Narrative Skills in Children with a Deficit in (Central) Auditory Processing Skills
Tena L. McNamara, Au.D. Jennifer C. Friberg, Ed.D.
Illinois State University
What is (C)APD?
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(Central) Auditory Processing Disorder
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(C)APD
“Difficulties in the perceptual processing of auditory information in the CNS, and in the neurobiologic activity underlying those processes, that gives rise to the electrophysiologic auditory potentials.”
ASHA (C)APD Work Group, 2005
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(C)APD is a disorder that is primarily evident in the auditory system
(C)APD may be associated with other co‐morbid conditions and lead to learning, language, & communication difficulties
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ASHA (C)APD Work Group, 2005 (C)APD is not caused by global disorders
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It is important to differentiate (C)APD from other related disorders
A comprehensive, multidisciplinary approach is needed to assess any child suspected of having a (C)APD
It is necessary to try to differentiate (C)APD from other disorders and assess the effect that (C)APD may have on related disabilities
Relationship Between (C)APD, Speech & Language
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How is the (C)APD affecting Speech and Language skills?
Where does the Speech‐Language Pathologist begin when assessing a child with (C)APD?
How can the Speech‐Language Pathologist utilize their time most efficiently when treating a child with (C)APD?
Why look at narrative abilities in children with (C)APD?
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Children are expected to produce and comprehend extended monologue texts throughout their day Adequate narrative skills are necessary for success in school, both academically and socially
Sequencing, organization, and cohesion all need to be woven into a narrative and children with a (C)APD often experience difficulties in these areas
How do we define oral narratives?
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Spoken description of real or fictional events experienced in the past, the present, or the future (Pence, 2007)
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Usually related by theme
Typically similar verb tense throughout Research Question
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Is there a relationship between performance on (central) auditory processing skills and narrative skills in school‐age children?
Method
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Subjects
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16 children between the ages of 7 years 7 months and 11 years 2 months of age participated in the study (mean age – 9.7 years)
The children ranged from 2nd though 5th grade
(C)APD Diagnositic Battery
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Each child selected for the study failed two or more tests from a (C)AP test battery which included:
z Comprehensive audiological evaluation
z Binuaral Integration
ƒ Staggered Spondaic Word Test
ƒ Dichotic Digits
z Binaural Separation
ƒ Competing Sentence Test z Binaural Interaction
ƒ Spondee Binaural Fusion
z Temporal Processing/Ordering
ƒ Pitch Pattern Sequence Test
ƒ Random Gap Detection Test
z Monaural Low Redundancy Speech
ƒ NU6 – 750 Hz Low Pass Filter Test
ƒ BKB Speech‐in‐Noise Test
z Phonemic Synthesis Test
Procedure
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Participants completed two assessment tools for narrative skills:
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A formal assessment using the Test of Narrative Language (Gillam & Pearson, 2004)
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Scores were recorded for Oral Narration and Narrative Comprehension subtests and from a combined score of the subtests for the Narrative Language Ability Index.
An Informal assessment using Applebee’s levels of narrative structure (Applebee, 1978; Huges, McGillivary & Schmidek, 1997) ƒ
Narratives were analyzed and grouped into developmental profiles of Heaps, Sequences, Primitive Narratives, Unfocused Chains, Focused Chains, True Narratives, and Narrative Summaries.
Applebee’s Narrative Levels: A Review
Heaps
Unrelated story elements with no seeming organization
Sequences
Story elements are topically related, but not causally linked
Primitive Narratives Story contains a concrete theme but little interrelation between story components
Unfocused Chain
“stories that wander” are related from one part to the next, but not from beginning to end
Focused Chain
Good connections between story parts, all related to a central theme
True Narrative
Well developed story with internal plans, morals, and forward motion to all elements
Results
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75% of the children scored below the average range on the Oral Narration subtest of the TNL
62.5% of the children scored below the average range on the Narrative Comprehension of the TNL
81.25% of the children scored below the average range for the combined Narrative Language Ability Index of the TNL
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87.5 percent of the children’s formulated narratives were categorized below the expected age‐level for Applebee’s profiles
68.75 percent of the children’s reformulated narratives were categorized below the expected age‐level for Applebee’s profiles
Table 1. Performance of children on the TNL:ON
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8
6
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TNL: ON
2
rio
r
su
pe
av
e
e
ab
ov
av
e
av
e
po
or
be
lo
w
ve
ry
po
o
r
0
Table 2. Performance of children on the TNL:NC
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8
6
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TNL: NC
su
pe
rio
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av
e
ab
ov
e
av
e
be
lo
w
po
or
ve
ry
po
or
0
av
e
2
Table 3. Performance of children on the TNL:NLAI
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8
6
4
TNL: NLAI
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rio
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su
pe
av
e
e
av
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ab
ov
av
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po
or
be
lo
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ve
ry
po
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0
Table 4. Applebee’s rating for children’s performance on formulated and reformulated narratives
Formulated
Su
m
m
ar
ie
s
Tr
ue
Fo
cu
se
d
Reformulated
Pr
im
iti
ve
Un
fo
cu
se
d
Se
qu
en
ce
7
6
5
4
3
2
1
0
Table 5. Pass/Fail rating for children’s performance on narratives using Applebee’s rating
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12
10
8
Formulated
6
Reformulated
4
2
il
Fa
Pa
ss
0
Discussion
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Results suggest that difficulties with narrative language are often associated with a (central) auditory processing deficit in primary school‐age children.
Children with a (C)APD may have difficulty comprehending and producing narratives.
Results are suggestive that many children with (C)APD have concomitant narrative language deficits. Now what?
Integrate narrative analysis into your assessment battery!
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Standardized Assessments
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TNL
Renfrew Bus Story
Developmental Assessments
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Macrostructure/Microstructure analysis
Ideas for intervention with narratives
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Work on narratives within the context of intervention!
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Focus on story structure within the context of:
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Story retellings
Story generation
Script‐based stories
Don’t get too focused on sequence!
Use good story grammar
Utilize neutral sub‐prompts to encourage more language Future Research Questions
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Is there a correlation between performance on specific tests used in the (C)AP battery with proficiency in narrative skills?
Is there a trend in the type of syntactical and morphological errors seen in narratives for children with (C)APD?
References
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American Speech‐Language‐Hearing Association. (2005). (Central) Auditory Processing Disorders. Available at http://www.asha.org/members/deskref‐
journals/deskref/default
Applebee, A. (1978). The child's concept of story: Ages two to seventeen. Chicago, IL: The University of Chicago Press
Gillam, R. B., & Pearson, N. (2004). Test of narrative language. Austin, TX: PRO‐ED.
Huges, McGillivary, & Schmidek. (1997). Guide to Narrative Language. Eau Claire, Wi: Thinking Publications Wesby, C.E., VanDongen, R., & Maggart, Z. (1989). Assessing narrative competence. Seminars in Speech and Language, 10(1), 63‐76.