Narrative ability in children with cerebral palsy.
Kids with CP miss story links and key facts, but more mazes can signal effort, not failure—adapt your narrative probe before labeling deficit.
01Research in Context
What this study did
Holck et al. (2011) compared how kids with cerebral palsy tell stories against kids without disabilities. They used two tools: the Bus Story Test (BST) and the Narrative Assessment Profile (NAP).
The team looked at story cohesion, essential details, and "mazes" (false starts or repeats). They wanted to see where CP stories break down most.
What they found
Children with CP left out key story links and main facts far more often than their peers. Their stories were harder to follow.
Surprise: more mazes did not mean worse stories for the CP group. Kids who used lots of mazes actually included more essential information.
How this fits with other research
Eagle (1985) saw bright spots: even kids with severe CP showed object permanence, hinting that cognitive skills can look intact when motor limits are bypassed. Pernille’s later study adds that expressive language may still lag even when basic cognition is on track.
Bartoli et al. (2019) found blind kids scored like sighted peers on adapted Theory-of-Mind storybooks. Both papers show that when we tweak the tool, kids with sensory-motor disabilities can reveal typical skills. Pernille’s negative result may simply flag that BST+NAP still demand motor speech the CP group can’t give.
Foti et al. (2015) meta-analysis lumps CP narrative deficits under the broad "reading disabilities" umbrella. Pernille zooms in and shows the problem is story structure, not single-word reading.
Why it matters
If you test a child with CP and hear jumbled stories, don’t assume global language delay. Score BST content separately from fluency, and give credit for mazes that carry new facts. Try keyboard, eye-gaze, or switch-accessible story apps before writing goals. Target cohesion links ("so", "because") and essential story elements first; fluency can wait.
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02At a glance
03Original abstract
In a previous study a group of children with cerebral palsy (CP) were found to have considerable difficulties with narratives, performing several standard deviations below the criteria for the Information score of the Bus Story Test (BST). To examine in depth the performance of children with CP and a control group with typically developing (TD) children on a narrative task, in order to search for possible underlying causes to the problems in the CP group. The results of the BST for 10 children with CP, mean age 7;11 years, were investigated. The analysis of the BST was supplemented with the use of the Narrative Assessment Profile (NAP) and quantitative analyses of number of words, mazes, propositions, types of conjunctions and story elements. A significant relationship between the explicitness dimension on the Narrative Assessment Profile and the BST Information score in the CP group suggested that the problems could be derived to a limited use of cohesion and a scarcity of essential information. Compared to the CP group, the TD group used significantly more causal conjunctions. The results indicate a general problem with cohesion at the textual level in the CP group. A further finding was the occurrence of a positive correlation between the use of mazes and the BST Information score in the CP group. These results have implications for the design of a more specific intervention for children, where the NAP was found to be a valuable tool in combination with the BST or other assessment materials. Further, it is shown that mazes, mostly regarded as a behaviour that not enhances speech production, for some children can be used as a means to find necessary words and pieces of information.
Research in developmental disabilities, 2011 · doi:10.1016/j.ridd.2010.10.001