Narrative attainment was assessed in a group of 76 four-year-old children at risk for brain injury because of histories of early corrective heart surgery. Elicited personal experience narratives were coded for narrative components, evaluative devices, and information adequacy and were contrasted with narratives produced by a comparison group of typically developing 4-year-olds. The production of autonomous narrative discourse was identified as an area of special vulnerability for children with this medical history. Despite considerable heterogeneity in narrative performance, children with early corrective heart surgery produced fewer narrative components than typically developing children. Results suggest that the elaboration of events and contextual information, the expression of subjective evaluation and causality, and clarity and explicitness of information reporting may constitute special challenges for this population of children. Implications of these findings for clinical assessment and possible risks for socioemotional relationships and academic achievement are discussed.

Children with histories of early corrective heart surgery (ECHS) are at risk for language, cognitive, and motor delays. This study examined parent–child play in 30 4-year-old children with ECHS and 30 typically developing children. Children were compared on basic language measures and on proportions of symbolic and nonsymbolic talk. Children with ECHS focused on concrete “here-and-now” talk and produced less symbolic talk than normative children. Only a third of the children with ECHS were able to produce story episodes. These findings reflect the ECHS children's relatively immature participation in joint pretense and their overreliance on earlier acquired strategies for pretend play. This style of participation may result from difficulty coordinating more complex social intentions with appropriate language forms.