Narrative Organization Skills of Children with ADHD - University at ...

Goals
Narrative Organization Skills
of Children with ADHD
Fei Luo, Geralyn Timler,& Dawn Vogler-
Elias
Child Language Laboratory
University at Buffalo
To demonstrate the narrative organization
skills of children with ADHD
To introduce a new narrative analysis
method
ADHD
Attention deficit/hyperactivity disorder
Developmentally inappropriate levels of
inattention, hyperactivity, and impulsivity
(American Psychiatric Association, 2000)
Narratives
Story telling or retelling
Important in daily social interaction and
academic activities (Trabasso & Stein,
1997)
Narrative Organization Skills of
Children with ADHD
Story retellings were shorter (Zentall, 1988)
and less organized (Tannock, Purvis, and
Schachar, 1993)
Had more sequence errors,
misinterpretations of the original stories,
and word substitutions (Purvis & Tannock,
1997)
Problems
Language status
– High rate of comorbidity of ADHD and
language impairments (LI)
35~50% of children with ADHD have concurrent
language impairments
Rates can be as high as 90% in studies using
clinically referred samples
(Baker & Cantwell, 1992; Beitchman et al., 2001;
Tannock & Schachar, 1996)
1

Narrative Organization
Coherent narratives are usually organized
by hierarchical goal structures (Trabasso
& Nickels, 1992; Trabasso et al., 1992)
Goal structure: a goal and its associated
attempts and outcomes (GAO units)
– Different levels of goals: superordinate goals
and subordinate goals
Development of Goal Structures
(Trabasso & Nickels, 1992)
3 and 4-year-olds begin to use goal
structures (i.e., GAO units) to organize
their narratives.
9-year-olds produce as many complete
GAO units as adults.
– Complete GAO = goal + attempt + outcome
Causal Network Model
(Trabasso, et al, 1989)
Used to identify the GAO units in narratives
Analysis of the GAO units is a more useful
measure of narrative organization in children
with ADHD (Renz, et al., 2003).
Research Question
Do typical children, children with ADHD
only, and children with ADHD+LI differ in
their narrative organization skills,
specifically their use of hierarchical goal
structures, indexed by GAO units
Participants
Means
(SD)
C.A. in
months
CELF-4
Core
Language
Method
Typical
(n = 13)
121 (15)
114 (8)
ADHD
Only
(n = 7)
126 (23)
100 (16)
ADHD +
LI
(n = 5)
121 (12)
76 (3)
Method (Cont’d)
Stimuli
– Two tasks from the Test of Narrative Language
(TNL:: Gillam & Pearson, 2004) were used to
elicit narratives.
2

Method (Cont’d)
Stimuli – Late for School
Stimuli - Aliens
Method (Cont’d)
Data Reduction
Method (Cont’d)
– Narrative samples were transcribed and entered
into the Systematic Analysis of Language
Transcripts (SALT:
Miller and Chapman, 2000).
Each narrative was segmented into T-units
– File identifiers were removed.
Method (Cont’d)
Coding
– Each T-unit was coded as one or more of the
following codes
Settings
Initiating events
Internal responses
Superordinate or subordinate goals
Attempts
Superordinate or subordinate outcomes
– Used Causal Network Model to identify the
hierarchical goal structures, i.e., GAO units
Example
1. In the morning, Jason woke up and was almost
late for school. (superordinate goal-inferred)
2. He wanted to catch his school bus to get to
school. (subordinate goal 1)
3. He went downstairs to get his breakfast
quickly. (attempt)
4. Then he went to tie his shoes. (attempt)
5. But he just missed his school bus.
(subordinate outcome 1)
6. And he had to walk to school. (attempt)
7. Finally he got to school. (subordinate
outcome 1)
8. His teacher told him that he was late for
school. (superordinate outcome)
Method (Cont’d)
Reliability
– The third author coded 20% of the samples
from each group.
– Inter-coder agreement was calculated for
each coding category as well as each GAO
unit. The agreement ranged from 75% to 85%.
3

Results
# of Subjects
7
6
5
4
3
2
1
Results: GAO Units Analysis
38%
54%
8%
8% 14%
86%
100%
# of Complete
Superordinate
GAO Units
0
1
2
Late for School
0
Typical
ADHD
Only
ADHD+LI
2 (2, 25) = 7.896, p=.019, 2 =.329
# of Subjects
6
5
4
3
2
1
0
Results: GAO Units Analysis
8%
46%
38%
8%
Typical
43%
43%
14%
ADHD
Only
80%
20%
ADHD+LI
2 (2, 25) = 9.191, p=.010, 2 =.383
# of Complete
Superordinate
GAO Units
0
1
2
3
Aliens
Discussion
Children with ADHD only organized
narratives with GAO units as well as
typical children
Language status accounted for differences
in the use of GAO units within the
narratives
– I.e., Children with ADHD+LI had fewer
complete superordinate GAO units
Implications
The GAO unit analysis, specifically
completeness of the superordinate GAO
unit, may be useful for identifying
organization difficulties in school-age
children’s narratives
A shorter version of the elicitation task can
reveal differences in narrative organization
Limitations and Future
Research
Small sample size
Small narrative samples
Include a group of children with language
impairment and no ADHD to further
examine the effects of ADHD on narrative
organization
4

Questions
5