Maas & Farinella (2012)

Single Subject Designs

 

Notes:

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

2. Key:

C = clinician

CAS = childhood apraxia of speech

CNT = could not test

DTTC = Dynamic Temporal and Tactile Cueing

ES = effect size

NA = not applicable

P = participant or patient

S = strong syllable

SLP = speech=language pathologist

w = weak syllable

WNL = within normal limits

 

SOURCE: Maas, E., & Farinella, K. A. (2012). Random versus blocked practice in treatment for childhood apraxia of speech. Language, Speech, and Hearing Services in Schools, 55, 561-578.

 

REVIEWER(S): pmh

 

DATE: August 8, 2014

ASSIGNED OVERALL GRADE: B+

 

TAKE AWAY: The focus of these single subject experimental design investigations was to determine if there was an advantage for blocked versus random practice for children with childhood apraxia of speech (CAS). The investigation is relevant to this blog because the intervention involved the manipulation of rate. The investigators included a thorough description of the participants (Ps), intervention, and scoring of P responses to treatment conventions. The intervention was judged to be effective for 3 of the 4 Ps but the results regarding the practice schedule were equivocal.

                                                                                                           

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

                                                                                                           

 

2. What type of evidence was identified?

a. What type of single subject design was used? Single Subject Experimental Design with Specific Clients- Alternating Treatments Design with Multiple Baselines across Behaviors

                                                                                                           

b. What was the level of support associated with the type of evidence?

Level = A                                                         

 

                                                                                                           

3. Was phase of treatment concealed?

a. from participants? No

b. from clinicians? No

c. from data analyzers? Yes

 

 

4. Were the participants adequately described? Yes

a. How many participants were involved in the study? List here: 4

 

b. The following characteristics were described:

• age: 5;0 to 7;9
• gender: 2m; 2f
• expressive language: moderate delay (2); severe delay (1); could not test (CNT, 1)
• receptive language: within normal limits (WNL, 2); low- average (1); mild-moderate delay (1)
• language spoken: all monolingual English speakers
• Hearing: all WNL
• Medical/neurological diagnosis: none had diagnoses at the time of the investigation
• motor skills: limited manual motor skills (1); history of hypotonia and gross/fine motor delay (1)
• sensory processing skills: impaired (1)

                                                 

c. Were the communication problems adequately described? Yes

• The disorder type was CAS
• Other aspects of communication that were described for each of the Ps:

P1

• inconsistent vowel/consonant substitutions/distortions
• segmented speech
• intermittent hypernasality
• equal and incorrect stress in multisyllabic words
• reduced intelligibility
• inconsistent phonological patterns

P2

• inconsistent vowel/consonant errors
• articulatory groping
• intermittent hypernasality
• breathy/harsh voice quality
• stereotypical nonword utterance
• mild left facial asymmetry
• possible mild unilateral upper motor neuron dysarthria

P3

• moderate-severe dysarthria (mixed spastic-flaccid)
• inconsistent consonants/vowels errors
• speech sound and syllable segmentation
• intermittent hypernasality
• intermittent hoarse/breathy voice quality
• weakness of the tongue
• prosodic abnormalities (incorrect and equal stress, reduced speech rate)

P4

• prosodic abnormalities (incorrect and excessive stress, segmentation of syllables)
• occasional speech sound distortions and vowel errors were occasionally observed

                                                                                                                       

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

a. If there was more than one participant, did at least 80% of the participants remain in the study? Yes

b. Were any data removed from the study? No

 

 

6. Did the design include appropriate controls? Yes

a. Were baseline collected on all behaviors? Yes

b. Did probes include untrained data? Yes

c. Did probes include trained data? Yes

d. Was the data collection continuous? No

e. Were different treatment counterbalanced or randomized? Yes

1. f. Was treatment counterbalanced or randomized? Randomized?

 

 

7. Were the outcomes measure appropriate and meaningful? Yes

a. The outcome:

OUTCOME #1*: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probes

* The investigators designed separate word lists for each P, taking into consideration speech sound error profiles. The following were the targets:

– initial cluster

– 2 syllable words

– 3 syllable words

– final clusters

– final fricative

– final liquids

– initial fricatives

– initial liquids

– 4 syllable Strong-Weak-Strong-Weak (SwSw) words

– 4 syllable wSwS words

– 3 syllable wSw words

– 3 syllable Sww words

b. The outcome was subjective.

c. The outcomes was not objective.                                            

d. The investigators provided outcome reliability data.

e.  The mean interrater reliability ranged from 79% to 87%.

 

8. Results:
9. Did the target behavior improve when it was treated? Inconsistent
10. b.   For

OUTCOME #1: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probes —The overall quality of improvement was moderate

– P1, P3, P4 –improved **

– P2 did not improve

(**NOTE–The findings regarding the relative effectiveness of the practice schedule were equivocal; 2Ps exhibited stronger progress for the blocked schedule and 1P exhibited stronger progress with the random schedule.)

9. Description of baseline:
10. Were baseline data provided? Yes

OUTCOME #1: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probes – 3 data points

 

1. Was baseline low and stable? (The numbers should match the numbers in item 7a.)

OUTCOME #1: For the most part, baseline was low (the highest percentage correct of a target during baseline was approximately 35%) and moderately stable.

                                                                                       

c & d. What was the percentage of nonoverlapping data (PND)?

OUTCOME #1: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probe

• P1 – PND was 75% to 100% (fairly to highly effective)
• P2 – PND was 0% for all targets (ineffective)
• P3 – PND was 0% to 75% (ineffective to fairly effective)
• P4 – PND was 0% to 50% (ineffective to questionable effectiveness)

 

 

1. What was the magnitude of the treatment effect.”

 

NOTE: The investigators used an effect size (ES) of 1.00 or more as evidence of effectiveness (p. 567); there was no gradation for effectiveness.

OUTCOME #1: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probe

• P1 – ES was 3.55 (random) and 4.04 (block)
• P2 – ES was 0.62 (blocked); random could not be calculated because of zero variance.
• P3 – ES was 3.16 (random) and 1.50 (block)
• P4 – ES was 1.31 (random) and 1.69 (block)

 

1. Was information about treatment fidelity adequate? Yes. Treatment fidelity ranged from 61% to 88%. One P was associated with percentages ranging from 61% to 71%. All other Ps had percentages of 75% or above.

 

 

2. Were maintenance data reported? Yes. There were multiple specific targets for each of the Ps. Although there were some exceptions, for the most part, Ps did not maintain their gains in therapy at a follow-up session one month after termination of the investigation.

 

 

3. Were generalization data reported? Yes Generalization varied; overall should be described as limited.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To improve motor speech learning

POPULATION: Childhood Apraxia of Speech; Child

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rate

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: speech sounds

DOSAGE: 3 times a week,

 

ADMINISTRATOR: SLP or a graduate clinician

 

STIMULI: visual stimuli (index cards—10 of each target), auditory stimuli, tactile cues

 

MAJOR COMPONENTS:

• The investigators use Dynamic Temporal and Tactile Cueing (DTTC) as a treatment but they compared using random and blocked practice schedules for their investigation.

• DTTC includes motor learning, modeling, integral stimulation, drill, focus on core vocabulary, rate reduction, variation in gap between C’s model and P’s attempt, tactile cues, reinforcement, and variation in feedback schedule.

• Blocked Practice = index cards for the same word were practiced together and then C moved on to the next word

• Random Practice = C shuffled the all the cards that were to be used for that day’s session

 

• C provided verbal feedback to P only 60% of the time

• Steps in DCCT

1. C directs P “Watch me, listen carefully, and repeat after me” (p. 577). C then produces the target word on the index card.

2. When P is correct, C waits 2 to 3 seconds, and either

– provides feedback (60% of the time) and reinforces C tangibly (e.g., stickers or bubbles) and

– goes to the next word.

3. When P is incorrect,

– during feedback trials (60% of the time)

• C waits 2- 3 seconds
• C notes that the production was not accurate and describes how it was inaccurate
• up to 2 times, C and P slowly and simultaneously produce the target word
• C then fades support by only mouthing the target word during an attempt to produce it
• C produces the word and P immediately imitates it
• C waits 2 to 3 seconds before providing feedback

– during No Feedback trials (40% of the time)

• C waits 2- 3 seconds
• up to 2 times, C and P slowly and simultaneously produce the target word
• C then fades support by only mouthing the target word during an attempt to produce it
• C produces the word and P immediately imitates it
• C waits 2 to 3 seconds and then says “Now let’s do another one” (p. 577).

Lee (2008)

EBP THERAPY ANALYSIS for
Single Subject Designs

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

Key:
ADHD = Attention Deficit Hyperactivity Disorder
ASD = Autism Spectrum Disorder
C = Clinician
Nan-Hu = a traditional, 2 string musical instrument
P = participant or patient
pmh = Patricia Hargrove, blog developer

SOURCE: Lee, L. L. (2008). Music enhances attention and promotes language ability in young special needs children. In L. E. Schraer-Joiner & K. A. McCord (Eds.), Selected Papers from the International Seminars of the Commission on Music in Special Education, Music Therapy, and Music Medicine (pp. 34- 45). Malvern, Victoria, Australia. Malvern, Victoria, Australia: International Society for Music Education.
Paper—http://issuu.com/official_isme/docs/2006-2008_specialed_proceedings/41

REVIEWER(S): pmh

DATE: July 2, 2014

ASSIGNED OVERALL GRADE: B- (The highest possible grade was A- because of the experimental design of the investigation.)

