Signals of CNS damage in the discourse behavior

Signals of CNS damage in the discourse behavior

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
Fetala Alcohol
Spectrum
TREIN and Evidence
during
narrative
generation CNS
task.
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

Discourse Behaviors

Disorders in Children
(FASD)

of CNS Damage?

Primary Questions:
1)Do TREIN errors increase with increasing evidence of structural CNS
abnormality?

(e.g., Alexander, 2006; Casey, Tottenham, & Fossella, 2002; Cools, Ivry, & D'Esposito, 2006; Longworth, Keenan, Barker, Marslen-Wilson, & Tyler, 2005; Monchi, Petrides, Strafella, Worsley, & Doyon, 2006; Poldrack
& Rodriguez, 2004; Robles, Gatignol, Capelle, Mitchell, & Duffau, 2005; Seger, 2006; Seger & Cincotta, 2006; Teichmann, Dupoux, Kouider, & Bachoud-Levi, 2006; Teichmann et al., 2005; Tricomi, Delgado,
McCandliss, McClelland, & Fiez, 2006; Bitan et al., 2006; Blakemore, 2008; Conklin, Luciana, Hooper, & Yarger, 2007; Ofen et al., 2007; Santesso & Segalowitz, 2008).

Analysis of Narrative Generation during Frog Where Are You?
Tallying Reference Errors In Narrative:TREIN (Thorne 2006; http://students.washington.edu/jct6)

Secondary Question: What is the relationship between severity of FAS diagnosis
and narrative performance when additional narrative measures are included
in analysis?

TREIN quantifies 9 aspects of Narrative:
Appropriate reference strategies:
Indefinite Nominal Introduction
Definite Nominal Introduction
Possessive Nominal Introduction

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:
CNS RANKS
1= unlikely
none
2 = possible
(n=8)
3 = probable
(n=4)
4 = definite
(n=4)
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
regions
-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

from Frog Where Are You? copyright Mayer 1969

Rate of Nominal Reference Errors
.07

CNS RANK

INI

rNRE

mean (SD)
16.7 (3.6)

Significant Contrasts

1-unlikely (n=16)

1>4 (p=0.003)

mean (SD)
1.57% (0.7)

2-possible (n=8)

15.4 (3.5)

2>4 (p=0.03)

2.59% (0.9)

2<4 (p=0.01) 3-probable (n=4) 14.0 (2.4) ns 3.40% (1.2) 3>1 (p=0.006)

4-definite (n=4)

8.8 (2.8)

4<2(p=0.03); 4<1(p=0.003) 4.48% (0.9) Significant Contrasts 1<4 (p<0.0001); 4>1 (p<0.0001); 1<3 (p=0.006) 4>2 (p=0.01)

Primary Question 2: Sensitivity/Specificity
Only rNRE had clinically important ability to identify Static Encephalopathy (Plante & Vance, 1994)
2 sd cut-off
sensitivity 88%,
specificity 92%
All False-positives CNS-Rank 2
1.5sd and 1.25 sd
sensitivity 88%
specificity (79% & 71% respectively)
False-positives included TD children.
Secondary Question: Correlations
Significant Correlations to CNS-Rank (Kendalls tau b, p< 0.05) Measure Rate of Nominal Reference Error (rNRE) Indefinite nominal introduction (INI) Cohesive pronoun ties Total Utterances Number of Different Words (NDW) Number of Words Personal pronouns Correlation 0.63 -0.40 -0.37 0.37 -0.31 -0.31 -0.28 Coding conducted blind to storyteller Interrater reliability: Kappa = 0.90 Conclusions and Moving Forward: Appropriate Introductions 30 There was a significant increase in TREIN errors with increasing evidence of structural CNS damage in this group of 32 children. .05 rNRE (p=0.0001; ANOVA) Pairwise Comparisons (Scheffe; p<0.05) 9 TREIN measures (TREIN Thorne, 2006). Secondary Question: Correlational analysis (Kendals Tau b) .06 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). Analysis: Primary Question 1: One-way ANOVA with Scheffes contrasts Pronominal Reference Errors Ambiguous Pronominal Reference TIE Pronominal Introduction Results 2) Do significant differences (i.e., > 2 SD) in narrative performance discriminate
between FASD with Static Encephalopathy and TD peers?

20

These errors were best reflected in the rate of Nominal Reference Errors
(rNRE), demonstrating clinical potential for the measure.

.04
.03
Indefinite Nominal

10

.02

(p= 0.003; ANOVA)

.01

Definite Nominal

0.00

0
unlikely

possible

probable

Increasing Evidence of CNS damage

definite

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.

Possessive
unlikely

possible

probable

definite

Increasing Evidence of CNS damage

Additional findings:
- 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.

Acknowledgements:
Dr. Lesley Olswang, Brianne Bowker and everyone at the Child Language Laboratory

p-value
<0.0001 =0.006 =0.008 =0.010 =0.025 =0.028 =0.043 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
Funding:
UWSPHSC Research Training in Speech, Language, and Hearing Sciences; Lynn Werner, Principal
Investigator, NIH
LEND: "Interdisciplinary Leadership Training in Neurodevelopmental and Related
McLaughlin, M.D., Principal Investigator, HRSA MCH Bureau

Disabilities" John F.

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