Levy et al. (2012)

May 13, 2019

 

EBP THERAPY ANALYSIS

Treatment Groups

Note: Scroll about two-thirds of the way down the page to read the summary of the procedures.

Key:

AAPS =  Arizona Articulation Proficiency Scale

C = Clinician

EBP = evidence-based practice

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

WNL = within normal limits

 

SOURCE: Levy, E. S., Ramig, L. O., & Camarata, S. M. (2012).  The effects of two speech interventions on speech function in pediatric dysarthria.Journal of Medical Speech-Language Pathology, 20 (4), 82-87.

 

REVIEWER(S):  pmh

 

DATE: May 10, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:   C+  The highest possible grade based on the design of the investigation is B+.  This Assigned Grade for Overall Quality is only concerned with the level of evidence supporting the intervention and is not a judgment of the quality of the intervention or even the investigation.

 

TAKE AWAY: This preliminary report provides intriguing information suggesting that both Lee Silverman Voice Treatment (LSVT) and Traditional therapy are associated in improvement in articulatory and loudness outcomes for children with dysarthria associated with cerebral palsy.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence?Prospective, Nonrandomized Group Design with Controls
  • What was the level of support associated with the type of evidence?

Level =  B+

 

                                                                                                           

  1. Group membership determination:
  • If there was more than one group, were participants (Ps) randomly assigned to groups? No

 

  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched?No, the assignment was based on convenience. Two of the Ps could attend 4 sessions a week; they were assigned to Lee Silverman Voice Treatment (LSVT.) The investigator recruited participants (Ps) who were available.

 

 

  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from analyzer? Varied

                                                                     ,

 

  1. Were the groups adequately described? Yes

–           How many  Ps were involved in the study?

  • total # of Ps:  3
  • # of groups: 2
  • Names of groups and the # of participants (Ps) in each group:

– Lee Silverman Voice Treatment (LSVT) = 2  (P1, P2)

     – Traditional Therapy =  1 (P3)

 

–   CONTROLLED CHARACTERISTICS

  • diagnosis:spastic cerebral palsy (CP) with associated dysarthria

 

–  DESCRIBED CHARACTERISTICS:

  • age:

–  P1 =  8 years, 10 months

     –  P2 =  3 years, 3 months

     –  P3  =  9 years, 7 months

  • gender:all Ps werefemale
  • cognitive skills:

–  P1 =   not described

     –  P2 =   not described

     –  P3  =  delayed

  • expressive language:

–  P1 =  delay

     –  P2 =  within normal limits (WLN)

     –  P3 = delayed

  • receptive language:

–  P1 = WLN

     –  P2 = WLN

     –  P3 = delayed

  • MLU:

–  P1 = 3.2

     –  P2 =  3.7

     –  P3  = 1.8

  • phonological/articulatory skills:

     –  P1 =  mild dysarthria

     –  P2 = delayed phonology, moderate dysarthria

     –  P3 = moderate dysarthria and apraxia

  • hearing level:all within normal limits

 

   Were the groups similar before intervention began?  No 

                                                         

–  Were the communication problems adequately described?  Yes

  • disorder type: all Ps had dysarthria associated with cerebral palsy. Comorbid conditions are listed in the “functional level.”
  • functional level

∞  P1 = mild dysarthria, delayed expressive language, receptive language was WNL

∞ P2 =  moderate dysarthria, receptive and expressive language was WNL, delayed phonology

∞ P3  = moderate dysarthria and apraxia, receptive and expressive language delays, cognitive delay

 

 

  1. Was membership in groups maintained throughout the study?
  • Did each of the groups maintain at least 80% of their original members? Yes
  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  • OUTCOME #1:Functional communication questionnaire completed by 3 caregivers for each P

 

  • OUTCOME #2:Articulatory Proficiency Score on the Arizona Articulation Proficiency Scale (AAPS)

 

  • OUTCOME #3: Listeners’ preferences for pre-intervention versus post-intervention for contrastive words

 

  • OUTCOME #4:Listeners’ preferences for pre-intervention versus post-intervention for spontaneous speech

 

  • OUTCOME #5:Listeners’ judgments whether for pre-intervention versus post-intervention contrastive words were easier to understand.

