Signals of CNS damage in the discourse behavior of school-aged children
John C. Thorne, Ph.C., CCC-SLP & Truman Coggins, PhD, CCC-SLP:
with prenatal alcohol exposure
University of Washington Child Language Laboratory
Damage in FASD and
TREIN and Evidence
Caudate of Basal Ganglia & Frontal Lobes form a functional loop
Part of the Executive system
Match response to context
Predict reward for response
Should impact higher-level aspects of discourse production
More severe impairment in children with FAS facial phenotype expected
Disorders in Children
of CNS Damage?
1)Do TREIN errors increase with increasing evidence of structural CNS
Static Encephalopathy = CNS RANK (3) or (4)
60% >2 SD smaller 1 or more regions
Smaller caudate nucleus of basal ganglia
Absolute and relative to brain size
about 40% caudate nucleus > 2 SD smaller
Neurobehavioral Disorder = CNS RANK (2)
43% >2 SD smaller 1 or more regions
CNS RANKS of 32 School-age Children:
16 diagnosed with FASD:
2 = possible
3 = probable
4 = definite
16 typically developing (TD) age-matched
All considered to have CNS-rank 1
Cohesive Nominal Reference TIE
Cohesive Pronominal Reference TIE
Risk of CNS damage increases with CNS Rank in FASD
FAS facial phenotype
70% >2 SD smaller 1 or more
-Smaller frontal lobes as group
-Absolute and relative
-33% >2 SD smaller
(Astley et al. Forthcoming)
Nominal Reference Errors:
Ambiguous Nominal Introduction
Ambiguous Nominal Reference TIE
Primary Question 2: Sensitivity/Specificity
Only rNRE had clinically important ability to identify Static Encephalopathy (Plante & Vance, 1994)
2 sd cut-off
All False-positives CNS-Rank 2
1.5sd and 1.25 sd
specificity (79% & 71% respectively)
False-positives included TD children.
Secondary Question: Correlations
Significant Correlations to CNS-Rank (Kendalls tau b, p< 0.05)
Rate of Nominal Reference Error (rNRE)
Indefinite nominal introduction (INI)
Cohesive pronoun ties
Number of Different Words (NDW)
Number of Words
Coding conducted blind to storyteller
Interrater reliability: Kappa = 0.90
There was a significant increase in TREIN errors with increasing evidence of
structural CNS damage in this group of 32 children.
rNRE (p=0.0001; ANOVA)
9 TREIN measures (TREIN Thorne, 2006).
Secondary Question: Correlational analysis (Kendals Tau b)
Groups defined on CNS Rank differed in mean rNRE (F= 15.8, p= 0.0001) and in their mean
number of Indefinite Nominal Introductions (INI; F=5.9, p= 0.003), a near-reciprocal of NRE.
Productivity: NDW, MLU, length measures, etc.
Mazes: Total Maze Words, per Utterance, etc.
Standard Words: Personal Pronouns, etc.
Primary Question 2: Calculate Sensitivity and Specificity for Static
Encephalopathy at 2, 1.5, 1.25 SD from the mean of TD group
(Thorne & Coggins 2008)
rate of Nominal Reference Errors (rNRE = NRE/Total Words)
- Identifies storyteller as FASD vs. Typically Developing Peer (TD)
- Can distinguish storytellers with FAS from other FASD
Primary Question 1: Significant effects of CNS-rank on 2 of 9 TREIN measures.
Narrative measures analyzed
26 standard SALT measures (Miller, 2004).
Primary Question 1: One-way ANOVA with Scheffes contrasts
Pronominal Reference Errors
Ambiguous Pronominal Reference TIE
2) Do significant differences (i.e., > 2 SD) in narrative performance discriminate
between FASD with Static Encephalopathy and TD peers?
These errors were best reflected in the rate of Nominal Reference Errors
(rNRE), demonstrating clinical potential for the measure.
(p= 0.003; ANOVA)
Increasing Evidence of CNS damage
Replication in a larger, more representative sample of children would bolster
validity of using the TREIN to identify integrative language impairment
resulting from CNS damage in this population.
Increasing Evidence of CNS damage
- Children with FAS had highest rNRE as expected (4.36%, SD 0.8)
- children with TD had lowest rNRE (1.57%, SD 0.7)
We are currently working to replicate these results using 160 Frog Where Are
You narratives available from the University of Washington Fetal Alcohol
Syndrome Diagnosis and Prevention Network.
Future research will directly examine structural CNS abnormalities in
children with FASD that exhibit difficulties with narrative generation as
measured by the TREIN.
- children with FASD without FAS fell in between (2.77%, SD 0.9)
(F= 23.0, p< 0.0001; contrasts: FAS>TD, p<0.0001, FAS>other FASD, p=0.005, other FASD>TD, p=0.004)
All 5 children with FAS and 4 with other FASD had rNRE > 2 SD from the TD group mean.
Dr. Lesley Olswang, Brianne Bowker and everyone at the Child Language Laboratory
Those with Static Encephalopathy had significantly smaller NDW (mean 92.1, SD 25.8)
than the group without (mean 125.8, SD 38.6; t-test -2.29, p=0.03).
Those with Static Encephalopathy also produced fewer cohesive pronoun ties (PNTIE=16, SD 8.6)
than the group without (mean 24.4, SD 11.6; t-test -2.18, p=0.04)
No cases produced NDW or PNTIE > 2 SD below mean of TD group (NDW=130, SD 43.1; PNTIE=27.4, SD 12).
No other measures analyzed produced important contrast between groups.
The whole crew at the UW FASDPNData provided by "Intervening with Children/Adolescents with FAS/ARND"
Susan J. Astley, Ph.D., Principal Investigator; Heather Carmichael Olson, Ph.D., CoInvestigator: Agency:
Centers for Disease Control and Prevention - U.S. Department of Health and Human Services
UWSPHSC Research Training in Speech, Language, and Hearing Sciences; Lynn Werner, Principal
LEND: "Interdisciplinary Leadership Training in Neurodevelopmental and Related
McLaughlin, M.D., Principal Investigator, HRSA MCH Bureau
* NOTE FROM ED SERVICES: Change to "example of data-driven performance improvement"? YES—all set * * * * * Using Data to Create Change Next, Don Butler from the University Health Systems of Eastern Carolina (Pitt County Memorial Hospital) To...
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