International Journal of Speech-Language Pathology

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The Autism Diagnostic Observation Schedule and narrative assessment: Evidence for specific narrative impairments in autism spectrum disorders Rebecca M. Banney, Keely Harper-Hill & Wendy L. Arnott To cite this article: Rebecca M. Banney, Keely Harper-Hill & Wendy L. Arnott (2015) The Autism Diagnostic Observation Schedule and narrative assessment: Evidence for specific narrative impairments in autism spectrum disorders, International Journal of Speech-Language Pathology, 17:2, 159-171, DOI: 10.3109/17549507.2014.977348 To link to this article: http://dx.doi.org/10.3109/17549507.2014.977348

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International Journal of Speech-Language Pathology, 2015; 17(2): 159–171

The Autism Diagnostic Observation Schedule and narrative assessment: Evidence for specific narrative impairments in autism spectrum disorders Rebecca M. Banney1, Keely Harper-Hill1,2 & Wendy L. Arnott1 1School

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2The

of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia, and University of Queensland Centre for Clinical Research, Herston, Queensland, Australia

­ bstract A Purpose: The Autism Diagnostic Observation Schedule (ADOS) contains a narrative generation task in which clients tell a story from a wordless picture book; however, the resulting narrative is not usually examined for its linguistic properties. This study aimed to examine narrative generation in autism spectrum disorder (ASD) by comparing narratives elicited from children with ASD during the ADOS to those produced by language-matched typically-developing (TD) peers. Method: Participants were children with ASD (n  11) and TD controls (n  17). Both groups were aged 9–15 years and were matched for expressive and receptive language skills and non-verbal intelligence. Narratives were analysed for local structure elements (length, fluency, errors, semantics and syntax), cohesion and global elements (story grammar and internal state language). Result: Results indicated that the narratives of the children with ASD were syntactically less complex, contained more ambiguous pronouns and included fewer story grammar elements than their control counterparts; with further analysis showing differences between younger and older children. Conclusion: The present findings provide evidence that children with ASD exhibit subtle story generation impairments and provide preliminary support for the inclusion of narratives elicited as part of the ADOS in the assessment of specific language skills in this population.­

Keywords: Story generation, ASD, ADOS, story grammar, pronominal referencing, syntax

Introduction Autism spectrum disorder (ASD) is characterized by deficits in the areas of verbal and non-verbal communication and reciprocal social interaction and by restricted or repetitive behaviours and interests (Molloy, Murray, Akers, Mitchell, & ManningCourtney, 2011). With respect to the verbal deficits, studies employing standardized assessments indicate that language impairments are found in only a subgroup of children with ASD (Harper-Hill, Copland, & Arnott, 2013). Some researchers claim, however, that standardized assessments may lack the sensitivity needed to accurately identify language difficulties in this population (e.g. Justice, Bowles, Kaderavek, Ukrainetz, Eisenberg, & Gillam, 2006). Narrative assessments may represent a more sensitive way of revealing aspects of linguistic vulnerability not readily detected by standardized tests (Hadley, 1998), especially for children with ASD (Botting, 2002). Current best practice emphasizes the importance of studying narrative performance across two main

levels (Norbury & Bishop, 2003; Westby, 1992). These are known as global structure (also known as macrostructure (Justice et  al., 2006) and macroorganization (Liles, Duffy, Merritt, & Purcell, 1995)) and local structure (also known as microstructure (Justice et  al., 2006) and micro-organization (Liles et  al., 1995)). Global structure consists of story grammar components and the complexity of episodic structures present in the narrative (Liles et al., 1995). Local structure, on the other hand, includes the internal linguistic representations of the narrative—such as the words, sentences and cohesion (Westby, 1992). Narratives can take many forms and the choice of elicitation context can have significant effects on measures of story structure, content and complexity (e.g. Duinmeijer, de Jong, & Scheper, 2012; Pearce, 2003). Two of the most frequently used oral narrative elicitation contexts are story generation and story ­re-tell (Pearce, 2003; Westerveld & Gillon, 2010). Despite the support for narrative as a sensitive tool

Correspondence: Rebecca Banney, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, 4072, Australia. Email: [email protected] ISSN 1754-9507 print/ISSN 1754-9515 online © 2014 The Speech Pathology Association of Australia Limited Published by Informa UK, Ltd. DOI: 10.3109/17549507.2014.977348

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160  R. M. Banney et al.  for profiling language difficulties in children with ASD, surprisingly few studies have examined narrative skills in this population. Below, story generation and story re-tell studies in ASD are reviewed in turn. The narrative generation studies that have been undertaken in ASD have yielded highly variable results. For example some have reported reduced syntactic complexity (Losh & Capps, 2003; Norbury & Bishop, 2003), while others have found normal syntactic complexity (Tager-Flusberg & Sullivan, 1995); Norbury and Bishop (2003) found impaired cohesion in ASD; and, more globally, Losh and Capps (2003) reported limited use of evaluative comments, but Tager-Flusberg and Sullivan (1995) reported no differences in the use of evaluations in the stories produced by their ASD and control groups. Evaluative comments include the use of internal state language and refer to story elements that “represent the narrator’s interpretation of events” and “build suspense and establish the point of the story” (Capps, Losh, & Thurber, 2000, p. 197). This variability may be due, at least in part, to heterogeneity in the experimental groups and for the different methods used to match participants for language ability. While a small number of narrative generation studies have prospectively matched their participants with ASD and typically-developing (TD) controls on general language (Capps et  al., 2000; Losh & Capps, 2003; Novogrodsky, 2013; Tager-Flusberg & Sullivan, 1995), the methods used to control for language have depended upon whether the children with ASD are low or high-functioning. Studies of narrative generation in low-functioning children with ASD have matched for language or mental age (Capps et al., 2000; Tager-Flusberg & Sullivan, 1995). Capps et  al. (2000) compared the performance of 13 participants with ASD (mean chronological age [CA]  12;6 years; mean mental age [MA]  8;9), 13 participants with developmental delay (DD; mean CA  9;8 years; mean MA  7;4), and 13 TD controls (mean CA  6;0 years) who had been matched for language age based on the groups’ performance on the Clinical Evaluation of Language Fundamentals (CELF; Semel, Wing, & Secord, 1987). Capps et al.’s results indicated that the ASD group told stories that contained subtle differences in the use of internal state language and were syntactically less complex than the language-matched controls. Similarly, Tager-Flusberg and Sullivan (1995) employed three groups, participants with ASD (n  27, mean CA  16;8, mean PPVT MA  10;0), participants with intellectual impairment (II; n  27, mean CA  12;6, mean PPVT MA  8;9) and TD controls (n  17, mean CA  9;1). Members of the ASD and II groups were matched for language using the sentence structure and formulated sentences sub-tests of the CELF and for cognition, and controls were selected based on their chronological ages falling within the mental and language age range of these