 

  • OUTCOME #6:Listeners’ judgments whether pre-intervention versus post-intervention spontaneous speech was easier to understand

 

  • OUTCOME #7:Sound pressure level (SPL) of contrastive words

 

  • OUTCOME #8:SPL of spontaneous speech

 

–   The outcome measures that are subjective:

  • OUTCOME #1:Functional communication questionnaire completed by 3 caregivers for each P
  • OUTCOME #2:Articulatory Proficiency Score on the Arizona Articulation Proficiency Scale (AAPS)
  • OUTCOME #3:Listeners’ preferences for pre-intervention versus post-intervention for contrastive words
  • OUTCOME #4:Listeners’ preferences for pre-intervention versus post-intervention for spontaneous speech
  • OUTCOME #5:Listeners’ judgments whether for pre-intervention versus post-intervention contrastive words were easier to understand.
  • OUTCOME #6:Listeners’ judgments whether pre-intervention versus post-intervention spontaneous speech was easier to understand

 

–  The outcome measures that are objective:

  • OUTCOME #7:Sound pressure level (SPL) of contrastive words
  • OUTCOME #8:SPL of spontaneous speech

                                         

 

  1. Were reliability measures provided?
  • Interobserver for analyzers?  No
  • Intraobserver for analyzers?No
  • Treatment fidelity for clinicians? No

 

 

  1. What were the results of the statistical (inferential) testing and/or the description of the results?

 

Summary Of Important Results

 

—  What level of significance was required to claim significance?  NA, only descriptive statistics were provided.

 

PRE AND POST TREATMENT ONLY ANALYSES

 

  • OUTCOME #1:Functional communication questionnaire completed by 3 caregivers for each P – All the caregivers reported that “their” child/student/relative had positive functional outcomes.

 

  • OUTCOME #2:Articulatory Proficiency Score on the Arizona Articulation Proficiency Scale (AAPS) – The Articulatory Proficiency Score on the AAPS increased for all Ps, although P2 remained in the unintelligible range. 

 

  • OUTCOME #3:Listeners’ preferences for pre-intervention versus post-intervention for contrastive words – Blinded listeners preferred post- intervention contrastive words for all Ps. 

 

  • OUTCOME #4:Listeners’ preferences for pre-intervention versus post-intervention for spontaneous speech – Blinded listeners preferred post- intervention spontaneous speech for all Ps. 

 

  • OUTCOME #5:Listeners’ judgments whether for pre-intervention versus post-intervention contrastive words were easier to understand. — Blinded listeners judged post- intervention contrastive words to be “easier to understand” for all Ps.

 

  • OUTCOME #6:Listeners’ judgments whether pre-intervention versus post-intervention spontaneous speech was easier to understand. — Blinded listeners judged post- intervention spontaneous speech to be “easier to understand” for all Ps.

 

  • OUTCOME #7:Sound pressure level (SPL) of contrastive words—SPL increased in post-intervention contrastive words for all Ps.

 

  • OUTCOME #8:SPL of spontaneous speech—SPL increased in post-intervention spontaneous speech only for P1 and P2 (the 2 Ps who had received LVST).

 

–   What was the statistical test used to determine significance?   NA, only descriptive statistics were used.

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported?Yes

 

  • For the LSVT Ps (P1, P2), the clinician (C) targeted generalization outside the clinic room.
  • For the LSVT Ps (P1, P2), progress in any outcome not concerned with loudness could be considered generalization.
  • For the Traditional Therapy P (P3), it is clear that any of the outcomes could be considered generalizations, with the possible exception of those concerned with spontaneous speech.

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Three children with dysarthria associated with cerebral palsy participated in the investigation. They were assigned to interventions based on their availability to attend treatment 4 times a week for 4 weeks (i.e., the LSVT group).

