

ASD subgroup: significantly lower post intervention scores

 

SOFTWARE USE OUTCOMES

 

  • OUTCOME #6: (Number of times the SLP used the software)

     – All Ss: range of use 1 to 12 sessions; mean = 4.7 sessions

     – ASD subgroup: range of use 2 to 10 session; mean = 5.83 sessions

 

  • OUTCOME #7: (Length of treatment sessions)

   – All Ss: range of length sessions 5 to 90 minutes; mean = 21.25 minutes; VoiceMatch was used 52.9% of the time, VoiceChart was used 47.1% of the time; no significant correlation between the number of minutes of treatment received by the S and the length of time his/her SLP had been employed at the facility

     – ASD subgroup: range of length of session 10 to 30 minutes; mean 25.99 minutes

 

STUDENT ENGAGEMENT OUTCOMES (ranked on a 5 point scale

1 = strong agreement/engagement, 5 = strong disagreement/no engagement)

 

  • OUTCOME #8: (SLP’s ranking of student’s enjoyment)

     – All Ss: ratings were low and stable for 1st and last sessions– 92.5% of SLPs ranked this as ≤3; mean 1.66

     – ASD subgroup: ratings were low and stable for 1st and last sessions

 

  • OUTCOME #9: (SLP’s ranking of student’s attention maintenance)

– All Ss: ratings were stable for 1st and last sessions; 87.5% of SLPs ranked this as ≤3; mean 1.74

     – ASD subgroup: ratings were low and stable for 1st and last sessions

 

  • OUTCOME #10: (SLP’s ranking of student’s consistency of responses maintenance)

     – All Ss: ratings were stable for 1st and last sessions; 87.5% of SLPs ranked this as ≤3; mean 1.78

     – ASD subgroup: ratings were low and stable for 1st and last sessions

  • OUTCOME #11: (SLP’s ranking of the student’s lack maladaptive behavior during treatment maintenance)

     – All Ss: ratings were stable for 1st and last sessions 85% of SLPs ranked this as ≤3; mean 1.79

     – ASD subgroup: ratings were low and stable for 1st session and decreased for the final session.

 

SLP OUTCOMES

 

  • OUTCOME #12: (SLP ranking of whether the software was enjoyable)–≤80% of SLPs reported the software was enjoyable

 

  • OUTCOME #13: (SLP ranking of ease of use of the software) —≤80% of SLPs reported the software was easy to use

 

  • OUTCOME #14: (SLP ranking of function of the software)–≤80% of SLPs reported the software was functional

 

  • OUTCOME #15: (SLP ranking of positive changes0–≤80% of SLPs reported they observed positive changes in the Ss.

 

– What was the statistical test used to determine significance? Place xxx after any statistical test that was used to determine significance. t-test

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

–  The EBP measure provided by the investigators was Standardized Mean Difference.

 

– Results of EBP testing and the interpretation:

 

  • OUTCOME #2: (SLP Ranking of the quality of lexical stress in a 5 minute sample)

All Ss: lower post intervention scores; d = 0.48 (small effect)

 

  • OUTCOME #3: (SLP Ranking of the quality of sentence stress in a 5 minute sample)

All Ss: lower post intervention scores; d = 0.77 (moderate effect)

ASD subgroup: lower post intervention scores; d = 0.80 (large effect)

 

  • OUTCOME #4: (SLP Ranking of the quality of intensity in a 5 minute sample)

     – All Ss: lower post intervention scores; d = 0.77 (moderate effect)

ASD subgroup: lower post intervention scores; d = 0.90 (large effect)

 

  • OUTCOME #5: (SLP Ranking of global intonation in a 5 minute sample)

     – All Ss: lower post intervention scores; d = 0.71 (moderate effect)

ASD subgroup: lower post intervention scores; d = 0.81 (large effect)

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Not clear

 

 

  1. A brief description of the experimental of the investigation:

 

  • This was a preliminary investigation to determine the potential of the software (SpeechPrompts) for treating prosody impairment. The investigators analyzed data from 2 groups of participants: SLPs (N = 10) and students (S) who were enrolled in speech-language therapy and had been identified as having prosodic problems.

 

  • Most (27), but not all, of Ss (N = 40) had been diagnosed with ASD. Accordingly, the investigators identified and analyzed separately data from a subgroup of Ss of with the diagnosis of ASD.

 

  • The outcomes associated with the SLPs involved

– their ranking their own perceptions of S engagement, attention, improvement , and behavior.

