May 3, 2018 SAC conference · Alison McInnes, Ph.D., S-LP(C) Department of Educational Psychology...
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18-04-16 1 Expository Language Skills in school-age children with ADHD Alison McInnes, Ph.D., S-LP(C) Department of Educational Psychology Faulty of Education University of Alberta SAC Annual Conference Edmonton, AB May 3, 2018 Agenda • Quick primer on ADHD • Research context • Research questions and methods • Findings • Implications A. McInnes, SAC Annual Conference 2018 , Edmonton, AB A quick primer on ADHD • What is ADHD? -a common neurodevelopmental disorder characterised by behavioural symptoms of inattention and/or hyperactivity/impulsivity - DSM-V (2013) - reclassification – age of onset – symptoms prior to age 12 - approx. 5-7% of children (1-2 kids in every classroom) - 2.5% of adults - high heritability - prevalence similar across continents/cultures - associated with lifelong functional impairments in social, school, and occupational contexts A. McInnes, Ph.D., U of Alberta
Transcript of May 3, 2018 SAC conference · Alison McInnes, Ph.D., S-LP(C) Department of Educational Psychology...
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ExpositoryLanguageSkillsinschool-agechildrenwithADHD
AlisonMcInnes,Ph.D.,S-LP(C)DepartmentofEducationalPsychologyFaultyofEducationUniversityofAlberta
SACAnnualConferenceEdmonton,ABMay3,2018
Agenda• QuickprimeronADHD
• Researchcontext
• Researchquestionsandmethods• Findings
• Implications
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AquickprimeronADHD• WhatisADHD?
-acommonneurodevelopmentaldisordercharacterised bybehaviouralsymptomsofinattentionand/or hyperactivity/impulsivity
-DSM-V(2013) -reclassification –ageofonset–symptomspriortoage12-approx.5-7%ofchildren(1-2kidsineveryclassroom)-2.5%ofadults-highheritability-prevalencesimilaracrosscontinents/cultures-associatedwithlifelongfunctionalimpairments insocial,school,andoccupationalcontexts
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AquickprimeronADHD
-involvementofpre-frontal,dorsolateralnetworks involvedwithexecutivefunctions-dysregulationofneurotransmitters-frequentco-morbiditywithlearningdisabilities, disruptivebehaviourdisorders(ODD,CD), mentalhealthconditions(Anxiety, Depression)-highlyheterogeneous
• (Faraone,Ashersonetal,NatureReviews,(vol.1)2015)
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CognitiveDeficitsinADHD
• Executivefunctions• ProcessingSpeed• WorkingMemory
VerbalVisualSpatial
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ORALLANGUAGEDEFICITSINADHD
BasiclanguageskillsHigherlevel/advancedlanguageskillsPragmaticlanguageskills
ResearchContext• Chronicacademicunderachievementisoneofthemost
pervasiveandimpairingfunctionaloutcomesofADHDinschoolagechildren(Barbaresietal.,2007;Currie&Stabile,2006)
• ADHDfrequentlyco-occurswithvariousneurodevelopmentalandmentalhealthconditions(e.g.,Reading/Writing/MathDisabilities,Depression,Anxiety)(Willcutt&Pennington,2000;Mueller&Tomblin,2012)
• OralLanguageImpairmentsco-ccurwithADHDandADHD+RDin25–40+%ofcases,dependingonage,sample,andassessmentsused(seeMartinussen,2015;Mueller&Tomblin,2012;Hellandetal.,2012).
• BUTresearchsamplestypicallydonotdistinguishADHD(noLI)fromADHD+LI
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ResearchContext
• PictureisuncleartodateregardingprofilesoflanguageimpairmentinADHD
• SomeattemptstofindphenotypicboundariesforADHDandLIinyoungchildren5-9yr(Redmondetal.,2005,Redmondetal.,2014)
• NocleardifferencesbetweenADHD+LIandLI• Noclearevidencethatlanguageimpairmentsthatco-occurwithADHDaresimilartowhatwerefertoasSLI,ormorerecently,DevelopmentalLanguageDisorder
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Research/Practicesre:ADHD,Language,andAcademicPerformance• Co-occurrenceof“structural”languagenotcommonly
addressedinresearch(i.e.,ADHD(noLI)fromADHD+LI)orschool-basedinterventions/programming
• Languagedeficitshavedifferentmanifestationsandfunctionalimpactatdifferentdevelopmentallevels• Preschool,primarygradesvs.laterelementary
• Interventionfocusmaybeonbehaviournotlanguage&literacyconcerns
• LackofconsistentapproachesandtoolsforidentifyingorallanguagedeficitsinADHD• CCC-3(parentratings)• standardisedtests-CELF-4,CELF-5etc.
