Exploring the Utility of Narrative Analysis in Diagnostic Decision Making: Picture-Bound Reference, Elaboration, and Fetal Alcohol Spectrum Disorders 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 ... Research Article
Research Article  |   April 01, 2007
Exploring the Utility of Narrative Analysis in Diagnostic Decision Making: Picture-Bound Reference, Elaboration, and Fetal Alcohol Spectrum Disorders
 
Author Affiliations & Notes
  • John C. Thorne
    University of Washington
  • Truman E. Coggins
    University of Washington
  • Heather Carmichael Olson
    University of Washington
  • Susan J. Astley
    University of Washington
  • 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@u.washington.edu.
Article Information
Special Populations / Genetic & Congenital Disorders / Attention, Memory & Executive Functions / Language / Research Articles
Research Article   |   April 01, 2007
Exploring the Utility of Narrative Analysis in Diagnostic Decision Making: Picture-Bound Reference, Elaboration, and Fetal Alcohol Spectrum Disorders
Journal of Speech, Language, and Hearing Research, April 2007, Vol. 50, 459-474. doi:10.1044/1092-4388(2007/032)
History: Received July 27, 2005 , Revised December 23, 2005 , Accepted July 13, 2006
 
Journal of Speech, Language, and Hearing Research, April 2007, Vol. 50, 459-474. doi:10.1044/1092-4388(2007/032)
History: Received July 27, 2005; Revised December 23, 2005; Accepted July 13, 2006
Web of Science® Times Cited: 16

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.

Acknowledgments
This research was supported in part by Health Resources and Services Administration: Maternal and Child Health Bureau Grant 6T73MC00041-11-01 and the Centers for Disease Control and Prevention Grant U84/CCU020163-03. Special thanks to Heather Collins and everyone at the University of Washington Child Language Laboratory and the Fetal Alcohol Diagnostic and Prevention Network.
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