TAKE AWAY: This multiple baseline investigation demonstrates the effectiveness music therapy in improving attention and language in developmentally delayed children from Taiwan who were speakers of Mandarin Chinese. The investigator provided a clear description of the phases of treatment.

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

2. What type of evidence was identified?
a. What type of single subject design was used? Single Subject Experimental Design with Specific Clients:- Multiple Baseline
b. What was the level of support associated with the type of evidence? Level = A-

3. Was phase of treatment concealed?
a. from participants? No
b. from clinicians? No
c. from data analyzers? No

4. Were the participants adequately described? No
a. How many participants were involved in the study? 3
b. The following characteristics were described
• age: 4 to 5 years
• gender: 2 m; 1 f
• cognitive skills: all developmental delays and one each of ASD, ADHD, and Down syndrome
• expressive language: at baseline—“no language ability (1P); no words (1P); did not want to speak and speech was unclear (1P)
c. Were the communication problems adequately described? Yes___ No _x__
• List the disorder type(s): language impairment, speech sound impairment
• List other aspects of communication that were described:
–At baseline, the author described the expressive language of each of the P’s”
– “no language ability (1);
– no words (1);
– did not want to speak and speech was unclear (1)

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

6. Did the design include appropriate controls? Varied. I would have liked to see data describing change or lack of change when a target was not being treated (other than baseline). Figure 2 may have contained some of this information but I needed more explanation of the figure.
a. Were baseline data collected on all behaviors? Yes
b. Did probes data include untrained data? Yes
c. Did probes data include trained data? No
d. Was the data collection continuous? Unclear, some data were collected throughout the investigation (Figure 2) but I could not interpret them. For example, I was not sure what the target objectives during baseline were and I did not know what the 1-8 scale represented. Also, I think the investigator only collected data on an outcome/target during the time it was targeted in intervention.
e. Were different treatment counterbalanced or randomized? Not Applicable, there was only one treatment.

7. Were the outcomes measure appropriate and meaningful? Yes
a. The outcomes of interest were
OUTCOME #1: Improve attention span
OUTCOME #2: Produce speech sounds
OUTCOME #3: Produce words
OUTCOME #4: Produce simple sentences
b. All of the outcomes were subjective.
c. None of the outcomes were objective.
d. All of the outcome measures were supported by reliability data.
e. The interobserver reliability data supporting each outcome measure–
OUTCOME #1: Improve attention span = .8691
OUTCOME #2: Produce speech sounds = .8444
OUTCOME #3: Produce words = .7619
OUTCOME #4: Produce simple sentences = .9096

8. Results:
a. Did the target behavior improve when it was treated? Yes
b. The overall quality of improvement was
OUTCOME #1: Improve attention span—all Ps improved markedly from pre to posttest (i.e., strong improvement)
OUTCOME #2: Produce speech sounds—all Ps improved markedly from pre to posttest (i.e., strong improvement)
OUTCOME #3: Produce words—all Ps improved markedly from pre to posttest (i.e., strong improvement)
OUTCOME #4: Produce simple sentences—all Ps improved markedly from pre to posttest (i.e., strong improvement)

9. Description of baseline:
a. Were baseline data provided? Yes
Because the baselines were staggered, each P had a different number of baselines.
P1: 4 sessions
P2: 6 sessions
P3: 8 sessions
(continue numbering as needed)

b. Was baseline low (or high, as appropriate) and stable? (The numbers should match the numbers in item 7a.)
OUTCOME #1: Improve attention span—low, stability not described
OUTCOME #2: Produce speech sounds—low, stability not described
OUTCOME #3: Produce words—low, stability not described
OUTCOME #4: Produce simple sentences—low, stability not described

c. What was the percentage of nonoverlapping data (PND)? Not applicable, insufficient data.

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

11. Was information about treatment fidelity adequate? Not Provided

12. Were maintenance data reported? No

13. Were generalization data reported? Yes. Baseline data were collected by observers in the classroom. Ps improved markedly on all outcomes from pre to post test which were administered by a pediatric physician.

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

SUMMARY OF INTERVENTION

PURPOSE: to investigate the effectiveness of music therapy on attention and language production in speech needs children

POPULATION: developmental delay, language impairment, speech sound impairment (Mandarin Chinese)

MODALITY TARGETED: expressive

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm (music)

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: vocalization, speech sounds, single words, simple sentences

OTHER TARGETS: attention

DOSAGE: 20 weeks, one hour per week

ADMINISTRATOR: Music Therapist

STIMULI: musical instruments, recorded music,

MAJOR COMPONENTS:

• Four phases of intervention:
1. Improving attention
2. Sound making/vocalizing
3. Producing single words
4. Producing simple sentences

• Overview of intervention:
– Prior to the intervention, the investigator administered baseline sessions and provided a free play session in which each P was allowed to select a favorite musical instrument.
– Each P selected a different instrument: rattles, drums, and hand bells.

• Phase1. Improving attention
– Goal: facilitate attention using musical instruments
– Steps:
1. Hello Song (C played a guitar song at the beginning of each session)
2. Attendance Song (C played P’s favorite instrument)
3. Musical Story Telling (C told story with sound effect instruments)
4. Relaxation Period (C played instrumental music which she had recorded)
5. Goodbye Song (C played a guitar song at the end of each session).

• Phase 2. Sound making/vocalizing
– Goal: facilitate the production of speech sounds (vocalizations)
– Steps:
1. Hello Song (C played and sung a guitar song and encouraged P to imitate the singing by vocalizing.)
2. Attendance Song (C played P’s favorite instrument. C encouraged P to imitate the instrument vocally.)
3. Sound Games [C played the Nan-Hu and encouraged P to imitate by vocalizing. C also played wind instruments (e.g., recorder, slide-whistle) and encouraged P to vocalize using approximations of lip shapes.]
4. Relaxation Period (C played soft music while P attempted to rest.)
5. Good-bye Song [C played a guitar song and sang a “soft sound song” (?) at the end of each session].

• Phase 3. Producing single words
– Goal: facilitate the production of single word utterances
– Steps:
1. Hello Song (C played and sung a guitar song and encouraged P to imitate a single word.)
2. Attendance Song (C played P’s favorite instrument. C encouraged P to imitate the instrument vocally using at least a single sound.)
3. Sound Games (C played the Nan-Hu and encouraged P to imitate the instrument and produce nonsense sounds.)
4. Relaxation Period (C played the guitar and sang a lullaby while P attempted to rest.)
5. Good-bye Song (C played a guitar song at the end of each session and P produced a single word from the song).

• Phase 4. Producing simple sentences
– Goal: facilitate the production of simple sentences
– Steps:
1. Hello Song (C played and sung a guitar song and encouraged P to imitate a simple greeting phrase.)
2. Attendance Song [C played P’s favorite instrument and sang a song. P produced a phrase (“Here I am”) in response to a prompt in the song.]
3. Singing Activities, Movement and Musical Storytelling [C played a variety of instruments (e.g., recorder, slide-whistle, sound effect instrument, bells, etc.) while telling a story. C encouraged P to imitate and then produce simple sentences.]
4. Relaxation Period (C played recorded soft music while P attempted to rest.)
5. Good-bye Song (C played a guitar song at the end of each session and P produced a simple greeting such as “See you” or “Good-bye”).

Rinta & Welch (2008)

SECONDARY REVIEW CRITIQUE

 

Source:  Rinta, T., & Welch, G. F. (2008). Should singing activities be included in speech and voice therapy for prepubertal children. Journal of Voice, 22, 100- 112.

 

Reviewer(s): pmh

 

Date:  June 29, 2014

 

Overall Assigned Grade: D-  (The highest possible grade was D.)

 

Level of Evidence:  D

 

Take Away:  The authors summarized evidence from previous research that supports the use of singing in speech and voice therapy with children.  This was not a comprehensive review as the authors only reviewed sources supporting their arguments. However, the authors did make a logical argument that was supported by the evidence.

 

What type of secondary review?  Narrative Review

 

1.  Were the results valid? Yes

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

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

c.  Authors noted that they reviewed the following resources: The authors did not describe the resources that they reviewed.

d.  Did the sources involve only English language publications? Unclear.  Although all the titles were in English, some of the references were published in countries in which English is not the first/official language.

e.  Did the sources include unpublished studies?  Yes

f.  Was the time frame for the publication of the sources sufficient?  Yes

g.  Did the reviewers identify the level of evidence of the sources?  No

h.  Did the reviewers describe procedures used to evaluate the validity of each of the sources?  No

i.  Was there evidence that a specific, predetermined strategy was used to evaluate the sources?  No

j.  Did the reviewers or review teams rate the sources independently?  No

k.  Were interrater reliability data provided?  No

l.  If the reviewers provided interrater reliability data, list them:  NA

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

n.  Were assessments of sources sufficiently reliable?  Not Applicable

o.  Was the information provided sufficient for the reader to undertake a replication?  No

p.  Did the sources that were evaluated involve a sufficient number of participants?  Unclear

q.  Were there a sufficient number of sources?  Yes

 

2.  Description of outcome measures:  Not applicable. Specific procedures were not described as the authors were making the case for including singing (in general) in speech and voice therapy with children.