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WorkingMemoryandLanguage
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Centralexecutive
Phonologicalloop
Visual-spatial
sketchpad
verbalstorage
visual-spatialstorage
INFORMATIONPROCESSING
verbal+visualstorageofeventsequences
INFORMATIONSTORAGE
Baddeley’smodelofWM,(1986,2000)
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Advancedlanguagedevelopmentandexpectationsinthe21stcenturyclassroom:
• “comprehend,interpret,andexpressinformationandideasclearlyandpurposefully….foracquisitionandexchangeofinformationandideas”(AlbertaEducation,Gr.4SocialStudies)
• “deliberativeenquiry”-initiatingandplanning,analysinginterpreting,andcommunicatingscientificideasandresults,workingcollaboratively(AlbertaEducation,Gr.7-9Science)
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AdvancedDiscourseLevelOralLanguage&ContentAreaLearning• IncreasingrelianceonEXPOSITORYGENREinhighergrades
languageofexplanation,logic,instruction,transmissionofinformation,persuasion,assertion,languageoftextbooks• defining,explaining,describing,• summarising,comparing/contrasting• givingopinionsandreasons• languageofassessment• answeringquestions• explainingandpresentinginformation
inprojectwork• tellingwhatyouknowandwhatyoulearned
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Expositoryvs.narrativeLanguage• Highervocabularydensity(+newdisciplinaryvocabulary)• Morecomplexsyntax
(e.g.,describingcause-effectandcontingentrelationships)• Variableandunpredictabletextstructure
Compare-contrastCause-effectEnumerativeSequenceOpinion/persuasion
Or:combinationoftextstructureswithinthetext• Narratives–familiarandpredictabletextstructure,morefamiliar
vocabulary,morepersonalrelevance
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Higherprocessingdemands(Snyder&Caccamise,2010)
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ResearchFocus:ADHD&ExpositoryLanguage• pastresearchinADHDanddiscoursehasfocusedon
narratives
• limitedresearchinhowchildrenwithADHDprocessandexpressexpositorylanguage(Mathers,2007;McInnesetal.,2003;)
• competencywithdiscourselevellanguageisrelevanttobothacademicperformanceandpeerrelations
(Greenetal.,2014)
-informationre-telling-self-generatedexplanations
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“INFORMATIVENESS”
Researchquestions
• HowproficientarechildrenwithADHD(butwithoutLI)inexpositoryre-tellscomparedwithtypicallydevelopingpeers?
• Howinformativearetheirexplanations?• re-tells(viaexternalinformation)• self-generatedexplanations(viabackgroundknowledge)
• Areaspectsoflanguageproductivityand“informativeness”relatedtoEFssuchasworkingmemory?
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Methodology-Samples• ADHDgroup(9-12yr)–noLI• Clinicandparent-referredsamples• *ADHDparticipantsoffmedicationforresearchassessment
Criteria:previousDxbyPediatricianorClinicalPsychologistDSM-IVsymptomsconfirmedwithparentratings (SWAN,SDQ,ConnersRatingScales(CRS-3rded))Rec/ExpLanguageScores>85onCELF-4
• TypicallyAchievingPeers(9-12yr)–TeachernominatedstudentsachievingatgradelevelinL.A.andMath(giftedstudentsexcluded)–publicschoolboardK-8schools
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Measures• CoreLanguageTests(CELF-4)• Non-verbalcognitiveskills(MatrixReasoning,WASI)• Expositorypassagetasks–comprehension/expression• Workingmemorytasks• Verbal–DigitSpan(Forward/backward)(CELF-4)
-SentenceSpantask• Visual-spatial–FingerWindowssubtest(WRAML)
-Self-OrderedPointingTask
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ExpositoryLanguageTasks
1.Expositorylisteningcomprehension/retelltaskproceduralexplanations(McInnes,2003)
howcranberriesaregrownhowhotairballoons howwaspsbuildtheirnests
2.Elicitedexpositorylanguagetask FavouriteGameorSporttask(Nippold,2007)
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Expositorypassagetask-childrenlistentorecordedexpositorypassage
-sequentialtextstructure-14sentences
-Dale-Challvocabularylevel–Grade5-answer5factualand10inferentialquestions-totalcomprehensionscore-re-telltheinformationasiftheywereexplainingittoafriend
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ProductivitymeasuresInformationcontent
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1.ExpositoryPassageTask(McInnesetal.,2003)
• DynamicAssessmentprocess (basedonCampione&Brown,1987)
-listen-comprehensionquestionswithgraduatedprompts-re-tell
• goalistocreateoptimalconditionsforrecountingandexplainingmainideasandinformationdetails
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LanguageSampleAnalysis
• Orallanguagesamplestranscribed,coded,andanalysedusingSystematicAnalysisofLanguageTranscripts(SALT)(Miller,Andriacchi,&Nockerts,2011)
