Nonoverlap Of All Pairs Research Articles

The use of a smartwatch as a prompting device for people with acquired brain injury: a single case experimental design study

ABSTRACTPrompting-based memory compensation is a potential application for smartwatches. This study investigated the usability and efficacy of a Moto360 smartwatch as a memory aid. Four community dwelling adults with memory difficulties following acquired brain injury (ABI) were included in an A-B-A single case experimental design study. Performance of everyday memory tasks was tested over six weeks with the smartwatch and software provided during weeks three and four. Participants were asked to use their usual memory aids and strategies during the control phases (weeks 1–2, 5–6). Three participants successfully used the smartwatch throughout the intervention weeks and gave positive usability ratings. A fourth participant experienced a seizure and subsequently left the study before the intervention phase. Three participants showed improved memory performance when using the smartwatch. Nonoverlap of all pairs (NAP) analysis showed a non-significant small increase in memory performance between baseline and intervention phases (mean NAP = 0.1, p = .84). There was a larger, significant decline between the intervention and return to baseline (mean NAP = 0.58, p < .01). The use of an off-the-shelf smartwatch device and software was feasible for people with ABI in the community. It was effective compared to practice as usual, although this was only apparent on withdrawal of the device.

The conditional power of randomization tests for single-case effect sizes in designs with randomized treatment order: A Monte Carlo simulation study.

The conditional power (CP) of the randomization test (RT) was investigated in a simulation study in which three different single-case effect size (ES) measures were used as the test statistics: the mean difference (MD), the percentage of nonoverlapping data (PND), and the nonoverlap of all pairs (NAP). Furthermore, we studied the effect of the experimental design on the RT's CP for three different single-case designs with rapid treatment alternation: the completely randomized design (CRD), the randomized block design (RBD), and the restricted randomized alternation design (RRAD). As a third goal, we evaluated the CP of the RT for three types of simulated data: data generated from a standard normal distribution, data generated from a uniform distribution, and data generated from a first-order autoregressive Gaussian process. The results showed that the MD and NAP perform very similarly in terms of CP, whereas the PND performs substantially worse. Furthermore, the RRAD yielded marginally higher power in the RT, followed by the CRD and then the RBD. Finally, the power of the RT was almost unaffected by the type of the simulated data. On the basis of the results of the simulation study, we recommend at least 20 measurement occasions for single-case designs with a randomized treatment order that are to be evaluated with an RT using a 5% significance level. Furthermore, we do not recommend use of the PND, because of its low power in the RT.

Comparing Single Case Design Overlap-Based Effect Size Metrics From Studies Examining Speech Generating Device Interventions.

Meaningfully synthesizing single case experimental data from intervention studies comprised of individuals with low incidence conditions and generating effect size estimates remains challenging. Seven effect size metrics were compared for single case design (SCD) data focused on teaching speech generating device use to individuals with intellectual and developmental disabilities (IDD) with moderate to profound levels of impairment. The effect size metrics included percent of data points exceeding the median (PEM), percent of nonoverlapping data (PND), improvement rate difference (IRD), percent of all nonoverlapping data (PAND), Phi, nonoverlap of all pairs (NAP), and Tau(novlap). Results showed that among the seven effect size metrics, PAND, Phi, IRD, and PND were more effective in quantifying intervention effects for the data sample (N = 285 phase or condition contrasts). Results are discussed with respect to issues concerning extracting and calculating effect sizes, visual analysis, and SCD intervention research in IDD.

Técnicas para el análisis de diseños de caso único en la práctica clínica: ejemplos de aplicación en el tratamiento de víctimas de atentados terroristas

This paper presents two techniques for the data analysis of single case designs in psychological treatment research: indices of data overlap between phases to estimate the size of treatment effect (or the magnitude of therapeutic change) and Jacobson and Truax's (1991) statistical approach to estimate the clinical significance of treatment effect. Based on a case of a victim of terrorism who suffered from posttraumatic stress disorder, major depressive disorder and panic disorder with agoraphobia and received trauma-focused cognitive-behavioral therapy, this paper illustrates the computation and application of percentage of non-overlapping data (PND), percentage of data points exceeding the median (PEM), non-overlap of all pairs (NAP), and statistical approach to clinical significance, and discusses their advantages and limitations as a complement of visual analysis of data.

