Researcher investigates language problems in children and adolescents with FAS

Working with older school-age children and adolescents with FAS, Dr. Truman Coggins, director of speech and language pathology for CHDD's University Center for Excellence in Developmental Disabilities and a CHDD research affiliate, is beginning to uncover the nature of the language impairment that affects this population.

In the FAS Clinic at CHDD, Coggins repeatedly heard concerns about the poor social skills of youngsters with FAS, their difficulty understanding logical consequences and their limited ability to use language in a social context. Traditional language assessment tests showed that many of these youngsters possessed a large vocabulary and could use grammatically correct language. What the tests didn't show was the limits of these youngster's abilities to use language for social-communicative purposes.

Language specialists typically break language into three parts when assessing disorders, explains Coggins, associate professor of speech and hearing sciences. The grammatical system relates to sounds and the inflection used on words, as well as word order and types of sentences. The semantic system covers knowledge of vocabulary and the ability to express and understand concepts. The pragmatic system, which is the social use of language, includes the ability to express and understand the reasons or purposes behind an idea, or the causes of an action.

Although the measures used with youngsters in the FAS clinic indicated they were within the normal range of skills in the first two systems, there was no measure for their skills in the pragmatic system. "Traditional tests don't reach beyond the sentence," says Coggins.

To develop an appropriate measure required starting from scratch. "There isn't much in the literature about communication disorders and FAS," notes Coggins. "Research has emphasized the medical aspects and more recently the cognitive and psychological aspects. There haven't been any studies looking specifically at language, so there aren't any experimental data."

For the past two years Coggins has been collecting data from children and adolescents with FAS. His ongoing investigation aims at developing a measure that will document and quantify language disorder related to prenatal alcohol exposure and specifically pinpoint deficits in social communication skills.

Coggins compared performance on language-related tasks between a group of children and adolescents with FAS and a control group of age-matched, typically developing youngsters. The study included 15 youngsters with FAS, ranging in age from 8 to 18 who had been seen in the FAS clinic, and 100 controls.

In the first task, the youngsters were shown a wordless storybook and asked to tell the story shown by the pictures. This task provides information on the ability to comprehend logical relationships, because storytelling entails more than describing the visual details in pictures. To construct an effective narrative, a person must clearly convey sufficient information and logically sequence a series of events, incorporating the notion of cause and effect.

Study subjects were scored on several aspects of producing a narrative. How informative was their description of the story depicted? Did a subject give enough detail so a listener could understand what was happening in the story? Informativeness was assessed by evaluating how many of the characters and pertinent actions a subject described, as well as evaluating the clarity of the description. Subjects were also scored on the number of episodes they described as a measure of narrative cohesiveness.

The group with FAS scored substantially lower than the control group on informativeness of descriptions and the number of episodes. In addition, the group with FAS had substantially higher scores on vagueness and irrelevance in their descriptions. These results underscore how poorly youngsters with FAS understand connections, Coggins points out.

The second task focused on the ability to comprehend the thoughts and feelings of another person--an ability known as mental state reasoning. This ability to "read the mind" of a listener is an integral part of successful social interaction. We use language to come to know what is in other people's minds, explains Coggins. Inability to understand another's beliefs and desires leads to constant misunderstandings that cut off social exchange.

To assess mental state reasoning, Coggins borrowed a test commonly used with children with autism--a disorder characterized by a fundamental impairment in social communication. Results of the test showed a definite difference between the youngsters with FAS and the controls.

"Almost all of the controls were able to understand mental states, but the kids with FAS were never able to attribute a mental state to another person," he reports. "So, it's not surprising that they have trouble with social interactions."

Coggins' findings are key building blocks in a complete linguistic profile of youngsters with FAS--the foundation for developing communication interventions that can give these youngsters the skills necessary to function in a social world.

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