Pragmatic Development Disorders

Disorders of Pragmatic Development

• Pragmatic disorder involves difficulty using language to convey and understand intended meanings
• Pragmatic disorder is described as a mismatch between language and context
• Developmental pragmatic disorder isn't mutually exclusive with specific diagnoses like high-level autism or ADHD
• Pragmatic disorder can exist without additional social impairment or learning disability
• Bishop (2000) refers to pragmatic disorder without social impairment or learning disability as Pragmatic Language Impairment (PLI)
• Pragmatic difficulties can arise as a secondary feature of any developmental language impairment

Pragmatics and Autism

• Referring to autism as a language impairment is more appropriate than sever communication impairment
• Core pragmatics is the knowledge of basic speech act types like assertion, questions, requests, and commands
• Core pragmatics is universally required to master language
• Autistic children echo questions/commands without learning appropriate response
• Carr et al.(1975) highlight this trend where autistic children echo questions
• Autistic children seem to act in fixed, fragmentary states, hindering creative, context-fitting speech acts
• Amplified core pragmatics is knowledge of the rules governing non-basic speech acts types like congratulation and proclamation
• Autistic children are often echolalic, repeating heard sentences but lacking interpretation or contextual understanding
• Talk-in interaction pragmatics involves knowledge governing conversation aspects like turn-taking and organization of repair
• Talk-in interaction pragmatic knowledge is deficient in autistic individuals, resulting in inadequate turn-taking
• Topic introduction, maintenance and change is highly inappropriate and discourse markers are used incorrectly in autistic speakers
• Interface pragmatics involves integrating linguistic data with other channels & is extremely deficient in autistic individuals
• The integration of data from linguistic, perceptual, and motor channels is included
• Peripheral sensory and motor processes are not damaged in autism
• Deficient integration of linguistic processes is the core issue
• Autistic individuals often show strong ability to discriminate visual and auditory information
• Autistic children have been described as eye contact avoiders
• The challenge is the integration between the motor channel involved in gazing and the linguistic channel

Pragmatics and Asperger Syndrome

• The I LAUGH framework (Winner, 2000) provides an overall model of social pragmatic deficits in Asperger's & HFA
• "I LAUGH" is an acronym representing concepts related to deficits in pragmatic language.
• I = Initiation: Difficulty initiating language/action for non-routine tasks/interactions.
• L = Listening with one's eyes & brain: Difficulty with auditory & visual processing of subtle social cues.
• A = Abstract & inferential: Difficulty deciphering meaning from abstract language & non-verbal cues.
• U = Understanding the perspective of others: Difficulty interpreting motives, emotions, & intents of others
• G = Getting the big picture or gestalt processing: Difficulty recognizing & comprehending underlying concepts
• H = Humor: Using humor inappropriately in particular contexts

Pragmatics and Specific Language Impairment (SLI)

• SLI is a heterogeneous category without diagnostic consensus.
• Two classification systems from the 1980s described SLI, showing fluent complex & clearly articulated expression
• There are abnormalities regarding SLI in how the language was used
• Children with such clinical profile are verbose with troubles in discourse & gives socially inappropriate responses
• The term "semantic-pragmatic disorder" describes such a profile
• Bishop (2000) notes pragmatic difficulties of children with SLI extend beyond language form/structure deficits.
• There are difficulties in responding and expressing communicative intentions
• Conversational abilities are difficult; problems in turn-taking and incoherent answers are common, this was observed by (Rice et al., 1991) and (Bishop, 2000)
• (Befi-Lopes et al 2002) found deficits in functional use of language with SLI children, including inappropriate communication

Semantic-Pragmatic Language Disorder (SPLD)

• 'Semantic–pragmatic language disorder' (SPLD) refers to;
• Phonology and syntax unimpaired
• Verbosity
• Comprehension Deficits
• Word Finding Deficits
• Atypical Word Choices
• Inadequate Conversational Skills
• Speaking Aloud
• Poor Topic Maintenance
• Answering beside the point of a question

PLI and Other Disorders

• PLI children aren't necessarily autistic
• Children with significant difficulty do not have difficulties in peer relations or interests, that are hallmarks of autism
• The group of PLI present with a language disorder like delayed comprehension development
• Botting & Conti-Ramsden (1999) support Bishop's claim of overlapping conditions.
• Children with PLI tended to develop 1rst words earlier SLI but their social impairment ratings were similar.
• Bishop (2000) stated that all children are different presenting SLI/Autism
• These children have some symptomatic overlap with both SLI and autistic disorder

Pragmatics and Attention Deficit Hyperactivity Disorder (ADHD)

• ADHD is linked to pragmatic language problems
• Pragmatic language problems are stronger when ADHD involves language impairments
• Tannock & Schachar (1996) link oft-proposed deficits to Executive Functioning (EF)
• Often these skills are described as mental control processes to enable self control in ambiguous situations
• EF is related to the prefrontal cortex and in ADHD, could account for pragmatic language difficulties
• Children with ADHD show similar language difficulties as patients with frontal dysfunction
• Children with ADHD mainly have difficulties with pragmatics and not semantics of language phonological processing