Preston et al. (2013)

September 1, 2021

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:

 C =  Clinician

 CAS =  Childhood Apraxia of Speech

 CELF-4  Clinical Evaluation of Language Fundamentals-4 

 CTOPP =  Comprehensive Test of Phonological Processing 

 EBP =  evidence-based practice

 EVT2 =  Expressive Vocabulary Test 2nd ed 

 NA = not applicable 

 P =  Patient or Participant

 PCC =  Percent Consonants Correct 

 pmh =  Patricia Hargrove, blog developer

 PPVT =  Peabody Picture Vocabulary Test 

 SLP =  speech–language pathologist

 SS =  Standard Score 

 VMPAC =  Verbal Motor Production Assessment for Children 

SOURCE: Preston, J. L., Brick, N., & Landi, N. (2013). Ultrasound biofeedback treatment for persisting childhood apraxia of speech. American Journal of Speech-Language Pathology, 22, 627-643. DOI: 10.1044/1058-0360(2013/12-0139)

REVIEWER(S):  pmh

DATE:  September 1, 2021

ASSIGNED OVERALL GRADE:  B+ The highest possible Assigned Overall Grade, based on the design of the investigation (multiple baseline across behaviors with 6 participants, Ps), is A-. The Assigned Overall Grade should not be interpreted as a judgment of the quality of the intervention, rather it describes the quality of the evidence supporting the intervention.

TAKE AWAY:  This preliminary investigation explored the effectiveness of ultrasound biofeedback paired with prosodic manipulation in improving the speech sound production of 9- to 15-year-old children diagnosed with CAS using a multiple baseline across behaviors experimental design. Six children participated in the investigation. All the participants (Ps) displayed at least some improvement in their ability imitate targeted sound sequences over the course of the 18-session program.

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

2.  What type of evidence was identified?                              

– What  type of single subject design was used? Single Subject Experimental Design with Specific Client– Multiple Baseline           

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

3.  Was the phase of treatment concealed?                           

•  from participants?  No 

•  from clinicians?  No 

•  from data analyzers?  Yes

4.  Were the participants (Ps) adequately described? Yes

–  How many Ps were involved in the study?  6

–  CONTROLLED CHARACTERISTICS:

•  age: children

•  current therapy:  All Ps were enrolled in speech-language therapy in their respective schools. School SLPs agreed to focus on targets other than articulation of the target sounds during the investigation.

•  diagnosis: Childhood Apraxia of Speech (CAS)

•  score on Sequencing subtest: below 85% from the Verbal Motor Production Assessment for Children (VMPAC)

•  articulation/phonology:

     – at least 1.5 standard deviations below the mean on the Goldman-Fristoe Test of Articulation 2 (GFTA2)

     – evidence of the following speech sound errors elicited from a variety of tasks (p. 629)

          ∞ omissions or additions of sounds/syllables in phonologically complex words

          ∞ metathesis or migration errors  

–  DESCRIBED CHARACTERISTICS: 

•  age:  9 to 15 years

•  gender:  All male

•  cognitive skills:  Weschler Abbreviated Scales of Intelligence- Reasoning (T score) = 39 to 65

•  receptive language:  Peabody Picture Vocabulary Test (PPVT) = Standard Score (SS) = 78-123

•  expressive language:

     – Expressive Vocabulary Test 2nd Ed (EVT2)

     – Clinical Evaluation of Language Fundamentals-4  (CELF-4) – Formulated Sentences  SS = 4 to 8

     – CELF-4 – Recalling Sentences SS = 1-13

•  speech sound errors:  All Ps produced rhotic errors; some produced other errors

•  articulation/phonology:

     – GFTA2 = <40 to 69

     – Percent Consonants Correct (PCC) = 65% to 97%

     – PCC- Late-8: 19% to 81%

     – Comprehensive Test of Phonological Processing (CTOPP)- Elision SS = 3 to 12

     – CTOPP – Blending SS = 4 to 10                    

•  oral-motor skills:

     – VMPAC Focal Oral Motor = 87to 98

•  educational level of parents:  At least on parent of each P attended college

•  Other clinical concerns:

     – Pervasive Developmental Disorder

     – Attention Deficit Hyperactivity Disorder

     – Language Impairment

     – Reading Disability

     – Trisomy 8

     – limb apraxia

     – dysarthria

     – velopharyngeal incompetence

     – history of otitis media with effusion

     – hypernasality

–  Were the communication problems adequately described? Yes 

–  Disorder type:  Childhood Apraxia of Speech

–  Other aspects of communication that were described:  

     • severity ranged from mild to severe

5.  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 

6.  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?  Yes 

•  Was the data collection continuous?  Yes

•  Were different treatment counterbalanced or randomized?  

7.  Were the outcome measures appropriate and meaningful? Yes

•  OUTCOME #1: Percent accuracy of each of 8 individually predetermined sound sequences per child

•  OUTCOME #2: Performance on the GFTA

•  All of the outcomes were subjective.

•  None of the outcomes were objective.

•  One of the outcome measures was associated with reliability data: 

     –  OUTCOME #1: Percent accuracy of each of 8 individually predetermined sound sequences per child: Interrater agreement for judgments of probe accuracy ranged from 79.3% to 91.5%. (NOTE: the perecent accuracy used for all probe data was the average between 2 listeners.)

8.  Results:

•  Did the target behaviors improve when treated?  Yes, for the most part

•  The overall quality of improvement for each of the each of the P for each of the outcomes was 

∞  OUTCOME #1: Percent accuracy of each of 8 individually predetermined sound sequences per child

     – U002 = limited success (achieved performance criterion of 80% accuracy on 2 of 3 targets)

     – U005 = moderate success (achieved performance criterion of 80% accuracy on 4 of 6 targets)

     – U007 = limited success (achieved performance criterion of 80% accuracy on 3 of 5 targets)

     – U008 = strong success (achieved performance criterion of 80% accuracy on 4 of 5 targets)

     – U009 = strong success (achieved performance criterion of 80% accuracy on 5 of 6 targets)

     – U012 = strong success (achieved performance criterion of 80% accuracy on 6 of 6 targets)

∞  OUTCOME #2: Performance on the GFTA-2

     – U002 = limited: points increase from pre-testing to 2 months post-testing: 1.1

     – U005 = strong: increase from pre-testing to 2 months post-testing: 4.5

     – U007 = limited: increase from pre-testing to 2 months post-testing: 1.2

     – U008 = moderate: increase from pre-testing to 2 months post-testing: 1.5

     – U009 = moderate: increase from pre-testing to 2 months post-testing: 2.5

     – U012 = strong increase from pre-testing to 2 months post-testing: 3.3

numbering as needed)

9.  Description of baseline: 

•  Were baseline data provided?  Yes, eight target sequences were generated for each P based on his speech sound patterns. Each of 8 target sequences were probed at baseline, at each treatment session, and at a 2-month follow-up session.

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

•  OUTCOME #1:

     – U002 = 2 of the 3 treated sound sequences were low and stable

     – U005 = 1 of the 6 treated sound sequences were low and stable

     – U007 = 3 of the 5 treated sound sequences were low and stable

     – U008 = 2 of the 5 treated sound sequences were low and stable

     – U009 = 1 of the 5 treated sound sequences were low and stable

     – U012 = 1 of the 6 treated sound sequences were low and stabl

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

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

  OUTCOME #1: : Percent accuracy of each of 8 individually predetermined sound sequences per child. (NOTE: The range of PNDs for each of the sound sequences treated during the intervention is reported. The number in parentheses represents the number of different sound sequences treated during the intervention.)

     – U002 = 83% to 100% (3). The interpretation of the PND  scores is 

          ∞ highly effective – 2 targets

          ∞ fairly effective – 1 target

     – U005 = 73% to 100% (6). The interpretation of the PND  scores is 

          ∞ highly effective – 4 targets

          ∞ fairly effective – 2 targets

     – U007 = 0% to 100% (5). The interpretation of the PND  scores is 

          ∞ highly effective – 2 targets

          ∞ questionable effectiveness – 1 targets

          ∞  unreliable/ineffective – 2 targets

     – U008 = 71% to 100% (5). The interpretation of the PND  scores is 

          ∞ highly effective – 4 targets

          ∞ fairly effective – 1 target

     – U009 = 100% (6). The interpretation of the PND scores is 

          ∞ highly effective – 6 targets

     – U012 = 100% (6). The interpretation of the PND scores is 

          ∞ highly effective – 6 targets

10.  What is the clinical significance

  OUTCOME #1: 

•  magnitude of effect for all treated target:

     – U002 = total for all targets = 3.2

     – U005 = total for all targets = 2.6

     – U007 = total for all targets = 4.0

     – U008 = total for all targets = 2.1

     – U009 = total for all targets = 2.2

     – U012 = total for all targets = 2.7

•  measure calculated: standardized mean difference

•  interpretation: each P improved at least 2 standard deviations from baseline on the production of treated sequences; strong improvement

11.  Was information about treatment fidelity adequate?  No 

12.  Were maintenance data reported?  Yes 

• Two months after the cessation of treatment, a research assistant, who was blind to the treatment status of the Ps, administered follow-up session. In the follow-up session, the research assistant administered the GFTA-2, 17 sentences, and the individualized probes from the pretest and treatment sessions.

• Overall maintenance for the Ps was reported as 

     – U002 = retained accuracy for 2 of 3 treated target

     – U005 = maintained accuracy for 5 of 6 treated targets

     – U007 = maintained accuracy for 2 of 2 successfully treated targets

     – U008 = maintained high accuracy for 2 of 5 treated targets; maintained moderate amount of accuracy for 3 of 5 treated targets

     – U009 = maintained accuracy for 6 of 6 treated targets

     – U012 = maintained accuracy for 6 of 6 treated targets

13.  Were generalization data reported? Yes  

• Sixty-four words were administered at the end of each session as well as at baseline, and post-treatment session. These 64 words were 8 examples of the 8 individualized targets for 8 Ps. One-half of the words were treated and the other half were not treated. Therefore, to progress from one sound sequence to the next by achieving 80% correct productions of probes for 2 sessions, P needed to generalize. 

