title: Exploring the utility of narrative analysis in diagnostic decision making: picture-bound reference, elaboration, and fetal alcohol spectrum disorders.
abstract: OBJECTIVE
  To evaluate classification accuracy and clinical feasibility of a narrative analysis tool for identifying children with a fetal alcohol spectrum disorder (FASD).
  
  
  METHODS
  Picture-elicited narratives generated by 16 age-matched pairs of school-aged children (FASD vs. typical development [TD]) were coded for semantic elaboration and reference strategy by judges who were unaware of age, gender, and group membership of the participants. Receiver operating characteristic (ROC) curves were used to examine the classification accuracy of the resulting set of narrative measures for making 2 classifications: (a) for the 16 children diagnosed with FASD, low performance (n = 7) versus average performance (n = 9) on a standardized expressive language task and (b) FASD (n = 16) versus TD (n = 16).
  
  
  RESULTS
  Combining the rates of semantic elaboration and pragmatically inappropriate reference perfectly matched a classification based on performance on the standardized language task. More importantly, the rate of ambiguous nominal reference was highly accurate in classifying children with an FASD regardless of their performance on the standardized language task (area under the ROC curve = .863, confidence interval = .736-.991).
  
  
  CONCLUSIONS
  Results support further study of the diagnostic utility of narrative analysis using discourse level measures of elaboration and children's strategic use of reference.
authors.affiliation: Department of Speech and Hearing Sciences, University of Washington, 1417 N.E. 42nd Street, Seattle, WA 98105-6246, USA. jct6@u.washington.edu
authors.forename: John C
authors.initials: JC
authors.lastname: Thorne
authors.forename: Truman E
authors.initials: TE
authors.lastname: Coggins
authors.forename: Heather
authors.initials: H
authors.lastname: Carmichael Olson
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Astley
mesh_terms: D002648:Child; D003657:Decision Making; D005240:Feasibility Studies; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology*; D006801:Humans; D007806:Language Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D033262:Narration; D009633:Nonverbal Communication; D010775:Photic Stimulation; D011247:Pregnancy; D012660:Semantics; D012720:Severity of Illness Index; D013064:Speech Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D013068:Speech Production Measurement; D014705:Verbal Behavior