– their ranking their own perceptions regarding the function, ease of use, enjoyment, and student improvement associated with SpeechPrompts

– measures of number of uses and length of time of use of SpeechPrompts collected by the software.

 

  • S outcomes were derived from SLP rankings of perceptions of the acceptability of certain aspects of Ss’ prosody.

 

  • The investigators briefly trained the SLPs to use SpeechPrompts and requested that they use it at least one time a week over an 8 week period. (NOTE: Outcome data indicated that SLPs the average use was between 4 and 6 times over the 8 weeks.)

 

  • For the most part, the data were analyzed descriptively although paired t-tests and standardized mean difference were calculated for one set of analyses (i.e., perceived S performance outcomes.)

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate whether the mobile application SpeechPrompts has potential for treating prosodic impairments in children and adolescents.

 

POPULATION: ASD, Speech and Language Impairment; Children, Adolescents

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: speaking rate, stress (lexical, sentence), intensity, intonation

 

DOSAGE: 1 time a week (this was requested but SLPs average use was 4-6 times in 8 weeks)

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The investigators used SpeechPrompts which was delivered via iPads.

 

  • SpeechPrompts provides visual representations of acoustic measures of prosody. Two features of SpeechPrompts were used in this investigation:

– VoiceMatch: provides visual representation of short segments of speech as a waveform for 2 speakers, here the Clinician (C) and the S.

– When using VoiceMatch, C modeled a sentence and then S attempted to replicate the rate and stress patterns of the C.

– VoiceChart: was used to provide feedback to the S regarding loudness level.

 

 


Persicke et al. (2013)

December 19, 2015

EBP THERAPY ANALYSIS for

Single Subject 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

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Persicke, A., Tarbox, J., Ranick, J., St. Clair, M. (2013). Teaching children with autism to detect and respond to sarcasm. Research in Autism Spectrum Disorders, 7, 193-198.

 

REVIEWER(S): pmh

 

DATE: December 12, 2015

 

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

 

TAKE AWAY: This single subject experimental design investigation provides good support of an intervention teaching children with Autism Spectrum Disorders (ASD) to comprehend sarcasm.

                                                                                                                       

 

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

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Single Subject Experimental Design with Specific Client Multiple ABA designs

                                                                                                           

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

                                                                                                           

 

  1. Was phase of treatment concealed? (answer Yes, No, or Unclear to each of the questions)
  • from participants? No
  • from clinicians? No
  • from data analyzers? Unclear

 

 

  1. Were the participants (Ps) adequately described? No

 

  • How many Ps were involved in the study? 3

 

— The CONTROLLED characteristics included

  • diagnosis: Autism

 

— The DESCRIBED characteristics included

  • age: 6 and 7 years old
  • gender: based on names they were males
  • parental involvement: improved understanding of sarcasm was a priority with parents and supervisors
  • current therapy: 2 to 10 hours a week of behavioral therapy; sarcasm was not targeted outside the investigation’s interventions
  • previous therapy: had been receiving behavioral in-home for 3 to 4 years; no direct work on sarcasm but all participants (Ps) had received training on the following skills (p. 195)

     – prosody

     – body language

     – facial expression

     – physical context of conversation

     – conversational audience

     – desires

     – emotions

     – sensory perspective taking

     – cause and effect

     – preferences

     – knowing

     – beliefs

     – intentions                                

                                                 

  • Were the communication problems adequately described? No
  • The disorder type was Communication Disorder associated with Autism Spectrum Disorder (ASD)

 

                                                                                                                       

  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? Yes
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? Yes

 

  • Were baseline/preintervention data collected on all behaviors? Yes

 

  • Did probes/intervention data include untrained stimuli? Yes

 

  • Did probes/intervention data include trained stimuli? No

 

  • Was the data collection continuous? Yes

 

  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– The outcome/dependent variable was

 

OUTCOME: Increased accuracy in responding to sarcastic comments in conversation

 

– The outcome was subjective.

                                                       

– The outcome was NOT objective                                                         

 

  • The reliability data for the outcome (Increased accuracy in responding to sarcastic comments in conversation) was

     – averaged across 36% of the sessions;

     – interobserver reliability was 99.4%;

     – the lowest interobserver reliability for a session was 97%.

 

 

  1. Results:

 

Did the target behavior(s) improve when treated? Yes

 

– The overall quality of improvement for the outcome (Increased accuracy in responding to sarcastic comments in conversation) strong.

