Assessment and theoretical interpretation of spoken discourse and cognitive skills in two adolescents with acquired brain injury

Although discourse assessment is recommended, few tools exist for adolescent acquired brain injury (ABI) and few theories describe the contribution of cognition to discourse impairment. This study explored whether a novel discourse protocol can identify difficulties following ABI and whether a discourse processing model provides a useful account of impairment. Using a case-control design, two adolescent males with moderate ABI (12 and 14 years) were compared to a neurotypical sample on a range of language and cognitive assessments. Patterns in performance were interpreted using a theoretical model. Participants completed a standardised omnibus language assessment, discourse assessment, and battery of cognitive tasks. Analyses revealed significant differences in discourse and cognition between adolescents with and without ABI. No impairment was detected on a standardised language assessment. Patterns in discourse and cognition aligned with a contemporary model of discourse processing. Participants with ABI demonstrated discourse deficits relative to the neurotypical reference sample. The findings demonstrate the value of discourse sampling across multiple genres and analysis of microlinguistic to superstructural features. A structure-building framework (SBF) model, originating in schizophrenia, provides a promising theory with which to interpret discourse impairment and has the potential to inform intervention for discourse in ABI.