Investigating Narrative Performance in Children With Developmental Language Disorder: A Systematic Review and Meta-Analysis

Abstract

Purpose: Narrative assessment is one potentially underutilized and inconsistent method speech-language pathologists may use when considering a diagnosis of developmental language disorder (DLD). However, narration research encompasses many varied methodologies. This systematic review and meta-analysis aimed to (a) investigate how various narrative assessment types (e.g., macrostructure, microstructure, and internal state language) differentiate children with typical development (TD) from children with DLD, (b) identify specific narrative assessment measures that result in greater group differences, and (c) evaluate participant and sample characteristics that may influence performance differences. Method: Electronic databases (PsycINFO, ERIC, and PubMed) and ASHAWire were searched on July 30, 2019, to locate studies that reported oral narrative language measures for both DLD and TD groups between ages 4 and 12 years; studies focusing on written narration or other developmental disorders only were excluded. We extracted data related to sample participants, narrative task(s) and assessment measures, and research design. Group differences were quantified using standardized mean differences. Analyses used mixed-effects meta-regression with robust variance estimation to account for effect size dependencies. Results: Searches identified 37 eligible studies published between 1987 and 2019, including 382 effect sizes. Overall meta-analysis showed that children with DLD had decreased narrative performance relative to TD peers, with an overall average effect of −0.82 SD , 95% confidence interval [−0.99, −0.66]. Effect sizes showed significant heterogeneity both between and within studies, even after accounting for effect size–, sample-, and study-level predictors. Across model specifications, grammatical accuracy (microstructure) and story grammar (macrostructure) yielded the most consistent evidence of TD–DLD group differences. Conclusions: Present findings suggest some narrative assessment measures yield significantly different performance between children with and without DLD. However, researchers need to improve consistency of inclusionary criteria, descriptions of sample characteristics, and reporting of correlations between measures to determine which assessment measures reliably distinguish between groups. Supplemental Material: https://doi.org/10.23641/asha.21200380

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“…Forest plots will be inspected to visualize the extent of heterogeneity (by examining the width of confidence intervals and degree of overlap). A forest plot aligned with dependent effect sizes will be used, similar to Winters et al ( 2022 ). While we have already identified subgroup analyses which we believe will contribute to any possible heterogeneity, other subgroup analyses may be explored if needed (e.g., treatment type employed).…”

“…Before conducting the analyses, we will check for outliers in the distribution of effect sizes. Outliers for the present review are effect size estimates that are more than three times outside the inter‐quartile range below the first quartile, or those more than three times the inter‐quartile range above the third quartile (Tukey, 1977 ; Winters et al, 2022 ). If outliers are present, we will conduct sensitivity analyses by removing these outliers and assess if this influences the results; if so, all analyses will be conducted with these outliers removed.…”

Vocabulary Diversity in Personal Narratives Produced in Response to the Global TALES Protocol in Dutch-Speaking Students with and without Dyslexia

“…Narratives have also been used in previous studies with children with findings pointing to the relevance of investigating spoken language of children with reading difficulties [26]. Analysis of narrative language samples has been used to characterize the linguistic competence of a wide range of individuals including those diagnosed with developmental language disorders (DLD) [e.g., [27][28][29][30][31], with mixed results. These studies revealed that children with DLD were able to produce a cohesive, structured narrative discourse using a discourse task based on a picture book or a task where an adult listener saw or did not see a movie with the child and examining whether subjects altered their story [29,30].…”

“…However, the children with reading difficulties showed significant difficulties in narrative ability compared to their peers without reading difficulties. Furthermore, a meta-analysis on oral narrative language measures of 37 studies between 1987 and 2019 confirmed significant narrative differences between children with and without language disorders [31].…”

“…Most of the previous research in children with DLD has thus focused on fictional narrative skills [27, 29, 30] as opposed to personal narrative skills [see 31]. Personal narratives refer to children’s accounts of personally experienced events and are one of the earliest developing forms of discourse, making up more than 50% of children’s daily conversations [32, 33].…”