groups. In contrast to Capps et  al., however, Tager-Flusberg and Sullivan reported no differences in the narratives produced by their three groups. As can be seen, however, the ASD and control groups in both studies could not be matched for chronological age. Hence, it remains unclear whether the relative maturity of the participants with ASD masked the severity of their narrative difficulties, a problem previously raised by Van der Lely (1997) when comparing the narratives of older experimental groups with younger language-matched controls. Other narrative generation studies involving higher functioning children with ASD have been able to match for both CA and language (Losh & Capps, 2003; Novogrodsky, 2013). Losh and Capps (2003) compared personal and storybook narrative generation in 28 children with ASD and 22 controls aged between 8–10 years. All children were reported to have normal intelligence and the two groups were matched for CA and Wechsler Intelligence Scale for Children (WISC; Wechsler, 1991) verbal IQ score. While the two groups produced narratives of a similar length, the narratives of the ASD group were syntactically less complex, had a more restricted range of complex syntax and had fewer story grammar components than those of the comparison group. The ASD group also used fewer evaluations than the controls, but only in their personal narrative generation. In contrast to the above more general studies of narrative ability, Novogrodsky (2013) specifically examined pronoun use as a function of narrative type, story re-tell vs story generation, and age. Novogrodsky’s participants, ASD (n  23) and controls (n  17), were matched for CA (range  5;11–14;4) and on the verbal ability index of the WoodcockJohnson Test of cognitive achievement-3rd edition (Woodcock, McGrew, & Mather, 2001). The results indicated that the ASD group used significantly more ambiguous pronouns than their control counterparts during story generation and, whereas the younger controls produced more ambiguous pronouns than the older controls (p  0.07), no agerelated difference was found for the participants with ASD. In fact, ambiguous pronoun usage was similar for the older participants with ASD and the younger controls. Hence, Novogrodsky’s findings expand on earlier studies that examined cohesion (Norbury & Bishop, 2003) to demonstrate specific age-related difficulties with pronominal referencing in ASD during a story generation task, but not during story re-tell. Novogrodsky warned that story re-tell tasks may mask pronominal referencing anomalies. Investigations of narrative re-tell in ASD are rare (Diehl, Bennetto, & Young, 2006; Manolitsi & Botting, 2011). Diehl et  al. (2006) predominantly analysed for narrative coherence in children with ASD and their TD counterparts. In contrast to this, Manolitsi and Botting (2011) undertook analysis at both global and local levels and compared performance in two participant groups: Greek

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Narrative generation in autism spectrum disorder    161

children with ASD and Greek children with specific language impairment (SLI). Despite their differences in methodology, commonalities in the narratives sampled from the children with ASD traverse these studies. Such common findings include poor coherence, relative to controls, as a result of re-telling events out of sequence and difficulties expressing causal relationships between events. Furthermore, unlike in studies of story generation, the syntactic complexity of their narratives was comparable to both Greek children with SLI (Manolitsi & Botting, 2011) and children with typical development (Diehl et al., 2006). In addition, similarities in measures of story events in the narratives of children with ASD were also reported (Diehl et al., 2006). The limited number of studies utilizing re-tell to elicit narratives in this population, and the variability between those studies which do exist, however, strictly limit the ability to draw conclusions about the utility of this technique. Overall the findings of the aforementioned narrative studies provide support for the clinical assessment of narrative generation skills in children with ASD. The Autism Diagnostic Observation Schedule (ADOS; Lord, Rutter, DiLavore, & Risi, 1998) may provide a cost-effective opportunity for obtaining narrative samples for this assessment. The ADOS is a widely-used semi-structured standardized assessment examining social behaviour, communication and imaginative play in children or adults suspected of having ASD. There are four ADOS modules and the clinician selects the one most relevant for the client based on their verbal skills (Lord & Schopler, 1992). Modules 3 and 4 contain a narrative task in which clients must tell a story from a wordless picture book. A number of books are recommended for this task, with one of the most popular being Tuesday by Wiesner (1991). Within the ADOS, this narrative task is traditionally shared between the examiner and child. The examiner’s role is to begin the narrative before handing over to the child. The child’s narrative enables the examiner to give an overall rating of the individual’s non-echoed language during spontaneous speech and gain an understanding of their interests and response to humour. Typically, the narrative sample is not analysed for its content or structure. Recognizing the unique clinical opportunity represented by the ADOS, two recent studies, Rumpf, Kamp-Becker, Becker, and Kauschke (2012) and Suh, Eigsti, Naigles, Barton, Kelley, and Fein (2014), compared narrative performance in children with ASD and TD peers by utilizing the narratives collected as part of the usual ADOS module 3 procedure using the wordless picture book Tuesday (Wiesner, 1991). Rumpf et al. (2012) compared the narratives of 11 monolingual German-speaking children with Asperger syndrome (AS), 11 children with attention deficit hyperactivity disorder (ADHD), and 11 TD controls. Participants were aged between

8;0–12;11 years. Suh et al. (2014) also compared the narratives of three groups: 15 children with high functioning autism (HFA), 15 children who no longer met criteria for ASD, and 15 TD controls, with participants aged between 9–15 years. In contrast to Rumpf et al. (2012), Suh et al. (2014) found no difference in story length or use of mental state terms (e.g., thought). However, both studies reported that the ASD group had difficulty conveying the core aspects of the story. Suh et al. (2014) also reported that the children in the ASD group used more ambiguous pronouns and more dysfluent behaviours (not examined by Rumpf et al., 2012) than the other groups. Importantly, however, one limitation across both studies is that the groups were not comprehensively matched for general language ability. Suh et al. (2014) prospectively matched groups only on verbal IQ; however, no details are provided regarding the specific test/s used, so it is unclear what language skills may have been assessed. Rumpf et  al.’s participants, on the other hand, were not matched apriori for general language ability. Rather, based on the finding that the narratives produced by the children with AS and the TD controls had a similar mean length of utterance in words (MLU-w), the authors proposed that the two groups had similar language abilities. Given that MLU is not a reliable indicator of overall language ability (Eisenberg, Fersko, & Lundgren, 2001), it remains unclear whether the ASD-related narrative impairments reported by Rumpf et  al. (2012) are indicative of specific impairments in narrative abilities or are the result of impoverished language skills. Regardless, taken together these findings suggest that the utility of narratives elicited as part of ADOS module 3 warrant further investigation. In summary, there is evidence that children with ASD produce narratives that are syntactically and structurally less complex and less cohesive than TD children. However, as noted by Petersen, Gillam, and Gillam (2008), reduced language abilities will result in impoverished narrative production, regardless of diagnosis. Accordingly, to adequately examine ASD-related narrative deficits, it is imperative that researchers clearly and comprehensively control for language ability. To this end, the aim of the present study was to compare the narratives that were (a) produced by children with ASD and TD children who were matched for age, non-verbal intelligence and language ability and (b) elicited during standard ADOS procedure. Drawing on the results of previous research (Capps et  al., 2000; Losh & Capps, 2003; Novogrodsky, 2013; Suh et al., 2014), it was hypothesized that the children with ASD would produce stories that were less complex (syntactically and structurally) and less cohesive than their age- and language-matched control counterparts. Also of interest was the impact of age on narrative performance. Based on the findings of Novogrodsky (2013), it was hypothesized that participants with ASD

162  R. M. Banney et al.  would fail to exhibit a normal age-related decrease in the production of ambiguous pronouns. Method This project received ethical clearance from The University of Queensland’s Medical Research Ethics Committee, Education Queensland and Catholic Education, Archdiocese of Brisbane and written consent was obtained from all participants and their parents.

