Exploring the Utility of Narrative Analysis in Diagnostic Decision Making: Picture-Bound Reference, Elaboration, and Fetal Alcohol Spectrum Disorders

• Published in: Journal of speech, language, and hearing research Vol. 50; no. 2; pp. 459 - 474
• Main Authors: Thorne, John C, Coggins, Truman E, Carmichael Olson, Heather, Astley, Susan J
• Format: Journal Article
• Language: English
• Published: United States ASHA 01.04.2007; American Speech-Language-Hearing Association (ASHA); American Speech-Language-Hearing Association
• Subjects: Anatomy; Autism; Behavior; Child; Children & youth; Classification; Coding; Decision Making; Diagnosis; Discourse Analysis; Effect of alcohol on; Expressive Language; Feasibility Studies; Female; Fetal Alcohol Spectrum Disorders - epidemiology; Fetal Alcohol Syndrome; Fetus; Group Membership; Humans; Language acquisition; Language Aptitude; Language Disorders - diagnosis; Language Disorders - epidemiology; Language Tests; Language Usage; Linguistics; Male; Measurement Techniques; Measures (Individuals); Narration; Nonverbal Communication; Norm Referenced Tests; Perspective Taking; Photic Stimulation; Pictorial Stimuli; Pragmatics; Pregnancy; Semantics; Semiotics; Severity of Illness Index; Social Cognition; Speech disorders; Speech Disorders - diagnosis; Speech Disorders - epidemiology; Speech perception; Speech Production Measurement; Standardized Tests; Task Analysis; Verbal Behavior; United States
• ISSN: 1092-4388; 1558-9102
• DOI: 10.1044/1092-4388(2007/032)

Contact author: John C. Thorne, Department of Speech and Hearing Sciences, University of Washington, 1417 N.E. 42nd Street, Seattle, WA 98105-6246. E-mail: jct6{at}u.washington.edu . Purpose: To evaluate classification accuracy and clinical feasibility of a narrative analysis tool for identifying children with a fetal alcohol spectrum disorder (FASD). Method: Picture-elicited narratives generated by 16 age-matched pairs of school-aged children (FASD vs. typical development [TD]) were coded for semantic elaboration and reference strategy by judges who were unaware of age, gender, and group membership of the participants. Receiver operating characteristic (ROC) curves were used to examine the classification accuracy of the resulting set of narrative measures for making 2 classifications: (a) for the 16 children diagnosed with FASD, low performance ( n = 7) versus average performance ( n = 9) on a standardized expressive language task and (b) FASD ( n = 16) versus TD ( n = 16). Results: Combining the rates of semantic elaboration and pragmatically inappropriate reference perfectly matched a classification based on performance on the standardized language task. More importantly, the rate of ambiguous nominal reference was highly accurate in classifying children with an FASD regardless of their performance on the standardized language task (area under the ROC curve = .863, confidence interval = .736–.991). Conclusion: Results support further study of the diagnostic utility of narrative analysis using discourse level measures of elaboration and children's strategic use of reference. KEY WORDS: assessment procedures, pragmatics, discourse analysis, language sample analysis, diagnostics CiteULike     Connotea     Del.icio.us     Digg     Facebook     Reddit     Technorati     Twitter     What's this?