 

 

  1. Description of baseline:

 

Were baseline data provided? Yes

  • OUTCOME: Increased accuracy in responding to sarcastic comments in conversation

Reggie had 3 baseline sessions

     – Hans had 4 baseline sessions

     – Kevin had 5 baseline sessions

 

Was baseline low and stable? Baseline was low and stable for all 2 Ps. One of the Ps display minimal variability.

 

Was the percentage of nonoverlapping data (PND) provided? No. However, this reviewer calculated PND

 

– What was the PND and what level of effectiveness does it suggest?

 

  • OUTCOME: Increased accuracy in responding to sarcastic comments in conversation

Reggie – PND = 100% — highly effective

     – Hans – PND = 90% — highly effective

     – Kevin – PND = 100%– highly effective

 

 

  1. What is the clinical significanceNA. Not provided.

 

  1. Was information about treatment fidelity adequate? No. The investigators reported that treatment fidelity was monitored but no data were provided.

 

 

  1. Were maintenance data reported? Yes
  • For 2 of the Ps, follow-up assessments were administered 1, 2, and 3 months after the post therapy phase. Both Ps maintained accurate performances.

 

 

  1. Were generalization data reported? Yes
  • All Ps were assessed using untrained stimuli, in untrained contexts, and with interacters who were not present during intervention. In each case, the Ps produced correct responses at a rate similar to trained cases.

 

 

  1. Brief description of the design:
  • Three boys diagnosed with ASD were subjects in a single subject experimental design investigation.
  • The investigation involved a staggered ABA design in which the Ps were administered 3, 4, or 5 sessions of preintervention (baseline) assessment.
  • The intervention consisted of 11 or 12 session administered by C.
  • The postintervention phase involved 7 post therapy sessions for all the Ps and an additional 3 session of follow-up assessment for 2 of the Ps. The postintervention phase involved procedures similar to the preintervention phase as well as generalization tasks.
  • The assessment for the pre and post intervention phases involved observing Ps’ reactions to sarcastic comments made by the clinician (C) during conversation.

 

 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: B

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of a program designed to increase the comprehension of sarcastic remarks in conversation

 

POPULATION: Autism Spectrum Disorders

 

MODALITY TARGETED: comprehension

 

ELEMENTS OF PROSODY USED AS INTERVENTION: overall intonation (specific elements of intonation were not identified)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: sarcasm

 

DOSAGE: 30 min per session, 2 to 3 times a week for a total of 11-12 sessions.

 

ADMINISTRATOR: “therapist” or parent (during Phase II)

 

MAJOR COMPONENTS:

 

  • Intervention progressed from contrived activities to conversation. It included generalization to untrained stimuli and contexts.

 

  • Treatment, for the most part, occurred in the home, although generalization activities could occur in the community

 

  • Treatment sessions lasted about 30 minutes. Pre-and Post – intervention sessions lasted about an hour.

 

PHASE 1—Rules and Videos

 

  • The clinician (C) provided

– rules

– models

– examples

– leading questions

– feedback (praise for correct responses; leading questions for incorrect responses)

– exaggerated cues (intense intonation and facial cues)

– brief videos of sarcastic remarks in context

 

  • C asked questions after the viewing of the videos focusing on cues P might use to determine if the comment was sarcastic and to provide P with a repertoire of questions to ask himself when determining if a comment was sarcastic or sincere.

 

  • C gradually faded the exaggerated intonation and facial cues.

 

  • Criterion = 80% for 3 sessions (2 Ps achieved criterion in 3 session; 1 P achieved criterion in 1 session.)

 

  • The investigators noted that it was not clear that this phase was essential due to the high rate of achieving criterion.

 

PHASE II – In Vivo Training

 

  • Each session involved 10 – 12 trials

 

  • At the beginning of each session, C stated the rule and directed P to restate it.

 

  • C produced sarcastic comments during conversation.

 

  • If P responded appropriately to the sarcasm, C praised him. If he was incorrect, C asked leading questions as in Phase I.

 

  • P’s intonation and facial expression were exaggerated in the first session, faded in the second session, and eliminated in the third session.

 

  • In each session, one -half the sarcastic stimuli were novel sentences and one-half had been used previously.

 

  • Intervention was administered in the home, in a park (for generalization), or in a coffeehouse (for generalization).

 

  • Administrators during this phase were therapists and parents/nannies. Parents and nannies were reported to be trained by the therapists.

 

  • Criterion = 80% for 3 sessions (2 Ps achieved criterion in 3 session; 1 P achieved criterion in 1 session.)