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Participants Participants included 11 children with ASD (eight males; three females) and 17 TD children (10 males; seven females). Participants in the ASD group were aged between 9;0–15;0 years and the TD group were aged between 9;0–15;2 years (see Table I for means and standard deviation). The two groups did not differ with respect to age (p  0.475, t-test for independent measures, two-tailed) or sex (p  0.689, Fisher’s Exact Test, two-sided). The participants with ASD were recruited from two sources: a private clinic specializing in ASD in the city of Brisbane and through dissemination of a flyer by the Asperger’s Syndrome Support Network of Queensland (ASSN-Q). Potential participants with ASD had received a medical diagnosis of ASD by a paediatrician or psychiatrist and met criteria using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 2000). To confirm diagnosis, module 3 of the ADOS was administered by the second author who is ADOS accredited. Of the 11 participants in the ASD group, two met the threshold for classification of autistic disorder, indicating more severe autistic symptomology, and nine met the classification of an ASD. Both ASD and TD children were required to have English as their first language, normal hearing and normal or correctedto-normal vision. The TD children were recruited

using advertisements, word-of-mouth and personal contacts. The exclusionary criteria for the TD children included a history of neurological impairment or developmental disorder such as a learning disability and speech or language difficulties. Participants’ receptive and expressive language abilities were profiled using the Clinical Evaluation of Language Fundamentals-4th Edition (CELF-4; Semel, Wiig, & Secord, 2003) and the Peabody Picture Vocabulary Test-4th Edition (PPVT-4; Dunn & Dunn, 2006). In addition, measures of non-verbal intelligence and attention were employed in order to control for the possible impact of these variables on narrative productions (e.g., King, Dockrell, & Stuart, 2013; Petersen et  al., 2008; Wetherell, Botting, & Conti-Ramsden, 2007). To quantify non-verbal intelligence, participants completed either the Raven’s Colored Progressive Matrices (CPM; Raven et  al. 1998 or the Raven’s Standard Progressive Matrices (SPM; Raven et al. 2000)). To examine the attentional capacities of participants, two sub-tests from the Test of Everyday Attention for Children (TEA-Ch; Manly, Robertson, Anderson, & Nimmo-Smith, 1999) were administered, namely the sustained auditory attention task and the selective/focused visual attention task. T-tests for independent samples revealed that the two groups did not differ significantly on any cognitive or linguistic measures, however, it is important to note that group differences with respect to auditory attention approached significance, t(26)   2.021, p  0.054 (see Table I). Narrative assessment The 29-page picture book Tuesday by Wiesner (1991) was used to elicit a narrative from each child. While the book is essentially “wordless”, there are four pages that each include a single phrase of text which provides important temporal information for the reader. These include “Tuesday evening, around eight” at the beginning of the story; “11:21 pm” and “4:38 am” during the story; and “Next Tuesday, 7:58

Table I. Group profiles on age and standardized cognitive and language assessments. ASD (n  11) Measure CA Raven’s PPVT-4 CELF-4 TEA-Ch (A) TEA-Ch (V)

M (SD) 138.00 95.55 107.45 97.82 7.91 9.00

(22.58) (19.57) (14.76) (14.74) (4.18) (2.41)

TD (n  17) Range

108–180 61–125 77–135 68–122 1–13 6–13

M (SD) 132.35 102.18 108.12 105.88 10.65 9.76

(18.4) (16.00) (9.35) (10.57) (2.99) (2.17)

Range

p-value

108–182 82–137 93–126 84–126 4–14 6–13

0.475 0.335 0.885 0.103 0.054 0.390

­ SD, Autism spectrum disorder; TD, typically developing; CA, chronological age in months; Raven’s, A Raven’s Standard Progressive Matrices; PPVT-4, Peabody Picture Vocabulary Test–4th edition; CELF-4, Clinical Evaluation of Language Fundamentals–4th edition core language score; TEA-Ch (A), Test of Attention in Children–Sustained Auditory Attention Task; TEA-Ch (V), Test of Attention in Children– Selective Visual Attention Task.



Narrative generation in autism spectrum disorder    163

pm” before the final page. The story begins with frogs sitting on lily pads in a pond. Then, something magical happens. The frogs rise into the air, riding on their lily pads like magic carpets. They embark on their journey into a nearby town where they experience an array of events and mishaps. As day breaks, the frogs lose their ability to fly and hop sadly back to their pond and the town’s police are left puzzled by the finding of lily pads on the streets. The following week at roughly the same time, pigs start flying. Please see the Supplementary Appendix A available online at http://informahealthcare.com/doi/abs/10.3 109/17549507.2014.977348 for examples of the stories produced by one participant with ASD and one TD control.

The child was also told that they could pretend they were telling the story to a younger child if they felt it helped. This prompt was given to all participants to avoid violating Grice’s maxims (Grice, 1975) and to encourage the child to produce narratives without assuming shared knowledge with the examiner/listener. For participants with ASD, some changes to the above script were implemented to ensure they understood the task. This included repeating and simplifying the instructions or repeating the modelled story stem until the child was able to tell the story unaided. Some encouragement to continue with the story was provided during the narrative in the form of general prompts. These included “tell me more”, “keep going” and “hmmm” (with rising intonation). Author 1, who was blinded to group membership, transcribed and analysed the audio recordings of the participants’ narratives. The transcriptions were formatted using the Systematic Analysis of Language Transcripts (SALT; Miller, Gillon, & Westerveld, 2010) and were segmented into minimal terminable units or t-units as per Hunt (1970). In a manner similar to Norbury and Bishop (2003), analysis was then conducted across the two main narrative structural levels: local (or surface linguistic structure) and global structure. While it is acknowledged that the area of cohesion is considered by some to be a measure of local structure, the current study included cohesion as a separate structural level to allow for closer comparison of participants’ ability to link local structural elements to what has happened previously in their story (Liles et al., 1995).

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Procedure For children with ASD, both preliminary language assessments and narrative generation tasks were administered by a qualified speech-language pathologist over the course of two-to-four sessions. The number of sessions was dependent on each ASD participant’s threshold for assessment. TD children were assessed over the course of 1 day, with the tests (including the narrative) being administered by three speech-language pathologists and two final year speech-language pathology students. All assessments were audio recorded and later verified by the speechlanguage pathologist who administered the assessments to the ASD group (Author 2). Participants were given frequent breaks between testing sessions. To avoid the possible impact of order effects on assessment results, the order of the administration of each assessment was counterbalanced across the two groups. For the children with ASD, the narrative task was administered using the standard ADOS procedure. The only departure from this procedure was that the task was audio-recorded. While the TD children were not administered a full ADOS, care was taken to ensure consistency in administration of the narrative task across groups, as the final-year students underwent training and were required to use the same instructions and story stem as used with the participants with ASD. All children were told to look at the pictures in the book to tell the story while the examiner provided a “story stem” (e.g., Hughes, McGillivray, & Schmidek, 1997). That is, the examiner introduced participants to the initial pages of the book, the story’s main character of the frogs; and the concept that something strange was happening to the frogs. The child was then asked to spend a few minutes looking through the story so that they knew what happened. While the child looked silently through the book, the examiner did not make any comments about the content of the story. When the child had finished looking through the pictures, the examiner turned back to the beginning of the book and instructed the child to begin telling the story.