Stimulus-Stimulus Pairing to Increase Vocalizations in Children with Language Delays: a Review.

Stimulus-stimulus pairing (SSP) is a procedure used to increase vocalizations in children with significant language delays. However, results from studies that have examined the effectiveness of SSP have been discrepant. The following review of the literature summarizes the results from 13 experiments published between 1996 and 2014 that used this procedure with children with language delays. Studies were analyzed across various participant and procedural variables, and an effect size estimate (nonoverlap of all pairs) was calculated for a portion of the participants in the studies reviewed. Results indicated an overall moderate intervention effect for SSP of speech sounds. Recommendations are provided for future researchers about information to report and potential avenues for future studies.

Increasing Single‐Word Requests to Multiword Requests in Children with Autism and Related Disabilities

Initial language training with children with autism often focuses on the production of single‐word requests (i.e., mands). As a child progresses in treatment, it is desirable to increase the mean length of utterance (MLU) of requests. The present study examined treatment outcomes of behavioral intervention designed to increase the MLU of requests in a larger sample of children with language delays (n = 30). Intervention consisted of prompts and differential reinforcement for lengthier requests, and trials were conducted flexibly throughout the treatment session. A non‐concurrent multiple baseline across participants design was utilized to establish experimental control, and MLU intervention consisted of a baseline and treatment phase for each participant. Nonoverlap of all pairs (NAP) was employed to estimate an effect size. Overall treatment effects were medium to large (average NAP = 0.89; average d = 2.36), and the majority of the sample (70%) demonstrated strong treatment effects. Results suggest that targeted behavioral intervention to increase the length of requests can be effective for children with autism and associated language delays. Copyright © 2015 John Wiley &amp; Sons, Ltd.

Evaluating Intervention Effects in Single‐Case Research Designs

Single‐case research designs have primarily relied on visual analysis for determining treatment effects. However, current foci on evidence‐based treatment have given rise to the development of new methods. This article presents descriptions, calculations, strengths and weaknesses, and interpretative guidelines for 5 effect size indices: the percent of nonoverlapping data, the percent of data exceeding the median, improvement rate difference, nonoverlap of all pairs, and Tau‐U.

Instruction in Letter-Sound Correspondences for Children With Autism and Limited Speech

This study used a multiple probe across participants’ research design to evaluate the effects of instruction on the acquisition of letter-sound correspondences (LSCs) by three young children with autism spectrum disorder and limited speech. All three children (ages 3–5 years) reached criterion for identifying the LSCs targeted during instruction, and a Nonoverlap of All Pairs (NAP) analysis showed evidence of medium to strong treatment effects. All three children also provided evidence of maintenance and generalization of LSC skills to other tasks. Implications for instruction and future research directions are discussed.

A Sensitivity Analysis of Three Nonparametric Treatment Effect Scores for Single-Case Research for Participants with Autism

The widely used percentage of nonoverlapping data (PND) treatment effect calculation was compared to more recently developed methods which, it has been argued, better account for outlying variables and trend in single-case design (SCD) intervention studies. Percentage of all nonoverlapping data (PAND) and nonoverlap of all pairs (NAP) were selected for comparison as both are amenable to hand calculation, making them widely accessible to clinicians and teachers as well as researchers. A data set was developed through a systematic search of peer-reviewed literature on self-management interventions conducted with participants with autism spectrum disorder (ASD). Treatment effect sizes derived from each method were compared for studies that provided sufficient data. Results indicated that PND provided a conservative measure of strength of treatment effect when compared to PAND and NAP scores. Interpretation scales for treatment effect scores derived from each method were reviewed. Implications for selecting a calculation method for participants with ASD are discussed.

Google Calendar: A single case experimental design study of a man with severe memory problems

A single case experimental design across behaviours was utilised to explore the effectiveness of Google Calendar text alerts delivered to a mobile phone as a memory aid. The participant was a 43-year-old man (JA) with severe memory problems and executive difficulties caused by a traumatic brain injury (TBI). JA was initially very unwilling to use any memory aid and so a detailed assessment of his beliefs about memory aids, his cognitive difficulties and his social context was performed and a set of specifications for an aid was produced collaboratively. Six weeks of baseline data and six weeks of intervention data were collected for three target memory behaviours and three control memory behaviours. Results were analysed using nonoverlap of all pairs (NAP) analysis which showed a reduction in forgetting in the three target behaviours and no change in two of the three control behaviours. A subjective measure (the revised Everyday Memory Questionnaire) also suggested improvement. This study illustrates that Google Calendar is a highly effective memory aid and emphasises the importance of choosing a memory aid to suit the person's lifestyle and beliefs.

