What is Pragmatic Language Impairment?

Slide show to accompany RALLI campaign YouTube film 'What is Pragmatic Language Impairment?' http://www.youtube.com/rallicampaign

1. what is pragmatic language
impairment?
Dr Courtenay Frazier Norbury
RALLI
Royal Holloway,
University of London

2. pragmatic difficulties:
difficulties using and understanding
language in context
•context is important because:
–most of what we say is ambiguous
–most of what we intend to communicate is not
explicitly stated

3. multiple meanings

4. “the fish is ready to eat”
I’ll have the
steak.

5. inference
what I say:
•time to go to the
shops.
•remember it’s wet
outside.
what I mean:
•we are going outside
•you need to get ready
•it is still raining
•make sure you put on
a waterproof jacket
and your wellington
boots

6. •for some children, problems using
language in context may be more
pronounced than problems with more
basic aspects of language such as
vocabulary and grammar
•these children may be referred to as
having ‘pragmatic language impairment’;
‘semantic-pragmatic disorder’ or ‘social
communication disorder’

7. origins of PLI: “semantic-pragmatic
disorder”
•Rapin and Allen (1982)
–semantic-pragmatic deficit syndrome used as
descriptive term
–communicative profile more often seen in autistic
disorder, but could occur in other developmental
populations, including SLI
•Bishop and Edmundson (1987)
–semantic-pragmatic disorder used as a diagnostic
term
–given to children with communicative profiles typical
of autistic disorder who did not meet full diagnostic
criteria for autism

8. Semantic-pragmatic Syndrome/disorder:
clinical descriptions (Rapin 1996)
•Phonology and syntax unimpaired
•Verbose
•Comprehension deficits for connected speech
•Atypical word choices
•Poor conversation skills
•Poor topic maintenance
•Answering beside the point of a question

9. terminology: move from semantic-pragmatic
disorder to pragmatic language impairment
(PLI)
•Conti-Ramsden et al (1997) investigated
the communication profiles of 7-year-olds
in language units in the UK
–sub-group scored within normal limits on
standard language measures, including those
tapping semantic skills
–same group were described by teachers and
clinicians as having significant pragmatic
impairments
•note that pragmatic difficulties are not often picked
up on standardised tests

10. terminology: move from semantic-pragmatic
disorder to pragmatic language impairment
(PLI)
•Bishop (1998) developed the Children’s
Communication Checklist (CCC) as a
standard measure of pragmatic
impairment in clinically referred
populations
–items tapping lexical-semantic abilities did not
differentiate those children thought to have
pragmatic impairments from cases of more
typical SLI

11. thus…
•semantic and pragmatic impairments do
not necessarily go hand in hand
•significant numbers of children in
language units (approx. 30%) have
pragmatic language difficulties
•“diagnosis” dependent on child’s everyday
communication skill rather than
standardised tests (see Adams, 2002 for
more about diagnosis).

12. is PLI a euphemism for autism?
•considerable academic and clinical debate
about the status of this ‘disorder’
–one view: PLI is just another word for autism
–another view: PLI represents the middle
ground between SLI and autism
–and finally: PLI is descriptive not diagnostic

13. Bishop & Norbury (2002)
•Children aged 6 – 12
•Recruited from specialist schools and
units
–31 considered PLI (low scores on Children’s
Communication Checklist)
–19 typical SLI (high scores on Children’s
Communication Checklist)
•None of the children had received a formal
diagnosis of autism

14. Bishop & Norbury (2002)
Three scenarios:
1. All children with PLI are autistic
2. PLI don’t meet criteria for autism, but do
for atypical autism or PDDNOS
3. PLI can be found in non-autistic children

15. Diagnostic Tools for Autism
•Autistic Diagnostic Interview with parents (ADI)
–Focus largely on early behaviour and development,
but some current functioning as well
•Autistic Diagnosis Observation Schedule
(ADOS)
–Focus on current behaviour only
•Social Communication Questionnaire (SCQ)
–40 items completed by parents, focus primarily on
early behaviours

16. PDDNOS
= pervasive developmental disorder not
otherwise specified
used to refer to child with some autistic
features who does not meet full criteria
(other terms: atypical autism, autistic
spectrum disorder)
If scoring above threshold on 2 out of 3
domains of autistic triad.

17. How many meet criteria for autism?
autisticPDDNOSnone
autistic
PDDNOS
none

ADOS-G
ADI/
SCQ
children from PLI group

18. How many meet criteria for autism?
autisticPDDNOSnone
autistic
PDDNOS
none

ADOS-G
ADI/
SCQ
children from SLI-T group

19. Bishop & Norbury (2002)
Three scenarios:
1. All children with PLI are autistic
2. PLI don’t meet criteria for autism, but do
for atypical autism or PDDNOS
3. PLI can be found in non-autistic children
x
x
√

20. Non-autistic children with PLI
•tended to use more stereotyped
language and abnormal intonation than
children with more ‘typical’ language
impairment, but…
–were interested in being ‘social’ (though
question how reciprocal interaction is)
–very sociable and talkative
–used non-verbal as well as verbal
communication
–excessive interests or repetitive behaviours
were not a feature

21. diagnostic status of PLI
depends on diagnostic criteria
for autism spectrum disorder
•more importantly, pragmatic deficits are
seen in children with AND without
impairments in structural aspects of
language (i.e. vocabulary and grammar)
•pragmatic deficits that aren’t picked up on
formal tests may be evident in social
interactions

22. intervention
•there is evidence that interventions
targeting pragmatic language skills are
effective (Adams et al. 2012)
•see the Social Communication
Intervention Project (SCIP) for details:
•http://www.psych-sci.manchester.ac.uk/scip/

23. recommended readings:
•Adams C. (2002). Practitioner review: the assessment of language pragmatics. Journal of Child Psychology and
Psychiatry, 43( 8), 973-87.
•Adams, C., Lockton, E., Freed, J., Gaile, J., Earl, G., McBean, K. , Nash, M., Green, J., Vail, A. & Law, J. (2012).
The Social Communication Intervention Project: a randomised controlled trial of the effectiveness of speech and
language therapy for school-age children who have pragmatic and social communication problems with or without
autism spectrum disorder. International Journal of Language and Communication Disorders, 47(3), 233-244.
•Bishop DVM, Norbury CF (2002), ”
Exploring the borderlands of autistic disorder and specific language impairment: A study using standardised diagnostic instruments
“, Journal of Child Psychology and Psychiatry. 43: 917-929.Bishop,
•Bishop D et al. (2008). Autism and diagnostic substitution: Evidence from a study of adults with a history of
developmental language disorder. Developmental Medicine and Child Neurology, 50, 341-345.
•Conti-Ramsden,G., Crutchley,A., Botting,N. (1997). The extent to which psychometric tests differentiate
subgroups of children with SLI. Journal of Speech, Language, and Hearing Research 40, 765-777.
•Rapin, I. (1996). Preschool children with inadequate communication: developmental language disorder, autism,
low IQ. Clinics in developmental medicine No. 139. Mac Keith Press, London, p 56-97.