Local structure Narratives were analysed for local structure by examining narrative length, fluency, errors, semantic content and syntactic structure. Narrative length was quantified by the total number of words and the total number of t-units. To analyse the fluency of the narrative, the number of mazes which included repetitions of words or phrases, revisions, false starts, filled pauses (e.g. ah, er, um, like) and fillers such as “kinda” and “sort of” was calculated. Two measures, the number of utterances which contained at least one maze and the total number of mazes, were used for analysis. Three types of errors were recorded, including: (i) omissions, which were defined as words or bound morphemes which were omitted but were necessary for grammatical precision; (ii) word-level errors or any words which were used incorrectly by the speaker; and (iii) utterance-level errors which consisted of errors which could not be associated to a specific word and any utterances which contained more than two omissions or word errors (e.g., Next Tuesday seven-fifty eight pm pigs). Two measures of semantic content were calculated including the number of different words as well as the type token ratio or TTR, defined as the number of different words (types) divided by the total number of words (tokens).

164  R. M. Banney et al.  Finally, syntactic structure included calculating: (i) syntactic complexity or clauses per t-unit and (ii) syntactic diversity, which was quantified by the number of different types of complex sentences employed by each participant. Complex sentences were defined as sentences which contained two or more main verbs and the complex sentence types were based on Steffani (2007).

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Cohesion Drawing on Norbury and Bishop (2003) and Van der Lely (1997), the way in which participants introduced and maintained reference to the main and supporting characters and their use of ambiguous references were examined. According to Van der Lely (1997), when used to introduce characters, indefinite noun phrases (e.g., “some frogs”) pre-suppose the least knowledge on the part of the listener while definite noun phrases (e.g. “the frogs”) and pronouns (e.g. “they”) assume shared knowledge. The proportion of each group who used indefinite noun phrases, definite noun phrases, and pronouns to introduce the main characters was calculated. With respect to maintenance of reference to the main characters, the total number of noun phrases and pronouns used to refer to the frogs, once they had been introduced, were counted. As this number would depend on the total number of words used, for each participant, the number of noun phrases and the number of pronouns were each divided by the total number of words. The supporting characters of interest were a turtle, an old lady, a man, a dog, a policeman, and a pig. For each supporting character, whether they were introduced and, if so, the marker used (indefinite noun phrase, definite noun phrase, noun only, or pronoun) was totalled for each group and proportions calculated for omissions and each type of linguistic marker. The total number of noun phrases and pronouns used for subsequent reference to these characters was also calculated. As for the main character, these values were calculated as a proportion of the total number of words. Finally, ambiguous references included the number of pronouns that were ambiguous or did not “tie” clearly to a single preceding noun phrase antecedent (e.g. the frogs flew into town. He saw an old lady). The reader is referred to Liles (1985) for the procedure for determining ambiguous references. Ambiguous pronouns were represented as a proportion of the total number of pronouns used to refer to the main and supporting characters, respectively.

Global structure At a more global level, the narratives were examined for complexity and the internal state references of emotion and cognition. Narrative complexity was measured using The Index of Narrative Complexity

(INC; Petersen et al., 2008) which was adapted specifically for use with the story Tuesday. The INC was chosen as it examines aspects of story grammar, including setting and episodic structure, in addition to the use of evaluation which has previously been shown to be impaired in ASD (see the Supplementary Appendix B available online at http:// informahealthcare.com/doi/abs/10.3109/17549507. 2014.977348 to view the current adaptation of the INC). All elements were scored and a total complexity score (total possible  25) recorded for each participant. With regards to internal state references, an utterance was credited for emotion/cognition when the narrator expressed insight into the characters’ affective and cognitive states (e.g. they were very angry) and behaviours (e.g. the man looked surprised to see the frogs) (based on Capps et  al., 2000 and Losh and Capps, 2003). Reliability All narratives were transcribed from the original audio recordings by a second transcriber, a trained final year speech-language pathology student who, like the original transcriber (Author 1), was blind to each participant’s group membership. Point-to-point agreement between the two transcribers was calculated on all transcriptions and found to be high (93%). Prior to analysis of the data, however, the two transcribers came together to resolve any transcription disagreements through consensus. To establish inter-rater reliability for the coding and analysis, Author 3, who was also blind to group membership, recoded a random selection of 21% (n  6) of the transcribed narratives. Reliability was calculated using the formula: the number of times the two coders (Authors 1 and 3) agreed ÷ (the number of times the two coders agreed  disagreed). For all measures, reliability between the two coders was high and exceeded 89.0% (range  89.7–98.0%). After calculation of reliability, any instances of disagreement were reviewed by the two raters and a consensus was reached. Statistical analyses were conducted using these consensus ratings.

Results Where assumptions of normality were met, data for the two groups were compared using t-tests for independent measures. Effect sizes (Cohen’s d) are reported for significant findings. Non-parametric Mann-Whitney U-tests were employed when assumptions of normality were violated. Consistent with previous narrative studies that examined performance across a number of structural areas (Duinmeijer et  al., 2012; Rumpf et  al., 2012), a more stringent significance level, in the present case p  0.01 (two-tailed), was adopted to limit the chances of incorrectly rejecting the null hypothesis.

Narrative generation in autism spectrum disorder    165



Table II. Measures of local structure as a function of group. ASD (n  11)

TD (n  17)

(SD)b/

Length Total wordsa Total t-unitsb Fluency Total mazesb Utterances with mazesb Errors Utterance level errorsa Omissionsb Semantic content NDWb TTRa Syntactic structure Syntactic complexityb Syntactic diversityb

Range

Range

174.00 (127.00) 26.00 (10.95)

90–463 14–48

258.00 (70.50) 26.65 (7.26)

174–369 18–42

0.053 0.852

8.36 (5.45) 7.00 (3.79)

1–20 1–14

9.06 (5.85) 7.59 (4.72)

0–22 0–18

0.752 0.719

2.00 (3.00) 0.55 (0.82)

0–8 0–2

2.00 (1.50) 0.29 (0.59)

0–4 0–2

0.329 0.353

100.36 (36.02) 0.53 (0.18)

50–185 0.37–0.63

119.18 (19.19) 0.47 (0.06)

79–146 0.36–0.56

0.083 0.208

1.25 (0.29) 3.72 (1.68)

0.62–1.71 1–6

1.51 (0.20) 4.18 (1.51)

1.22–1.87 2–7

0.009** 0.468

p-value

­ SD, Autism spectrum disorder; TD, typically developing; NDW, number of different words; TTR, type A token ratio; Syntactic complexity, clauses/number of t-units; Syntactic diversity, number of different types of complex sentence; all p-values are two-tailed. aMedians and interquartile ranks are reported for comparisons using Mann-Whitney U. bMeans and standard deviations are reported for comparisons using T-tests for independent samples; **p  0.01.

