Story Grammar Analyses Capture Discourse Improvement in the First 2 Years Following a Severe Traumatic Brain Injury.

PURPOSE: Narration within a story grammar framework requires speakers to organize characters and events logically. Despite abundant research characterizing narrative deficits following a traumatic brain injury (TBI), the evolution of narrative story grammar over the first 2 years post-TBI has rarely been explored. This study analyzed story grammar in complex narratives of adults with and without severe TBI to (a) examine between-group differences and (b) investigate longitudinal changes over the first 2 years post-TBI. METHOD: Story grammar analyses of Cinderella narratives from 57 participants with TBI and 57 participants with no brain injury yielded measures of productivity (total number of episodes, total number of story grammar elements), elaboration (total number of elaborated-complete episodes, mean number of episodic elements per episode), and completeness (total number of incomplete episodes). Mann-Whitney U tests compared measures across groups; generalized estimating equation (GEE) models identified predictors of change, including recovery time (3, 6, 9, 12, and 24 months post-TBI) and demographic/injury-related characteristics. RESULTS: Between-group differences were statistically significant for all productivity and elaboration measures at 3, 6, and 9 months post-TBI; one productivity measure and one elaboration measure at 12 months; and none of the measures at 24 months. GEE models showed significant improvements in all productivity and elaboration measures over the first 24 months post-TBI, with educational attainment and duration of posttraumatic amnesia affecting recovery. Incomplete episodes only showed between-group differences at 12 months and did not capture recovery. CONCLUSION: Productivity and elaboration are key story grammar variables that (a) differentiate complex narration in individuals with and without severe TBI and (b) capture narrative improvements over the first 2 years post-TBI. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25148999.

Preliminary evidence supporting the clinical utility of an Analog Task of Prosocial Helping.

BACKGROUND: Prosocial helping is a fundamental communication behaviour that supports successful social relationships. This study investigated the clinical utility of the Analog Task of Prosocial Helping (AToP-H): a tool for assessing how helping is influenced by the communicative function it serves and the cues used to elicit helping in young children with and without a social communication disorder. AIMS: To present evidence of the AToP-H's reliability, validity and clinical utility. METHODS & PROCEDURES: The AToP-H examines three communicative functions expressed through helping-instrumental (request-based), informative (information-based) and empathic (emotion-based) helping-within a naturalistic context. Prosocial helping is elicited using semi-structured interactions in which increasingly explicit cues are provided to scaffold child responses. To gather reliability and validity evidence, the AToP-H was administered to 20 children with autism spectrum disorder (ASD) (49-79 months) and 20 with typical development (37-77 months). OUTCOMES & RESULTS: Procedural reliability and inter-observer agreement for the AToP-H were high. Item-level codes were consistent with overall task performance, showing strong internal consistency. Supporting construct validity, higher scores were observed in older children with ASD, consistent with an expectedly protracted developmental period for prosocial helping. Children with ASD required more cues to elicit helping overall and informative and empathic helping in particular. Furthermore, more children with ASD did not respond or required explicit cues to respond with informative and empathic helping. Supporting criterion-related validity, total helping cue scores were significantly correlated with measures of social cognition, social abilities and receptive language, but were only weakly correlated with general language. CONCLUSIONS & IMPLICATIONS: The AToP-H shows promise in measuring helping performance as an indicator of young children's social communication strengths and weaknesses as well as scaffolding cues to facilitate intervention planning. WHAT THIS PAPER ADDS: What is already known on the subject Prosocial helping is critical for successful relationships, which can be difficult for children with social communication disorders such as ASD. Two factors that influence helping are the communicative function of the helping behaviour and the cues used to elicit helping. Existing helping tasks have been developed for research purposes, focusing on internal validity with little attention to applying or generalizing results to clinical settings or groups. Thus, assessing factors that influence helping behaviours in naturalistic, ecologically valid contexts could provide clinicians with critical information to improve prosocial helping in children with social communication disorders. What this paper adds to existing knowledge This paper presents preliminary psychometric evidence for a naturalistic clinical task: the AToP-H, which assesses instrumental (request-based), informative (information-based) and empathic (emotion-based) helping elicited with increasingly explicit cues. What are the potential or actual clinical implications of this work? Evidence from samples of young children with and without ASD supports the reliability and validity of AToP-H scores. The AToP-H shows promise as a clinical tool to effectively assess and plan interventions targeting social communication, prosocial helping and associated interactions.