Languageproductivityindicators-length-#communicationunits(C-units),#words-vocabularydiversity-NumberofDifferentWords(NDW)-syntacticcomplexity-MeanLengthofUtterance(MLU) -SubordinationIndex(SI)-fluency–%ofutteranceswithmazesandpauses
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Study1PilotStudy• ADHD-noLI(n=11);TypicallyAchievingPeers(n=11)• Matchedonage;non-verbalIQ>85
• Nodifferenceincomprehensionscores,lengthofsamples,vocabularydiversity:#words,#C-units,NDW
• GroupDifferences:WorkingMemory(TApeers>ADHD-noLI)• DigitsForward**• DigitsBackward**• FingerWindowsBackward**
**p<.01
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Study1-T.A.>ADHD(-LI)
• GroupDifferences:Languageproductivity(viaSALT)• MLU(words,morphemes)**• TypeTokenRatio**• SubordinationIndex*
• GroupDifferences:Content–Informativeness(counts)• Informationdetails*
• GroupDifferencesOverallquality(rubric)• Gist*• Fluency*• Contenta• Overallrating*
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*p<.05**p<.01
Study2• ADHDgroup(noLI):n=31(age:9-12)• selectedfromalargersample(n=50)• recruitmentfromlocalADHDandLDassociationsanduniversity
psycho-educationalassessmentclinicwaitlist• Typicallyachievinggroup:n=26(age:9-12)
• Expositorypassagetask,FavouriteGameorSporttask• Workingmemorymeasures• Digitspan(ForwardandBackward)• SentenceSpan• FingerWindows(ForwardandBackward)• Self-OrderedPointingTask(SOPT)
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VerbalWM
Visual-SpatialWM
Groupcomparisons• Nogroupdifferences:ADHDandTAgroup
AgeNon-verbalcognitiveability-MatrixReasoning(WASI)TotalPassageComprehensionscores
• ADHDgroupExpressiveLanguagescores MeanSDFormulatedSentences11.7(2.1)ExplainingWordAssociations 10.3(1.9)
(CELF-4)
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Groupcomparisons-Productivity ADHD(n=31)TA(n=26)
C-units 13.0(4.8) 11.1(2.9)Wordcount 138.3(56.6)139.6(45.2)#DiffWords61.1(19.3)66.5(17.7)MeanLengthUtt(MLU)10.3(2.2)** 13.0(2.1)SubordIndex(SI) 1.1(.4)** 1.5(.5)%Mazes 44.9(16.6)40.6(17.7)%Pauses 46.2(15.3)***12.4(12.1) A.
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Poorexpressivecontrolovercomplexsyntaxneededto“gettheinformationacross”tothelistener
GroupComparisons-Content
ADHD(n=31)TA(n=26)Mainideas .41(.19)**.56(.17)Informationunits .27(.10)***.40(.12) A.
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Proportionscores–mainideasandinformationdetailsmentionedinre-tells
Groupcomparisons-Workingmemory
ADHD(n=31) TA(n=26)DigitsForward 7.3(2.2)** 10.3(3.2)DigitsBackward 7.8(1.9)** 10.7(2.4)SentenceSpan(#correct) 15.3(2.7)**19.1(3.0)FingerWindowsForward 9.4(2.8)** 11.9(2.5)FingerWindowsBackward9.2(4.2)** 15.2(3.0)Self-OrderedPointingTask30.3(2.4)** 32.9(1.9)
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Errors/productiondifficultiesinADHDsamples
• Incompletewordsandphrases• Abandonedutterances• Odd/awkwardwording–grammaticalerrors• Unintendedwording-revisions• Pooranaphoricreferencing• Events/stepsoutoforder• Erroneousdetails• Extraneousinformation(notfrompassage)• Over-referencingfrombackgroundknowledgeratherthanfromthepassage
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Difficultybeing“informative”
• challengingforbothgroupstoreformulatetheinformation
• TAgroupstillmanagedtogetmoreinformationacrossandusemorecomplexsentences,clearorderlysequence,andadequatereferencing
• childrenwithADHD(noLI)struggled
tocoordinatelinguistic(grammar,syntax)andinformationalaspectsofthetask(mainideas,details)toprovideacompleteaccount
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2.Self-generatedexplanation:Favouritegameorsporttask(Nippold,2007)• ExpositoryScoringSchemeRubric(Heilman&Malone,2014)
• Contentcategoriesratings:0–5
• ObjectofGame• Preparations• Start• CourseofPlay• Rules• Duration• Strategy• Terminology• Cohesion
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ADHDgroupratingsMiminal/Immature-Emerging-Proficient0-1 2-3 4-5 ----------------------------------------------------------------------------------------------• Nosamplesratedabove3(emergentlevel)• ADHD(noLI)n=20ADHD+LIn=7
- Allparticipantsneededpromptingtoadddetails- Manycategoriesomitted/incomplete/vague- Poororganizationofinformationforthelistener- Poorreferencing- Vaguedescriptions,poorspecificity,needforclarification- Tangential–off-task- Poorcoherence–pointsdon’thangtogethersequentially,
muchjumpingbetweentopics/abrupttransitions
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ImplicationsforunderstandingoralcommunicationbreakdownsinADHD
• Inhigherchallengeexpositorydiscourse,morelikelytosee-povertyofcontent(incomplete,inadequateinformation)-awkwardandpoorlyformulatedexplanations-relianceonsimplebasicsentences(trade-off?)
