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N I C O L A B O T T I N G L A N G U A G E A N D C O M M U N I C AT I O N S C I E N C E

C I T Y U N I V E R S I T Y L O N D O N

Narrative as a clinical assessment

Overview

�  Background about narrative

�  Different types of narrative �  Narrative in relation to diagnosis / other skills

�  Narrative as a measure / predictor of change

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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 - 1

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Reg. past TPS present prog. plural

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Normative trends -2

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questions negatives MLU

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Normative trends - 3

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pers.pronouns mazes

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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

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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

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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  

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Narrative across genres (Botting, 2002)

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Word Length Past tense errors

BusFrog

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

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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…...

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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

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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)

Subgroups

ASDPLISLI

Char

acter

spee

ch

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40

30

20

10

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Sound effects and character speech

Subgroups

ASDPLISLI

Soun

d effe

cts

1.5

1.4

1.3

1.2

1.1

1.0

.9

.8

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.6

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.3

.2

.10.0

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Poorer story structure

SLI

Shorter narratives

Less complex sentences

Numerous mazes

Limited use of referents

Tense errors

Overuse of devices

Relevant use of SFX

Use of “mind” terms

Typical WF errors

Poorer story structure

ASD

Typical length narratives

Less complex sentences?

Unusual word use

Confused referents

Fewer tense errors?

Poor use of devices (except set-phrases)

Overuse use of SFX

Little use of “mind” terms

Little character speech

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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  

�  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  

Narrative in ASD and SLI (Manolisti & Botting 2011)

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�  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  

Narrative in ASD and SLI (Manolisti & Botting 2011)

Man & Bot results

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Different relationships between factors

�  For  ASD:  

�  For  SLI:  nothing  significantly  associated                    (no  r>0.35)  

Narrative CELF receptive

Pragmatic Language

�  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  

Narrative in ASD and SLI (Manolisti & Botting 2011)

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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

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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 17.5 25 82.5

B

8 M SLI 37.5 7 97.5

C

11 M ASD 50 30 62.5

D

8 M RES 50 48 62.5

E

8 M ASD 1 13 92.5

F 11

M SLI 3 13 17.5

G

11 F RES 25 77 37.5

H 8 M ASD 17.5 7

37.5

Diagnoses and percentile language scores

N I C O L A B O T T I N G

Narratives and development

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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  

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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  

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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  

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Intervention content

Group Rules (5 minutes)

Children take turns to recall one of the group rules e.g. good looking, good listening, good sitting, good waiting.

If a child has forgotten a group rule you can prompt them by pointing to the visual aid corresponding to the rule.

Gelling/Turn Taking Activity (5 minutes)

Children take it in turns to say their favourite place and why.

Support the children by modelling your favourite place and why.

Understanding Activity Find the group (15-20 minutes)

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”.

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.

Speaking Activity Sequencing (15-20 minutes)

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.

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

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Semantic score change

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Story structure change

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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  

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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

N I CO LA . BOT T ING . 1@C I T Y . A C .UK  

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