 

3.  Description of results:  Not applicable

a.  What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size?  (Not applicable. No data were provided.

 

b.  Summarize overall findings of the secondary review:

The authors summarized evidence from previous research that supports the use of singing in speech and voice therapy with children.  This was not a comprehensive review as the authors only reviewed sources supporting their arguments. The 3 arguments were

1.  There are neurological links between speech/language, emotion (including emotional prosody) and music/singing. Tapping these links can facilitate speech and voice interventions.

2.  Singing can be linked to psychological well being which in turn can indirectly influence voice.

3.    Although there is marked variability among cultures, there is a link between communication and musical development. This supports the use of singing/music during the earliest stages of speech/vocal development.

 

c.  Were the results precise?  No 

d.  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

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

f.  For the most part, were the results similar from source to source?  Yes.  The authors only reviewed sources supporting their contention. 

g.  Were the results in the same direction?  Yes.  The authors only reviewed sources supporting their contention. 

h.  Did a forest plot indicate homogeneity?  Not Applicable

i.  Was heterogeneity of results explored?  No

j.  Were the findings reasonable in view of the current literature?  Yes

k.  Were negative outcomes noted?  No

           

                                                                                                                   

4.  Were maintenance data reported?  No

 

 

5.  Were generalization data reported?  No

 

 

 

SUMMARY OF INTERVENTION

 

Population:   Speech impairment, language impairment, voice disorders; Child

 

Note:  This article was an expository that made the case for adding singing to interventions for speech impairment, language impairment, and voice disorders in prepubertal children. The authors did not address specific intervention procedures although they provided several examples of how  singing could be incorporated into interventions.

 

 

Daly (2009)

NOTE:  Scroll about 2/3 of the way down this page to read the summary.

 

EBP THERAPY ANALYSIS

Treatment Groups

 

SOURCE: Daly, A. (2009). Teaching prosody through Readers Theatre. Capstone Paper for Master of Arts at Hamline University, Saint Paul, MN.

Paper:

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=100&ved=0CGMQFjAJOFo&url=http%3A%2F%2Fwww.hamline.edu%2FWorkArea%2FDownloadAsset.aspx%3Fid=2147491013&ei=mm3XUtPtJemisQSznIGICA&usg=AFQjCNFSbg9FCOvKXz1hUOShlefxZyQFag&bvm=bv.59568121,d.cWc

 

Review: https://clinicalprosody.wordpress.com/2014/06/02/daly-2009/

 

REVIEWER: pmh

 

DATE: June 1, 2014

 

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade was C+ due to the design of the investigation.)

 

TAKE AWAY: This single group investigation revealed that a comprehension-based Readers Theatre intervention for 2^nd graders who are English Language Learners can improve timing (phrasing), intonation, and stress (i.e., fluency) of oral reading.

 

 

1. What type of evidence was identified?

a. What was the type of evidence? (bold the appropriate design)

• Prospective, Single Group with Pre- and Post-Testing and

• Descriptive Research

• The investigator used a combined quantitative and qualitative (Action Research) approach.

 

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

 

 

2. Group membership determination:

a. If there were groups, were participants randomly assigned to groups?           

N/A, there was only one group.

 

 

3. Was administration of intervention status concealed?

a. from participants? No

b. from clinicians? No

c. from analyzers? No

                                                                    

 

4. Was the group adequately described? Yes

1. How many participants were involved in the study?

• total # of participant:   6

• # of groups: 1

• # of participants in each group: 6

• List names of groups: NA, there was only one group.

                                                                                

b. The following variables were described:

• age: 7 – 8 years of age

• gender: 2m, 4f

• language: all English Language Learners (ELL); first 21% of the children in the district are ELL

• first language: Hmong (3); Spanish (3)

• SES: 52% of children at school were eligible for reduced/free lunch

• educational level of clients: all Ps in G2

• reading level: 3/6 Ps were reading below grade level; all Ps (including those who read at grade level) read word-by-word when orally reading.

 

c.   Were the groups similar before intervention began? Not Applicable

 

d. Were the communication problems adequately described?

• disorder type: (List) no disorder- all ELL; literacy problem 3/6 had below grade level, all had oral reading problems (fluency)

• functional level

– speaking and listening skills on a 1 (beginning) – 5 (ready to transition out of ELL classes) scale: 3 (1P), 4 (4P), 5 (1P)

– reading and writing skills on a 1 (beginning) – 5 scale (ready to transition out of ELL classes): 3 (4P), 4 (2P)

– reading level: Late G1 (2P); Early G2 (1P); Mid G2 (1P); Late G2 (2P)

 

• other (list)

 

5. Was membership in groups maintained throughout the study?

a. Did each the group maintain at least 80% of their original members? Yes

b. Were data from outliers removed from the study? No

 

6. Were the groups controlled acceptably? No, this was a single group study.

 

 

7. Were the outcomes measure appropriate and meaningful? Yes

a. The outcomes were

• OUTCOME #1: Improved ranking on timing rubric

• OUTCOME #2: Improved ranking on stress rubric

• OUTCOME #3: Improved ranking on intonation rubric

• OUTCOME #4: Positive P perception of the intervention (no pretest data provided)

 

b. All of the outcome measures were subjective.

 

c. None of the outcome measures were objective.

                                         

 

8. Were reliability measures provided?

a. Interobserver for analyzers? No. The investigator did not provide data but insured reliability by having a second, independent judge. For the rubrics, the judges came to a consensus on disagreements. Most scores on the rubric were within one point of one another. A second judge also reviewed the observations; the investigator did not describe how disagreements were handled.    

 

b. Intraobserver for analyzers? No

 

c. Treatment fidelity for clinicians? No. However, the investigator made about notes about routines, teaching, and learning (i.e., the observation data).  

 

 

9. What were the results of the statistical (inferential) testing?The investigator did not subject the data to inferential testing. The results which follow are solely from descriptive analyses.

 

9a.

PRE VS POST TREATMENT—The investigator provided 3 cycles of treatment. Before initiating treatment in a cycle, the investigator administered a pretest; after treatment for a cycle, the investigator administered a posttest.

– Pretest/Posttest comparisons found to be markedly improved:

• OUTCOME #1:Improved ranking on timing rubric— Scores for each cycle increased from pretest to posttest. Moreover, each pretest was higher than the previous pretest but lower than the previous posttest.

• OUTCOME #2:Improved ranking on stress rubric— Scores for each cycle increased from pretest to posttest. Moreover, each pretest was higher than the previous pretest but lower than the previous posttest.

• OUTCOME #3:Improved ranking on intonation rubric— Scores for each cycle increased from pretest to posttest. Moreover, each pretest was higher than the previous pretest but lower than the previous posttest.

• OUTCOME #4: Positive P perception of the intervention (no pretest data provided)—The Ps’ remarks about the treatment were positive.

 

b. What was the statistical test used to determine significance? Not Applicable

 

c. Were confidence interval (CI) provided? No

 

                                   

10. What is the clinical significance? Not provided.

 

 

11. Were maintenance data reported? No

 

 

12. Were generalization data reported?Yes.The investigator administered a “transfer assessment” following the completion of the 3 cycles. The transfer assessment involved a new script at the same reading level as the previous cycles. To avoid a “cold reading”, the group read the transfer script 2 times before the assessment. Overall, Ps’ transfer scores were higher than the first pretest but lower than the final posttest. Scores for the stress rubric were lower than the timing and intonation rubrics.

           

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   C-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of comprehension-focused Readers Theatre on the intonation, timing (phrasing), and stress of ELL second graders while oral reading.

 

POPULATION: English Language Learners (ELL), Literacy (fluency problems); Child

 

MODALITY TARGETED: production (for oral reading)

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: intonation; timing (phrasing); stress

 

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation; timing (phrasing); stress

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable): Literacy (fluency)

 

DOSAGE: small group (7Ps—one P was not part of the investigation); 35 minute sessions; 4 weeks; 3 six session cycles

 

ADMINISTRATOR: English as a Second Language (ESL)Teacher

 

STIMULI: written scripts, diagrams, pictures, oral modeling by C, visual cues (e.g., hand signals, symbols on scripts)

 

MAJOR COMPONENTS:

– TECHNIQUES: Readers Theatre (expressive oral reading or prosodic reading), repeated reading, comprehension instruction strategies, modeling; metalinguistics, feedback

 

– CYCLES:

• There were 3 cycles: timing, stress, intonation

• each cycle lasted 6 days

• each cycle was associated with a different script.

• each session began with a pretest and ended with a post test using the practice script

• following the Cycle 3 post test, there was a transfer (generalization) assessment in which Ps orally read a script that had not been practiced (although the group had read it aloud 2 times to avoid a cold reading).