How Should We Determine Treatment Effectiveness with Single-Case Design Research for Participants with Autism Spectrum Disorder?

Guidelines to inform research evidence standards have acknowledged that there is currently no agreed-upon method for treatment effect size estimation in single-case research. This study has examined the application of treatment effect size calculations to supplement visual analysis in single-case research designs (SCD) for participants with autism spectrum disorder (ASD). Ethical considerations for researchers regarding the collection of baseline data in light of behaviors often associated with ASD are discussed. The adequacy of the volume of data points from baseline and treatment phases was explored, and the conclusion had drawn that the majority of studies were not suitable for regression calculations. The median length of total data series was also explored, and the suitability of three nonparametric hand calculations, percentage of nonoverlap (PND), percentage of all nonoverlapping data (PAND), and nonoverlap of all pairs (NAP), is discussed in this light.

A Meta-Analysis of Behavioral Interventions for Adolescents and Adults with Autism Spectrum Disorders

Evaluation of evidence-based treatments is important for adolescents and adults with autism spectrum disorders (ASD) given the increasing number of interventions available and the prevalence of ASD. In this study, we sought to evaluate the effectiveness of behavioral interventions for this population by conducting a meta-analysis of published single-case research studies. A new metric for calculating effect size in single-case research, nonoverlap of all pairs, was utilized. In addition, the certainty of evidence, a system to evaluate research methodology, was applied to the reviewed articles. Forty-three articles were identified in the study. Results suggested that the behavioral interventions in the areas of academic skills, adaptive skills, problem behavior, phobic avoidance, social skills, and vocational skills have medium-to-strong effect sizes. Medium-to-high confidence in findings was noted for 81 % of the studies in the meta-analysis; however, three-fourths of the reviewed studies did not include treatment integrity, which may affect the ability to draw conclusions about the effectiveness of the interventions. Overall, the evidence is promising for the use of behavioral interventions for this population; however, additional research and dissemination are needed to fill the gap between research and practice in order for practitioners to meet the increasing demand as individuals with ASD age.

Effects of Augmentative and Alternative Communication on Challenging Behavior: A Meta-Analysis

The purposes of this review were to (a) use meta-analytic procedures to examine the effectiveness of single-case AAC intervention research on challenging behaviors exhibited by individuals with disabilities, (b) identify study characteristics that moderate intervention effects, and (c) evaluate the quality of research. The authors provided inferential and descriptive analyses of 54 studies representing 111 participants and estimated effect sizes using the Nonoverlap of All Pairs (NAP) method. Overall, AAC interventions were found to be equally effective across a broad spectrum of participants and interventions. AAC interventions were more effective with younger children than with adults. Interventions in which functional behavior assessments (FBA) were used had significantly larger effect sizes than those that did not use FBAs. Further, functional communication training interventions resulted in larger effect sizes than Picture Exchange Communication System interventions. Descriptive analysis revealed that (a) interventions often occurred in atypical environments (e.g., therapy room, experimental room) and with atypical interventionists (e.g., therapists, researchers), and (b) numerous studies did not exhibit quality characteristics of single-case research.

Meta-Analysis of Incremental Rehearsal Using Phi Coefficients to Compare Single-Case and Group Designs

The current study meta-analyzed single-case design (SCD) and group research regarding incremental rehearsal (IR). We used phi to meta-analyze data from 19 IR studies. Data from the SCD studies resulted in a nonoverlap of all pairs (NAP) score of 98.9 % (95 % CI = 97.6–100 %), which resulted in a weighted phi of .77 (95 % CI = .69–.83). The group research data resulted in a median d of 1.67 (95 % CI = 1.43–1.91), which converted to a weighted phi of .63 (95 % CI = .39–.87). Results suggested that using NAP to compute a weighted phi from SCD research led to a coefficient that was not significantly different from the weighted phi based on group studies z = .46, p > .05, and there was not significant heterogeneity among the effect sizes (Q (k = 17, df = 16) = 11.73, p > .05, I 2 = 0). Efficiency data resulted in a weighted phi of −.22 (95 % CI = −.79 to .34), which suggested a small effect when comparing the efficiency to other approaches, but the studies used different data to determine efficiency. Suggestions for future research are included.

