Look for narrative ability in children with epilepsy

Children with chronic epilepsy have significantly decreased language skill abilities, particularly narrative ability, compared with their unaffected peers, report US researchers.

Children with recent-onset epilepsy also display decreased abilities compared with their healthy counterparts, but to a lesser degree than their peers with chronic epilepsy.

The findings emerge from a study involving standardized language and communications tests as well as language sample analysis with adult listener judgment.

Nan Bernstein Ratner (University of Maryland, College Park) and colleagues believe the inclusion of these latter types of test "capture functional aspects of language and tap into communicative skills that standardized tests do not."

The study included 10 children who had been recently diagnosed with epilepsy and 15 children who had a chronic history of continued seizure activity (for more than 3 years), all aged between 50 and 155 months. The team compared the test results for these children with those of 25 age- and gender-matched children without either form of the condition.

The cohort undertook the Clinical Evaluation of Language Fundamentals, Fourth Edition (CELF-4) or preschool edition, where appropriate, and created a verbal narrative for a wordless picture book. The verbal narrative was then scored by a group of 45 adult listeners.

Performances in both IQ and CELF tests were poorest in children with chronic epilepsy. Verbal IQ test results were significantly worse for children with epilepsy than for their unaffected peers, but did not differ significantly between those with recent-onset and chronic epilepsy.

The two groups of children with epilepsy did not differ from each other in CELF performance, note the researchers; however, those with recent-onset epilepsy had the lowest average Core Language scores, at a mean of 86.78, compared with 95.90 for those with chronic epilepsy and 113.1 for unaffected children (where a score of 100 is the mean standard score).

Analysis of the children's narratives revealed few differences in narrative length, lexical diversity, and syntactic complexity, while narrative structure distinguished the two groups of children with epilepsy from their unaffected peers.

Specifically, the total number of narrative elements included in stories was 8.1 for children with recent-onset epilepsy compared with 9.3 for their unaffected peers, and children with chronic epilepsy included an average of 8.3 narrative elements compared with 12.2 among their healthy counterparts.

Overall, listener perception scores (including quality, vocabulary, story structure, fluency and grammar) were significantly lower for children with chronic epilepsy than for children with recent-onset epilepsy.

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