Narrative Discourse in Children With Closed Head Injury, Children With Language Impairment, and Typically Developing Children

Abstract

In this paper, narrative discourse abilities are compared across three groups—children with a moderate to severe closed head injury (CHI), children with language impairment (LI), and a group of typically developing peers— using narrative retells and generation of story morals. Narrative expression is also examined in a subset of the CHI group who manifested language problems on structured measures. Narrative retells are analyzed at multiple levels of representation, including language and information measures, using the methods described in the companion paper to this article (Chapman, this issue). The most important finding was the significant impairment on information measures in children with moderate to severe CHI, despite relatively good recovery on language measures. The children with LI performed significantly lower than the typical group on measures of both language (amount and complexity of language) and information structure (amount, preserved semantic meaning, episodic structure), as well as generating abstract story morals. The CHI group showed the greatest variability in performance, with discourse abilities overlapping both the LI and control groups. Additional analyses suggested that a subgroup of children with CHI, those with an associated language impairment, were particularly at risk for deficits on information measures. The utility of discourse tasks for differential diagnosis and treatment is discussed.