• Across all the Ps,31 sound sequences were treated with 23 (76.7%) achieving criterion of 80% correct productions over 2 consecutive sessions.

• In addition, GFTA-2 scores and the 17-item sentence list increased significantly.

14.  Brief description of the design:

• Six children with childhood apraxia of speech (CAS) received treatment which included biofeedback.

• The investigation involved a multiple baseline across behaviors experimental design.

• To assess program effectiveness, the children were assessed during baseline, following each session, and two months after the termination of therapy using imitative probes without feedback containing treated and untreated stimuli.

• The GFTA-2 and a 17-item sentence list also were administered to assess effectiveness. 

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

SUMMARY OF INTERVENTION

PURPOSE:  To explore the effectiveness of a treatment program that includes biofeedback for Childhood Apraxia of Speech 

POPULATION:  Childhood Apraxia of Speech; Adults

MODALITY TARGETED:  production

ELEMENTS OF PROSODY USED AS INTERVENTION:  rate, intonation, loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  speech sounds

DOSAGE:  18 sessions, administered over 10 to 16 weeks, 2 session per week, 1 hour sessions

ADMINISTRATOR:  SLP

MAJOR COMPONENTS:

• Schedule:

     – 15 minutes for ultrasound training for sound sequence #1 (e.g., /ar/)

     – 8 to 10 minutes of tabletop activities for sound sequence #1 (e.g., /ar/)

     – 15 minutes for ultrasound training for sound sequence #2 (e.g., /kl/)

     – 8 to 10 minutes of tabletop activities for sound sequence #2 (e.g., /kl/)

     – 10 minutes of probe tasks

 • Probe tasks: these tasks could be different each session because they changed as the P achieved criterion for a sound sequence.

• Ultrasound treatment procedures:

     – The purpose of the ultrasound procedure was to provide real-time visual feedback regarding the placement and movement of the tongue.

     – An ultrasound transducer was placed under the P’s chin. To keep the transducer in place (1) the P held it in place or (2) the P leaned on a microphone stand and a clamp held the transducer in place.

     – The view (i.e., sagittal or coronal) of the ultrasound differed based on the nature of the sound sequence.

     – The clinician (C) described the targeted tongue movements and placements. If applicable, C designed a transparency to place on the monitor to identify targets. 

     – For the most part, the P’s rate of speech was slowed to allow for interpretation of the visual feedback.

     – In addition to the visual feedback, C also provided verbal feedback (e.g., descriptions) and shaping.

     – C first focused on the target sound in isolation or in syllable, using the biofeedback and descriptions to facilitate production. Once P produced 5 consecutive productions of the target sound in isolation or syllable during the 15-minute treatment phase, C changed the target to syllables or words, as appropriate. 

     – For each of a session’s target sound sequences, 8 or 9 words (mono- or multi- syllabic) were identified for treatment. Only 4 of these words were included in that session’s probe task.

     – Some special techniques included

          ∞ For multisyllabic targets: backwards chaining. When working on the syllable sequence /re/, once “race” was produced accurately, the multisyllabic word “erase” was targeted.

           ∞ For production of the target sequence in a phrase:  the target sequence was included at the beginning or end of a phrase. Biofeedback focused on the production of the word with the target sequence (e.g., “race to the store” or “the turtle won the race” for the target sequence /re/) 

     – The prosodic component of the training involved providing prosodic cues during practice to facilitate accurate production of the sound sequences. The prosodic cues focused on recommendations to modify rate, intonation, or loudness of the target. The C did NOT provide feedback regarding the C’s production of prosody; that is, feedback remained focused on tongue movement accuracy.

• Table-top activities

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


Murray et al. (2014)

September 26, 2016

SECONDARY REVIEW CRITIQUE

 

 

NOTE: Scroll approximately two-thirds of the way down the page to access the summaries. You will note that there are no descriptions of the treatments. They were not provided in the body of the article.

 

KEY:

 

C = clinician

CAS = Childhood Apraxia of Speech

DTTC = Dynamic Temporal and Tactile Cueing (DTTC)

MIT = Melodic Intonation Therapy

NA = not applicable

P = patient or participant

PICA =

pmh = Patricia Hargrove, blog developer

ReST = Rapid Syllable Transition Treatment

SCED = single case experimental design

SLP = speech-language pathologist

SR = Systematic Review

TCM = Tactile Cue Method

 

Source: Murray, E., McCabe, P., & Ballard, K. J. (2014). A systematic review of treatment outcomes for children with childhood apraxia of speech. American Journal of Speech-Language Pathology, 23, 486-504.

 

Reviewer(s): pmh

 

Date: September 22, 2016

 

Overall Assigned Grade: B- (The highest possible grade based on the design of the investigation is B.)

 

Level of Evidence: B (Systematic Review, SR, with broad criteria)

 

Take Away: This SR is concerned with a variety of treatment outcomes. Only those outcomes or treatments concerned with prosody will be analyzed and summarized in this review. The SR reviewers recommended two prosody-related 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: 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? 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? Yes

 

  • Did the authors of the secondary research or review teams rate the sources independently? Variable, apparently some but not all aspects of the reviews were independently analyzed by two or more authors.

 

  • Were interrater reliability data provided? Yes

 

  • If the authors of the secondary research provided interrater reliability data, list the data here:
  • Intrarater reliability for judgments of the confidence of the diagnosis of CAS = 94%
  • Inter-rater reliability for judgments of the confidence of the diagnosis of CAS = 91%
  • Intrarater reliability for exclusion of article = 96%
  • Interrater reliability for exclusion of article = 91%

 

  • Were assessments of sources sufficiently reliable? Yes, reliability data that were provided were good

 

  • 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, across all the articles (not just the prosody related articles) in the SR there were 83 participants (Ps.)

 

  • Were there a sufficient number of sources? Variable, across all the articles in the SR there were 42 studies of which only 23 articles using single case experimental designs (SCED) were analyzed thoroughly in the SR. In this review, only articles/treatments concerned with prosody have been analyzed and summarized .

 

  1. Description of prosody-related outcome measures:

 

  • Outcomes #1: Improved prosodic accuracy –using Rapid Syllable Transition Treatment (ReST) from Ballard et al. (2010); Journal of Speech, Language, and Hearing Research

 

  • Outcome #2: Increase vowel accuracy using Dynamic Temporal and Tactile Cueing (DTTC) or combined Melodic Intonation Therapy (MIT)/Tactile Cue Method (TCM)

– from Maas et al. (2012) America Journal of Speech- Language Pathology;

– from Maas & Farinella (2012); Journal of Speech, Language, and Hearing Research; and

– from Martikainen & Korpilahti (2011); Child Language Teaching and Therapy

 

  • Outcome #3: Improved diagnostic accuracy from Rosenthal (1994) using Rate Control Therapy in Clinics in Communication Disorders

 

  • Outcome #4: Improved performance on the PICAC from Krauss & Galloway (1982) using MIT combined with traditional therapy in Journal of Music Therapy

 

  • Outcome #5: Increased MLU from Krauss & Galloway (1982) using MIT combined with traditional therapy in Journal of Music Therapy

 

 

  1. Description of results:

 

– What measures were used to represent the magnitude of the treatment/effect size? Improvement Rate Difference (IDR) was calculated on treatments identified as having a preponderance of supporting evidence. Table 3 notes effect sizes and significant effects but does not identify the methods used within the articles to calculate the measures.

 

– Summarize overall findings of the secondary research:

 

  • The following treatments are the most likely to be associated with progress on targeted prosodic outcomes for children with CAS:

– Motor Approaches:

  • DTTC
  • ReST

 

  • Sessions should be scheduled for at 2 times a week with 60 trial in each session.

 

  • DTTC appears to be most effective with Ps with severe CAS.

 

  • ReST appears to be most effective with Ps 7 to 10 years of age with mild to moderate CAS.

 

  • The SR reviewers classified each of the treatments as having conclusive, preponderant, or suggestive evidence of effectiveness. The ranking for the treatments using prosody as a treatment or targeting prosody as an outcome are:

 

CONCLUSIVE: none

 

PREPONDERANT:

– DTTC

– ReST

 

SUGGESTIVE:

– MIT/TCM

– MIT combined with traditional therapy

– Rate Control Therapy

 

– Were the results precise? NA

 

– 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.

 

  • For the most part, were the results similar from source to source? Unclear

 

  • Were the results in the same direction? Yes

 

  • Did a forest plot indicate homogeneity? NA

 

  • Was heterogeneity of results explored? Yes

 

  • Were the findings reasonable in view of the current literature? Yes
  • Were negative outcomes noted? Yes

 

 

  1. Were maintenance data reported? Yes
  • Only about 25% of the articles reported maintenance data. Most of the reported results were positive, although some of the maintenance results varied within the Ps of an investigation.

 

 

  1. Were generalization data reported? Yes
  • Twelve article reported generalization data: 7 reported response generalization, 5 reported stimulus generalization

 

 

SUMMARY OF INTERVENTION

 

NOTE:  The descriptions of the treatment procedures are limited because they were not provided in the body of the article.

 

Population: CAS

 

Prosodic Targets: duration, stress, prosody accuracy

 

Nonprosodic Targets: vowel accuracy, diagnostic accuracy, MLU, performance on the PICAC (naming, imitation.)

 

 

RAPID SYLLABLE TRANSITION TREATMENT (ReST)

from Ballard et al. (2010)

 

Description of Procedure/Source #1—(Rapid Syllable Transition Treatment, ReST)

  • The authors of the SR classified this procedure as primarily motor.

