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2/6/16
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LinguisticMazesinChildrenwithAutismSpectrumDisorderorAttentionDe:icitHyperactivityDisorder
LIZBETHH.FINESTACK,PH.D.,CCC-SLP
KATHERINEBANGERT,DOCTORALSTUDENT,M.A.,CCC-SLP
SOMERL.BISHOP,PH.D.,UNIVERSITYOFCALIFORNIA,SANFRANCISCO
Disclosures
u WehavenorelevantfinancialornonfinancialrelaLonshipsrelatedtoanyinformaLonpresented.
Whatarelinguisticmazes?
Dollaghan&Campbell(1992)MazeTaxonomy
Whatarelinguisticmazes?
Pauses RepeLLons
Revisions Orphans
Filledpause:“I(uh)wentshopping”Silentpause:“I…wentshopping.”
Pauses
“We(we)wenttothestore.”RepeLLons
“Mybrother,ImeanmysistersaidIcouldgo.”
Revisions
“Iwenttothe…TomorrowisFriday.”Orphans
Dollaghan&Campbell(1992)MazeTaxonomy
Whatarelinguisticmazes? Whydolinguisticmazesoccur?
MazeproducLonassociatedwithweaknessesinthelanguageandexecuLvefuncLoningcogniLvedomains.
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MazeFrameworkproposedbyRispoliandcolleagues(2001,2003,&2008)
Stalls
• Reflect“glitches”inlanguageencoding
• IncludefillerpausesandrepeLLons
Revisions
• Reflectexternalmonitoring
• Increasewithuseofmorecomplexlanguage
MazesandSpeci:icLanguageImpairment
• ChildrenwithSLIgenerallyproducemazesatahigherratethantypicallydevelopingchildren
• Dollagahn&Campbell,1992;Thordardo7r&Weismer,2002;Navarro-Ruiz&Rallo-Fabra,2001;Guo,Tomblin,&Samelson,2008;NeFelbladt&Hannson,1999;Wetherell,D.,Bo7ng&ConK-Ramsden,2007
• ThordardobrandEllisWeismer(2002):Comparedtotypicallydevelopingchildren,childrenwithSLIproduced:
• SignificantlymorerepeLLons,revisions,andorphans• BUTfewerfilledpauses
Whataboutotherspecialpopulations? AttentionDe:icitHyperactivityDisorder(ADHD)
u Redmond(2004)u ChildrenwithADHDhadsignificantlyhigheruseofmazesthantypicallydevelopingchildrenandchildrenwithSLI.
u ThefluencydifficulLeswereperhapscausedbylimitaLonsinexecuLvefuncLoninthesechildren.
u RedmondsuggestedthatmazeusemightbeusedasadiagnosLcindicatorofADHD.
AutismSpectrumDisorder
u Shribergetal.(2006)u ComparedadolescentandadultmaleswithhighfuncLoningauLsm,Asperger’ssyndrome,andtypicallydevelopingpeers
u IndividualswithhighfuncLoningauLsmandthosewithAsperger’ssyndromeproducedmorewordrepeLLonsandrevisionsthanpeerswithtypicaldevelopment
CurrentStudy
u ToevaluateRispoli’sandThordardobrandEllisWeismer’sframeworks,wecomparedtherelaLonshipsbetweentheproducLonoffillerpauses,repeLLons,andrevisionsandcogniLveandlanguagedevelopmentinchildrenwith:
u ADHD
u ASD
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ResearchQuestions
1.AretheredifferencesinmazeusebychildrenwithADHDandchildrenwithASD?
Predic1on:
• Weknowinbothgroups,therearesubgroupswithlanguageandexecuLvefuncLoningweaknessesandbothgroupshaveelevatedmazeuse.
• Thesegroupshavenotbeendirectlycomparedbefore,thereforewedidnothaveaclearpredicLonregardinggroupdifferences.
2.Ismazeusecontextdependent?
Predic1on:
• RecallingsentencesrequireslessencodingbecauseparLcipantsareprovidedwithamodelsentence.
• WeexpectedmoremazesinconversaLonalcontextsversusrecallingsentencestasks.
ResearchQuestions
3.Aremazetypesproducedatthesamerate?Predic1on:
BasedThordardobrandEllisWeismer’sframeworkwhichcharacterizesfillerpauseuseasapragmaLcfuncLontoholdthelistener’sakenLon,weexpectedfor:
• TheASDgroup,fewerfilledpausesthanrepeLLonsandrevisions.