 

  • P1 and P2 were assigned to LSVT intervention while P3 was assigned the Traditional intervention. It should be noted that P3 was reported to exhibit markedly more comorbid impairment than did P1 and P2.

 

  • All Ps were subjected to identical 2 pre-assessment sessions and 1 post assessment session.

 

  • For the most part, judges/raters were blinded to the treatment status of the Ps.

 

  • The results of the assessments were descriptively analyzed.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to explore the effectiveness of Lee Silverman Voice Treatment and Traditional therapy on the speech of children with cerebral palsy.

 

POPULATION:  Cerebral Palsy; Children

 

MODALITY TARGETED:  Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  Loudness

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  Loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  articulation, intelligibility

 

OTHER TARGETS:  perceived satisfaction

 

DOSAGE:

  • LSVT:  four 50 – 60 minute sessions, 4 times a week, for 4 weeks, daily homework (10 minutes) and carryover activities.
  • Traditional Therapy:  two 50 minutes session, 2 times a week, for 4 weeks

 

ADMINISTRATOR:

  • LVST: an SLP with LSVT training
  • Traditional Therapy:  2 master’s SLP students supervised by the SLP who provided LVST intervention

 

MAJOR COMPONENTS:

 

  • There were 2 interventions:LSVT and Traditional Therapy

 

LSVT

 

  • The clinician (C) adapted LSVT LOUD for adults to the needs of children.

 

  • C used motivational games.

 

  • Treatment “core” exercises included

–  focusing on healthy loudness and increasing cognitive demand

–  providing feedback on loudness

–  producing functional phrases

–  targeting generalization outside the clinic

 

TRADITIONAL THERAPY

 

  • This intervention was child-directed and was based on a protocol developed by Pennington et al. (2010)

 

  • Major components included discussing

–  “posture,

–  speech clarity,

–  monitoring of speech,

–  breathing at the start of exhalation for simple phrases,

–  activities involving stress and intensity regulation, and

–  breath control.”  (p. 83.)

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Stoeckel (2016)

August 14, 2018

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  Scroll ½ way down this post to access the summaries for the 5 activities.

KEY

C =  clinician

CAS = Childhood Apraxia of Speech

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

Source:  Stoeckel, R. (2016.)  5 fun ways to mix prosody into CAS therapy.  Retrieved from http://www.medbridgeeducation.com/blog/2016/10/5-fun-ways-to-mix-prosody-into-cas-therapy/ 

Reviewer(s):  pmh

Date:  August 14, 2018

Overall Assigned Grade (because there are no supporting data, the highest grade will be 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. The Level of Evidence grade should not be construed as a judgment of the quality of the recommended activities. It is only concerned with the nature of the evidence supporting the author’s recommendation.

 

Take Away:  This blog post briefly describes activities that speech language pathologists (SLPs) can use to integrate prosody into interventions for children with Childhood Apraxia of Speech (CAS.) 

  1. Was there a review of the literature supporting components of the intervention?No, the author did not provide a review of the literature supporting the recommended activities but did provide a brief review of a rationale for integrating prosody activities into intervention for children with CAS.

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? No, the author did not provide a review of the literature supporting the recommended activities but did provide a brief review of a rationale for integrating prosody into intervention for children with CAS.

 

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

 

  1. Did the author(s) provide a rationale for components of the intervention? No

 

  1. Description of outcome measures:

 

  • Are outcome measures suggested? No

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

NOTE:  The author recommended 5 activities for integrating prosody into treatment of children with CAS. The 5 activities are

–  Songs and Fingerplays

–  Toys that Provide Auditory Feedback

–  Action Figures, Dolls, and Stuffed Animals

–  Board Games

–  Books

Songs and Fingerplays

POPULATION:  Childhood Apraxia of Speech; Children

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  stress, music

ELEMENTS OF PROSODY USED AS INTERVENTION:  duration, loudness, pitch

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: production of word or phrase

MAJOR COMPONENTS:

  • The clinician (C) can focus on either one aspect of prosody or multiple aspects of prosody depending on the age of the child.
  • For example, C may encourage the participant (P) to use duration alone to mark stress or to use pitch, loudness, and duration.
  • This activity can also be used to focus on target words/phrases to be produced in the songs.

