Accentuate the Negative: Grammatical Errors during Narrative Production as a Clinical Marker of Central Nervous System Abnormality in School-Aged Children with Fetal Alcohol Spectrum Disorders

• Published in: Journal of speech, language, and hearing research Vol. 60; no. 12; pp. 3523 - 3537
• Main Author: Thorne, John C
• Format: Journal Article
• Language: English
• Published: United States American Speech-Language-Hearing Association 01.12.2017
• Subjects: Accuracy; Alcohol use; Anatomy; Aphasia, Broca - diagnosis; Aphasia, Broca - etiology; Behavior; Biomarkers - analysis; Case-Control Studies; Child; Children; Clinical Diagnosis; Cohesion; Communication; Complexity; Congenital Impairments; Diagnosis; Diagnostic tests; Elementary School Students; Error Analysis (Language); Error Patterns; Evidence; Expectation; Expressive Language; Female; Fetal Alcohol Spectrum Disorders - diagnosis; Fetal Alcohol Spectrum Disorders - psychology; Fetal Alcohol Syndrome; Fidelity; Grammar; Grammatical errors; Health aspects; Humans; Hyperactivity; Language disorders; Language Impairments; Language Tests - statistics & numerical data; Linguistics; Male; Medical diagnosis; Narration; Narratives; Nervous system; Nervous system abnormalities; Nervous System Malformations - diagnosis; Nervous System Malformations - psychology; Neurological Impairments; Neuropsychological Tests - statistics & numerical data; Predictive Value of Tests; Predictor Variables; Pregnancy; Prenatal Influences; Productivity; Retrospective Studies; Social Cognition; Speech Language Pathology; Speech therapists; Story Telling
• ISSN: 1092-4388; 1558-9102
• DOI: 10.1044/2017_JSLHR-L-17-0128

Purpose: The purpose of this study was to examine (a) whether increased grammatical error rates during a standardized narrative task are a more clinically useful marker of central nervous system abnormality in Fetal Alcohol Spectrum Disorders (FASD) than common measures of productivity or grammatical complexity and (b) whether combining the rate of grammatical errors with the rate of cohesive referencing errors can improve utility of a standardized narrative assessment task for FASD diagnosis. Method: The method used was retrospective analysis of narrative and clinical data from 138 children (aged 7-12 years; 69 with FASD, 69 typically developing). Narrative analysis was conducted blind to diagnosis. Measures of grammatical error, productivity and complexity, and cohesion were used independently and in combination to predict whether a story was told by a child with an FASD diagnosis. Results: Elevated grammatical error rates were more common in children with FASD, and this difference facilitated a more accurate prediction of FASD status than measures of productivity and grammatical complexity and, when combined with an accounting of cohesive referencing errors, significantly improved sensitivity to FASD over standard practice. Conclusion: Grammatical error rates during a narrative are a viable behavioral marker of the kinds of central nervous system abnormality associated with prenatal alcohol exposure, having significant potential to contribute to the FASD diagnostic process.