 

Evidence Supporting Procedure/Source #1—(Rapid Syllable Transition Treatment, ReST)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Preponderant.
  • The treatment and maintenance (2 to 4 weeks post intervention) were judged to reflect positive outcomes.
  • This was one of the interventions that reported improved prosodic accuracy, in this case with a large effect size for pairwise variability index duration.
  • The effect sizes associated with generalization measures was small to moderate.
  • ReST was recommended for children between the ages of 7 to 10 years.

 

 

 

DYNAMIC TEMPORAL AND TACTILE CUEING (DTTC)

– from Maas et al. (2012) America Journal of Speech- Language Pathology and

– from Maas & Farinella (2012); Journal of Speech, Language, and Hearing Research

 

Description of Procedure/Source #2—(Dynamic Temporal And Tactile Cueing, DTTC)

  • The authors of the SR classified this procedure as primarily motor.

 

Evidence Supporting Procedure/Source #2——(Dynamic Temporal And Tactile Cueing, DTTC)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Preponderant.
  • The treatment and maintenance (4 weeks post intervention) were judged to reflect positive outcomes.
  • This was one of the interventions that reported improved prosodic accuracy with effect sizes from moderate to large for the some of the outcomes.
  • The effect sizes associated with generalization measures was small to moderate.
  • The authors of the SR recommended DTTC for Ps with severe CAS.

 

Evidence Contraindicating Procedure/Source #2——(Dynamic Temporal And Tactile Cueing, DTTC)

  • The overall treatment effect for treatments was small or questionable.
  • The effect sizes associated with generalization measures was small or questionable.

 

 

 

MELODIC INTONATION THERAPY (MIT)/TACTILE CUE METHOD (TCM)

– from Martikainen & Korpilahti (2011); Child Language Teaching and Therapy

 

Description of Procedure/Source #3—(Melodic Intonation Therapy, MIT/Tactile Cue Method, TCM)

  • The authors of the SR classified this procedure as primarily motor.

 

Evidence Supporting Procedure/Source #3——(Melodic Intonation Therapy, MIT/Tactile Cue Method, TCM)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Suggestive.
  • The treatment was judged, for the most part, to reflect positive outcome.
  • Positive outcomes, for the most part, were maintained for 12 weeks.

 

Evidence Contraindicating Procedure/Source #3——(Melodic Intonation Therapy, MIT/Tactile Cue Method, TCM)

  • Generalization was not reported.

 

 

 

RATE CONTROL THERAPY

– from Rosenthal (1994) in Clinics in Communication Disorders I

 

Description of Procedure/Source #4—(Rate Control Therapy)

  • The authors of the SR classified this procedure as primarily motor.

 

Evidence Supporting Procedure/Source #4—(Rate Control Therapy)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Suggestive.

 

Evidence Contraindicating Procedure/Source #4—(Rate Control Therapy)

  • Statistical analysis was not provided for outcome data.
  • Maintenance and generalization data were not reported.

 

 

 

MIT COMBINED WITH TRADITIONAL THERAPY

– from Krauss & Galloway (1982) in Journal of Music Therapy

 

Description of Procedure/Source #5—(MIT combined with traditional therapy)

  • The authors of the SR classified this procedure as primarily linguistic.

 

Evidence Supporting Procedure/Source #5–(MIT combined with traditional therapy)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Suggestive.
  • There was significant improvement on the PICAC (naming, imitation.)

 

 

Evidence Contraindicating Procedure/Source #5—(MIT combined with traditional therapy)

  • Maintenance and generalization data were not reported.

 


Ramdoss et al. (2012)

May 3, 2015

SECONDARY REVIEW CRITIQUE

Key:

 

ASD = Autism Spectrum Disorders

d = standardized mean difference

CBI = computer-based interventions

NA = not applicable

NAP = Non-overlapping of All Pairs

P = participant

pmh = Patricia Hargrove, blog developer

SR = systematic review

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

 

Reviewer(s): pmh

 

Date: April 30, 2015

 

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

 

Level of Evidence: B

 

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

 

What type of secondary review? Narrative Systematic Review

  • Classic Systematic Review

 

  1. Were the results valid? Yes

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

 

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

 

– Authors noted that they reviewed the following resources:

  • electronic based databases
  • references from identified literature

 

– Did the sources involve only English language publications? Yes

– Did the sources include unpublished studies? No

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

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

– Did the reviewers describe procedures used to evaluate the validity of each of the sources? Yes

– Was there evidence that a specific, predetermined strategy was used to evaluate the sources? Yes

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

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

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

 

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

 

– Were assessments of sources sufficiently reliable? Yes

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

 

– Did the sources that were evaluated involve a sufficient number of participants? Variable. Numbers of participants (P) in the sources ranged from 4 to 79 with a mean of 28 Ps.

 

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

  1. Description of outcome measures:

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

The outcome measures were

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

 

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

 

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

 

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

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

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

– suggestive

– preponderant

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

– Summarization overall findings of the secondary review:

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

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

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

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

 

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

 

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

 

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

 

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

 

– Were the results precise? Unclear

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

 

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

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

–  Were the results in the same direction? Yes

–  Did a forest plot indicate homogeneity? Not Applicable

 

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

           

                                                                                                                   

  1. Were maintenance data reported? No

 

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

 

 

SUMMARY OF INTERVENTION

 

Population:   ASD; children, adolescents, adults

 

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

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

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

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

PROCEDURE #1

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

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

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

EVIDENCE SUPPORTING PROCEDURE/SOURCE #1

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

EVIDENCE CONTRAINDICATING PROCEDURE/SOURCE #1

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

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

PROCEDURE #2

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

EVIDENCE SUPPORTING PROCEDURE/SOURCE #2

  • Moderate, significant improvement on interpreting facial expression

EVIDENCE CONTRAINDICATING PROCEDURE/SOURCE #2

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

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

PROCEDURE #3

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

EVIDENCE SUPPORTING PROCEDURE/SOURCE #3

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

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

PROCEDURE #4

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

 

EVIDENCE SUPPORTING PROCEDURE/SOURCE #4

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

EVIDENCE CONTRAINDICATING PROCEDURE/SOURCE #4

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

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

PROCEDURE #5

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

EVIDENCE SUPPORTING PROCEDURE/SOURCE #5

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

EVIDENCE CONTRAINDICATING PROCEDURE/SOURCE #5

  • Small N.

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

PROCEDURE #6—

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

EVIDENCE SUPPORTING PROCEDURE/SOURCE #6

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

EVIDENCE CONTRAINDICATING PROCEDURE/SOURCE #6

  • No significant effect for recognizing emotion from facial expression.

Thompson & McFerran (2015)

March 28, 2015

 

 

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

IDD = intellectual and developmental disability

MT = music therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Thompson, G. A., & McFerran, K. S. (2015). Music therapy with young people who have profound intellectual and developmental: Four cases exploring communication and engagement with musical interactions. Journal of Intellectual and Developmental Disability, 40, 1-11.

REVIEWER(S): pmh

 

DATE: March 23, 2015

ASSIGNED OVERALL GRADE: D- (Highest possible grade, based on the design of the investigation is D+.)

 

TAKE AWAY: Music therapy (MT) was not clearly better than a comparison intervention but the investigators contended that music therapy creates engaging environments which set the stage for interpersonal communication. Behaviors that were observed during MT in school-aged Australian children included answering, rejecting/protesting, choice making, and producing social conventions.    

                                                                                                           

 

  1. What was the focus of the research? Clinically Related

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Case Studies– Composite data from ongoing sessions with a control/comparison treatment

– ABAB (withdrawal/reversal)

  • 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 adequately described? Yes

How many participants were involved in the study? 4        

– The following characteristics/variables were described:

  • age: 10-15 years
  • gender: 1m; 3f
  • cognitive skills: profound intellectual and developmental disability (IDD)
  • expressive language: all nonverbal
  • previous MT: no Ps had received MT at school. One P had been enrolled in MT during preschool
  • receptive language: unclear for 3Ps; 1P responded with appropriate yes/no questions to simple questions
  • diagnosis: intellectual disability plus epilepsy (3Ps); a syndrome involving cognitive impairment and other characteristics (1P)
  • educational level of participant: all participants (Ps) were enrolled in an Australian school for students with IQs below 50.

                                                 

– Were the communication problems adequately described? Yes

  • The disorder type was all Ps were nonverbal
  • Other aspects of communication that were described include

— The investigators listed the preferred communication strategies of each of the Ps. The common strategies included smiling, vocalizing, eye gazing, signing, gestures, laughing/giggling.

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? No
  • If there was more than one participant, did at least 80% of the participants remain in the study? No. One P withdrew after Phase 2 due to medical issues. This reduced participation to 75%.
  • Were any data removed from the study? Yes. Although data were collected for each session, in the data analysis only one session was randomly selected from each phase’s MT session so that an equal number of MT and Toy Play sessions could be compared.

 

 

  1. Did the design include appropriate controls? No. These were case studies.
  • Were baseline/preintervention data collected on all behaviors? No
  • Did probes/intervention data include untrained data? No
  • Did probes/intervention data include trained data? Yes
  • Was the data collection continuous? Yes data was collected in each session. However, (1) only one session was randomly selected from each phase’s MT session so that an equal number of MT and Toy Play sessions could be compared and (2) during the descriptive analysis, data were collected for each session combined across treatment sessions.
  • Were different treatment counterbalanced or randomized? Yes
  • Was it counterbalanced or randomized? counterbalanced

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  • The outcomes were

OUTCOME #1: Increased number of answers during treatment session

OUTCOME #2: Increased number of rejections/protests during treatment session

OUTCOME #3: Increased number of choice making during treatment session

OUTCOME #4: Increased production of social conventions (greetings, responding to name, farewells, responding to the environment) during treatment sessions

OUTCOME #5: Increased number of imitations during treatment sessions

OUTCOME #6: Increased rate of engaged participation (i.e., attention to self, requesting an object, requesting an action, requesting information, commenting)

OUTCOME #7: To identify different frequencies in the production of interaction acts in MT and in toy play

  • All the outcomes were subjective.
  • None of the outcomes were objective.

