Pragmatic Language Impairment

Pragmatic Language Impairment

 

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Pragmatic Language Impairment- Pragmatics is the corpus of rules that govern the use of language in various social situations, i.e. the social skills of language (when, where, with whom, and how language is used).  Pragmatic skills are important for social, educational, and career success. Social norms have expectations for proper pragmatic usage in language, such as topic maintenance, turn-taking in conversation, eye contact, and providing the listener with information. These rules may vary depending upon cultural norms.

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A pragmatic language disorder may harm social relationships and social acceptance by others. Children with pragmatic language difficulties may be unable to vary their language use, may relate information or stories in a disorganized way or say inappropriate or off-topic things during a conversation. Pragmatic speech disorder can also be related to difficulties with grammar and vocabulary development. As children get older and more social skills are demanded peers may avoid conversation with children with pragmatic speech issues and therefore these children have fewer friends and are less accepted in social situations.

Symptoms

  • Difficulty with conversation exchanges
  • Difficulty telling a story
  • Difficulty responding to indirect requests (e.g. “Wouldn’t it be nice if I had a toy?” as opposed to “Get me a toy,” as a form of politeness)
  • Difficulty with topic initiation
  • Difficulty with conversational repair strategies (e.g. asking “What did you say?” or “Can you explain?”)
  • Demonstrating little variety in language use                                                 conversation1

Pragmatic Language Impairment

Diagnostic Criteria for Social (Pragmatic) Communication Disorder

The following criteria are from The 2013 Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, DSM-5™.  

  1. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
  2. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
  3. Impairment in the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding the use of overly formal language.
  4. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
  5. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meaning of language (e.g., idioms, humour, metaphors, multiple meanings that depend on the context for interpretation.)
  6. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
  7. The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
  8. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.

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Treatment

Treatment for a pragmatic language disorder involves teaching appropriate strategies for social awareness.

  1. Use role play to help your child understand appropriate language use in various social situations such as school, church, the library, a party, etc. Create scenarios for your child and help them learn how to respond in a socially appropriate manner.
  2. Discuss with your child various ways of requesting, such as polite (May I have a drink?) versus impolite (Give me a drink NOW) and direct (Shut up) versus indirect (Would you mind talking in a quieter voice?). Discuss with your child why some ways of asking or requesting something might be more persuasive and appropriate than others.
  3. Work on general conversation and storytelling with your child. Work on commenting on a particular topic that was introduced before changing to a new topic. Use pictures, objects or a story outline to enhance visual cues for storytelling. Demonstrate how facial expressions should match the language being used as well as the social situation, such as smiling when hearing about a friend’s birthday party versus not smiling or laughing when hearing a friend has been in an accident.
  4. Read and discuss: Read a book with your child, asking and encouraging open-ended questions such as “what do you think about what he did?”
  5. Talk about the feelings: Books and stories provide a great opportunity to talk about feelings. Suggest why you think a character in a story is behaving or feeling a particular way. Try extending this to real-life situations, privately discussing what a friend or sibling might be feeling and why.
  6. What’s next? Have your child try to predict what will happen next in a story. Help him locate the clues. Or work backwards. Once an event happens, go back and figure out the clues leading up to the event. Take, for example, a picture of spilled milk and food on the floor; ask what might have happened.
  7. Introduce your child to popular, developmentally appropriate shows and public figures so he can join related conversations with friends and classmates.
  8. Plan structured play dates. Begin with just one friend at a time and have a planned activity with a time limit – say, 60 to 90 minutes to start.

Pragmatic Language Impairment

 

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