 

 Toys that Provide Auditory Feedback

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness, music

ELEMENTS OF PROSODY USED AS INTERVENTION:  rhythm

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: production of syllables

MAJOR COMPONENTS:

  • Toys with embedded microphones can facilitate the production of different aspects of prosody.
  • The use of drums can encourage the production of loudness or of targeted syllables.

 

Action Figures, Dolls, and Stuffed Animals

POPULATION:  Childhood Apraxia of Speech; Children

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality; words/phrases

MAJOR COMPONENTS:

  • Role playing with action figures, dolls, and stuffed (plush) animals can focus on prosody by encouraging P to use different speaking styles for different characters and to signal different meanings.
  • C encourages target words/phrases production as part of the play.

 

Board Games

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate, contrastive stress

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality 

MAJOR COMPONENTS:

  • Before taking a turn P imitates sentences/phrases modeled by C with

– different voice qualities or

– different rates

  • C asks P questions to elicit contrastive such as

– Is it YOUR turn or MY turn?  (p. 2)

– Does your character have BLUE eyes? (p. 2.)

Books

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affective prosody

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: literacy 

MAJOR COMPONENTS:

EMERGING READERS:

  • When reading with the P, C has him/her complete a sentence that signals

– an emotion,

– emphasis,

–  a character voice (p. 2.)

 

READER:

  • C identifies passages that could benefit with modifications of prosody to enhance interest.
  • C provides reading material a little below P’s reading level when P is practicing prosodic modifications during reading aloud activities.

 

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

 


Chenausky & Schlag (2018)

April 29, 2018

EBP THERAPY ANALYSIS

Treatment Groups 

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

 Key:

AMMT =  Auditory-motor mapping training

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

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

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

and degree of backness)

ASD =  Autism Spectrum Disorder

C = Clinician

EBP = evidence-based practice

f = female

m = male

MV =  Minimally Verbal

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

SRT =  Speech Repetition Therapy

 

 

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

 

 

REVIEWER(S):  pmh

 

DATE:   April 24, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY: 

– Proof of Concept Study =  C-

– Replication Study =  C-

– Comparison Study =  B-

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence?

     – Prospective, Nonrandomized Group Design with Controls?   Comparison Study

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

 

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

     – Proof of Concept Level = C+

     – Replication Level = C+

     – Comparison Level = B+

 

PROOF OF CONCEPT STUDY

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

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

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

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

                                                                    

 

  1. Was the group adequately described? No

 

–  How many  Ps were involved in the study?

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

 

–  CONTROLLED CHARACTERISTICS

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

 

–  DESCRIBED CHARACTERISTICS

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

 

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

                                                         

–  Were the communication problems adequately described?  No

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

 

 

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

                                                                                                             

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

 

 

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

 

 

  1. Was the outcome measure appropriate and meaningful? Yes

 

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

 

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

 

  • The outcome measures was subjective.

 

*  The outcome measure was NOTobjective.

                                         

 

  1. Were reliability measures provided?

                                                                                                             

  • Interobserver for analyzers?Yes

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

–  for the measure “approximately correct”

            ∞ percent of interobserver agreement was 68%

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

                0.0005)

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

                 “at least ‘moderate’ or ‘good’)

 

  • Intraobserver for analyzers?No 

 

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

 

 

  1. What were the results of the statistical (inferential) testing and/or the description of the results?

 

– Summary Of Important Results

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

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

 

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

 

  • What was the statistical test used to determine significance?