Local structure Table II displays means and standard deviations (parametric) or medians and quartile ranges (nonparametric), ranges and p-values for all measures of local structure. No word level errors were recorded for either group and so these are not shown. As can be seen, the only measure that was significantly different for the two groups was syntactic complexity, t(26)  -2.816, p  0.009 (two-tailed), 95% CI (0.446 to 0.07), d  1.09, with the ASD group using fewer clauses per t-unit than controls. In order to determine whether this difference related to the use of any particular type of complex sentence, each t-unit with more than one clause was classified by sentence type according to Steffani (2007) (see

Figure 1). While the ASD group appeared to use fewer simple conjoined sentences than the TD group, this comparison failed to reach significance (p  0.062). All other comparisons failed to reach significance. Cohesion Table III displays group proportions for the cohesive devices used to introduce the frogs and the supporting characters. No members of either group used pronouns to introduce the frogs; however, members of both groups omitted articles in introducing the frogs (e.g. the turtle looked up and saw flying frogs everywhere). The most frequently used device for the mem-

5 4.5

ASD

4

TD

3.5

Mean Score

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Measure

Mean (SD)b/ Median (IQR)a

Mean Median (IQR)a

3 2.5 2 1.5 1 0.5 0 –0.5 –1

Complex sentence types

Figure 1. Mean number of complex sentence types produced by each group.

166  R. M. Banney et al.  Table III. Cohesive devices used to introduce characters as a function of group, with frequency of each device expressed as a proportion within character type. Cohesive device Main character (frogs) Indefinite NP Definite NP Noun only Pronoun Supporting characters Indefinite NP Definite NP Noun only Pronoun Omitted

ASD (n  11)

ASD (n  11)

TD (n  17) Measure

0.36 0.45 0.18 0.00

0.24 0.35 0.41 0.00

0.40 0.27 0.14 0.02 0.18

0.55 0.25 0.11 0.02 0.07

­ SD, Autism spectrum disorder; TD, typically developing; NP, A noun phrase; Supporting characters are turtle, old lady, man, dog, policeman and pigs; values represent the proportion of each group that employed the particular cohesive device.

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Table IV. Narrative cohesion: Subsequent references and ambiguity as a function of group.

bers of the ASD group to introduce the frogs was the definite noun phrase, followed by the indefinite noun phrase and noun only. For the TD group, the most frequently used device was noun only, followed by definite noun phrase and indefinite noun phrase. A group comparison using Crosstabs revealed, however, that the pattern was similar for the two groups. To further compare the proportion of each group that pre-supposed listener knowledge of the frogs, the proportion of each group that used the more pre-supposing definite noun phrase vs the proportion that used the less pre-supposing indefinite noun phrase or noun phrase only were compared using Crosstabs. Again, the pattern was similar for the two groups. From Table III, it appeared that, compared to the TD controls, a greater proportion of the ASD group omitted reference to supporting characters; however, further Crosstab comparisons across groups revealed this difference was not significant. As shown in Table IV, once introduced, the pattern for referring to the frogs (using pronouns or nouns) was similar for the two groups, as were subsequent references to the supporting characters. The ASD group produced a significantly greater proportion of ambiguous pronouns, Z   2.727, p  0.006, median difference  0.17, 95% CI (0.04–0.27). Global structure The mean (SD) total complexity scores for the ASD and TD control groups were 9.55 (2.21) and 12.71 (2.69), respectively. A t-test for independent samples revealed a significant group difference, t(26)    3.249, p  0.003 (two-tailed), 95% CI ( 5.16 to  1.17), d  1.26. In order to examine whether this difference related to specific areas of the complexity measure, setting (items 1 and 2), episodic structure (items 3–8) and evaluation scores (items 9–13) were derived for each participant by summing the narrative complexity items, as shown in brackets above (see the Supplementary Appendix B available online

Main character (frogs) NPsb Pronounsb Supporting characters NPsb Pronounsb Ambiguity Pronounsa

TD (n  17)

Mean (SD)b/ Mean (SD)b/ Median (IQR)a Median (IQR)a p-value 5.55 (4.44) 10.18 (5.19)

6.12 (3.30) 14.94 (7.59)

0.698 0.081

2.36 (3.85) 2.18 (2.23)

1.88 (1.54) 4.18 (3.00)

0.646 0.070

0.26 (0.27)

0.03 (0.12)

0.006**

­ SD, Autism spectrum disorder; TD, typically developing; NPs, A noun phrases; Supporting characters are turtle, old lady, man, dog, policeman and pigs; values for ambiguity are represented as proportions of all pronouns used to refer to both the main and supporting characters. aMedians and interquartile ranks are reported for comparisons using Mann-Whitney U. bMeans and standard deviations are reported for comparisons using T-tests for independent samples. **p  0.01.

at http://informahealthcare.com/doi/abs/10.3109/17 549507.2014.977348). Mean setting, episodic structure and evaluation scores for each group are shown in Figure 2. Further t-tests revealed a significant group difference only with respect to episodic structure t(26)   3.718, p   0.001 (two-tailed), 95% CI ( 3.5 to  1.02), d  0.986. With respect to emotional and cognitive states, the mean (SD) number of references were 2.91 (2.47) for the ASD group and 3.71 (1.96) for the TD control group. The number of references did not differ significantly for the two groups. The impact of age on narrative generation Following Novogrodsky (2013), participants were sub-divided into younger and older groups using 11 years as the cut-off point and further group comparisons conducted on the significant measures of syntactic complexity, proportion of ambiguous pronouns produced and episodic structure. Because of small group numbers, non-parametric Mann Whitney tests were employed to compare the performance of the younger (ASD n  5; TD n  7) and older (ASD n  6; TD n  10) participants across group and a significance level of p  0.05 was adopted. All comparisons were two-tailed except for the young vs old ambiguous pronoun use for which specific onetailed a-priori hypotheses had been made. As shown in Table V, no difference was found between the young ASD and TD control groups with respect to syntactic complexity or ambiguous pronouns, but a significant difference was found for episodic structure, Z   2.066, p  0.039, median difference   2, 95% CI ( 5 to 0). The older ASD group performed significantly worse than their control counterparts on all measures: syntactic complexity, Z   2.117,

Narrative generation in autism spectrum disorder    167

9 ASD

*

8

TD

Mean Score

7 6 5 4 3 2 1 0

Setting

Episodic structure

Evaluation

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Figure 2. Mean setting, episodic structure and evaluation scores for each group. *p0.01.

p  0.034, median difference  0.2, 95% CI (0.52 to 0.08), ambiguous pronouns, Z  2.898, p   0.003, median difference  0.2, 95% CI (0.04– 0.45) and episodic structure, Z  1.982, p   0.048, median difference  2, 95% CI ( 4 to 0). No difference was found between the young and old ASD groups on any measures, whereas the older TD participants produced more ambiguous pronouns than the younger children in the TD group, Z  1.752, p  0.040 (one-tailed), median difference  0.06, 95% CI (0–0.16). The performance of the younger TD participants and the older ASD participants was similar for syntactic complexity and ambiguous pronouns; however, the older ASD group had significantly lower scores than the younger controls for episodic structure, Z  2.294, p  0.022, median difference  3, 95% CI (4 to 0). The relationship between language and cognitive measures and narrative generation

Table V. Comparisons by age group.