 

  1. Results:
  • Did the target behavior improve when it was treated? Yes, in both MT and toy play.
  • There were Insufficient data to make judgments about quality of improvement. However, the investigators reported that both (MT and toy based) interventions were successful in engaging the Ps. Accordingly, the findings reported below are descriptive in nature.

OUTCOME #1: Increased number of answers during treatment session: All Ps produced more answers during MT

OUTCOME #2: Increased number of rejections/protests during treatment session: All Ps produced more rejections/protests during toy play

OUTCOME #3: Increased number of choice making during treatment session: variable across Ps but the Ps made choices.

OUTCOME #4: Increased production of social conventions (greetings, responding to name, farewells, responding to the environment: All Ps produced more answers during MT

OUTCOME #5: Increased number of imitations during treatment sessions: No imitations were produced by any of the Ps in either of the treatments

OUTCOME #6: Increased rate of engaged participation (i.e., attention to self, requesting an object, requesting an action, requesting information, commenting): MT and toy play resulted in similar number of communicative acts

OUTCOME #7: To identify different frequencies in the production of interaction acts in MT and in toy play: Although the individuals Ps produced some different patterns of interaction in MT and toy play, the specific behaviors were idiosyncratic.

 

  1. Description of baseline:
  • Were baseline data provided? No

                                               

 

  1. What was the magnitude of the treatment effect? NA

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:

 

  • Four case studies.
  • For each P, the music therapist alternated 3 sets of MT sessions (lasting 6-10 sessions each) with 3 single sessions of toy play.
  • Each of the sessions was videotaped and the music therapist analyzed the communicative acts emitted by the Ps from the video tapes.
  • Because the number of treatment sessions was unequal for the 2 different interventions (MT and toy play), the investigators randomly selected 1 MT session from each phase of treatment.
  • Due to medical issues, one of the Ps withdrew from the investigation following the second phase of intervention.

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: D-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if music therapy results in (1) increased rate of engaged participation and (2) different patterns of production of interaction acts compared to toy play.

POPULATION: intellectual and developmental disability (IDD); Children and Adolescents

 

MODALITY TARGETED: production

 

ELEMENTS OF PROSODY USED AS INTERVENTION: music (pitch, rhythm, tempo)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: imitation, interactions/engaged participation (attention to self, requesting an object, requesting an action, requesting information, commenting), answering, social conventions/greeting, rejections/protests

 

OTHER TARGETS: choice making

DOSAGE: 30 minute individual sessions during 3 school terms (about 6 months); total number of sessions for Ps ranged from 21 sessions in 25 weeks to 27 session in 21 weeks

 

ADMINISTRATOR: Music therapist

 

MAJOR COMPONENTS:

  • There were 2 treatments: Music Therapy (MT) and Toy Play.
  • The overall schedule of intervention was

– Initial assessment sessions (2 sessions): the clinician (C; the Music Therapist) determined musical preferences using dynamic assessment techniques

– MT Phase I (10 sessions): C scheduled 2 sessions per week of MT; an additional purpose of this phase was to establish rapport

– Toy Play Comparison Session I (1 session)

– MT Phase II (6 sessions): C scheduled 2 sessions per week of MT

– Toy Play Comparison Session II (1 session)

– MT Phase III (6 sessions): C scheduled 2 sessions per week of MT.

– Toy Play Comparison Session III (1 session)

  • MT procedures:

– Structure of the MT sessions was

  • Greeting activity (Hello song using P’s name)
  • C offered P several musical instruments that P will play or hear
  • C elicited P’s engagement using a variety of techniques including

– modifying lyrics of songs to include P’s name

– slowing or pausing music at the “cadence point” (p. 5)

         – increasing the tempo or loudness of music

– using a variety of music styles while improvising

– playing music that P prefers

  • Closing song/music: a Goodbye song that was slower and softer than previous music
  • Toy Play procedures

– Structure of the Toy Play sessions was

  • Greeting activity (verbal)
  • C offered P 2 or 3 preferred toys
  • C elicited P’s engagement using a variety of techniques including

– games or familiar play routines

– slowing or pausing music at the “cadence point” (p. 5)

         – increasing the tempo or loudness of music

– using a variety of music styles while improvising

– playing music that P prefers

  • Closing: a verbal Goodbye

Matsuda & Yamamoto (2013)

January 29, 2015

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

CA = chronological age

CARS = Childhood Autism Rating Scale

EBP = evidence-based practice

MA = mental age

MTS = matching to sample

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Matsuda, S., & Yamamoto, J. (2013). Intervention for increasing comprehension of affective prosody in children with autism spectrum disorders. Research in Autism Spectrum Disorders, 7, 938-946.

 

REVIEWER(S): pmh

 

DATE: January 26, 2015

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

 

TAKE AWAY: The investigators used 4 single-subject experimental design (multiple baseline across participants) studies to explore the effectiveness of a cross-modal matching to sample (MTS) intervention designed to improve the comprehension of affective prosody of Japanese children diagnosed with autism spectrum disorders (ASD.) The results indicate that the children improved their rate of correct responses to an adult’s direction to indicate which picture represented a targeted emotion produced using a single word.

                                                                                                           

 

  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 Clients – Multiple Baseline—across participants

                                                                                                           

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

                                                                                                           

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

 

 

  1. Were the participants adequately described? Yes

How many participants were involved in the study? 4

– The following characteristics/variables were described:

  • age: 3 to 7 years (mean = 5 years, 6 months)
  • gender: all male
  • cognitive skills: on the Kyoto Scale of Psychological Development

– Ken (Chronological Age, CA, = 4-10) Mental Age (MA) = 2-11

– Taro (CA = 7-0) MA = 6-7

– Jiro (CA = 7-3) MA = 6-8

– Kazu (CA 3-7) MA = 2-11

  • level of severity of autism: on the Childhood Autism Rating Scale (CARS)

– Ken: severe

– Taro: mild/moderate

Jiro: severe

– Kazu: mild/moderate                 

  • educational level of participant:

– Ken: regular kindergarten

– Taro: in regular class in elementary school

– Jiro: in regular class in elementary school

– Kazu: regular kindergarten

                                                 

– Were the communication problems adequately described? No

  • The communication disorder type was not provided.

                                                                                                                       

  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 data? No
  • Did probes/intervention data include trained data? Yes
  • Was the data collection continuous? Yes
  • Were different treatment counterbalanced or randomized? Not Applicable

 

  1. Was the outcome measure appropriate and meaningful? Yes
  • List the outcome was

OUTCOME: Percentage of correct responses to request to match affective prosody (happy, angry, surprised, sad) to pictures depicting emotions

  • The outcome was subjective.
  • The outcome was not objective.
  • The following reliability data were reported:

OUTCOME: Percentage of correct responses to request to match affective prosody (happy, angry, surprised, sad) to pictures depicting emotions using a single Japanese word using a single Japanese word

   – Individual interobserver reliability for each participant (P): percentage of agreement ranged from 95% to 100%; Kendall’s W ranged from 0.99 to 1.00

 

  1. Results:
  • Did the target behavior improve when it was treated? Yes
  • For each of the Ps, the overall quality of improvement was

OUTCOME: Percentage of correct responses to request to match affective prosody (happy, angry, surprised, sad) to pictures depicting emotions using a single Japanese word—

– Ken: strong

– Taro: moderate

– Jiro: strong

– Kazu: moderate

  1. Description of baseline:
  • Were baseline data provided? Yes, the number of baseline session for each P were

– Ken: 3

– Taro: 5

– Jiro: 6

– Kazu: 7

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

– Ken: low, stable

– Taro: moderate, stable

– Jiro: low-moderate, variable

– Kazu: moderate, variable

(continue numbering as needed)

  • What was the percentage of nonoverlapping data (PND)?

NOTE: The PND was calculated by the reviewer, not the investigators. It should be considered to be an approximation because it was derived from Figure 1.

– Ken: 100%– highly effective

– Taro: 100%– highly effective

– Jiro: 92%– highly effective

– Kazu: 100%– highly effective

 

 

  1. What was the magnitude of the treatment effect? NA

 

  1. Was information about treatment fidelity adequate? Not Provided. However, because the prosody was presented live by a Japanese speaking male, measures of the accuracy of portrayal of the emotion in the picture cards can be found in the appendix. Overall, productions were moderately accurate.

 

  1. Were maintenance data reported? Yes
  • 3Ps maintained gains at the first one-week follow up. One P initially did not and was administered a second round of intervention. After the second round of intervention, that P maintained his progress.
  • All 4 Ps maintained gains following the termination of therapy.

 

 

  1. Were generalization data reported? Yes
  • Generalization was measured after the successful completion of all post testing (post-training probes, one week follow up, one month follow up). The generalization consisted of changing of the speaker from male to female.
  • A male speaker administered (live) all pretests, treatment sessions, and post tests.
  • A female speaker (live) administered the generalization tests.
  • All the Ps maintained a high percentage of correct responses during generalization.

 

  1. Brief description of the design:
  • This investigation consisted of 4 single subject experimental design studies (multiple baseline across participants.)
  • Prior to the experimental procedures, the investigators administered procedures to insure that the Ps could (1) follow intervention procedure (i.e., cross modal matching procedures and (2) match pictures of facial expressions to other pictures representing the same expressions.
  • Four prosodic affects/facial expressions were targeted in intervention: happy, surprised, angry, and sad.
  • During baseline, the male clinician (C) placed all 4 pictures of facial expression on the table. He then produced the targeted Japanese word using one of the 4 prosodic affects.
  • Data from the baseline was used as pretesting scores and to guide the selection of training pairs. During training only 2 cards were placed in front of the child: the card representing the emotion that had the highest percentage of correct responses and another emotion.
  • Following the achievement of the criterion for intervention, C administered post-test probes. If P reached the post-testing criteria, intervention was terminated.
  • If a P did not reach criterion, he received additional therapy. One P did not reach criterion at the first post-test probe. He did, however, achieve criterion on the second round of post-test probes.
  • After post-test probes, C administered 2 rounds of follow-up post tests. Three of the 4 Ps achieved criterion on the first follow-up post-test which was administered one week after the termination of intervention. The P who did not reach criterion was administered another round of intervention. (Following that additional round, the P passed criteria for post-test probes and a subsequent one-week follow-up.)
  • One month after the termination of intervention, C administered a one-month follow up post-test. All Ps achieved criterion.
  • Following the passing of the one-month follow-up post test, a female speaker administered a generalization tests across 2 sessions.