–  t-test

     –  binominal test of significant

 

  • Were confidence interval (CI) provided?Yes

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

 

 

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

 

 

  1. Were maintenance data reported?No

 

 

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

 

 

  1. Describe briefly the experimental design of the investigation.

 

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

 

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

 

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

 

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

 

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

 

 

GRADE= C-

 

 

REPLICATION STUDY

 

 

  1. Group membership determination:

                                                                                                           

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

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

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

                                                                    

 

  1. Was the group adequately described? No

 

– How many  Ps were involved in the study?

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

 

–  CONTROLLED CHARACTERISTICS

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

 

–  DESCRIBED CHARACTERISTICS

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

 

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

                                                         

–  Were the communication problems adequately described?  No

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

 

 

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

                                                                                                             

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

 

 

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

 

 

  1. Was the outcome measure appropriate and meaningful? Yes

 

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

 

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

                                         

 

  1. Were reliability measures provided?

                                                                                                             

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

 

  • Intraobserver for analyzers?No 

 

  • Treatment fidelity for clinicians?Yes

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

 

 

  1. What were the results of the statistical (inferential) testing and/or the description of the results?

 

–  Summary Of Important Results

 

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

 

PRE AND POST TREATMENT ONLY ANALYSES

 

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

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

∞  that there was no significant difference between the groups,

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

∞  that the trajectories of their improvement were similar

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

 

 

—  What was the statistical test used to determine significance?

  • t-test
  • ANOVA

 

–  Were confidence interval (CI) provided?  No

 

 

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

 

 

  1. Were maintenance data reported?No

 

 

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

 

 

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

 

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

 

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

 

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

 

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

 

GRADE C-

 

 

COMPARISON STUDY

 

  1. Group membership determination:

                                                                                                           

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

 

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

     –  The Ps were matched on the basis of

∞  chronological age

∞  mental age

∞  baseline phonemic (phonetic) repetition ability

                                                                    

 

  1. Was administration of intervention status concealed?

                                                                                                           

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

                                                                    

 

  1. Were the groups adequately described? No

 

–  How many  Ps were involved in the study?

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

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

–  SRT = 7

 

–  CONTROLLED CHARACTERISTICS

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

 

–  DESCRIBED CHARACTERISTICS

  • age:

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

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

  • gender:

     –  AMMT = 7m

     –  SRT = 2f; 5m

 

–   Were the groups similar before intervention began? Yes

                                                         

–  Were the communication problems adequately described?  No 

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

– AMMT =  7.1 (+/- 3.4)

– SRT =  8.9 (+/- 5.4)

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

                                                               

  • Were data from outliers removed from the study? No 

 

 

  1. Were the groups controlled acceptably? Yes

                                                                                                             

  • Was there a no intervention group?No   
  • Was there a foil intervention group? No
  • Was there a comparison group?Yes
  • Was the time involved in the foil/comparison and the target groups constant? Yes

 

 

  1. Was the outcome measure appropriate and meaningful? Yes

                                                                                                             

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

 

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

                                         

 

  1. Were reliability measures provided?

                                                                                                             

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

 

  • Intraobserver for analyzers?No 

 

  • Treatment fidelity for clinicians?Yes

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

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

 

 

  1. What were the results of the statistical (inferential) testing and/or the description of the results?

 

  • Summary Of Important Results

 

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

 

TREATMENT AND FOIL/COMPARISON/NO TREATMENT GROUP ANALYSES

 

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

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

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

 

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

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA

 

 

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

 

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

 

 

  1. Were generalization data reported?Yes

 

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

 

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

 

 

  1. Describe briefly the experimental design of the investigation.

 

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

 

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

 

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

 

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

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B-

 

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION:  ASD

 

MODALITY TARGETED:  production

 

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: Articulation

 

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

 

ADMINISTRATOR:  probably SLP

 

 

MAJOR COMPONENTS:

 

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

 

 

AUDITORY-MOTOR MAPPING TRAINING (AMMT)

 

  • AMMT is derived from Melodic Intonation Therapy.