 

– DAILY SCHEDULE:

• 5 minute opening—snack and interaction among group members. (They were a cohesive group prior to the Readers Theatre intervention.)

• Then C administered the activities described below.

 

FOR EACH CYCLE, THE FOLLOWING PROCEDURES WERE ADMINISTERED

• Day 1: Pretesting: the group read the script aloud 2 times and worked on difficult words. C then recorded each P individually reading the script.

 

• Day 2:

– C read aloud the script using expressive prosody (i.e., modeling).

– C then presented activities designed to improve the background knowledge associated with the theme of the script for the Cycle. (The investigator describes these activities starting on page 45.)

– The group read aloud the script (i.e., everyone in the group read all the parts.)

– C provided Ps with copies of the script and directed Ps to practice them at home each day.

 

• Day 3:

– C presented a brief lesson on the prosodic element of timing.

– C assessed Ps’ comprehension of the topic and clarified her presentation.

– C read the script 2 times: 1 time with an inappropriate timing element that was the focus of the cycle and 1 with an acceptable representation.

– Ps identified the preferred reading of the script

– The group identified the errors produced by C during the “inappropriate” reading.

– Ps and C marked the first 2 pages of scripts with symbols for timing (e.g., // for long pause, / for short pause in timing)

– C highlighted a different role for each P with Ps reading aloud their own parts from the script.

– Ps then exchanged scripts so that each P performed each role.

– If necessary, the group discussed meaning of lines and/or how to improve the timing of a line.

 

• Day 4:

– C presented a brief lesson on the prosodic element of stress.

– C wrote a line from the script on the board and read it aloud with appropriate stress.

– C directed the Ps to identify the loudest word and then she underlined the word with a thick line.

– C asked Ps to identify words that were “a little loud” but not as loud as the previous (full stressed) word. Then she underlined those words with thin lines.

– C asked Ps to identify words that were spoken softly and she did not underline them.

– C presented another line from the script and repeated the process

– C explained to the Ps that speakers emphasize words that they think are important and that they already did this when they spoke. C also explained that as actors the Ps needed to be sure they understood the scripts so they could emphasize the correct words.

– As a group, the Ps and the C read through the script identifying the level of stress for each work (thick line, thin line, no line).

– The Ps then read through the script several times. Each P took a different role, each time the script was read.

– At the end of the session, C assigned the roles to the Ps for the final performance. C provided Ps with highlighters that they took home to mark their lines in their homework script.

– C reminded Ps that good actors practice their lines many times and encouraged them to practice at home.

 

• Day 5:

– During the 2^nd and 3^rd cycles, the following was included. However, it was eliminated from Cycle 1. Rather, during Cycle 1, C reviewed stress and timing (phrasing) with the Ps.

• C sang the “Star Spangled Banner” using hand signals to signify rising or falling pitch.

• C explained to the Ps that in every day speech, pitch rises and falls, although not as much as for singing.

• C repeated a sentence she had produced at the beginning of the session, using hand signals to signify rising and falling pitches.

• C noted that actors decide to use rising and falling pitches based on their understanding of the lines in the script.

• C wrote a line from the script on the board and signified rising or falling pitch with symbols.

• C continued writing lines of the board. Each time, the group said the line slowly and a P drew lines indicating the proper intonation.

– During Cycle 3, C repeated sentences Ps spoke during snack time and linked the intonation pattern to a line in the script using hand signals to signify intonation patterns. C encouraged Ps to use the every day intonation patterns in their readings.

– Ps read aloud the script one time and then they read it with each P taking his/her part.

– C directed Ps to go into separate sections of the room and to practice reading aloud their own lines. C circulated among the Ps and provided corrective feedback.

– C then placed Ps in their respective places for the performance (Day 6) and the Ps read through their lines in turn.

 

• Day 6:

– Ps rehearsed the script before the performance.

– After the performance, P briefly debriefed.

– C administered the post test to P individually.

 

– ADDITIONAL RECOMMENDATIONS FOR CHANGES/INSIGHTS DERIVED FROM SYSTEMATIC OBSERVATIONS:

• Increase the number of days in a cycle to 7.

• Increase vocabulary work during comprehension instruction.

• Explicit attention to prosody (timing/phrasing, intonation, stress) is effective but it may be helpful to limit attention to a single feature per cycle.

• Cs might consider allowing a few weeks between each cycle to facilitate consolidation of gains.

• Modeling and visual cues (hand signal, written symbols) are useful in teaching about timing.

• One challenge associated with timing—For sentences that extended beyond a single line of script, some Ps tended to pause at the end of the line on the script. (C provided extra modeling and a reminder to pause only at slashes to deal with this issue.)

• Some of the students had trouble with stress, particularly function words.

• Visual cues for intonation were less successful than for stress and timing (phrasing). To deal with this. C adopted the music teacher’s strategy for signifying pitch in music. (See page 69.)

 

 

Geist et al. (2008)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

SOURCE: Geist, K., McCarthy, J., Rodgers-Smith, A., & Porter, J. (2008). Integrating music therapy services and speech-language therapy services for children with severe communication impairments: A co-treatment model. Journal of Instructional Psychology, 35 www.freepatentsonline.com:article:Journal-Instructional-Psychology:193791683.html

 

 

REVIEWER(S): pmh

 

DATE:  May 14, 2014

 

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

 

TAKE AWAY: The authors explained the rationale for co-treatment of communication disorders by music therapists (MT) and speech-language pathologists (SLP) and described the strategy used with a single case.

 

 

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

 

2. What type of evidence was identified? Case Study – Program Description(s) with Case Illustration(s)

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

Level = D+                                                      

                                                                                                           

3. Was phase of treatment concealed?                                             

a. from participants? No                             

b. from clinicians? No                                 

c. from data analyzers? Yes                      

 

4. Was the participants adequately described? Yes

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

 

b. P characteristics

– The following characteristics were controlled:

• age: between 2 and 12 years

• communication skills: severe communication impairment

• responsive to music

• parental consent

 

– The following characteristics were described:

• age: 4 years

• gender: m

• expressive language: 9-12 months (Rossetti Infant Toddler Language Scale)

• receptive language: 9-12 months (Rossetti Infant Toddler Language Scale)

• gesture functional level: 15-18 months (Rossetti Infant Toddler Language Scale)

• medical diagnoses/challenges: preterm; on respirator up to 7 weeks; tracheotomy from 8-21 months; bronchopulmonary dysplasia (therefore, highly susceptible to illness)

• previous therapy: yes, speech language therapy; no music therapy (MT)

• responsiveness to music: attended to book sung to him, increased engagement during music activity

 

c. Were the communication problems adequately described? Yes

• The disorder type: severe language impairment; child

• Other aspects of communication that were described:

– used gestures to request

– no intelligible speech

– comprehension problems (words and commands)

– familiar with social routines

– used pictures to request items (target in previous therapy)

– signed to continue activity (target in previous therapy)

– did not greet classmates

                                                                                                                       

5. Was membership in treatment maintained throughout the study? Not applicable

a. If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable

b. Were any data removed from the study? No

 

6. Did the design include appropriate controls? No, this was an illustrative case study.

a. Were baseline/preintervention data presented on all behaviors? No

b. Did probes/intervention data include untrained data? No data

c. Did probes/intervention data include trained data? No data

d. Was the data collection continuous? No data

e. Were different treatment counterbalanced or randomized? Not Applicable

 

7. Was the outcome measure appropriate and meaningful? Yes

a. The outcome was:

OUTCOME #1: to increase classroom participation as represented by greetings and participation during story time

b. Was the outcome subjective? Yes

c. Was the outcome objective? N

d. Was the outcome measure reliable:? Yes  

e. The support for the reliability of the outcome measure was 10 blind assessors video pre and post intervention videos; all identified the post video as more engaged

 

 

8. Results:

a. Did the target behavior improve when it was treated? Yes

b. The overall quality of improvement was unclear—no data were provided.

 

 

9. Description of baseline:

• Were baseline data provided? No

                                               

 

10. What was the magnitude of the treatment effect? INA

 

 

11. Was information about treatment fidelity adequate? No

 

 

12. Were maintenance data reported? No

 

 

13. Were generalization data reported? No

 

 

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

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe a strategy for integrating music and speech-language therapy and to provide documentation for its success in an illustrative case study.

 

POPULATION: Language impairment; Child

 

MODALITY TARGETED: production

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm, pitch

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: Increased participation in classroom interactions

 

ADMINISTRATOR: music therapist (primary administrator); SLP served as consultant; teacher

 

MAJOR COMPONENTS:

• The overall strategy included:

1. assessment of communication status

2. assessment of responsiveness to music

3. coordination of team meetings (including parents) to identify goals and targets

4. development of procedures for collaboration between music therapist and speech-language pathologist

5. administration and evaluation the intervention strategy

 

• Phases of treatment:

1. 1:1 MT sessions (3 initial sessions)

2. Small group (4 -5 of classmates; 4 sessions)

3. Large group(20 classmates)

 

• 1:1 MT sessions

– C introduced activities such as

• greeting songs

• listening to songbook activities

• playing instruments

•  closing songs

 

• Small group

– Teacher observed

– SLP observed and consulted on the use of AAC (Augmentative/Alternative Communication)

– same activities as 1:1 MT sessions

– C also worked on waiting his turn

– P used AAC to participate; it could be faded as he progressed.

