How Speech Production Affects Narrative Production in 4- to 6-Year-Old Children With Developmental Language Disorder and Poor Intelligibility.

BACKGROUND

Poor intelligibility is common in young children with developmental language disorders (DLDs). Relatedly, children with DLD and poor intelligibility, like children with DLD solely, have often also difficulties in other aspects of language abilities: such as making grammatical and cohesive sentences and telling narratives with an adequate plot structure. However, relatively few studies examined the relation between speech production, narrative cohesion, and narrative coherence in one and the same design.

AIM

This research was conducted to investigate the relation between speech production, narrative cohesion, and narrative coherence in children with DLDs and poor intelligibility.

METHODS AND PROCEDURES

One hundred and forty-nine 4-to-6-year-old children with DLD and poor intelligibility who were referred for special treatment to improve their speech production, were included in this study. Speech and language assessments were conducted at the start of the treatment, and the results of these assessments were used in the current study. For speech production, spontaneous language was analysed to derive measures for the production of consonants, vowels, and word structure. Additionally, a measure of nonword repetition was used. For narrative production, the Frog Story Test was used, resulting in a measure of narrative cohesion (sentence production) and a measure of narrative coherence (plot structure). Effects of hearing and chronological age on speech and language production were controlled for in the analyses.

OUTCOMES AND RESULTS

Mediation analysis demonstrated that there was no direct effect of speech production on narrative coherence but the indirect effect was significant. The relation between speech production and narrative coherence was fully mediated by narrative cohesion, also when controlling for age and hearing capacity. Significant effects were also found for the relation between speech production and narrative cohesion and between narrative cohesion and narrative coherence.

CONCLUSIONS AND IMPLICATIONS

This study confirms that the relation between speech production and narrative coherence in children with DLD and poor intelligibility is fully mediated by children's narrative cohesion performance. For clinical practice, these results show the importance of fostering both speech and language production capacities in strengthening the narrative performance of these children.

WHAT THIS PAPER ADDS

What is already known on the subject Children with developmental language disorder (DLD) and poor intelligibility show difficulties in both speech production and in narrative production. More precisely, they often show problems in making sentences and in generating a coherent story. The occurrence of problems both at the sentence level and at the plot structure level has been subject to several studies in children with poor intelligibility with and without additional diagnosis of DLD. However, it is not clear how and if speech production is related to narrative abilities. What this paper adds to existing knowledge This study investigates the relationship between speech production and narrative production. The results reveal an indirect relationship between speech production and narrative coherence in children with DLD and poor intelligibility. These children are hampered in telling coherent stories because their speech production problems result in poor word structures, partly used to form cohesive sentences. Using sentences with sufficient cohesion is a necessary condition for realising a coherent story. Speech analysis of spontaneous language results in a varied set of daily used words in sentences and might thus best reflect a child's capacity in speech production. What are the potential or actual clinical implications of this work? The results of this research suggest the importance of assessing narrative skills in children with DLD and poor intelligibility because these children experience both problems at the level of narrative cohesion as on narrative coherence.