• TheADHDgroup,nosignificantdifferencesacrossmazetypes.
4.Howdoesmazeuserelatetolanguageability?Predic1on:
TheRispoliframeworkassociatesfillerpausesandrepeLLonswithencodingdifficulty,andrevisionswithlanguagemonitoringability.Thereforeweexpected:
• FillerpausesandrepeLLonstohaveaweakassociaLonwithlanguageability.
• RevisionusetobeposiLvelycorrelatedwithlanguageability.
Methodu ParLcipants
u 16childrenwithADHD
u 8childrenwithASD
u Agerange:5-13years
ParticipantCharacteristics
ASD ADHD Total Mean
(min-max) SDMean
(min-max) SDMean
(min-max) SD
AgeNVIQVIQMLUCELF
102.570-140
110.2589-136
111
96-139
5.323.5-6.8
61.9345-78
24.8
16.69
14.04
1.18
10.5
11770-152
96
75-117
94.8865-118
4.92
3.2-6.8
59.8837-82
22.03
11.94
16.61
.90
15.06
112.1770-152
100.7575-136
100.2565-139
5.05
3.2-6.8
60.4637-82
23.5
15.02
17.32
.996
13.5
MazeSamplingContexts
Au1smDiagnos1cObserva1onSchedule
(ADOS;Lord,Ruker,DiLavore,&Risi,2002)
u Consistsoffourmodulesthatprovidesocial-communicaLvesequencesthroughvariousstructuredandunstructuredsituaLons
ClinicalEvalua1onofLanguageFundamentals-4:Recalling
SentencesSubtest(CELF-4;Semel,Wiig,Secord,2003)
u Evaluatesthechild’sabilitytolistenandrepeatverbaLmsentencesofincreasinglengthandsyntacLc
TranscriptionandMazeCoding
u TrainedresearchassistantstranscribedvideorecordingsofADOSandaudiorecordingsoftheRecallingSentencessubtestoftheCELF
u TranscribedusingSystemaLcAnalysisofLanguageTranscripLonsconvenLons,includingmazevariables
u Keystudyvariablesincluded:
u meanlengthofukeranceinmorphemes(MLU)
u rateofmazetypesperukerance:
u fillerpauses
u repeLLons
u revisions
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TranscriptionandMazeCoding
u PercentagreementforconversaLon:u RepeLLons93%
u Filledpauses90%
u Revisions78%
u Mazesoverall88%
ADOSReliability
TranscriptionandMazeCoding u PercentagreementforSentence
RepeLLon:u RepeLLons78%
u Filledpauses92%
u Revisions89%
u Mazesoverall90%
CELFReliability
Results
1. AretheredifferencesinmazeusebychildrenwithADHDandchildrenwithASD?
ADOS:NonparametricMann–WhitneyUTests;Bars=+/-1SD
0
0.05
0.1
0.15
FillerPauses RepeLLons Revisions
RateperUPeran
ce
ADHD
ASD
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
TotalMazes
RateperUPeran
ce
p=.49 p=.08 p=.79 p=.38
1.AretheredifferencesinmazeusebychildrenwithADHDandchildrenwithASD?
**controllingforutterancelength**
ADOS:NonparametricMann–WhitneyUTests;Bars=+/-1SD
00.10.20.30.40.50.60.70.80.9
11WordUkerances 12WordUkerances 13WordUkerances
Percen
tofUPeran
cesw
ith
Mazes
ADHD
ASD
p=.14 p=.68 p=.32
1. AretheredifferencesinmazeusebychildrenwithADHDandchildrenwithASD?
CELF:NonparametricMann–WhitneyUTests;Bars=+/-1SD
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
FillerPauses RepeLLons Revisions
RateperUPeran
ce
ADHD
ASD
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
TotalMazes
RateperUPeran
ce
p=.83 p=.61 p=.21 p=.93
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1.AretheredifferencesinmazeusebychildrenwithADHDandchildrenwithASD?
**controllingforutterancelength**
CELF:NonparametricMann–WhitneyUTests;Bars=+/-1SD
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
11WordUkerances 12WordUkerances 13WordUkerances
Percen
tofUPeran
cesw
ith
Mazes
ADHD
ASD
p=.88 p=.53 p=1.00
2.Ismazeusecontextdependent?