• Large Group

– MT and SLP taught the teacher strategies to facilitate P’s engagement, including the use of the AAC device.

–

 

Pennington et al. (2009)

SECONDARY REVIEW CRITIQUE

 

Note: Brief summaries of the interventions concerned with treating prosody or using prosody to treat other outcomes can be accessed by scrolling about two-thirds of the way down.

 

 

Source: Pennington L, Miller N, & Robson S. (2009). Speech therapy for children with dysarthria acquired before three years of age. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006937. DOI: 10.1002/14651858.CD006937.pub2

Reviewer(s): pmh

 

Date: April 30, 2014

 

Overall Assigned Grade: A (Highest possible grade based on the design is A+.)

 

Level of Evidence: A+

 

Take Away: Because the search revealed no experimental or quasi-experimental studies, some of the components of a Systematic Review were not completed. The authors did review 10 observational sources that provided some level of evidence but only six were clearly concerned with prosody. The SR noted that treating certain aspects of prosody may result in improved intelligibility, certain aspects of voice quality, and articulation. Only the prosody related critiques were reviewed below.

 

What type of secondary review? Classic Systematic Review

 

1. Were the results valid? Yes

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

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

c. Authors noted that they reviewed the following resources:

• conference proceedings

• hand searches

• internet based databases    

d. Did the potential sources involve only English language publications? No, sources could be in any language

e. Did the potential sources include unpublished studies? Yes

f. Was the time frame for the publication of the sources sufficient? Yes

g. Did the reviewers identify the level of evidence of the sources?

Yes, the reviewers noted that all reviewed sources did not meet inclusion criteria as they were observational investigations

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

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

j. Did the reviewers or review teams rate the sources independently? Yes

k. Were interrater reliability data provided? Yes

l. What was the interrater reliability for exclusion of the 10 sources? 100%

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

n. Were assessments of sources sufficiently reliable? Not Applicable

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

p. Did the sources that were evaluated involve a sufficient number of participants? Yes, but these were for sources that were excluded from the Systematic Review.

q. Were there a sufficient number of sources? No

2. Description of outcome measures:

• Outcome Fox (2005): To improve

– sound pressure level (SPL),

– maximum duration,

– maximum and minimum pitch in HZ,

– pitch range in HZ,

– harmonics to noise ratio (HNR)

– C’s preference for loudness

– C’s preference for loudness variability

– C’s preference of overall pitch

– C’s preference for pitch variability

– C’s preference for articulatory precision

– C’s preference for overall voice quality

• Outcome Fox (2008): To improve

– sound pressure level (SPL),

– harmonics to noise ratio (HNR)

– jitter

– duration in maximum duration and sentence repetition tasks

– Parents’ preference for voice quality

• Outcomes for Pennington (2006): To improve

– intelligibility

– P’s perception of acceptability of the intervention

• Outcome for Pennington (2009): To improve

– intelligibility

– P’s perception of acceptability of the intervention

• Outcome for Puyuelo (2005): To improve measures of

– voice control

– intelligibility

– respiration

– articulation

– prosody

• Outcome for Robson (2009): To improve

– perception of severity of voice impairment

– harmonics to noise ratio

– jitter

– shimmer

– mean fundamental frequency

– rate with pauses

– rate without pauses

– time with pauses

– time without pauses

 

 

3. Description of results:

a. What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? No EBP metrics were provided

b. Summarize overall findings of the secondary review:

• The reviewers found no research meeting the criteria which included experimental and quasi-experimental designs (i.e. controlled studies).

• The review of the observational studies revealed that focusing on certain aspects of prosody may result in improved intelligibility, certain aspects of voice quality, and articulation. However, these results need to be verified using more rigorous research designs.

c. Were the results precise? Unclear

d. 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

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

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

g. Were the results in the same direction? Yes

h. Did a forest plot indicate homogeneity? Not

i. Was heterogeneity of results explored? No

j. Were the findings reasonable in view of the current literature? Yes

k. Were negative outcomes noted? Yes

                                                                                                                   

4. Were maintenance data reported?Yes. The reviewers noted whether or not maintenance data were collected, although the outcomes were not always reported in the Systematic Review. When maintenance results were reported, the findings were inconsistent.

 

 

SUMMARY OF INTERVENTION

 

Population:Cerebral Palsy, Dysarthria; Child

 

Prosodic Targets:

– sound pressure level (SPL),

– maximum duration,

– maximum and minimum pitch in HZ,

– pitch range in HZ,

– C’s preference for loudness

– C’s preference for loudness variability

– C’s preference of overall pitch

– C’s preference for pitch variability

– duration in maximum duration and sentence repetition tasks

– prosody

– mean fundamental frequency

– rate with pauses

– rate without pauses

– time with pauses

– time without pauses

 

Nonprosodic Targets:

– harmonics to noise ratio (HNR)

– C’s preference for articulatory precision

– C’s preference for overall voice quality

– jitter

– Parents’ preference for voice quality

– intelligibility

– P’s perception of acceptability of the intervention

– voice control

– respiration

– articulation

– perception of severity of voice impairment

– harmonics to noise ratio

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rate, loudness, prosodic contrasts (not defined), intonation, pausing, rhythm, duration

 

 

Description of Procedure associated with Fox (2005):

• Outcome: To improve

Acoustic Measures

– sound pressure level (SPL),

– maximum duration,

– maximum and minimum pitch in HZ,

– pitch range in HZ,

– harmonics to noise ratio (HNR)

Perceptual Measures

– C’s preference for loudness

– C’s preference for loudness variability

– C’s preference of overall pitch

– C’s preference for pitch variability

– C’s preference for articulatory precision

– C’s preference for overall voice quality

• The intervention involved administration of Lee Silverman Voice Therapy Loud.

 

Evidence Supporting Procedure associated with Fox (2005)

– Improvement in all acoustic outcomes for 3 of the 4 Ps who received treatment. This improvement was maintained at follow-up.

– With the exception of overall pitch, therapists preferred the post treatment perceptual measures.

 

 

Description of Procedure associated with Fox (2008):

• OUTCOME: To improve

– sound pressure level (SPL),

– harmonics to noise ratio (HNR)

– jitter

– duration in maximum duration and sentence repetition tasks

– Parents’ preference for voice quality

• The intervention involved administration of Lee Silverman Voice Therapy Loud.

 

Evidence Supporting Procedure associated with Fox (2008)

– Improvement in SPL in sustained vowels (post therapy and follow-up) and in sentences (after therapy)

– Improvements in jitter (post therapy and follow-up)

– After therapy, parents rated their children’s voices as “louder”, less “nasal” and more “natural”.

 

Evidence Contraindicating Procedure associated with Fox (2008)

– Analyzers were not blinded.

 

 

Description of Procedure associated with Pennington (2006):

• OUTCOME: To improve

– intelligibility

– P’s perception of acceptability of the intervention

• The investigators employed asystems approach to intervention focusing on breath control for speech and prosodic contrasts. These terms were not described in the Systematic Review.

 

Evidence Supporting Procedure associated with Pennington (2006)

• 4 of the 6 Ps improved single intelligibility post therapy but not at follow-up.

• 3 of 6 Ps improved connected speech intelligibility post therapy but not at follow-up.

• 3 of the 6 Ps perceived duration and intensity of the intervention to be acceptable

Evidence Contraindicating Procedure associated with Pennington (2006)

• No control group.

 

 

Description of Procedure associated with Pennington (2009):

• OUTCOME: To improve

– intelligibility

– P’s perception of acceptability of the intervention

• The investigators used a systems approaching targeting the stabilization of respiration, phonatory effort, speech rate, and phrase length or syllables per breath.

 

Evidence Supporting Procedure associated with Pennington (2009)

• 15 of the 16 Ps improved intelligibility.

• All P reported satisfaction with the intervention procedures.

 

Evidence Contraindicating Procedure associated with Pennington (2009)

•  No treatment fidelity treatment.

• No maintenance data.

 

 

Description of Procedure associated with Puyuelo (2005):

• OUTCOME: To improve measures of

– voice control

– intelligibility

– respiration

– articulation

– prosody

• There were 2 blocks of therapy:

Block1. Improving motor control by focusing on articulation, chewing, and expiratory breathing. (This was not successful.)

Block2. Improving control of exhalation for speech, coordinating exhalation and phonation, voice training, and prosody (intonation, pause, rhythm, and duration). Parents were also involved in this block (speech stimulation activities and use of narratives).

 

Evidence Supporting Procedure associated with Puyuelo (2005)

• Block 1 yielded improvement only in voice control.

• In Block 2 resulted in improvement of

– respiration

– voice

– articulation

– intelligibility

– prosody

 

Evidence Contraindicating Procedure associated with Puyuelo (2005)

• Long duration of intervention.

• Block 1 yielded improvement only in voice control.

• No control group.

• Data analyzers were not blinded.