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if cross modal matching to sample intervention can improve the receptive prosody of Japanese children diagnosed with ASD.

POPULATION: Autism Spectrum Disorders

 

MODALITY TARGETED: Receptive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: prosodic affect

DOSAGE: unclear

 

ADMINISTRATOR: probably a psychologist

 

STIMULI: auditory, visual

 

MAJOR COMPONENTS:

BACKGROUND

  • Four emotions/affects were treated: happy, surprised, angry, and sad.
  • The investigators employed a cross-model matching-to-sample two-choice training procedure.
  • The cross-modal portion of the procedure involved using auditory (the C’s production of a single Japanese word using a targeted prosodic affect) and visual (pictures depicting facial expressions signaling the targeted affect) stimuli.
  • The matching-to-sample portion of the procedure involved requiring the P to point to or hand to the C the picture representing the affect the C has just produced.
  • The two-choice portion of the procedure involved selected only 2 emotions to train at a time. Because up to four emotions were treated for each P, the investigators developed a strategy for pairing emotions/affects.
  • Overall there were 5 major portions of the experiments: pre-assessment, baseline, two-choice intervention, post –tests, and generalization tests.
  • During baseline, the investigators identified the strongest (highest percentage of correct comprehension responses) and the weakest (lowest percentage of correct comprehension responses) emotions/affects. In the pairings, the strong emotions were paired with weak emotions. Each of the different pairings of emotions was considered a “Phase” of treatment. Only one pairing was worked on in a Phase.
  • Criterion for moving from one Phase to the next was 100% correct responding for 2 treatment sessions in a row.
  • Criterion for termination of treatment was an average of 90% correct responding for each of the post-tests (post-test probes, 1-week generalization, and 3-week generalization).

PROCEDURES

  • C placed two cards depicting 2 emotions in front of P.
  • C directed P to select the card that represents (says) the targeted emotion/affect.
  • C produced the single Japanese target word using the targeted emotion/affect.
  • During the first Phase of this training, C was allowed to show his face to P while he was producing the targeted word and prosodic emotion/affect. This was not permitted for subsequent Phases.
  • If P responded to the direction, C enthusiastically provided positive feedback verbally and gesturally (i.e., high-fives, handshaking.)
  • If P failed to respond, C waited 5 seconds and readministered the direction.
  • If P responded incorrectly to the direction or failed to respond a second time, C pointed to the correct card, said “This is the correct one”, and prompted P to hand him the card.

Saperston (1973)

January 13, 2015

 

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

                                                                                                                              

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Saperston, B. (1973). The use of music In establishing communication with an autistic mentally retarded child. Journal of Music Therapy, 10, 184-188.

 

REVIEWER(S): pmh

 

DATE: January 11, 2015

ASSIGNED OVERALL GRADE: D- (The highest possible grade was D+.)

 

TAKE AWAY: This descriptive case study, with limited data, describes a music therapy approach to initiating communication interactions with an 8 year-old, nonverbal, cognitively impaired boy who had been diagnosed with autism. The investigator details an intervention in which by following the child’s lead he was able to help the child establish a link between the child’s actions and the music played by the music therapist and eventually establish eye contact and beginning forms of interpersonal communication.         

 

 

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

                                                                                                           

 

  1. What type of evidence was identified?
  2. What type of single subject design was used? Case Study- Description of the course of treatment with a single participant (P)

                                                                                                           

  1. What was the level of support associated with the type of evidence? Level = D+

                                                                                                           

 

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

 

 

  1. Was the participant adequately described? No
  2. How many participants were involved in the study? 1
  3. The following characteristics were described:
  • age: 8 years old
  • gender: m
  • cognitive skills: 27 “social quotient”
  • expressive language: nonverbal
  1. Were the communication problems adequately described? No
  • The disorder type was nonverbal
  • Other aspects of communication that were described:

– C did not observe any communicative behavior by P or any relating to people or objects

– no eye contact

– P usually sat on the floor with his head near his knees and his eyes shut. At times, P rocked or walked across the room and sat down again on the floor.

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable (NA)
  2. If there was more than one participant, did at least 80% of the participants remain in the study? NA
  3. Were any data removed from the study? The investigator did not provide

 

 

  1. Did the design include appropriate controls? No. However, the investigator noted that no one else worked with P during the 18 months of intervention
  2. Were baseline/preintervention data collected on all behaviors? No. There were no baseline data.
  3. Did probes/intervention data include untrained data? No. There were no probes.
  4. Did probes/intervention data include trained data? No. There were no probes.
  5. Was the data collection continuous? NA
  6. Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcomes measures appropriate and meaningful? Yes
  2. The outcomes were

Note: The outcomes were changed as P made progress. The clinician (C) followed P’s lead when determining when to change outcomes. The overall purpose of the intervention was to establish communication with P using music

OUTCOME #1: C improvised on the piano without requiring specific responses from P

OUTCOME #2: P had to produce some movement for C to play music (i.e., P could cause music to start and stop.)

 

OUTCOME #3: P responded to C’s playing a chord and singing “Hello, (P’s name)”

 

OUTCOME #4: P controlled changes In music played by C using select motor movements.

OUTCOME #5: to increase eye contact

 

  1. All of the outcomes were subjective:  All
  2. None of the outcomes were objective:  None
  3. The investigator did NOT provide reliability data for the outcome measures.

 

 

  1. Results:
  2. Did the target behavior improve when it was treated? Yes
  3. b.   For each of the outcomes, list the overall quality of improvement:
  • This reviewer cannot make a judgment about the quality of improvement because no data were provided. That is, the investigator only made general statements about outcomes such as “something very exciting happened ….”, followed by a description of a P behavior.
  • However, the investigator modified outcomes as P made progress. Therefore, the following may be offered as evidence of improvement:

OUTCOME #1: (C improvised on the piano without requiring specific responses from P): Sessions 1-3: P did not appear to change his behavior relative to the music.

OUTCOME #2: [P had to produce some movement for C to play music (i.e., P could cause music to start and stop.)]: Actually, the first session when C initiated this change, C played for 10 minutes without requiring a change. Sessions 4-19—P did not appear to link music and movement; in session 20 he make the link by laughing and stomping which appeared to be intentional to the investigator.

 

OUTCOME #3: [P responded to C’s playing a chord and singing “Hello, (P’s name)”]. During the 4th month of intervention, P began to look at C while he was at the piano. C began to sing “Hello, (P’s name)” during this time. Gradually, the frequency of P’s glances at C increased and P began smiling at C.

 

OUTCOME #4: (P controlled changes in music played by C using select motor movements.) P introduced this step during Months 5 and 6: P could change the timing and intensity of the music by modifying his movements. He exhibited the ability to control music playing and would often laugh, glance briefly at C, and smile. By month 10 he was moving about the whole room and would happily sit by C at the piano. The investigator noted at the end of 18 months P was beginning to vocalize.

OUTCOME #5: (to increase eye contact): Starting about Month 10, C held P’s head in his hands and sang his name for 10 minutes. By the next month, P appeared to enjoy this activity. C then sang P’s name contingent on direct eye contact. Over the next 2 months, the time that P sustained eye contact increased to 1 minute. C administered this step for only 10 minutes of each session. Other outcomes were targeted during the rest of the session,

  1. Description of baseline:
  2. Were baseline data provided? No

                                               

 

  1. What was the magnitude of the treatment effect? NA

 

 

  1. Was information about treatment fidelity adequate? Not Provided _____

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported?

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: ____D-_____

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe an intervention for establishing initial communication skills using music therapy

POPULATION: Autism Spectrum Disorders, Cognitive Impairment; Children

 

MODALITY TARGETED: production

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm, loudness, pitch, tempo (music)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: eye contact, interaction–begin

DOSAGE: 30 minute sessions, 3 times a week, for 18 months:

Sessions #1-19   involved 7-10 minutes of musical interaction. The remainder of the time, the P did not interact or move

Sessions #w20 – to about Month 4 of treatment: musical interaction increased to about 15 minutes of the session

Sessions from the 10 month of treatment: 30 minutes of interaction

ADMINISTRATOR: music therapist (C)

 

STIMULI: auditory (music)

 

MAJOR COMPONENTS:

OUTCOME #1: C improvised on the piano without requiring specific responses from P

OUTCOME #2: P had to produce some movement for C to play music (i.e., P could cause music to start and stop.) Actually, the first session for this outcome when C initiated this change, C played for 10 minutes without requiring P to make a movement. When P walked around the room, initially C would

– play a low G for movement of the P’s foot

– play an octive higher G for movement of P’s right foot

– play a mid-range tone cluster when P sat down.

Eventually, C paired other movements with other music:

– walking remained the same as above but the tempo and loudness of the music would also change with the intensity and speed of walking

– stomping = lower range tone cluster

– rocking = C played an I-IV progression in F major. Forward rocking was paired with an I chord and backward rocking was paired wit an IV chord.

– shuffling = C rapidly played broken chords

– hand pounding = C played a C major chord

 

OUTCOME #3: P responded to C’s playing a chord and singing “Hello, (P’s name)” During the 4th month of intervention, P began to look at C while he was at the piano. C began to sing “Hello, (P’s name)” during this time. Gradually, the frequency of P’s glances at C increased and P began smiling at C.