ADHD:RelatedSamplesSignedRankTests;Bars=+/-1SD
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
FillerPauses RepeLLons Revisions
RateperUPeran
ce
ADOS
CELF
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
TotalMazes
RateperUPeran
ce
p=.44 p<.01 p<.01 p<.01
2.Ismazeusecontextdependent?**controllingforutterancelength**
ADHD:RelatedSamplesSignedRankTests;Bars=+/-1SD
00.10.20.30.40.50.60.70.8
11WordUkerances 12WordUkerances 13WordUkerances
Percen
tofUPeran
cesw
ith
Mazes
ADOS
CELF
p=.50 p=.06 p=.50
2.Ismazeusecontextdependent?
ASD:RelatedSamplesSignedRankTests;Bars=+/-1SD
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
FillerPauses RepeLLons Revisions
RateperUPeran
ce
ADOS
CELF
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
TotalMazes
RateperUPeran
ce
p=.40 p=.07 p=.33 p=.04
2.Ismazeusecontextdependent?**controllingforutterancelength**
ASD:RelatedSamplesSignedRankTests;Bars=+/-1SD
00.10.20.30.40.50.60.70.80.9
11WordUkerances 12WordUkerances 13WordUkerances
Percen
tofUPeran
cesw
ith
Mazes
ADOS
CELF
p=.07 p=.09 p=.02
3.Aremazetypesproducedatthesamerate?
0
0.01
0.02
0.03
FillerPauses RepeLLons Revisions
ADHD
0
0.01
0.02
0.03
FillerPauses RepeLLons Revisions
ASD
ADOS:RelatedSamplesWilcoxonSignedRankTests;Bars=+/-1SD
p=.07
P<.01
p=.06
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3.Aremazetypesproducedatthesamerate?
0
0.1
0.2
0.3
0.4
FillerPauses RepeLLons Revisions
ADHD
0
0.1
0.2
0.3
0.4
FillerPauses RepeLLons Revisions
ASD
CELF:RelatedSamplesWilcoxonSignedRankTests;Bars=+/-1SD
p=.06
p=.02
p=.04
4.Howdoesmazeuserelatetolanguageability?
ADOS
ADOS Age NVIQ VIQ CELFRawScore MLU FillerPause
RateRepe11on
RateRevisionRate
TotalMazeRate
Age
NVIQ -.007
VIQ -.087 .716**
CELFRawScore .476* .387 .440*
MLU .435* .396 .354 .561**
FillerPauseRate -.268 -.006 .380 .005 .133
Repe11onRate -.325 .485* .526** .374 .338 .106
RevisionRaze 0.65 .318 .314 .180 .597** .233 .387
TotalMazeRate -.210 .318 .559** .279 .544* .537** .724** .831**
SummaryofFindings
1. AretheredifferencesinmazeusebychildrenwithADHDandchildrenwithASD?
• No,nogroupdifferencesbasedonADOSorCELF,evenwhencontrollingforsentencelength
• Onlytrend:ASDgroupmoremazerepeLLonsthanADHDbasedonADOSsample(p=.06;d=.42)
2.Ismazeusecontextdependent?
• Yes,forASD:Whencontrollingforukerancelength,ASDgrouptendedtoproducemoremazesbasedonADOS(ps=.02-.09;ds=.70-.99)
SummaryofFindings
3.Aremazetypesproducedatthesamerate?
• No,forADHD:ProducemorerevisionsthanfillerpausesandrepeLLons(ps<.01-.06;ds=.55-1.33)
• ForASD,effectisnotrobust
4.Howdoesmazeuserelatetolanguageability?
• ADOSmazesposiLvelycorrelatedwithNVIQandMLU,butnotCELFrawscore
• CELFmazesstronglycorrelatedwithage,butnotwithVIQorCELFrawscore
Conclusionsu MazeproducLondoesnotappearto
clinicallydifferenLatechildrenwithADHDandthosewithASD
u GreatermazeuseinADOScontextsuggeststhatmazesreflectencodingweaknesses
u Differencesintypesofmazesproducedlikelyreflectsdifferenceinunderlyingcauseofrevisionsandothermazetypes
u SomesuggesLonthatmazeusestronglyrelatedtolanguageabilitybasedonstrongmazeandlanguagecorrelaLonsinADOSsample
Acknowledgements
u Wearegratefultoallthechildrenandtheirfamilieswhomadethisprojectpossible.
u StudycompleLonandpreparaLonofthismanuscriptweresupportedbyaGrant-in-AidAwardfromtheUniversityofMinnesotaandR01HD065277andR03DC011365grantawardsfromtheNaLonalInsLtutesofHealth.
