Narrative as a clinical assessment

Transcription

1 Narrative as a clinical assessment NICOLA BOTTING LANGUAGE AND COMMUNICATION SCIENCE CITY UNIVERSITY LONDON Overview Background about narrative Different types of narrative Narrative in relation to diagnosis / other skills Narrative as a measure / predictor of change 1

2 Why use narrative? Some formal assessments become overused 70% of conversational narrative in young children used to communicate experiences Allows comparison across disorders Good information on normal development Normative trends Reg. past TPS present prog. plural 2

3 Normative trends questions negatives MLU Normative trends pers.pronouns mazes 3

4 Why use narrative? Interesting for the child Sensitive at measuring change Allows both flexibility and structure Links to literacy development and national curriculum Why use narrative? Relates to other language & literacy Bishop and Edmundson (1987) 83% of children could be classified as having persistent SLI or not using the Bus Story alone Gallagher, Frith & Snowling (2000) Literacy delayed group aged 6 had lower Bus stories when 3-4 years of age Botting (2008) Children with SLI and reading difficulties showed different narrative profiles 4

5 Potential difficulties with narrative assessment Time Which materials to use How to analyse them Standardisation Speech clarity Types of narrative prompt Retelling a story Generating a story Describing a picture Pictures vs. no pictures Questions about a story Structured scoring vs. free scoring 5

6 Other narratives Personal narratives Comprehension of narratives Inferencing Idioms Non-literal language Abstract concepts Written narratives Play narratives Type of narrative makes a difference Retelling vs. genera.on Story telling vs. personal narra.ves Supported by pictures vs. free narra.ve 6

7 Narrative across genres (Botting, 2002) Bus Frog 50 0 Word Length 4 28 Past tense errors 2% vs.12% tense errors aged 8 Narrative across genres (Wetherell, Botting & Conti-Ramsden, 2007) Age 14: 4.3% vs. 1.7% for SLI a bigger gap than for TD 7

8 Narrative & different diagnostic groups Narrative assessment may show differences between subgroups Norbury and Bishop (2002) found a few differences e.g.,ambigious references but not as many as expected Tager-Flusberg (1995) used Frog story to show ASD styles in narrative Child with SLI aged 8 Once there was a little boy called John. He has a little pet frog. One night, when John was fast asleep with his little dog, the frog tipped on the floor and decided to run away. One night one day one morning he sawed that the frog was missing. John looked everywhere, but he wasn t there. He call out of the window and said Frog where are you? But the dog was put his head in a glass jar It broke the dog fell and the glass broke... 8

9 Child with broader autistic spectrum disorder aged 8 The frog gone/ "Troo, trog, trog, yahoo, trog, trog, yahoo"/ "Where is he?"/ "Oh please tell me trog"/ "Trog, trog!"/ She looked under the dresses/ Under the shoes/ In the shoe/ and the dog was trapped in the jar/ "Trog, trog, come back here trog" he shouted/ But they never came back/ "howl, howl" [long episode of dog howling]/ "Oh dearie, oh dear, oh dear"/ "I must go down quickly"/ "howl, howl" [long episode of dog howling]/ Possible subgroup differences Story structure Types of word finding error Character speech & SFX Different underlying reason for devices Emotional / mentalising terms 9

10 Word finding errors (Botting, 2002) SLI Pragmatic Impairment Bottle Stickfire (jar) (match) Things Bedtime uniform (antlers) (pyjamas) Tap Water (sink) (compass) Bird Stunk (robin) (stuck) Glass Hodda (jar) (scales) Weigher Bumblenest (scales) (beehive) Pour Snow animal (funnel) (reindeer) Sound effects and character speech Sound effects Subgroups SLI PLI ASD Character speech 10 0 SLI PLI ASD Subgroups 10

11 Use of mind terms Poorer story structure Shorter narratives Tense errors Overuse of devices SLI Relevant use of SFX Less complex sentences Typical WF errors Numerous mazes Limited use of referents Poorer story structure Little use of mind terms Typical length narratives Fewer tense errors? Poor use of devices (except set-phrases) ASD Less complex sentences? Unusual word use Confused referents Little character speech Overuse use of SFX 11

12 Narrative in ASD and SLI (Manolisti & Botting 2011) Compared children with ASD and SLI on narra.ve genera.on Peter and the Cat & CELF 13 children in each group mean age 7;3 No difference on age, gender or IQ across groups Narrative in ASD and SLI (Manolisti & Botting 2011) Are there differences across groups on narra.ve? Are there differences across groups on standardised tasks (CELF)? Are the rela.onships between skills different across groups 12

13 Narrative in ASD and SLI (Manolisti & Botting 2011) CELF Recep.ve language poorer for those with ASD No difference on CELF expressive score Overall difference on macro- narra.ve skills No overall difference on micro- skills, but individual sub- item differences Man & Bot results 13