Age group

TD (n  17)

Median IQR Median

Younger (n  5) Syntactic complexity 1.28 Ambiguous pronouns 0.26 Episodic structure 4.00 Older (n  6) Syntactic complexity 1.24 Ambiguous pronouns 0.27 Episodic structure 5.00

(n  7) 1.44 0.12 8.00 (n  10) 0.34 1.55 0.36 0.00 2.00 7.00

0.65 0.25 3.00

Discussion The present study aimed to compare the narrative production skills of children with ASD and age, non-verbal IQ and language-matched TD children. Consistent with previous research in ASD (Capps et al., 2000; Losh & Capps, 2003; Norbury & Bishop, 2003; Rumpf et  al., 2012), the stories of the two groups bore both similarities and differences. Overall, the children with ASD produced narratives that were just as fluent, error-free and lexically diverse as their TD counterparts. Importantly, however, key group differences did arise. In particular, the narratives of the children with ASD were less complex with respect to syntax and episodic structure and contained more pronominal referencing ambiguities than the narratives of the TD children. The following will discuss the present findings across the different narrative structural levels. Local structure

Finally, while the present ASD and control groups had been matched for language and cognition, it was

ASD (n  11)

important to determine whether these skills contributed to the group differences in narrative generation. Accordingly, for both the ASD and TD groups, separate two-tailed correlational analyses were conducted between the CELF core language, Raven’s Standard Progressive Matrices, TEA-Ch (A) and TEA-Ch (V) scores and the narrative measures of syntactic complexity, episodic structure and ambiguous pronouns. Where assumptions of normality and the presence of a linear relationship were met, twotailed bivariate Pearson correlations were employed. Otherwise, Spearman’s rho correlation coefficients were used. The only significant correlation identified was between TEA-Ch (V) and syntactic complexity for the ASD group, rs  0.671, p  0.024.

IQR

p-value

0.27 0.17 3.00

0.255 0.530 0.039*

0.32 0.06 4.00

0.034* 0.003** 0.048*

­ SD, Autism spectrum disorder; TD, typically developing; IQR, A interquartile range; Younger group, chronological age less than 11 years; Older group, chronological age greater than 11 years; syntactic complexity, clauses/t-unit; ambiguous pronouns, proportion of all pronouns used to refer to both the main and supporting characters that were ambiguous; episodic structure, total for narrative complexity items 3–8 inclusive. *p  0.05, **p  0.01.

The identification of reduced syntactic complexity in the stories told by the participants with ASD finds support in a number of earlier narrative generation studies (Capps et  al., 2000; Losh & Capps, 2003; Norbury & Bishop, 2003). Of interest is that, when syntactic complexity was examined as a function of age, ASD-related deficits were present only in the older children. Further, that the present participants with ASD performed in a comparable manner to the controls on standardized measures of language function (including the CELF-4 and PPVT, see Table I) challenges the notion that deficits of expressive syntax are present only in a sub-group of children with ASD who also have a concomitant language impairment (McGregor, Berns, Owen, Michels, Duff, Bahnsen, et al., 2012). Rather, in the absence of language impairment, difficulties may be observed at a discourse level when impoverished pragmatic skills, a hallmark feature of ASD, are also challenged. Further research that includes separate assessment of pragmatic skills and specifically examines age would further inform such speculation.

168  R. M. Banney et al. 

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Cohesion Overall, the participants with ASD used similar devices to introduce and maintain reference to the story’s characters. When introducing the main character of the story, the frogs, while more of the TD group (ASD  54%, TD  65%) appeared to presuppose less knowledge on behalf of the listener by using indefinite noun phrases (“some frogs”) or article omissions (“flying frogs”) than the more presupposing definite noun phrases (“the frogs”, ASD  45%, TD  35%), group differences were not significant. Given the task instructions and that the examiner and the child shared the first pages of the book prior to the children telling the story; it is not surprising that such a large proportion of each group pre-supposed listener knowledge of the frogs. Further, that both groups used more indefinite noun phrases to introduce the supporting characters, who were not part of the shared aspects of the story, suggests that the children with ASD were sensitive to the listener’s needs and were able to use appropriate linguistic devices as required. Consistent with earlier studies (Norbury & Bishop, 2003; Novogrodsky, 2013; Suh et  al., 2014), the participants with ASD used a greater proportion of ambiguous pronouns, with the group difference being driven by difficulties experienced by the older children with ASD. Indeed, consistent with the findings of Novogrodsky, the proportion of ambiguous pronouns produced by the older participants with ASD was similar to the proportion recorded for the younger controls. Closer investigation of pronoun ambiguity highlighted that participants with ASD displayed agreement errors (e.g. he turned around because a dog was chasing them) and, most commonly, ambiguous use of third person subject pronouns following discussion of two different characters (e.g. one of them ran right into a dog and he started running away, where “he” could be the dog or one of the frogs). This increased pronoun ambiguity is not surprising given Novogrodsky’s (2013) findings that pronoun ambiguity decreases markedly in TD children after 11 years and is also consistent with studies of adults with ASD that have also reported higher rates of pronoun ambiguity compared with controls (Colle, Baron-Cohen, Wheelwright, & Van der Lely, 2008; McCabe, Hillier, & Shapiro, 2013). It further supports claims that difficulties in using pronominal reference arise from understanding post-syntactic constraints (Petrovic, Kalisch, Pessiglione, Singer, & Dolan, 2008) and are, in fact, errors with the pragmatic domain (Chien & Wexler, 1990). Linguistically, the use of indefinite articles to introduce a character (or item) pre-supposes that this character will be referred to again within the story (Dekker, 2002). The normal introduction of characters suggests that participants used appropriate linguistic devices consistent with planning for future reference

to the characters they ably introduced. However, it is the greater pragmatic requirements associated with pronoun-use required to subsequently refer to these characters, using pronominal reference, that led to greater ambiguity. Global structure The present participants with ASD evidenced impairments in their overall story structure. More specifically, while all children provided the listener with similar setting information and evaluative comments, the children with ASD produced stories with fewer episodic elements than the TD children. Closer inspection of individual participant profiles revealed that this group difference was due more to the ASD participants failing to include two particular story elements rather than providing elements of lesser quality. These elements were the internal response of the frogs, with 64% of the ASD group vs 47% of the TD group failing to reference the emotional response of the frogs in being able to fly, and story complication, with 72% of the ASD group vs only 12% of the TD group omitting reference to the frogs losing their ability to fly at the end of the story. This finding of poorer global structure in the narratives of the ASD group is not surprising given the contribution of pragmatic skills to macrostructural organization (Duinmeijer et al., 2012). It is, however, at odds with previous narrative generation research that reported similar measures of episodic structure for typical and clinical groups, including SLI and ASD (Norbury & Bishop, 2003). Norbury and Bishop (2003) proposed that, rather than reflecting robust story grammar skills in their experimental groups, their null finding may reflect the age of their participants (6–10 years) for whom such narrative skills are still developing and so between-group differences are less apparent. That both ASD subgroups in the present study, children who were younger than 11 years and children who were older than 11 years, performed worse than the age-matched controls is inconsistent with this contention. The present findings with respect to narrative macrostructure also provide some validation for the scoring system used in the current study. In contrast to Norbury and Bishop (2003), Duinmeijer et  al. (2012) reported significant story grammar abnormalities in their cohort of children with SLI of a similar age. Duinmeijer et  al. suggested that their significant results may reflect the use of a more sensitive scoring procedure. The present study employed an adaptation of the INC, a clinical tool designed to measure treatment-related change in narrative complexity (Petersen et al., 2008). That this measure successfully differentiated between ASD and control groups provides support for the clinical utility of the current variant of the INC developed specifically for use with the story Tuesday.