Use of behavioural contracting to increase adherence with rehabilitation treatments on an inpatient brain injury unit: A case report

Background: This systematic, single-subject case study presents a 37-year old male with a severe traumatic brain injury who exhibited agitation and poor adherence with rehabilitation treatment on an inpatient traumatic brain injury unit. Attempts to address presumed awareness issues were unsuccessful. Medication trials also failed to produce an observable response in the patient's behaviour.Case study: A behavioural contract was presented by staff that specified positive behaviours the patient needed to demonstrate in order to reach his goal of being discharged from the hospital. Immediately, patient agitation ratings decreased and soon normalized. Statistical analysis of single subject times series data using the method of Nonoverlap of all Pairs results in a ratio of 0.875, indicating a moderate effect size for the intervention.Conclusions: The patient was able to comply with all requests and, with supports, was able to be safely discharged from the hospital ahead of schedule. Factors that could have contributed to this outcome and potential limitations are discussed.

Examining Estimates of Effect Using Non-Overlap of All Pairs in Multiple Baseline Studies of Academic Intervention

The inclusion of single-case design (SCD) studies in meta-analytic research is an important consideration in identifying effective evidence-based practices. Various SCD effect sizes have been previously suggested; non-overlap of all pairs (NAP) is a recently introduced effect size. Preliminary field tests investigating the adequacy of NAP are promising, but no analyses have been conducted using only multiple baseline designs (MBDs). This preliminary study investigated typical values of NAP in MBDs, investigated agreement with visual analysis, and suggested cut scores for interpreting a NAP effect size. Typical values of NAP in MBDs were larger compared to a previous meta-analysis of studies using AB, MBD, or ABAB withdrawal designs, and agreement of suggested cut scores and visual analysis was moderate.

Choosing Among Techniques for Quantifying Single-Case Intervention Effectiveness

If single-case experimental designs are to be used to establish guidelines for evidence-based interventions in clinical and educational settings, numerical values that reflect treatment effect sizes are required. The present study compares four recently developed procedures for quantifying the magnitude of intervention effect using data with known characteristics. Monte Carlo methods were used to generate AB designs data with potential confounding variables (serial dependence, linear and curvilinear trend, and heteroscedasticity between phases) and two types of treatment effect (level and slope change). The results suggest that data features are important for choosing the appropriate procedure and, thus, inspecting the graphed data visually is a necessary initial stage. In the presence of serial dependence or a change in data variability, the nonoverlap of all pairs (NAP) and the slope and level change (SLC) were the only techniques of the four examined that performed adequately. Introducing a data correction step in NAP renders it unaffected by linear trend, as is also the case for the percentage of nonoverlapping corrected data and SLC. The performance of these techniques indicates that professionals' judgments concerning treatment effectiveness can be readily complemented by both visual and statistical analyses. A flowchart to guide selection of techniques according to the data characteristics identified by visual inspection is provided.

An Improved Effect Size for Single-Case Research: Nonoverlap of All Pairs

Nonoverlap of All Pairs (NAP), an index of data overlap between phases in single-case research, is demonstrated and field tested with 200 published AB contrasts. NAP is a novel application of an established effect size known in various forms as Area Under the Curve (AUC), the Common Language Effect Size (CL), the Probability of Superiority (PS), the Dominance Statistic (DS), Mann-Whitney’s U, and Sommers D, among others. NAP was compared with 3 other non-overlap-based indices: PND (percent of nonoverlapping data), PEM (percent of data points exceeding the median), and PAND (percent of all nonoverlapping data), as well as Pearson’s R 2. Five questions were addressed about NAP: (a) typical NAP values, (b) its ability to discriminate among typical single-case research results, (c) its power and precision (confidence interval width), (d) its correlation with the established effect size index, R 2, and (e) its relationship with visual judgments. Results were positive, the new index equaling or outperforming the other overlap indices on most criteria.