 

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

 

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

 

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

 

  • There are 5 hierarchical steps in AMMT:

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

 

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

 

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

 

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

∞  C says: “My turn: bubbles.” (p. 6)

∞  C says: “You turn …..”  (p. 6)

 

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

 

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

 

 

SPEECH REPETITION THERAPY  (SRT)

 

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

 


Ankari & Davis (2018)

April 3, 2018

EBP THERAPY ANALYSIS for

Single Case Designs

NOTES: 

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

Key:

ASD =  Autism Spectrum Disorder

C = Clinician

EBP = evidence-based practice

F0 =  fundamental frequency

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PVSP =  Perceived performance on the Prosody-Voice Screening Profile

SLP = speech–language pathologist

WNL = within normal limits

 

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

 

REVIEWER(S):  pmh

 

DATE: March 22, 2018

 

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

 

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

                                                                                                           

 

  1. What was the focus of the research? Clinical

 

 

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

Level = D+   

                                                                                                           

 

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

 

 

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

 

–  How many Ps were involved in the study?  1

 

–  DESCRIBED CHARACTERISTICS

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

 

–  Were the communication problems adequately described?  Yes

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

–  Problems in the following aspects of prosody

         ∞  phrasing

         ∞  rate

         ∞  stress

    –   Voice quality was WNL.

 

                                                                                                                       

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

                

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

 

 

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

                                                                      

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

 

 

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

 

OUTCOMES

 

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

 

SUBJECTIVE OUTCOMES

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

 

OBJECTIVE OUTCOMES

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

 

 

–  Reliability data

 

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

–  F0

–  stressed syllable duration

– unstressed syllable duration

– stressed syllable intensity

– unstressed syllable intensity

 

 

  1. Results:

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

 

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

numbering as needed)

 

 

  1. What is the clinical significanceNo data provided.

 

  1. Was information about treatment fidelity adequate? No

 

 

  1. Were maintenance data reported?No

 

 

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

 

 

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

– 24 spontaneous utterances

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

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

 

 

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

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION:  ASD; Children (Adolescence)

 

MODALITY TARGETED:  Expressive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific dependent variables here):intensity, duration, F0, loudness, pitch, stress, rate,

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable):  voice quality

 

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

 

ADMINISTRATOR:  the second author

 

MAJOR COMPONENTS:

 

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

 

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

 

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

 

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

 

  • A summary of the 6 steps of the intervention:

 

  1. C reads aloud a practice sentence with one of the 3 targeted prosodic affects and identified the targeted affect to the P. C and P produce the sentence in unison.
  2. C models the practice sentence with the targeted prosodic affect and facial expression then directs P to imitate her.
  3. C models the practice sentence with the targeted prosodic affect but ot with facial expression then directs P to imitate her prosody.
  4. C produces the practice sentence with a neutral affect and directs P to reproduce with but to include the targeted affective prosody.
  5. C asks a question designed to elicit the targeted emotion and P answers with the practice sentence and the targeted prosodic affect.
  6. C engages in role-playing in which P produces the practice sentence with the targeted affective prosody.

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


Medina (1990)

December 27, 2017

EBP THERAPY ANALYSIS

Note: Scroll about two-thirds of the way down the page to read the summary of the procedures.

Key:

A = Administrator

C = Clinician

EBP = evidence-based practice

Gain1 = Gain score from Pretest to Post test 1

Gain2 = Gain score from Post test 1 to Post test 2

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Medina, S. L. (1990). The effects of music on second language acquisition. Paper presented at the Annual Meeting of the Teachers of English to Speakers of Other Languages (San Francisco, CA, March 1990) ERIC Educational Resources Information Center data base. ERIC Document # ED 352-834 retrieved from http://www.geocities.ws/ESLmusic/articles/print/article02.html  on March 8, 2015.

 

REVIEWER(S): pmh

 

DATE: December 26, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY:  C+ (The highest possible grade based on the design of the study, Prospective, Nonrandomized Group with Controls, is B+.) The assigned overall grade represents the quality of the evidence supporting the intervention; it is not meant as a judgment regarding the quality of the intervention.