Main Concept, Sequencing, and Story Grammar Analyses of Cinderella Narratives in a Large Sample of Persons with Aphasia.

Recently, a multilevel analytic approach called Main Concept, Sequencing, and Story Grammar (MSSG) was presented along with preliminary normative information. MSSG analyses leverage the strong psychometrics and rich procedural knowledge of both main concept analysis and story grammar component coding, complementing it with easy-to-obtain sequencing information for a rich understanding of discourse informativeness and macrostructure. This study is the next critical step for demonstrating the clinical usefulness of MSSG's six variables (main concept composite, sequencing, main concept+sequencing, essential story grammar components, total episodic components, and episodic complexity) for persons with aphasia (PWAs). We present descriptive statistical information for MSSG variables for a large sample of PWAs and compare their performance to a large sample of persons not brain injured (PNBIs). We observed significant differences between PWAs and PNBIs for all MSSG variables. These differences occurred at the omnibus group level and for each aphasia subtype, even for PWAs with very mild impairment that is not detected with standardized aphasia assessment. Differences between PWAs and PNBIs were also practically significant, with medium to large effect sizes observed for nearly all aphasia subtypes and MSSG variables. This work deepens our understanding of discourse informativeness and macrostructure in PWAs and further develops an efficient tool for research and clinical use. Future research should investigate ways to expand MSSG analyses and to improve sensitivity and specificity.

Macrostructural Analyses of Cinderella Narratives in a Large Nonclinical Sample.

Purpose Macrostructural narrative analyses are important clinical measures, revealing age-related declines and disorder-related impairments in the accuracy, completeness, logical sequencing, and organization of content. The current study aims to provide preliminary data on typical aging and psychometric evidence supporting multilevel Main Concept, Sequencing, and Story Grammar (MSSG) analyses that capture these aspects of narratives. Method Transcripts of Cinderella narratives for 92 healthy control participants stratified across four age brackets from the online database AphasiaBank were coded by Richardson and Dalton (2016) for main concept (MC) analysis. In the current study, MSSG analyses were completed for (a) logical sequencing, independently and in combination with MC accuracy and completeness (MC + sequencing), and (b) story grammar organization (i.e., inclusion of episodic components and complexity of episodes). Interrater agreement (99%-100%) revealed highly reliable scoring. Results Descriptive statistics for the typically aging sample are presented for sequencing, MC + sequencing, total episodic components, and episodic complexity. Scores for participants over 60 years of age were lower (poorer) than scores for those 20-59 years of age, supporting the construct validity of score use for identifying age-related declines in performance. Conclusions This study's novel MSSG analyses of narrative production efficiently assess the logical sequencing and story grammar organization of content in healthy controls. Preliminary reliability and validity evidence support the use of all scores to measure age-related changes in narrative macrostructure. Data from this typically aging sample provide a foundation for future research and clinical assessment aimed at quantifying narrative deficits in adults with communication disorders. Supplemental Material https://doi.org/10.23641/asha.12683495.

Predictors of Pragmatic Communication in School-Age Siblings of Children with ASD and Low-Risk Controls.

Little empirical evidence exists about school-age pragmatic communication or predictors in siblings at heightened familial risk for ASD (HR) and low-risk (LR) controls. The Pragmatic Rating Scale-School-Age (Landa unpublished) was scored for 49 HR siblings and 18 LR controls at 8-12 years. Social-communication and language measures were collected between 14 and 36 months. At 36-months, siblings were classified as ASD (HR-ASD, n = 15), broad autism phenotype (HR-BAP, n = 19), or typically developing (HR-TD, n = 15). Results revealed a pragmatic continuum with significantly better scores for HR-TD than HR-BAP or HR-ASD, and HR-BAP than HR-ASD. Per regression models including all participants, 14-month joint attention initiations predicted school-age pragmatic communication, as did 24-month social-communication and expressive language scores. Early joint attention, social-communication, and language abilities contribute to later pragmatic functioning.

Implementation Research: Embracing Practitioners' Views.