 

 

Description of Procedure associated with Robson (2009):

• OUTCOME: To improve

– perception of severity of voice impairment

– harmonics to noise ratio

– jitter

– shimmer

– mean fundamental frequency

– rate with pauses

– rate without pauses

– time with pauses

– time without pauses

• The investigators used a systems approaching targeting the stabilization of respiration, phonatory effort, speech rate, and phrase length or syllables per breath.

 

Evidence Supporting Procedure associated with Robson (2009)

• The investigators reported

– Limited decrease in fundamental frequency,

– Limited decrease in intensity

– Limited decrease in jitter of children’s voices.

– Limited increase in speaking time between pauses.

 

Evidence Contraindicating Procedure associated with Robson (2009)

• The investigators did not find a change in perceived severity of voice impairment.

• No maintenance data.

 

Holck (2004)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

SOURCE: Holck, U. (2004). Turn-taking in music therapy with children with communication disorders. British Journal of Music Therapy, 2, 45-53.

 

REVIEWER(S): pmh

 

DATE: April 12, 2014

 

ASSIGNED OVERALL GRADE: D- (Due to the case study design, D+ is the highest possible assigned overall grade.)

 

TAKE AWAY: Due to the nature of the design, the support for this intervention is weak. Nevertheless, the investigator provides a thoughtful guide for using music to facilitate turn taking with a Danish speaking child who did not show interest in interactions and did not signal communicative intent.

                                                                                                           

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

                                                                                                           

2. What type of evidence was identified?                              

a. What type of single subject design was used?

• Case Studies– Description with Pre and Post Test Results

• Single Subject Experimental Design with Specific Client   

b. What was the level of support associated with the type of evidence?

Level = D+                                                      

                                                                                                           

3. Was phase of treatment concealed?                                 

a. from participants? No

b. from clinicians? No

c. from data analyzers? No

 

4. Were the participants adequately described? No

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

b. The following characteristics/variables were described:

• age: 2 ½ years

• gender: M

• cognitive skills: moderate learning disabled  

• sensory skills: tended to be overwhelmed by sensory stimulation

4c. Were the communication problems adequately described? No

• The disorder types was language impairment.

• Other aspects of communication that were described included

— imitated and played with speech sounds

— did not display communicative intent

— did not point or show interest in give and take game

— had few words that were only spoken with mother

                                                                                                                       

5. Was membership in treatment maintained throughout the study? Not applicable, there was only one P.

a. If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable

b. Were any data removed from the study? No

 

6. Did the design include appropriate controls? No, this was a case study.

a. Were baseline/preintervention data collected on all behaviors? No, no baseline/preintervention data were provided.

b. Did probes/intervention data include untrained data? No, no probe /intervention data were provided.

c. Did probes/intervention data include trained data? No, no probe /intervention data were provided.

d. Was the data collection continuous? No, no probe /intervention data were provided.

e. Were different treatment counterbalanced or randomized? Not Applicable

 

7. Were the outcomes measure appropriate and meaningful? Unclear, the investigator’s definition of outcome measures were not clear but they appeared to be more closely tied to music than conversation.

a. The outcomes were

OUTCOME #1: To increase the rate of appropriate turn yielding and taking

OUTCOME #2: To improve preverbal and social skills

(continue numbering as needed)

 

 

8. Results:

a. Did the target behavior improve when it was treated? Yes

b. The overall quality of improvement for each of the outcomes is difficult to discern because the investigator did not provide sufficient data. The ratings listed below are estimates:

• OUTCOME #1: To increase the rate of appropriate turn yielding and taking–limited

• OUTCOME #2: To improve preverbal and social skills—limited

 

 

9. Description of baseline:

a. Were baseline data provided? No

 

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

 

 

 

11. Was information about treatment fidelity adequate? Not Provided

 

 

12. Were maintenance data reported?

 

 

13. Were generalization data reported? No

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To explain and illustrate how music therapy and turn analysis can be used to improve preverbal and social skills.

 

POPULATION: language disorder (limited social and verbal communication); child

 

MODALITY TARGETED: production

 

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: turn taking

 

DOSAGE: 6 sessions (length and frequency were not specified)

 

ADMINISTRATOR: music therapist

 

MAJOR COMPONENTS:

 

• 6 sessions

 

– Session 1:

• C assisted P (for safety) as he bounced on a large physical therapy ball. This was an activity that P liked. C and P sat side-by-side in front of a mirror.

• While P was bouncing, C sang lines from familiar songs or sang descriptions of P’s actions.

• Occasionally, C would sing a line about stopping and would physically stop P’s bouncing.

• After a brief interval, C would sing a phrase indicating that C could begin bouncing again and allowed him to continue bouncing again.

 

– Session 2 and 3:

• During Session 2, P spontaneously vocalized in an excited manner with his vocalizations moving from one pitch to the next (glissando). When C attempted to join him, he stopped.

• When he next used glissando, C interrupted him and then handed the turn over to him by

1. singing a short (3 note) glissando ,

2. stressing the last note (a common strategy for yielding a turn in conversation),

3. C shortened P’s glissisandi by interrupting him at progressively shorter intervals.

4. P was allowed to keep bouncing during the glissandi work as long as he maintained attention or and his speech sounds were not “diffuse” (?, not sure what this is, pmh). In such cases, C sang the song directing him to stop and physically stopped him.

• During these sessions, C moved to the floor and asked P’s mother to hold him. C introduced the guitar playing a repetitious sequence of chords which provided a rhythm to replace the bouncing.

 

– Sessions 4, 5, and 6

• At this point, P was regularly using short 3 notes, sung in a “favorite” key, ending in a rising then falling terminal contour.

• C and P imitated speech sounds, included sounds that sounded like Danish words.

 

 

Abram (n.d.)

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

SOURCE: Abrams, S. (n.d.). The effects of fluency instruction incorporating Readers Theatre on oral reading fluency in an eighth-grade classroom.  On January 1, 3018 retrieved from www.eiu.edu/researchinaction/pdf/Carla_Hymes_Paper.pdf

 

REVIEWER(S):  pmh

 

DATE: March 31, 2014

 

ASSIGNED GRADE FOR OVERALL QUALITY: C-   (The highest possible grade for this investigation based on its design is C+. The grade represents a judgment about the quality of the evidence supporting the treatment, not the quality of the treatment.)

 

TAKE AWAY: This pre-post test investigation involved an intervention using decoding strategies, reading aloud grade level materials, and Readers Theatre. The results indicated improvement in reading rate but not prosodic reading fluency. Readers Theatre may have potential to improve reading prosody despite the findings of this investigation. The short treatment dosage, difference between intervention and assessment tasks, the assessment task itself, and use of grade-level rather than reading level passages (see Allington, 2006) may have contributed to the lack of improvement in prosodic reading fluency.

 

 

1. What type of evidence was identified?

                                                                                                           

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

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

                                                                                                           

2. Group membership determination:

a. If there were groups, were participants randomly assigned to groups? N/A

b. If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched? N/A

 

 

3. Was administration of intervention status concealed?

                                                                                                           

a. from participants? No

b. from clinicians? No

c. from analyzers? No

                                                                    

 

4. Were the groups adequately described? No

1. How many participants were involved in the study?

• total # of participant:   8

• # of groups: 1

 

b. The following variables were described:

 

• gender: 6f, 2m

• Language: all Ps were English language proficient

• SES: all Ps received reduced or free lunch

• educational level of clients: 8^th graders from a reading intervention classroom; all part of the special education program

 

c.   Were the groups similar before intervention began? Not Applicable

                                                         

d. Were the communication problems adequately described? No

• disorder type: reading below grade expectation

 

 

5. Was membership in groups maintained throughout the study?

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

b. Were data from outliers removed from the study? Yes. Scores that were 1.5 times the interquartile range were removed from each of the outcomes.

 

 

6. Were the groups controlled acceptably? Not Applicable

 

 

7. Were the outcomes measure appropriate and meaningful? It was Unclear whether the measures were valid and reliable measures of fluency.

a. The outcomes were

• OUTCOME #1: Improved performance on Words Correct Per Minute Test (WCPM)—a measure of accuracy and rate
• OUTCOME #2: Improved performance on Multidimensional Fluency Scale (MDFS)—a score combining measures of reading expression, volume, phrasing (pauses, stress, intonation variation), smoothness (prosodic fluency), and pace (rate)

 

b. All the outcome measures were subjective.

 

c. None of the outcome measures were objective.

 

                                         

8. Were reliability measures provided?

                                                                                                            

a. Interobserver for analyzers? No

b. Intraobserver for analyzers?   No

c. Treatment fidelity for clinicians? No

 

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

                                                                                                             

PRE VS POST TREATMENT: Pre and post measures were compared for the single group

 

a. Were there significant differences?

 

• OUTCOME #1: Improved performance on Words Correct Per Minute Test (WCPM)—a measure of accuracy and rate—Yes, post scores were significantly better (p = 0.00006)

 

• OUTCOME #2: Improved performance on Multidimensional Fluency Scale (MDFS)—a measure of reading expression, volume, phrasing (pauses, stress, intonation variation), smoothness (pausing), and pace (rate) — No significant difference in pre and post test scores

 

b. The statistical test used to determine significance was t-test

c. Were confidence interval (CI) provided? No

 

                                   

10. What is the clinical significance? Not provided

 

 

11. Were maintenance data reported? No

 

 

12. Were generalization data reported?Yes. The Outcomes required that Ps read unfamiliar passages which could be interpreted as generalization. Outcome #1 improved but Outcome #2 did not.