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Narrative generation in autism spectrum disorder    169

While the present group of children with ASD were closely matched to their control counterparts on measures of language, non-verbal intelligence and visual attention, group differences with respect to sustained auditory attention approached the 0.05 significance level (p  0.054). Measures of sustained auditory attention have been shown to correlate positively with plot structure in story generation tasks in children with SLI (Duinmeijer et al., 2012), suggesting the possibility that the less complex story structures produced by the ASD group may have arisen from subtle deficits in both non-linguistic (attention) and linguistic domains. The absence of a correlation between auditory attention and episodic structure suggests that this was not the case for the present group of children with ASD. The finding of a significant positive relationship between visual attentional skills and syntactic complexity is of interest and was not predicted. Studies such as Duinmeijer et al. (2012) have considered the impact of auditory attention and verbal working memory on narrative performance and reported a significant positive correlation between mean utterance length and verbal working memory in story generation but not in story re-tell. To the authors’ knowledge, however, no studies have considered the influence of selective visual attention on story generation or re-tell. In considering research investigating elicitation contexts it appears that the use of wordless picture books (as opposed to a single picture) elicits more complex stories even in TD children (Pearce, 2003). Given the current findings and that story generation (and re-tell) can rely heavily on the interpretation/integration of visual stimuli, the impact of visual attentional skills on narrative performance may provide a fruitful area for further research. The present results support the presence of story grammar deficits in ASD; however, other aspects of global structure including narrator evaluations did not appear to be affected, a finding inconsistent with previous studies (Capps et  al., 2000). Both groups, however, produced surprisingly few evaluative comments. As can be seen from Figure 2, the mean for both groups was less than 50% of the total possible points for evaluation (total possible  10). It is possible that the task instructions, in particular that the examiner modelled the start of the story and that participants were told to pretend they were telling the story to a younger child, may have led to the simplification of stories for both groups. Participants may have engaged less in the interpretation of events and more in describing the pictures, thereby masking ASDrelated problems with evaluative devices. Accordingly, future studies would benefit from examining narrative elicited in the absence of similar modelling.

linguistic vulnerability in the ASD population which was not detected by standardized language assessments. Hence, the results of the present study provide important preliminary support for the narrative sample collected as part of the ADOS clinical protocol, as an efficient and unique opportunity to detect subtle differences in the use of language by children with ASD. Taken together the findings of the present and previous narrative generation studies (Capps et  al., 2000; Novogrodsky, 2013) suggest that, when clinicians are assessing narrative ability in children with ASD who perform within the average range on standardized language assessments, their analysis should focus on syntactic and structural complexity and pronoun ambiguity as these appear to provide a fruitful area for investigation in this population.

Clinical implications

Conclusion

In the current study, narrative assessment using the book Tuesday yielded valuable information regarding

Overall, the results of the current study further support the contention that narrative is a sensitive tool

Limitations and future directions A limitation of the present study is its small sample size. Group differences on a number of narrative measures including word length, lexical diversity and the use of pronouns and, indeed, the measure of auditory attention fell in the p  0.10 range. It is possible that, for these measures, the failure to reject the null hypothesis is related more to decreased statistical power due to small subject numbers than to the lack of a true group difference. Further research with larger sample sizes would also allow for regression analysis examining the unique contribution of the different language and cognitive variables to narrative performance within and across groups. In addition, while the current study used the ADOS to confirm diagnoses, previous research has shown that the sensitivity of the instrument is increased if used in combination with the Autism Diagnostic InterviewRevised (ADI-R; Rutter, Le Couter, & Lord, 2003). Accordingly, it would have been preferable to use both the ADOS and the ADI to confirm the diagnostic status of the children in the ASD group. This study measured narrative performance on only one task, story generation. Findings from other researchers indicate that, for children with ASD, performance may vary across genres (Losh & Capps, 2003). Accordingly, in order to comprehensively profile narrative performance in this population, different types of elicitation methods should be employed including story re-tell and personal narratives. Additionally, the results of previous studies indicate that the stimulus chosen may influence findings (e.g. Capps et al., 2000; Losh & Capps, 2003). Given that Tuesday is just one of the books recommended for use in the ADOS, further studies comparing performance across all ADOS recommended books is suggested.

170  R. M. Banney et al.  for detecting impairments in language use in the ASD population (Botting, 2002; Hadley, 1998; Justice et  al., 2006). Furthermore, these findings provide evidence that children with ASD can have language difficulties in narrative beyond that of their performance on standardized language assessments. In particular, these deficits affect the areas of syntactic complexity, pronoun ambiguity and episodic structure. Finally, the results of the current study suggest that the ADOS and the narrative elicited during its administration may provide an important clinical assessment opportunity for detecting subtle difficulties in the discourse of children with ASD.

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Declaration of interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.­­­­­­­­ References American Psychiatric Association. (2000). The diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association Press. Botting, N. (2002). Narrative as a tool for the assessment of linguistic and pragmatic impairments. Child Language Teaching and Therapy, 18, 1–21. Capps, L., Losh, M., & Thurber, C. (2000). ”The frog ate the bug and made his mouth sad”: Narrative competence in children with autism. Journal of Abnormal Child Psychology, 28, 193–204. Chien, Y. C., & Wexler, K. (1990). Children’s knowledge of locality conditions in binding as evidence for the modularity of syntax and pragmatics. Language Acquisition, 1, 225–295. Colle, L., Baron-Cohen, S., Wheelwright, S., & Van der Lely, H. K. J. (2008). Narrative discourse in adults with high-functioning autism or Asperger syndrome. Journal of Autism and Developmental Disorders, 38, 28–40. Dekker, P. (2002). Pronouns in a pragmatic semantics. Journal of Pragmatics, 34, 815–827. Diehl, J. J., Bennetto, L., & Young, E. C. (2006). Story recall and narrative coherence of high-functioning children with autism spectrum disorders.Journal of Abnormal Child Psychology, 34, 83–98. Duinmeijer, I., de Jong, J., & Scheper, A. (2012). Narrative abilities, memory and attention in children with a specific language impairment. International Journal of Language and Communication Disorders, 47, 542–555. Dunn, L. M., & Dunn, L. M. (2006). The Peabody Picture Vocabulary Test (4th ed.). Circle Pines, MN: American Guidance Service. Eisenberg, S. L., Fersko, T., & Lundgren, C. (2001). The use of MLU for identifying language impairment in preschool children: A review. American Journal of Speech-Language Pathology, 10, 323–342. Grice, H. P. (1975). Logic and conversation. In P. Cole, & J. L. Morgan (Eds.), Syntax and Semantics III: Speech Acts (pp. 41–58). New York: Academic Press. Hadley, P. A. (1998). Language sampling protocols for eliciting text-level discourse. Language, Speech, and Hearing Services in Schools, 29, 132–147. Harper-Hill, K., Copland, D., & Arnott, W. (2013). Do spoken nonword and sentence repetition tasks discriminate language impairment in children with ASD? Research in Autism Spectrum Disorders, 7, 265–275. Hughes, D., McGillivray, L., & Schmidek, M. (1997). Guide to Narrative Language: Procedures for Assessment. Eau Claire, WI: Thinking Publications.