 

OUTCOME #4: P controlled changes in music played by C using select motor movements. C introduced the following during Months 5 and 6: P could change the timing and intensity of the music by changing his movements.

 

OUTCOME #5: to increase eye contact: Starting about Month 10, C held P’s head in his hands and sang his name for 10 minutes. Once P appeared to enjoy this activity, C sang P’s name contingent on direct eye contact. This activity was administered for only 10 minutes of each session. Other outcomes were targeted during the rest of the session.


O’Halpin (2001)

November 8, 2014

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

Fo = fundamental frequency

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

SVO = Subject + Verb + Object

 

SOURCE:  O’Halpin, R. (2001). Intonation issues in the speech of hearing impaired children: Analysis, transcription, and remediation. Clinical Linguistics & Phonetics, 15, 529-550.

 

REVIEWER(S): pmh

 

DATE: November 1, 2014

ASSIGNED OVERALL GRADE:    (The highest possible grade, based on the design of the study, was D+.)

 

TAKE AWAY: The author described the assessment, the prosodic characteristics, and interventions for children with hearing impairment. Only the intervention, which is supported by some very brief case studies, is described in this review. Overall, the case information provides initial support for an adaptation of King and Parker’s (1980) intervention program using visual feedback. The production of SVO sentences of an 8-year-old with impaired hearing more closely resembled a typical peer with respect to pitch patterns associated with contrastive stress.

 

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

                                                                                                           

 

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

Level = D+                                                      

                                                                                                           

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

 

  1. Were the participants adequately described? No _x__, but this was only a small part of a larger article.

 

  1. How many participants were involved in the study? 3

 

  1. The following characteristics were described:
  • age: 8 years
  • expressive language: could produce Subject + Verb + Object (SVO) sentences
  • receptive language: could understand SVO sentences
  • hearing: all profoundly hearing impaired; average pure-tone hearing levels ranges from 96 dB to 104 dB

                                                 

  1. Were the communication problems adequately described? No
  • The disorder type was profound hearing Impairment
  • List other aspects of communication that were described:

– all wore binaural hearing aids

– all had previous speech therapy on a regular basis that did not include visual representation of speech

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes
  2. If there was more than one participant, did at least 80% of the participants remain in the study? Yes
  3. Were any data removed from the study? No

 

  1. Did the design include appropriate controls? No, these were case studies.
  2. Were baseline/preintervention data collected on all behaviors? Yes
  3. Did probes/intervention data include untrained data? No. No intervention data were provided. Post intervention data were provided only for one participant (P).
  4. Did probes/intervention data include trained data? No. No intervention data was provided. Post intervention data was provided only for one P.
  5. Was the data collection continuous? No
  6. Were different treatment counterbalanced or randomized? Not Applicable

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. The outcome measure was

OUTCOME #1: To improve intonational markings of contrastive stress such as declination and down-stepping using acoustic measurement

  1. The outcome was not subjective.
  2. The outcome was objective.
  3. No reliability data were provided.

 

  1. Results:
  2. Did the target behavior improve when it was treated? Yes
  3. b.   The overall quality of improvement was moderate: With some exceptions, the pitch movement more closely resembled that of an age-match typical hearing peer.   (See figures 3 and 5.)

NOTE: Reminder, the OUTCOME was to improve intonational markings of contrastive stress such as declination and down-stepping using acoustic and perceptual measurement/

  1. Description of baseline:
  2. Were baseline data provided? No

                                               

 

  1. What was the magnitude of the treatment effect? NA

 

 

  1. Was information about treatment fidelity adequate? No

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: D-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of visual displays in improving outcomes in the intonation of children with hearing impairment.

POPULATION: Hearing Impairment; Children

 

MODALITY TARGETED: Production and Compehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: Intonation, stress- contrastive

DOSAGE: not provided

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual

 

MAJOR COMPONENTS:

 

  • This intervention is based on the work of King and Parker (1980)* with the added component of providing visual representation of pitch (fundamental frequency, Fo), loudness (intensity), and time (duration).
  • This is a structured program in which the linguistic complexity of the target utterances increases gradually from monosyllable words to short phrases.
  • Prior to the initiation of this intervention, Ps should be able to produce consistently SVO sentences in spontaneous speech.
  • There are 2 parts to the intervention: Elicited tasks (Part I) and Naturalistic tasks (Part II)

PART I—Elicited Tasks

  • Within each step, the feedback (visual displays and observation of lip movement) is increasingly delayed. The purpose of this delay is to encourage self-monitoring and to decrease dependence on visual feedback.

Step 1: C explains the visual displays to P and defines the vocabulary that will be used in the intervention.

Step 2a: C teaches P to identify the acoustic characteristics of voice quality of speakers with typical hearing. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 2b: C elicits prolonged, steady phonations with good voice quality from P. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 3: C teaches P to identify rise and falls in pitch during the production of monosyllable words. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 4a: P produces monosyllables with a falling or rising pitch pattern. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 4b: P produces 2 and 3 syllable words with a falling or rising pitch pattern. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 5a: C teaches P to identify the most important word in a short phrase by noting changes in pitch. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 5b: C elicits contrastive stress patterns from P. Feedback is provided with visual displays as well as the observation of lip patterns.

  • Elicitations here consist of questions directed to the Ps that require stress on one of the content words in an SVO sentence. For example, for the sentence “The boy is eating the apple.” Questions might include:

– Who is eating the apple? (stressed word = boy)

– What is the boy doing with the apple? (stressed word = eating)

– What is the boy eating? (stressed word = apple)

Step 6: C elicits the targeted intonation patterns in structured therapy activities.

PART II—NATURALISTIC TASKS

  • P practices skills learned in Part 1. C elicits spontaneous speech in games, picture description tasks, and narrative tasks.

* King, A., & Parker, A. (1980). The relevance of prosodic features to speech work with hearing-impaired children. In F. M. Jones (Ed.), Language disability in children: Assessment and Rehabilitation. Lancaster, UK: MTP Press.


Seybold (1971)

October 6, 2014

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

MT = music therapist/therapy

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

ST = speech therapy

 

SOURCE: Seybold, C. D. (1971). The value and use of music activities in the treatment of speech delayed children. Journal of Music Therapy, 8, 102-110.

 

REVIEWER(S):  pmh

 

DATE: October 5, 2014

ASSIGNED GRADE FOR OVERALL QUALITY: D (Due to the design of the investigation, the highest possible overall quality grade for this investigation was C-.)

 

TAKE AWAY: Although there were problems with the data, some of which was not the investigator’s fault (see the review), both groups [traditional speech therapy (ST) and music therapy (MT)] performed similarly. Additionally, the investigator provides a clear description of music activities designed to facilitate spontaneous communication in preschoolers diagnosed as speech delayed.

 

  1. What type of evidence was identified?
  2. What was the type of evidence? Prospective Randomized Group Design with Post-testing
  3. What was the level of support associated with the type of evidence? Level = C. We do not have a listing for this design because it is unusual. (The investigator lost the pretests due to thief.)

                                                                                                           

  1. Group membership determination:
  2. If there were groups, were participants randomly assigned to groups? Yes
  1. Was administration of intervention status concealed?

                                                                                                           

  1. from participants? No
  2. from clinicians? No
  3. from analyzers? No

                                                                    

 

  1. Were the groups adequately described? No
  2. How many participants were involved in the study?
  • total # of participant: 8
  • # of groups: 2
  • # of participants in each group: 4, 4
  • List names of groups: Music Therapy (MT) group (n =4); ; Speech Therapy (ST) group (n = 4)

 

  1. The following variables were described
  • age: mean age MT group = 5-2; mean age ST group = 5-1
  • gender: all make
  • educational level of clients: all preschoolers

 

  1. Were the groups similar before intervention began? Unclear

                                                         

  1. Were the communication problems adequately described? No _x__    
  • disorder type: all participants (P) were diagnosed as speech delayed but this was not defined
  • other:

     – all Ps were currently in therapy at a Midwest US university clinic

– all Ps were considered to have functional (i.e., nonorganic) impairments

 

  1. Was membership in groups maintained throughout the study?
  2. Did each of the groups maintain at least 80% of their original members? Yes
  3. Were data from outliers removed from the study

 

  1. Were the groups controlled acceptably? No
  2. Was there a no intervention group? No
  3. Was there a foil intervention group? No
  4. Was there a comparison group? Yes
  5. Was the time involved in the foil/comparison and the target groups constant? Yes

 

  1. Were the outcomes measure appropriate and meaningful? Unclear
  2. List outcome:
  • OUTCOME #1: Performance on the Houston Test of Language Development
  1. The outcome measures is subjective:

 

  1. The outcome measures is not objective?

                                         

 

  1. Were reliability measures provided?
  2. Interobserver for analyzers? No
  3. Intraobserver for analyzers?   No
  4. Treatment fidelity for clinicians? No

 

  1. What were the results of the statistical (inferential) testing?
  2. TREATMENT VERSUS COMPARISON GROUP
  • OUTCOME #1: Performance on the Houston Test of Language Development
  • significance level = 0.10
  • MT improved more than the ST group
  1. What statistical test was used to determine significance? Mann-Whitney U

 

  1. Were confidence interval (CI) provided? No

                                   

  1. What is the clinical significance? NA

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  D

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of music activities in improving the expressive language of preschool children diagnosed as speech delayed

POPULATION: Speech Delay; Children (preschool)

 

MODALITY TARGETED: expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific dependent variables here):

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm, intonation, stress (music activities)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: performance on a standardized test of language development

DOSAGE: individual sessions, 50 minute sessions, 2 times a week, 8 weeks

 

ADMINISTRATOR: male music therapist MT for MT group; female speech-language pathologist (SLP) for ST group.

 

STIMULI: auditory, visual, gestural/motoric

 

MAJOR COMPONENTS:

  • There were 2 interventions: MT and ST. The MT intervention involved administering the same procedures to all the MT Ps. The ST intervention involved the administration of different procedures for the ST Ps. The procedures listed in the ST section are the one that are common to all ST Ps.