 

• OUTCOME #1: Improved performance on Words Correct Per Minute Test (WCPM)—a measure of accuracy and rate
• OUTCOME #2: Improved performance on Multidimensional Fluency Scale (MDFS)—a measure of reading expression, volume, phrasing (pauses, stress, intonation variation), smoothness (prosodic fluency), and pace (rate)

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: __C-___

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:To investigate the effectiveness of focusing on pronunciation, appropriate reading pace, correct phrasing, expression, sentence stress, and repeated oral readings to improve the fluency of reading aloud.

POPULATION: reading problems

 

MODALITY TARGETED: expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rate, phrasing, prosodic fluency, loudness, sentence stress, intonation variation

 

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation variation, pausing, sentence stress, rate, phrasing

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: literacy—rate and accuracy of reading; expression of oral reading

 

DOSAGE: group, 50 minutes, 4 times a week, 6 weeks

 

ADMINISTRATOR: teacher

 

STIMULI: grade-level reading materials, auditory models of teacher, videos, pictures of selected words in a reading passage

 

MAJOR COMPONENTS:

 

• Weeks 1 and 8 were devoted to pre and post testing

 

• Weeks 2 and 3: focus– automaticity and pace

– C modeled automaticity oral reading and discussed it with P at the beginning of Week 2 and 3 sessions.

– C instructed Ps regarding the decoding of unknown words.

– C introduced ‘vowel spots’ and demonstrated how they represent syllables within a word.

– C demonstrated that syllables can be detected by placing hands under the chin while saying the word and encouraged Ps to practice this hint.

– C explained open and closed syllables and noted how they correspond to long and short vowels.

– C presented information about digraphs and Ps brainstormed examples of them.

– C explained prefixes, suffixes, root words. Ps brainstormed examples of them.

– Ps practiced segmenting and pronouncing words.

– C identified compound words and presented compound words with suffixes and prefixes to the Ps.

– C explained multisyllable words.

– Ps practiced pronouncing multisyllable words from text.

– Ps read passages and identified words they could not pronounce. They then counted the number of syllables in the word as well as identified any suffixes, prefixes, root words, and compound words.

 

• Weeks 4 and 5: focus- rate and fluency

– C read aloud 3 versions of the same passage with differing rates.

– Ps discussed the versions and identified the optimal rate.

– C presented Ps with a list of sight list words and directed Ps to read through the list (aloud) for 1 minute. The task was repeated 2 more times while C encouraged Ps to read at their quickest rate while maintaining accuracy.

– C provided Ps with a list of common phrases. Ps read the list to a partner and they checked one another for accuracy. Ps then read the phrase list to determine how many they could read accurately in one minute. This was repeated 2 more times.

– C presented 2 verses of a song that was known to the Ps.

– Ps re-read the verses and identified unfamiliar words.

– Ps discussed the unfamiliar words with the groups and then pairs of Ps worked together to pronounce the words.

– C presented a video modeling targetsof fluency and pace of the verses.

– Ps then read to verses aloud with partners and they ae checked for accuracy.

 

•  Weeks 6 and 7: focus–  prosody, automaticity, pacing in Readers Theatre

– Readers Theatre is an intervention that involves repeated reading of passages with appropriate prosody.

– Using the Readers Theatre procedure, Ps silently re-read an expository passage and identified unfamiliar words.

– As a visual aid to the Ps, C provided selected pictures of the entities in the passage.

– Ps practiced unfamiliar words in pairs and were assisted by C.

– C modeled reading the passage aloud.

– Ps volunteered to read aloud parts of the passage and the whole class participated in the read aloud activity.

– C presented a new script.

– The Ps discussed the title and offered their ideas about what the passage was about.

– C divided the class into 2 groups and assigned parts for each of the Ps.

– C and a teacher’s aide also were assigned parts.

– Ps prepared their parts by pre-reading, identifying unfamiliar words, and assisting one another in proper pronunciation of words.

– C modeled the appropriate reading of the passage.

– C noted the importance of punctuation, how it should be interpreted, and how to produce acceptable prosodic expression.

– Each group presented their interpretation of the passage and then the whole group reflected on the story.

 

Allington (2006)

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

NOTE:  For summary of teaching strategies, scroll about two-thirds of the way down on this page.

Source:  Allington, R. L. (2006). Fluency: Still waiting after all these years.  In S. J. Samuels & A. E. Farstrup (Eds.), What research has to say about fluency instruction (pp. 94-105). Washington, DC: International Reading Association

Click to access fluency_still-wait.pdf

 

Reviewer(s):  pmh

 

Date:  March 15, 2014

 

Overall Assigned Grade:  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:  This expert opinion presents evidence from the literature that dysfluent reading may be associated with teacher behaviors. The author suggests that changes in teaching strategies can result in improvements in dysfluent readers. The recommended strategies include presenting Ps with reading materials at the appropriate reading level (not too difficult), teaching Ps to self-monitor, offering P’s opportunities that are offered to good readers (multiple opportunities for silent reading, opportunities to select materials they find interesting, appropriate reading level materials), and refraining from interrupting readers until the end of the sentence.

Although the focus of the teaching strategies was dysfluent reading, these strategies could be helpful with prosodic problems.

 

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

 

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

 

3.  Were the interventions based on clinically sound clinical procedures?  Yes

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

5.  Description of the outcome measure:

•  Outcome:  to reduce reading dysfluency (word-by word reading; little/no attention to prosody, phrasing, intonation/inflection; reading clumps of words that are not phrases; reading with monotonic intonation and little/no phrasing although rate may be fast and accurate)

 

6.  Was generalization addressed?  No

 

7.  Was maintenance addressed?  No

 

 

SUMMARY OF INTERVENTION

 

NOTE:  The author did not list the following as interventions. Rather, this reviewer (pmh) derived them from the manuscript.

Description of Intervention #1–To provide appropriate reading level

 

POPULATION:  Literacy problems (dysfluent readers); child/adolescent

TARGETS:  To facilitate fluent reading

 

PROCEDURES: 

•  C ensures that all reading material is appropriate for P’s level of functioning. This includes academic texts and quiet reading materials as well as intervention reading materials.

 

RATIONALE/SUPPORT FOR INTERVENTION:

• This is supported logically.

Description of Intervention #2—To provide many opportunities for reading (reading volume)

 

POPULATION:  Literacy problems (dysfluent readers); child/adolescent

 

TARGET: To facilitate fluent reading

TECHNIQUES:  silent reading, reading aloud, independent reading, repeated reading (see Intervention #3)

 

PROCEDURES: 

•  C provides an environment in which P has the potential to read successfully.

•  C encourages P on numerous occasions throughout the day to read aloud and silently throughout the day. Reading materials should be appropriate to P’s reading level.

RATIONALE/SUPPORT FOR INTERVENTION:

•  The author cited evidence that struggling readers engaged in far less reading than good readers and that the readings should facilitate successful reading.  That is, reading should be appropriate to the P’s reading level and interests.

•  The author cites literature indicating that independent and repeated readings are both associated with increases in fluency and word recognition but that independent reading is more closely associated with comprehension gains.

Description of Intervention #3—Repeated reading

 

POPULATION:  Literacy problems (dysfluent readers); child/adolescent

 

TARGET:  To facilitate fluent reading

TECHNIQUES:  repeated reading

 

PROCEDURES: 

•  This intervention is associated with reading volume but it is not identical to it.

•  P reads aloud and re-reads (multiple times) the same material.

RATIONALE/SUPPORT FOR INTERVENTION:

•  The author cites literature indicating that independent and repeated readings are both associated with increase in fluency and word recognition

Description of Intervention #4—Instructors’ modification of teaching behaviors with struggling readers

 

POPULATION:  Literacy problems (dysfluent readers); child/adolescent

 

TARGET: To increase self monitoring and reading fluency

 

PROCEDURES: 

•  C restricts interruptions of P’s reading aloud to making comments at the end of a sentence.

•  When C does interrupt P, C encourages self-monitoring by asking P to re-read or cross check.

•  C avoids the following during interruptions:  interrupting after a misread word, asking the struggling reader to read aloud only more often than successful readers, and telling P to sound out a word.

•  C monitors P’s tendency to pause and wait for a prompt when reading aloud. C should be careful NOT to interrupt at this time, if possible.

•  C regularly provides opportunities for P to read silently.

•  C encourages P to select reading materials that are of high interest and at the appropriate reading level

•  C focuses attention on comprehension.

RATIONALE/SUPPORT FOR INTERVENTION :

•  The author makes the case that teachers’ behaviors with struggling readers actually disrupt the fluency that they are targeting and make the Ps dependent on their feedback.

•  The author recommends that Cs adopt the behaviors that they use with successful readers to their instructional strategies with struggling readers.