Hunt, K. W. (1970). Syntactic maturity in schoolchildren and adults. Monographs of the Society for Research in Child Development, 35, 1–67. Justice, L. M., Bowles, R. P., Kaderavek, J. N., Ukrainetz, T. A., Eisenberg, S. L., & Gillam, R. B. (2006). The index of narrative microstructure: A clinical tool for analyzing school-age children’s narrative performances. American Journal of SpeechLanguage Pathology, 15, 177–191. King, D., Dockrell, J. E., & Stuart, M. (2013). Event narratives in 11–14 year olds with autistic spectrum disorder. International Journal of Language and Communication Disorders / Royal College of Speech & Language Therapists, 48, 522–533. Liles, B. Z. (1985). Cohesion in the narratives of normal and language-disordered children. Journal of Speech and Hearing Research, 28, 123–133. Liles, B. Z., Duffy, R. J., Merritt, D. D., & Purcell, S. L. (1995). Measurement of narrative discourse ability in children with language disorders. Journal of Speech and Hearing Research, 38, 415–425. Lord, C., & Schopler, E. (1992). A follow-up study of highfunctioning autistic children. Journal of Child Psychology and Psychiatry, 33, 489–507. Lord, C., Rutter, M., DiLavore, P., & Risi, S. (1998). Autism Diagnostic Observation Schedule Manual. Los Angeles, CA: Western Psychological Service. Losh, M., & Capps, L. (2003). Narrative ability in high-functioning children with autism or Asperger’s syndrome. Journal of Autism and Developmental Disorders, 33, 239–251. McCabe, A., Hillier, A., & Shapiro, C. (2013). Brief report: Structure of personal narratives of adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 43, 733–738. McGregor, K. K., Berns, A. J., Owen, A. J., Michels, S. A., Duff, D., Bahnsen, A. J., et  al. (2012). Associations between syntax and the lexicon among children with or without ASD and language impairment. Journal of Autism and Developmental Disorders, 42, 35–47. Manly, T., Robertson, I. H., Anderson, V., & Nimmo-Smith, I. (1999). The Test of Everyday Attention for Children. Bury St. Edmunds: Thames Valley Test Company Limited. Manolitsi, M., & Botting, N. (2011). Language abilities in children with autism and language impairment: Using narrative as an additional source of clinical information. Child Language Teaching and Therapy, 27, 39–55. Miller, J., Gillon, G., & Westerveld, M. (2010). Systematic Analysis of Language Transcripts (SALT), New Zealand Version 2010 [computer software]. Madison, WI: SALT Software LLC. Molloy, C. A., Murray, D. S., Akers, R., Mitchell, T., & ManningCourtney, P. (2011). Use of the autism diagnostic observation schedule (ADOS) in a clinical setting. Autism, 15, 143–162. Norbury, C. F., & Bishop, D. V. M. (2003). Narrative skills of children with communication impairments. International Journal of Language and Communication Disorders, 38, 287–313. Novogrodsky, R. (2013). Subject pronoun use by children with autism spectrum disorders (ASD). Clinical Linguistics & Phonetics, 27, 85–93. Pearce, W. M. (2003). Does the choice of stimulus affect the complexity of children’s oral narratives? Advances in Speech-Language Pathology, 5, 95–103. Petersen, D. B., Gillam, S. L., & Gillam, R. B. (2008). Emerging procedures in narrative assessment: The index of narrative complexity. Topics in Language Disorders, 28, 115–130. Petrovic, P., Kalisch, R., Pessiglione, M., Singer, T., & Dolan, R. J. (2008). Learning affective values for faces is expressed in amygdala and fusiform gyrus. Social Cognitive and Affective Neuroscience, 3, 109–118. Raven, J., Raven, J. C., & Court, J. H. (1998).Coloured Progressive Matrices. (Vol. 2). San Antonio, TX, USA: Harcourt Assessment. Raven, J., Raven, J. C., & Court, J. H. (2000).Standard progressive matrices. San Antonio, TX: Pearson.

Downloaded by [Deakin University Library] at 20:40 20 October 2015



Narrative generation in autism spectrum disorder    171

Rumpf, A. L., Kamp-Becker, I., Becker, K., & Kauschke, C. (2012). Narrative competence and internal state language of children with Asperger Syndrome and ADHD. Research in Developmental Disabilities, 33, 1395–1407. Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism diagnostic interview-revised. Los Angeles, CA: Western Psychological Service. Semel, E., Wiig, E. H., & Secord, W. (1987). Clinical evaluation of language fundamentals-revised. San Antonio, TX: The Psychological Corporation. Semel, E. M., Wiig, E. H., & Secord, W. (2003). Clinical evaluation of language fundamentals (4th ed.). San Antonio, TX: The Psychological Corporation. Steffani, S. A. (2007). Identifying embedded and conjoined complex sentences: Making it simple. Contemporary Issues in Communication Science and Disorders, 34, 44–54. Suh, J., Eigsti, I.-M., Naigles, L., Barton, M., Kelley, E., & Fein, D. (2014). Narrative performance of optimal outcome children and adolescents with a history of an autism spectrum disorder (ASD). Journal of Autism and Developmental Disorders, 44, 1681–1694. Tager-Flusberg, H., & Sullivan, K. (1995). Attributing mental states to story characters: A comparison of narratives

produced by autistic and mentally retarded individuals. Applied Psycholinguistics, 16, 241–256. Van der Lely, H. K. J. (1997). Narrative discourse in grammatical specific language impaired children: a modular language deficit? Journal of Child Language, 24, 221–256. Wechsler, D. (1991). Wechsler Intelligence Scale for Children (3rd ed.). San Antonio, TX: The Psychological Corporation. Westby, C. (1992). Narrative analysis. In W. Secord (Ed.), Best Practices in School Speech-Language Pathology (pp. 53–63). San Antonio, TX: The Psychological Corporation. Westerveld, M. F., & Gillon, G. T. (2010). Oral narrative context effects on poor readers’ spoken language performance: Story retelling, story generation, and personal narratives. International Journal of Speech-Language Pathology, 12, 132–141. Wetherell, D., Botting, N., & Conti-Ramsden, G. (2007). Narrative in adolescent specific language impairment (SLI): A comparison with peers across two different narrative genres. International Journal of Language and Communication Disorders/ Royal College of Speech & Language Therapists, 42, 583–583. Wiesner, D. (1991). Tuesday. New York: Clarion Books. Woodcock, R. W., McGrew, K. S., & Mather, N.. (2001). Woodcock-Johnson Tests of Cognitive Abilities (3rd ed.). Itasca, IL: Riverside Publishing.

Supplementary material available online Supplementary Appendix A and B to be found online at http://informahealthcare.com/doi/abs/10.3109/17 549507.2014.977348.