 

TAKE AWAY: Second-graders who were speakers of Spanish and learning English as a second language were treated with one of four story-based interventions that compared music versus speech as a presentation strategy and illustrations versus no illustrations as extralinguistic support. The target of the intervention was increased receptive vocabulary. Inferential statistics revealed that there were no significant differences between music versus speech and the illustration versus no illustration contexts. This was interpreted as supporting the use of music as an intervention because it yielded results similar to speech only presentations. Analysis of descriptive statistics suggested that while low proficiency students improved performance at follow-up, high proficiency students’ performance decreased.

 

  1. What type of evidence was identified?

 

  • What was the type of evidence? Prospective, Nonrandomized Group Design with Controls

 

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

Level = B+

 

 

  1. Group membership determination:
  • If there was more than one group, were participants (Ps) randomly assigned to groups? Unclear

– Participants (Ps) were initially sorted into 4 groups based on performance on a vocabulary test.

– The investigator then randomly assigned members of the groups to one of four treatment groups. P. 4 this is my interpretation it may be wrong but the writing is not clear to me

 

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

– matching/sorting is on the basis of pretreatment vocabulary. Then the Ps were randomly assigned—sounds more like block assignment to me.

If the answer to 2a and 2b is ‘no’ or ‘unclear,’ describe the assignment strategy:

 

 

  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? No

 

 

  1. Were the groups adequately described? No.

 

–           How many Ps were involved in the study?

  • total # of Ps:   48
  • # of groups: 4
  • Names of groups and the number of participants in each group:

     ∞ No Music- Illustrations, N = 13

     ∞ No Music- No Illustration, N = 11

     ∞ Music- Illustrations, N = 12

     ∞ Music – No Illustrations, N = 12

 

CONTROLLED CHARACTERISTICS:

  • language skills: Spanish speaking, limited English proficiency
  • educational level of parents: Second Grade

 

DESCRIBED CHARACTERISTICS:

  • location: Suburb of Los Angeles (CA)
  • Social-Economic Status: Students in the school were primarily low income

 

–   Were the groups similar before intervention began? Unclear

 

– Were the communication problems adequately described? No

  • Participants (Ps) were Spanish speakers who were learning English as a Second Language.

 

 

  1. Was membership in groups maintained throughout the study?
  • Did each of the groups maintain at least 80% of their original members? Yes, probably. Originally, there were 52 Ps but 4 Ps dropped out. The distribution of those who discontinued was not identified but the overall maintenance level was 92%

 

  • Were data from outliers removed from the study?

 

 

  1. Were the groups controlled acceptably? Unclear
  • Was there a no intervention group? No
  • Was there a foil intervention group? No
  • Was there a comparison group? Yes
  • Was the time involved in the comparison and target groups constant? Yes

 

 

  1. Was the outcome measure appropriate and meaningful? Yes
  • OUTCOME #1: The amount of gain in receptive vocabulary
  • The outcome measure was subjective.
  • The outcome measures was NOT objective.

 

 

  1. Were reliability measures provided?
  • Interobserver for analyzers? No
  • Intraobserver for analyzers?
  • Treatment fidelity for clinicians? No

 

 

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

Summary Of Important Results

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

 

 

PRE AND POST TREATMENT ANALYSES

 

  • OUTCOME #1: The amount of gain in receptive vocabulary

∞ There were no significant differences for music versus no music and illustration versus no illustration (and their interactions) among the 4 treatment groups at the post test 1 (immediately after the intervention) and post test 2 (follow up, 1.5 weeks after intervention.)

     ∞ The investigator noted some patterns descriptively:

  • Immediately after treatment (post test 1) and the 1.5 week delay (post test 2 or follow up) the scores of Ps receive music treatment and viewing illustrations tended to be higher.