MT INTERVENTION

  • Each activity began with a music activity. When the P produced the musical target, the clinician (C) presented a nonmusical activity.
  • The following schedule represents a typical session:
  1. C and P sang a “Good Morning” song (tune = “Happy Birthday.”)
  1. C and P sang “The Alphabet” song accompanied by musical instruments (e.g., piano, autoharp). Following a musical response, C encouraged P to talk about letters of the alphabet while playing with lettered blocks or while copying letters on the chalkboard.
  1. C and P sang “Old MacDonald” or the “Farmer in the Dell.” Then P played with toy animals, colored pictures of animals, or looked at pictures of animals while C stimulated conversation.
  1. C and P engaged in a game entitled the “Bumblebee” while playing kazoos or similar instruments. When P created a buzzing sound with the kazoo and then touched one of C’s body parts with the kazoo, C named the body part. C and P then reversed roles. C and P also sang and acted out “If You are Happy and You Know It, Clap Your Hands”
  1. C and P sang the song the “Wheels on the Bus Go Round and Round” to teach a variety of concepts (e.g., “open” and “close”, colors, “in” and “out”). Once P completed the singing and acting out of the song with C, she/he was encouraged say and act out the action words.
  1. C and P sang narrative songs such as “Little Rabbit Foo Foo” or “Down by the Station” to introduce imagination, language concepts, and singular/plural distinctions. C played sound effects and encouraged P to play “tone clusters” and glissandos.
  1. C and P sang narrative songs such as “Little Rabbit Foo Foo” or “Down by the Station” to teach numbers. Following the song, C introduced activities that encouraged play and spontaneous language.
  1. C allowed P 5 to 10 minutes per session to play with an instrument and musical activity (marching, jumping, singing, etc.) of choice.
  1. C and P sang a “Goodbye” song (tune = “Frere Jacques.”)

ST INTERVENTION

  1. C modeled sentences based on P’s functional level of communication for P to imitate. Then P was required to use the target sentence in a noncompetitive, nonturn taking (e.g., “Cootie”) activity in order to obtain an item.
  1. C and P participated in a competitive, turn taking activity in which turns were earned by making requests with a targeted language structure.
  1. C asked P to identify colors, clothing, and body parts during games.
  1. C introduced action pictures representing letters of the alphabet (e.g., a boy blowing bubbles represented “buh”.) C said “buh” and P (or perhaps C, it is not clear) produced a corresponding word and progressed to producing the word in a phrase/sentence.
  1. C stimulated spontaneous speech during games. The targets could be producing speech about colors, body parts, “basic language concepts” or encouraging the use of the imagination.

Van Nuffelen (2011)

September 22, 2014

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY:

C = clinician

DAF = delayed auditory feedback

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

Source: Van Nuffelen, G. (2011). Speech prosody in dysarthria. In V. Stojanovik & J. Setter (Eds.), Speech prosody in atypical populations: Assessment and remediation (pp. 147- 167). Surry, UK: J & R Press.

 

Reviewer(s): pmh

 

Date: September 21, 2014

 

Overall Assigned Grade (because there are no primary supporting data, the highest grade will be F): 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: As the author notes, despite the common perception of dysarthria as an adult issue, children also can exhibit one or more forms of dysarthria. The   focus of this chapter was on using prosody to improve intelligibility (ability of a listen to understand a verbal message without context) and comprehensibility (ability of a listen to understand a verbal message in context) in adults or children with dysarthria.

The author provides background information about prosody’s relevance to speech-language pathology and analyzes assessment procedures (these will be reviewed in this blog at a later date when we add a section on assessment issues.) This review is concerned with the recommendations for using prosody to improve intelligibility and/or comprehensibility. Prior to working on expressive prosody, the author recommends that receptive prosody be targeted if assessment suggests this is skill is a challenge. The author provides techniques and content for treating intonation, stress, and rate as they relate to intelligibility/comprehensibility.

    

  1. Was there review of the literature supporting components of the intervention? 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:
  • Outcome #1: to improve receptive prosody
  • Outcome #2: to improve stress and intonation by chunking utterances into appropriate syntactic units
  • Outcome #3: to increase the length of breath groups that correspond with syntactic units
  • Outcome #4: to use stress to differentiate word classes
  • Outcome #5: to use stress to emphasize appropriately a word in an utterance
  • Outcome #6: to use intonation to differentiate speech acts
  • Outcome #7– to produce utterance with appropriate affective prosody
  • Outcome #8– to produce a speaking rate that optimizes intelligibility/comprehensibility

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

Description of Intervention #1to improve receptive prosody (specific intervention procedures and content were not provided)

 

POPULATION: Dysarthria; Adult, Child

TARGETS: to differentiate acceptable and unacceptable productions of examples of prosodic patterns

TECHNIQUES: feedback from C (clinician)

STIMULI: auditory, audio-recordings

 

ADMINISTRATOR: SLP

 

PROCEDURES

  1. C plays audio recordings of examples of prosodic patterns.
  2. P (patient) judges if the example is correct or incorrect.
  3. C provides feedback to the P regarding the accuracy of the judgment.

RATIONALE/SUPPORT FOR INTERVENTION: The author cited research indicating that receptive prosody is co-located in the brain with certain forms of dysarthria. Accordingly, there is a possibility that some speakers with dysarthria such as those with spastic dysarthria or upper motor neuron dysarthria may also have a receptive prosodic problem. There is only limited research about the receptive prosodic skills of speakers with dysarthria so it is important to insure that receptive prosodic skills are intact. Also, among children with high-functioning autism, there is a significant correlation between receptive and expressive prosody. (Logical support)

Description of Intervention #2 to improve stress and intonation by chunking utterances into appropriate syntactic units

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: matching of the production of breath units with syntactic units.

TECHNIQUES: behavioral instruction/metalinguistics, modeling, visual feedback

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for treating chunking/phrasing listed in the chapter.

– C identifies the typical length of P’s breath group

– C guides P to produce utterances with pauses associated with a breath group at a syntactic boundaries.

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure pauses.

RATIONALE/SUPPORT FOR INTERVENTION: Speakers with dysarthria can have short breath groups. If pausing to breath does not correspond with a syntactic boundary, intelligibility problems can occur. (Logical support)

Description of Intervention #3— to increase the length of breath groups that correspond with syntactic units

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: breath units

TECHNIQUES: behavioral descriptions/metalinguistics, modeling, visual feedback using instruments that acoustically measure duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for lengthening breath groups listed in the chapter.

– C identifies the typical length of P’s breath group

– C guides P to produce longer breath groups.

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration.

RATIONALE/SUPPORT FOR INTERVENTION: Speakers with dysarthria can have short breath groups. Increasing the length of breath groups can increase the length of utterances and, perhaps, intelligibility/comprehensibility. (Logical support)

Description of Intervention #4—to use stress to differentiate word classes

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: production of lexical stress (e.g., ob JECT versus OB ject)

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure intensity, frequency, duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving lexical stress listed in the chapter.

– C presents contrastive stress drills in which minimal pair words for P to produce that differ only in location of stress (“RE ject” versus “re JECT”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration, intensity, pause, and frequency.

RATIONALE/SUPPORT FOR INTERVENTION: Improving lexical stress assists the listener in understanding what the speaker is intending. (Logical support)

Description of Intervention #5–to use stress to emphasize appropriately a word in an utterance

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: phrasal/sentence stress

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure intensity, frequency, and duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving phrasal stress listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in location of stress (e.g., “DAVID took the money” versus “David took the MONEY”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration, intensity, pause, and frequency.

RATIONALE/SUPPORT FOR INTERVENTION: The speaker should stress the word that he/she believes is the most important word in the sentence for the listener. (Logical support)

Description of Intervention #6—to use intonation to differentiate speech acts

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: intonation, intonation terminal contour

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure frequency

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving intonation listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in the intonation (terminal contour) signaling different speech acts (e.g., “David took the money.” versus “David took the money?”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure frequency.

Description of Intervention #7– to produce utterance with appropriate affective prosody

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: affective prosody

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure frequency, intensity, pause, and duration

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving affective prosody listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in the intonation (terminal contour) signaling different emotions (e.g., happy, sad, angry)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure frequency.

Description of Intervention #8– to produce a speaking rate that optimizes intelligibility/comprehensibility

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: rate, intelligibility, comprehensibility

TECHNIQUES: behavioral description/metalingustics, speaking slower on demand, pacing, alphabet board, hand or finger tapping, delayed auditory feedback

STIMULI: auditory, visual, tactile/kinesthetic

 

ADMINISTRATOR:

 

PROCEDURES:

  • To reduce the rate of speech, the clinician may focus on
  1. reducing articulation rate
  2. inserting additional, syntactically appropriate pauses
  3. increasing the length/duration of pauses
  • The author described several approaches for slowing speech rate”
  1. Speaking slower on demand—C instructs P to talk at a specific percentage of his/her typical speaking rate (e.g., one-third P’s normal rate).
  1. Pacing – C directs P’s attention to a device (e.g., pacing board, metronome, Facilitator of Metronomic Pacing by Key Elemetrics, or the computer software Pacer) and asks P to talk saying a word or syllable for each square on the pacing board or in time with the metronome or computer program.
  1. Alphabet Board – P points to the first letter of each word when speaking.
  1. Hand or Finger Tapping – P taps for each intended syllable when speaking.
  1. Delayed Auditory Feedback (DAF) –C identifies the optimal delay time and then directs P to talk while wearing the DAF device..