Purpose: This research explores practitioners' perspectives during the implementation of triadic gaze intervention (TGI), an evidence-based protocol for assessing and planning treatment targeting gaze as an early signal of intentional communication for young children with physical disabilities. Method: Using qualitative methods, 7 practitioners from 1 early intervention center reported their perceptions about (a) early intervention for young children with physical disabilities, (b) acceptability and feasibility in the use of the TGI protocol in routine practice, and (c) feasibility of the TGI training. Qualitative data were gathered from 2 semistructured group interviews, once before and once after TGI training and implementation. Results: Qualitative results documented the practitioners' reflections on recent changes to early intervention service delivery, the impact of such change on TGI adoption, and an overall strong enthusiasm for the TGI protocol, despite some need for adaptation. Conclusion: These results are discussed relative to adapting the TGI protocol and training, when considering how to best bring about change in practice. More broadly, results highlighted the critical role of researcher-practitioner collaboration in implementation research and the value of qualitative data for gaining a richer understanding of practitioners' perspectives about the implementation process.

Brief Report: An Independent Replication and Extension of Psychometric Evidence Supporting the Theory of Mind Inventory.

This study presents an independent replication and extension of psychometric evidence supporting the Theory of Mind Inventory (ToMI). Parents of 20 children with ASD (4; 1-6; 7 years; months) and 20 with typical development (3; 1-6; 5), rated their child's theory of mind abilities in everyday situations. Other parent report and child behavioral assessments included the Social Responsiveness Scale-2, Vineland Adaptive Behavior Scales-2, Peabody Picture Vocabulary Test-4, and Clinical Evaluation of Language Fundamentals-Preschool, 2. Results revealed high internal consistency, expected developmental changes in children with typical development, expected group differences between children with and without ASD, and strong correlations with other measures of social and communication abilities. The ToMI demonstrates strong psychometrics, suggesting considerable utility in identifying theory of mind deficits in children with ASD.

Assessing young children's intention-reading in authentic communicative contexts: preliminary evidence and clinical utility.

BACKGROUND: Identifying what a communication partner is looking at (referential intention) and why (social intention) is essential to successful social communication, and may be challenging for children with social communication deficits. This study explores a clinical task that assesses these intention-reading abilities within an authentic context. AIMS: To gather evidence of the task's reliability and validity, and to discuss its clinical utility. METHODS & PROCEDURES: The intention-reading task was administered to twenty 4-7-year-olds with typical development (TD) and ten with autism spectrum disorder (ASD). Task items were embedded in an authentic activity, and they targeted the child's ability to identify the examiner's referential and social intentions, which were communicated through joint attention behaviours. Reliability and construct validity evidence were addressed using established psychometric methods. OUTCOMES & RESULTS: Reliability and validity evidence supported the use of task scores for identifying children whose intention-reading warranted concern. Evidence supported the reliability of task administration and coding, and item-level codes were highly consistent with overall task performance. Supporting task validity, group differences aligned with predictions, with children with ASD exhibiting poorer and more variable task scores than children with TD. Also, as predicted, task scores correlated significantly with verbal mental age and ratings of parental concerns regarding social communication abilities. CONCLUSIONS & IMPLICATIONS: The evidence provides preliminary support for the reliability and validity of the clinical task's scores in assessing young children's real-time intention-reading abilities, which are essential for successful interactions in school and beyond.

The diagnostic accuracy and construct validity of the structured photographic expressive language test--preschool: second edition.

PURPOSE: In order to support evidence-based practice, this study served to evaluate the diagnostic accuracy, convergent validity, and divergent validity of the Structured Photographic Expressive Language Test-Preschool: Second Edition (SPELT-P2; J. Dawson, J. A. Eyer, J. Fonkalsrud, 2005) in order to determine whether it can be used as a valid measure for identifying language impairment in preschoolers. METHOD: The SPELT-P2 was administered to 54 children with typically developing language and 42 children with specific language impairment. RESULTS: A discriminant analysis revealed good sensitivity (90.6%), good specificity (100%), and good positive and negative likelihood ratios, with a standard score cutoff point of 87 used to determine group membership. Analyses of convergent and divergent validity also supported use of the SPELT-P2 for identifying language impairment in preschoolers. IMPLICATIONS: The empirical evidence supports use of the SPELT-P2 as a valid measure for correctly identifying the presence or absence of language impairment in 4- and 5-year-old preschool children.