Analysis of Narrative Ability in Children with Cochlear Implants

PURPOSE: The purposes of this study were to: 1) develop a scoring system to assess narrative ability in children; 2) evaluate the impact of auditory speech perception with a cochlear implant on narrative ability; and 3) evaluate the importance of narrative ability to reading comprehension in deaf children. DESIGN: Narrative productions prompted from an eight-picture sequence story were elicited from 8 and 9 yr olds; 87 who had at least 4 yr of cochlear implant experience and 28 who had normal hearing. The stories were transcribed and a scoring system for narrative ability was developed based on the use of complete narrative structure, conjunctions linking semantic relations, and referents that served to identify and distinguish characters in the narrative. Narrative ability scores of cochlear implant users were examined in relation to their age, IQ, speech perception, language, and reading test scores. In addition, narrative ability scores for children with normal hearing were compared with two groups of cochlear implant users, those with above average speech perception scores and those with below average speech perception scores. RESULTS: Within the sample of hearing-impaired children, narrative ability scores correlated significantly with speech perception, language syntax, and reading test scores. A multiple regression analysis was conducted to predict reading comprehension scores from four predictor variables (age, IQ, language syntax, and narrative ability). Results reflected the independent contribution of discourse-level language skills, as measured by the narrative ability score, as well as sentence-level language skills in predicting reading test scores. Analysis of stories obtained from 8- and 9-yr-old children with normal hearing revealed the classic pattern that included a high point, a resolution, and one or more evaluative statements. Their stories achieved cohesion from correct use of both conjunctions and referents. Deaf children who received above-average speech perception scores with a cochlear implant (i.e., scored above 48% on the Word Intelligibility by Picture Identification speech perception test) told narratives that were similar in structure and use of referents to those of age mates with normal hearing. Although their use of subordinate conjunctions was not as well developed as normal-hearing children, it was significantly above that of deaf children who received less speech perception benefit after a similar period of implant use. These below-average speech perceivers exhibited significantly poorer use of narrative structure and cohesive devices than either normal-hearing age mates or children who achieved above average speech perception with a cochlear implant. CONCLUSIONS: Narrative ability is an important predictor of reading comprehension ability in deaf children above and beyond IQ and syntactic competence. Children who receive a cochlear implant under 5 yr of age and obtain above average speech perception benefit from the device construct narratives that are similar in structure and cohesion to those of their hearing age mates by age 8 to 9.