• Expositorydiscoursedemandsgreaterexecutivecontrolfor
coordinatinglinguisticandinformationalaspectsofthemessage-workingmemoryissuesmorelikelytoaffectthislevelof functioning
• CouldthisextendtoandunderliewrittenformulationdifficultiesinADHD?
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Implications–SLPs• Standardisedlanguagetestsdonotaddresshigherlevellanguage
issuesthatarerelevanttolanguagefunctionsneededintheclassroominmidelementarygradesandbeyond
• OrallanguageissuesinADHDareunder-addressedclinicallyand
educationally• AllchildrenwithADHDshouldhavetheirlanguageskills
assessed,especiallythosewhoarestrugglingacademically• eveniftheyreceivealanguageassessment,doesnottellthewhole
story• Idealcontextisinsitu–workingwithcomplextasksintheclassroom
• Limitedproficiencywithexpressionofhigherlevelacademiclanguagemayaccountinpartforchronicunderachievement
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Implications–teachersandclassroomassessment-Gettingthemessageacross• Improvingverbalexpositorydiscourseisnotatypicaltargetforinstructionalsupportorintervention,yetitsupportssomanyacademicskills
• Poorlyformulatedimmediateresponsesmaybepoorandinaccuratereflectionofchild’sknowledge–needtoprobe
• higherlevelcommunicationdifficultiesshouldbe“ontheradar”forchildrenwith ADHDasapotentialsource ofpooracademicperformance
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PotentiallyUsefulModels/ResourcestoSupportIntervention
• Self-RegulatedStrategyDevelopment(SRSD)–writing• Graham&Harris(2007)
• Think-alouds
• EMPOWERWriting–www.architectsforlearning.com
• “AcademicDiscussions”www.jeffzwiers.org
• CH.13-14AssessmentandInterventionforAdvancedLanguage:LanguageDisorders:FromInfancythroughAdolescence(4thed)(2012).RheaPaul&CourtenayNorbury
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SelectedReferences• Green,B.,Johnson,K.,&Bretherton,L.(2014).Pragmatic language
difficultiesinchildrenwithhyperactivityandattentionproblems:anintegratedreview.InternationalJofLanguageandCommunicationDisorders,49(1),15-29.
• Heilman,J.,&Malone,T.(2014).Therulesofthegame:Propertiesofadatabaseofexpositorylanguagesamples.LanguageSpeechHearingServicesinSchools,45,277-290.
• Koonce,N.M.(2015).Whenitcomestoexplaining.ApreliminaryinvestigationoftheexpositorylanguageskillsofAfricanAmericanschool-agechildren.TopicsinLanguageDisorders,35(1),76-89.
• Martinussen,R.(2015)TheoverlapofofADHD,readingdisorders,andlanguageimpairment.PerspectivesonLanguageandLiteracy,41(1),9-14.
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SelectedReferences• Mathers,M.(2006).AspectsoflanguageinchildrenwithADHD:
Applyingfunctionalanalysistoexplorelanguageuse.JofAttentionDisorders,9(3),523-533.
• Miller,J.,Andriacchi,K.,&Nockerts,A.(2011).AssessingLanguageProductionUsingSALTSoftware:AClinician’sGuidetoLanguageSampleAnalysis.Middleton,WI:SALTSoftware,LLC
• Nippold,M.,&Scott,C.(2010).Overviewofexpositorydiscourse:Developmentanddisorders.InMarilynA.Nippoldand CherylM.Scott(Eds.),ExpositoryDiscourseinChildren,Adolescents,andAdults.NewYork,NY:PsychologyPress.
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SelectedReferences• Sciberras,E.,Mueller,K.,Efron,D.,Bisset,M.,&Anderson,V.
(2014).LanguageproblemsinchildrenwithADHD:Acommunity-basedstudy.Pediatrics,133(5),793-800.
• Westerveld,M.,&Moran,C.(2013).Spokenexpositorydiscourseofchildrenandadolescents:Retellingversusgeneration.ClinicalLinguisticsandPhonetics,27(9),720-734.
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