RATIONALE/SUPPORT FOR INTERVENTION: Logical—

  • Rather than normalizing the rate of speech, the target should be to produce speech at a rate that optimizes intelligibility/comprehensibility. At this point, there is no strategy that has been identified as superior for all Ps. Rather, Cs should identify the strategy that works for the individual P insuring that it improves intelligibility/comprehensibility.
  • Of the approaches for reducing rate, the author presented the following rationales:
  1. reducing articulation rate—a number of studies support that this increases articulatory precision (distinctiveness) but research is contradictory as to whether reducing rate increases intelligibility
  2. inserting additional, syntactically appropriate pauses—this may improve comprehensibility by highlighting syntactic and/or word boundaries or by giving the listener additional time to interpret the utterance
  3. increasing the length/duration of pauses–—this may improve comprehensibility by highlighting syntactic and/or word boundaries or by giving the listener additional time to interpret the utterance
  • The author presented the following support for the techniques for slowing speech rate”
  1. Speaking slower on demand—The author cited research to support this approach but her own previously reported research did not yield significant changes in articulation rate, pause duration, or pause frequency.
  2. Pacing –The author cited her own previously reported research indicating a significant decrease articulation in rate and significant increases in total pause duration and pause frequency.
  3. Alphabet Board –The author cited her own previously reported research indicating significant decreases in articulation rate and pause frequency and significant increases in mean and total pause duration.
  4. Hand or Finger Tapping – The author cited her own previously reported research indicating a significant a decrease articulation in rate and a significant increase pause frequency.
  5. Delayed Auditory Feedback (DAF) – The author cited her own previously reported research indicating a significant decrease articulation rate.

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION—see above


Helfrich-Miller (1984)

August 24, 2014

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

KEY:

C = clinician

CAS = Childhood Apraxia of Speech

P = participant or patient

pmh = Patricia Hargrove, blog developer

MIT = Melodic Intonation Therapy

NA = not applicable

SLP = speech-language pathologist

 

SOURCE: Helfrich-Miller, K. R. (1984). Melodic Intonation Therapy with developmentally apraxic children. Seminars in Speech and Language, 5, 119-126.

 

REVIEWER(S): pmh

 

DATE: August 23, 2014

 

ASSIGNED OVERALL GRADE: D- (Because the evidence involved summaries of 2 case studies and 1 single subject experimental design, the highest possible grade was D+.)

 

TAKE AWAY: To support this program description of an adaptation of Melodic Intonation Therapy (MIT) to Childhood Apraxia of Speech (CAS) the investigator included 3 brief summaries of previously presented cases. The cases indicate that MIT results in change in articulation measures and one measure of duration and, to a lesser degree, listener perception.

                                                                                                           

 

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

                                                                                                           

 

  1. What type of evidence was identified?
  2. What type of single subject design was used? Case Studie – Program Description with Case Illustrations: summaries of previously reported investigations— 2 of the investigations were case studies; 1 was a single-subject experimental design (time series withdrawal)
  3. What was the level of support associated with the type of evidence?

Level = D+                                                      

 

                                                                                                           

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

 

 

  1. Were the participants adequately described? No
  2. How many participants were involved in the study? 3
  3. The following characteristics/variables were described:
  • age: 10 years old (1); not provided (2)
  • gender: m (all 3)
  1. Were the communication problems adequately described? No
  • The disorder type was CAS.
  • Other aspects of communication were noy described.

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes
  2. If there was more than one participant, did at least 80% of the participants remain in the study? Yes
  3. Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? Varied. The case studies did not have adequate controls but the single subject experimental design may have. (Controls were not clearly described.)
  2. Were preintervention data collected on all behaviors? Varied. The summary of the case studies provided this information but the summary of the single subject experimental design did not.
  3. Did probes/intervention data include untrained data? Unclear
  4. Did probes/intervention data include trained data? Unclear
  5. Was the data collection continuous? No
  6. Were different treatment counterbalanced or randomized? Not Applicable

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. The outcomes were

OUTCOME #1: number of articulation errors (case studies)

OUTCOME #2: percentage of articulation errors (case studies)

OUTCOME #3: vowel duration (single subject experimental design)

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)

OUTCOME #5: listener judgment (single subject experimental design)

 

  1. The following outcomes are subjective:

OUTCOME #1: number of articulation errors (case studies)

OUTCOME #2: percentage of articulation errors (case studies)

OUTCOME #5: listener judgment (single subject experimental design)

                                                                                                             

  1. The following outcomes are objective:

OUTCOME #3: vowel duration (single subject experimental design)

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)

                                                                                                             

  1. None of the outcome measures are associated with reliability data.

 

 

  1. Results:
  2. Did the target behavior improve when it was treated? Inconsistent
  3. b. The overall quality of improvement was

OUTCOME #1: number of articulation errors (case studies)– moderate

OUTCOME #2: percentage of articulation errors (case studies)– moderate

OUTCOME #3: vowel duration (single subject experimental design)- – unclear but there was a significant difference in pre and post testing

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)– ineffective

OUTCOME #5: listener judgment (single subject experimental design)—The investigator noted a trend toward improvement but did not note whether or not the change was significant.

 

 

  1. Description of baseline: Were baseline data provided? No

 

 

  1. What was the magnitude of the treatment effect? NA

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? Yes. The outcomes associated with the case studies measured maintenance. The investigator measured the Outcomes #1 (number of articulation errors) and #2 (percentage of articulation errors) 6 months after the termination of therapy. The results indicated that gains were maintained for both outcomes.

 

  1. Were generalization data reported? Yes. Since none of the outcomes were direct targets of intervention, all of them could be considered generalization. Accordingly, the findings were

OUTCOME #1: number of articulation errors (case studies)—moderate improvement

OUTCOME #2: percentage of articulation errors (case studies)—moderate improvement

OUTCOME #3: vowel duration (single subject experimental design)- – Results were unclear but there was a significant difference in pre and post testing

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)– ineffective

OUTCOME #5: listener judgment (single subject experimental design)—The investigator noted a trend toward improvement but did not note whether or not the change was significant. There was no description of the magnitude of the change.

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: D-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe an adaptation of MIT for children with CAS

 

POPULATION: Childhood Apraxia of Speech; Child

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY TREATED: duration

 

ELEMENTS OF PROSODY USED AS INTERVENTION: tempo (rate, duration), rhythm, stress, intonation

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: articulation

 

OTHER TARGETS: listener perception

 

DOSAGE: The investigator reported that average course of treatment using MIT for CAS involves 10-12 months of therapy meeting 3 times a week.

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual/gestural

 

MAJOR COMPONENTS:

 

  • MIT focuses on 4 aspects of prosody:
  1. stylized intonation (melodic line)
  2. lengthened tempo (reduced rate)
  3. exaggerated rhythm
  4. exaggerated stress

 

  • It is best to avoid modeling patterns that are similar to known songs.

 

  • Each session includes 10 to 20 target utterances and no 2 consecutive sessions contain the same target utterances.

 

  • C selects a sentence and then moves it through each step associated with the current level of treatment. When P successfully produces the sentence at all the steps of the current level, C switches to the next sentence beginning at Step 1 of that level.

 

  • To move out of a level, P must achieve 90% correct responses in 10 consecutive sessions. Tables 3, 4, and 5 provide criteria for correct response in the different Levels of Instruction.

 

  • There are 3 Levels of Instruction.

 

  • As Ps progress within and through the levels

– utterances increase in complexity

– the phonemic structure of words increases.

– C reduces cueing

– C increases the naturalness of intonation in models and targets.

 

  • Tables 1 and 2 contain criteria and examples for the formulation of target utterances.

 

  • The purpose of MIT is to sequence words and phrases.

 

  • Unlike the original MIT, this adaptation pairs productions with signs (instead of tapping).

 

  • Tables 3, 4, and 5 as well as the accompanying prose in the article, provide detailed descriptions of the program. The following is a summary of those descriptions:

 

LEVEL 1

 

  • If P fails any step with a targeted utterance, that target is terminated and C selects a new utterance.

 

Step 1.   C models and signs the intoned target utterance 2 times and does not require C to imitate.

 

Step 2. C and P produce the targeted intoned utterance and the sign in unison.

 

Step 3. C continues with the targeted intoned utterance but fades the unison cues.

 

Step 4. C models the intoned target utterance and the sign. P imitates the intoned target utterance.

 

Step 5. C asks a question to elicit the intoned target utterance (e.g., “What did you say?”) P produces the intoned target utterance.

 

Step 6. C asks a question to elicit the last words of the intoned target utterance (e.g., if the intoned target utterance was “Buy the ball,” the question could be “What do you want to buy?”)

 

LEVEL 2:

 

Step 1. C models and signs the intoned target utterance 2 times and does not require C to imitate.

 

Step 2. C and P produce the targeted intoned utterance and the sign in unison.

 

Step 3. C continues with the targeted intoned utterance but adds a 6 second delay before P can intone the targeted utterance. If P has trouble with this step, C can use a “back-up” which involves returning to the previous step with the targeted intoned utterance.

 

Step 4. C asks a question to elicit the intoned target utterance (e.g., “What did you say?”) P produces the intoned target utterance.

 

Step 5. C asks a question to elicit the last words of the intoned target utterance (e.g., if the intoned target utterance was “Open the door”, the question could be “What should I open?”)

 

LEVEL 3:

 

Step 1. C models and signs the intoned target utterance, P intones and signs the utterance. If P fails, the “back-up” is unison intonation with C fading the cueing.

 

Step 2. C presents the target utterance using Sprechgesang (or speech song– an intoned production that is not singing) and signing. P is not required to respond.

 

Step 3. C and P, in unison, produce the targeted utterance using Sprechgesang and signing. If P fails, the back up is to repeat Step 2.

 

Step 4. C presents the targeted utterance with normal prosody and no signing. P imitates the targeted utterance with normal prosody.

 

Step 5. C asks a question to elicit the target utterance (e.g., “What did you say?”) P produces the target utterance after a 6 second delay.

 

Step 6. C asks a question to elicit the last words of the target utterance (e.g., if the target utterance was “I want more juice,” the question could be “What do you want?”)