Exploring the Utility of Narrative Analysis in Diagnostic Decision Making: Picture-Bound Reference, Elaboration, and Fetal Alcohol Spectrum Disorders

Abstract

Results support further study of the diagnostic utility of narrative analysis using discourse level measures of elaboration and children's strategic use of reference.

Narrativa oral de indivíduos com Transtorno do Espectro Alcoólico Fetal

“…It is speculated that the greater occurrence of incomplete utterances in the narration of individuals with FASD may indicate the difficulty that individuals often present in planning and elaboration of the utterances, either in lexical selection or in semantic organization of the words that composed the ongoing utterance as of later statements, which should be related with one another in order to maintain the meaning of the narrative. Syntactic and semantic impairments have been reported in studies investigating the performance of individuals with FASD in language tests (12,15,16,18) or in more naturalistic language samples, such as oral narrative (11,13,14,19) , since individuals with FASD needed revisions and reformulations of utterances throughout the oral narrative.…”

“…As shown, it is noted that, although some studies reported clinical manifestations that signal the difficulties presented by individuals with FASD in oral narrative, as to the microstructural aspects of narrative (13,14,17) and fluency of spoken language (19) , little is known about the aspects that refer to the macrostructural dimension and global coherence of narrative. Also, although the association between the microstructural aspects (referential cohesion) of narrative and the items of the 4-Digit Diagnostic Code (facial characteristics and CNS impairment) has been reported as part of the FASD phenotype (20) , such findings are still to be further explored.…”

“…These changes were described in the studies focusing on assessment of spoken language by means of standardized language tests (16) , as well as in those which prioritized naturalistic samples of spoken language, such as story narration (13,14,17,19) .…”

“…Such compromise is frequently characterized by significant deficits in language comprehension (12)(13)(14)(15) . The studies investigating language production of individuals with FASD reported impaired phonological component (15) , reduced expressive vocabulary for the age (12,(16)(17)(18)(19) , production of vague, irrelevant, and inaccurate utterances (17) ; difficulties to elaborate concepts and production of ambiguous statements (13,14) , as well as increased frequency of hesitancy and silent pauses, which indicate significant difficulties to organize the story narrative scheme and use appropriate syntactic and semantic structures throughout the narrative (19) .…”

“…Studies on the oral narrative of populations with FASD have been conducted and have shown the relevance of narrative performance for prognostic discussions, as well as for the identification of individuals with FASD at school age from specific measures for analysis of narrative coherence and cohesion (13) . Among the microstructural aspects of narrative, nominal agreement and referential cohesion mistakes are the most recurrent narrative difficulties of individuals with FASD, which help to distinguish narrative performance in their peers with typical development (14,20) .…”