    ∞ The following patterns also were evident in the description of the results

  • Average gains at post test 1 following the 4 treatment sessions ranged from 0.73 (No Music, No Illustration Group) to 1.5 (Music and Illustration Group.)
  • Average gains at post test 2 (or follow up) ranged from 0.82 (No Music, No Illustration Group) to 1.75 (Music and Illustration Group.)

     ∞ The investigator also described the performance of a small group of Low Proficiency Ps (i.e., Ps who had scores below 8 of 20 items correct on the pretest.)

  • Low Proficiency Ps tended to gain more than higher proficiency Ps.
  • Average gains at post test 1 ranged from 0.33 (No Music, No Illustration Group) to 2.33 (Music and Illustration Group.)
  • Average gains at post test 2 (follow up) ranged from 1.00 (No Music, No Illustration Group) to 3.33 (Music and Illustration Group.)

 

  • What was the statistical test used to determine significance? ANOVA
  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance?  NA, no EBP data were reported.

 

 

  1. Were maintenance data reported? Yes. The difference in gains from post test 1 to post test 2 were not compared using inferential statistics. However, post test 2 performance regularly outpaced post test 1 performance. This suggests that Ps, not only maintained their gains but that the gains increased over the 1.5 weeks.

 

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.
  • Four groups of 2nd grade speakers of Spanish who were also English Language Learners received a story-related treatment to improve receptive vocabulary.

 

  • There were four different versions of the story-related treatment. The Ps listened to a cassette recorded story that included the target. The 4 versions were

∞ No Music- Illustrations, story spoken accompanied by illustrations

∞ No Music- No Illustration, story spoken accompanied but no illustrations

∞ Music- Illustrations, story sung accompanied by illustrations

∞ Music – No Illustrations, story sung accompanied by no illustrations

 

  • The spoken and sung versions of the story had identical scripts.

 

  • Prior to the initiation of treatment, the investigator met with the Ps to establish rapport and then she administered a pretest (baseline.)

 

  • Treatment lasted for 4 days and then the investigator administered Post Test 1.

 

  • One and one-half weeks following the termination of the intervention, Post Test 2 (i.e., follow-up) was administered.

 

  • Receptive vocabulary scores were compared using two 2-way (2×2, Medium x Extralinguistic Support) ANOVA for the following dependent measures:

–   Gain score from Pretest to Post test 1 (Gain1)

–   Gain score from Post test 1 to Post test 2 (Gain2)

 

  • The condition each had 2 aspects:

– Medium: Music; No Music

– Extralinguistic Support: Illustrations: NO Illustrations

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate whether (1) stories set to music were associated with the same amount of improvement in receptive vocabulary as stories presented orally and (2) stories paired with illustrations were associated with the same amount of improvement in receptive vocabulary as stories presented without illustrations.

 

POPULATION: Second language learners

 

MODALITY TARGETED: Receptive vocabulary

 

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

 

DOSAGE: small groups; 4 days; tapes (spoken or song) were played 3 times in each treatment session

 

STIMULI: songs, spoken scripts, and illustrations

 

MAJOR COMPONENTS:

 

  • The administrator (A) provided one of four treatments to each of the groups of Ps:

∞ No Music- Illustrations, N = 13

∞ No Music- No Illustration, N = 11

∞ Music- Illustrations, N = 12

∞ Music – No Illustrations, N = 12

 

  • Overall, the treatment sessions were similar. The Ps were treated in groups sessions in which A played a prerecorded sung or spoken story 3 times. The story was accompanied by pictures for the “Illustration” treatment groups but not for the “No Illustration” treatment group. The stories for all groups were the same and used identical scripts.

 

  • For the Music and No Music Treatment conditions, the tapes were clear and intelligible. Both Music and No Music tapes were described as “appealing.” The song for the Music tape was a simple tune.

 

• For the Illustration and No Illustration conditions, the A displayed large pictures depicting the story. Written words were not included in the Illustration condition and, of course, the A did not use the pictures for the No Illustrat


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.