14 Different relationships between factors For ASD: Pragmatic Language CELF receptive Narrative For SLI: nothing significantly associated (no r>0.35) Narrative in ASD and SLI (Manolisti & Botting 2011) CELF overes.mated skills in this study CELF suggested similar payerns of expressive language ability across groups Narra.ve revealed difficul.es And suggested differing performance across groups 14

15 Rating narratives Exercise and break Have a look at the narra.ve examples Rank order them according to how competent you think they are Try to decide whether the child was typical, language impaired or on the au.s.c spectrum Use details like tense marking, length of uyerances, content, story structure Narrative stimuli in the examples 15

16 Diagnoses and percentile language scores Child Age Gender Status TROG (Receptive grammar) at 8 years Naming vocabulary at 8 years Non-Verbal IQ at 8 years A 8 M SLI B 8 M SLI C 11 M ASD D 8 M RES E 8 M ASD F 11 M SLI G 11 F RES H 8 M ASD Narratives and development NICOLA BOTTING 16

17 Narrative can help predict outcome Stothard et al (1998) Group who were satisfactory at 5 and still doing okay at 15 showed significantly higher Bus Stories at 5. Bo_ng et al (2001) Children with the poorest outcomes at 11 years were best predicted by narra.ve Narrative as a predictor of outcome 117 children with SLI Language scores tracked from 7 to 11 years of age Poor outcome defined as low language on at least 2 tests 17

18 Narrative to measure change Botting, Minton, Harakas,Tucker & Orchard-Lisle (in preparation) Evaluated change aaer interven.on Mainstream language groups Teacher selected children with language needs Mixed group Par.cipants were 48 children aged 4-8years (mean age 5;9) 15 girls, 33 boys Narrative to measure change Post- hoc tes.ng showed that: Almost half (22/48; 46%) met tradi.onal criteria for SLI (at least language 2 tests <1.25SD; non- verbal IQ within 1SD). Only 11/48 (23%) were on SLT caseload Caseload children did not differ on any measure to non- caseload children Non verbal IQ did not change over.me 18

19 Narrative to measure change Children were tested at 4.me points: Baseline Pre- therapy Post- therapy Follow- up Narrative to measure change Frog Story narra.ve task at 4.me points: Measures: o Norbury and Bishop s seman.c score o Token (number of words) o Type (number of different words) o Number of complex sentences o Story structure measure 19

20 Intervention content Group Rules (5 minutes) Gelling/Turn Taking Activity (5 minutes) Understanding Activity Find the group (15-20 minutes) Speaking Activity Sequencing (15-20 minutes) Children take turns to recall one of the group rules e.g. good looking, good listening, good sitting, good waiting. Children take it in turns to say their favourite place and why. Place a selection of pictures face up on the table. One at a time, ask the children to find pictures belonging to a certain category. For example, find me 2 fruits. Give each of the children 3 step sequencing pictures. Ask the children to look carefully at the pictures and put them in the correct order, thinking about which one is first, next and last. When the children have put their pictures in order, ask them to describe the sequence. If a child has forgotten a group rule you can prompt them by pointing to the visual aid corresponding to the rule. Support the children by modelling your favourite place and why. If a child is having difficulty finding the pictures, give them one picture and ask if they can find another one to go with it. E.g. Here is a picture of an apple which is a fruit. Can you find another fruit to go with the apple? If a child is easily able to identify an item belonging to a category, ask them to find 2 items that they think go together, name the items and then say which category they both belong to. Ask the child to describe what is in each picture. Then discuss which picture will be first and then which one will follow. Use a visual cue to show the direction in which the pictures should be sequenced (e.g. draw 3 boxes going from left to right) in order to support the child s ability to sequence the pictures correctly. Extend the number of pictures to 4 when the child is able to consistently sequence 3 picture cards. Number of different words (type) score 20

21 Semantic score change * * Story structure change 21

22 Narrative change and intervention No effect of caseload those already in the SLP system responded the same as those not iden.fied No effect of IQ on response to interven.on No effect of gender on response to interven.on Suggests that for interven.on purposes the SLI diagnosis is not as important Summary Narra.ve showed different features across genre and across diagnosis Narra.ve picked up change aaer interven.on and can be analysed in a number of different ways It can be used to supplement other clinical informa.on 22

23 Summary Narrative provides structure AND real life validity It is information rich - linguistic and cognitive In combination with other measures it could help to tease out group differences It is particularly good for measuring change Older children, those with complex difficulties, with long SLT histories or with other primary languages may be particularly suited to narrative assessment Thank YOU! NICOLA.BOTTING.1@CITY.AC.UK 23