Whipple (2004)

 

SECONDARY REVIEW CRITIQUE

 

NOTE:  Scroll down about  1/3  of the way down to read the summary of the intervention procedures

 

SOURCE:  Whipple, J. (2004).  Music in intervention for children and adolescents with autism: A meta-analysis.  Journal of Music Therapy, 41, 90-106.

 

REVIEWER(S):  pmh

 DATE:   February 28, 2014

LEVEL OF EVIDENCE:  B

 ASSIGNED OVERALL GRADE:  B

TAKE AWAY:  This meta-analysis supports the effectiveness of music therapy (pitch and rhythm) for the improvement of a variety of skills (i.e., communication, social/behavioral skills, cognition.)                                                                                                         

What type of secondary review?  Meta Analysis

1.  Were the results valid? Yes

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

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

c.  Authors noted that they reviewed the following resources:  

•  conference posters 

•  references from identified literature

•  theses/dissertations 

•  specified journals

d.  Did the sources involve only English language publications?  Yes

e.  Did the sources include unpublished studies?  Yes

f.  Was the time frame for the publication of the sources sufficient?  Yes

g.  Did the reviewers identify the level of evidence of the sources?  No

h.  Did the reviewers describe procedures used to evaluate the validity of each of the sources?  No

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

j.  Did the reviewers or review teams rate the sources independently?  No

k.  Were interrater reliability data provided?  No

l.  If the reviewers provided interrater reliability data, list them:  NA

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

n.  Were assessments of sources sufficiently reliable?  Not applicable

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

p.  Did the sources that were evaluated involve a sufficient number of participants?  Unclear/Variable

q.  Were there a sufficient number of sources?  Yes

2.  Description of outcome measures:

•  Outcome #1:  reduction of challenging behaviors

•  Outcome #2:  improve rate of correct responses to directions involving gross motor completion tasks

•  Outcome #3:  improve accuracy on a computer task

•  Outcome #4:  improved use of communication acts

Outcome #5:  increase rate of correct responses to directions involving shapes and the accurate identification of shapes

•  Outcome #6:  increase score on a formal test of receptive vocabulary  (Peabody Picture Vocabulary Test)

•  Outcome #7:  increase appropriate pointing to and looking at stimuli during songs

•  Outcome #8:  improve eye contact and verbalization

•  Outcome #9:  increase rate of spontaneous speech

•  Outcome #10:  increase eye contact, initiation, and social acknowledgement

•  Outcome #11:  to eye contact and communicative acts

•  Outcome #12:  to decrease the rate of self-stimulatory behaviors

 

 

3.  Description of results:           

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

•  standardized mean difference (d)

•  confidence interval

b.  Summarize overall findings of the secondary review:

Overall, the results were positive. All the outcomes improved with d ranging from 0.09 (negligible) to 3.36 (large) and  mean of 0.83 (large). In addition, the confidence interval did not cross zero. The investigators removed the largest positive outcome (3.36) because it was a statistical outlier. The results remained strong and positive. The effect size of 3 of the outcomes was small (0.20-0.49), 4 were moderate (0.50-.079), and 6 were large (>0.80)

c.  Were the results precise?  Yes

d.  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? Yes

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

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

g.  Were the results in the same direction?  Yes 

h.  Did a forest plot indicate homogeneity?  Not Applicable

i.  Was heterogeneity of results explored?  Yes 

j.  Were the findings reasonable in view of the current literature?  Yes

k.  Were negative outcomes noted?  No, there were no negative outcomes.

 

4.  Were maintenance data reported?  No

 

 

SUMMARY OF INTERVENTION

 

Prosodic Targets:   none

Nonprosodic Targets:

 

•  reduction of challenging behaviors

•  rate of correct responses to directions involving gross motor completion tasks, shapes

•  accuracy on a computer task

•  use of communication acts

•  accurate labeling of shapes

•  score on a formal test of receptive vocabulary

•  appropriate pointing to and looking at stimuli during songs

•  eye contact

•  verbalization

•  spontaneous speech

•  initiation

•  social acknowledgement

•  rate of self-stimulatory behaviors

Aspects of Prosody Used in Treatment of Nonprosodic Targets:  The interventions involved music therapy that included at least pitch and rhythm activities.

 

 

DESCRIPTIONS OF PROCEDURES:  The investigator provided only brief information about each intervention.  I have included the sources associated with each approach to facilitate reader’s access to the original sources.

Description of Procedure #1—(Social Stories Set to Music)

•  Brownell (2002) and Pasiali (2002)

•  Individual sessions

•  Used a Developmental Social-Pragmatic (DSP) strategy focusing on activities of daily living, following the child’s lead, responding to the child’s communicative attempts, interpreting atypical behaviors as communicative if the evidence supports it, focusing on the child’s strengths, and assisting the child in regulating and expressing affect.

•  C presented social stories using live music and encouraged the P’s active involvement.

•  The songs were either standards selected by C or P-preferred music.

 

Evidence Supporting Procedure/Source #1—(Social Stories Set to Music)

•  The effect sizes were 0.67 and 0.52  (both moderate improvement.)

 

 

Description of Procedure #2—(Sung Instructions)

•  Carroll (1983) and Laird  (1997)

•  Individual sessions

•  Used a Discrete Trial-Traditional Behavioral (DT-TB) intervention strategy.  Although activities of daily living were targets, they were presented in massed trials in environments with minimal distractions. Generally, trials consisted of a stimulus presented by C, the P’s response, and reinforcement and/or feedback by C.

•  Using live original or children’s music, C presented songs containing instructions and encouraged the child’s active involvement.

 

Evidence Supporting Procedure/Source #2—(Sung Instructions)

•  Effect sizes were 0.38 and 0.79 (small to moderate improvement.)

 

 

Description of Procedure/Source #3—(Background Music)

•  Clauss (1994), Wood (1991), Litchman (1976)

•  Individual or group sessions

•  Clauss (1994) use a Contemporary Applied Behavioral Analysis (CABA) strategy.  In CABA, C reinforces targeted responses but focuses on P’s  communicative initiations, P’s interests and preferences, and limits structure.

•  Wood (1991) used DSP strategy.  DSP is the Developmental Social-Pragmatic strategy that focuses on activities of daily living, following the child’s lead, responding to the child’s communicative attempts, interpreting atypical behaviors as communicative when supported by the evidence, focusing on the child’s strengths, and assisting the child in regulating and expressing affect.

•  Litchman (1976) used a DT-TB. DT-TB is the Discrete Trial-Traditional Behavioral intervention strategy. Although activities of daily living were targeted, the targets were presented in massed trials in environments with minimal distractions. Generally, trials consisted of a stimulus presented by C, the P’s response, and reinforcement and/or feedback by C.

•  C provided background music during the DT-TB, CABA or DSP sessions.

•  In all cases, the P’s involvement in the music was considered to be passive.

•  Clauss used live piano music, Wood used recordings of Baroque and Hemi-Sync music, and Litchman used recordings of children’s music.

 

Evidence Supporting Procedure/Source #3—(Background Music)

•  Two of the sources targeted 2 outcomes each and one source targeted one outcome.

•  The effect size of four outcomes were positive 0.29 (small), 0.42 (small), 0.95 (large), and 1.71 (large).

 

Evidence Contraindicating Procedure/Source #3—(Background Music)

•  One effect size was minimal – 0.09.

 

 

Description of Procedure/Source #4—(Picture Identification and Direction Following)

•  O’Loughlin (2000)

•  Individual sessions

•  Used a CABA strategy.  CABA involves reinforcing targeted responses but focusing on P’s communicative initiations, P’s  interests and preferences, and limits structure.

•  C presented pre-recorded language based songs and encouraged P’s active involvement.

 

Evidence Supporting Procedure/Source #4——(Picture Identification and Direction Following)

•  There were two outcomes; the effect sizes were  0.83 (large) and 0.62 (moderate).

 

Description of Procedure/Source #5—(Reinforcer was a music therapy session)

•  Watson (1979)

•  Individual sessions

•  Used a CABA strategy.  CABA involves reinforcing targeted responses but focusing on P’s communicative initiations, P’s interests and preferences, and limits structure.•

•  C presented a therapy session using live, rhythm instruments. C encouraged P’s active involvement.

 

Evidence Supporting Procedure/Source #5—(Reinforcer was a music therapy session)

• The effect size was 1.19 (large.)

 

Description of Procedure #6—(Several Music Therapy Sessions)

•  C administered several music therapy sessions.

•  Individual sessions

•  Used a DSP strategy.  DSP is the Developmental Social-Pragmatic strategy that focuses on activities of daily living, following the child’s lead, responding to the child’s communicative attempts, interpreting atypical behaviors as communicative when supported by evidence, focusing on the child’s strengths, and assisting the child in regulating and expressing affect.

•  C encourages P to participate actively in musically accompanied games, movements, and singing.

 

Evidence Supporting Procedure #6—(Several Music Therapy Sessions)

•  Effect size is 3.36 (large).

 

Evidence Contraindicating Procedure #6—(Several Music Therapy Sessions)

•  This source was removed from the overall meta-analysis as an outlier. The effect size was more than 2 standard deviations above the other sources.