Pragmatic Impairment Research Articles

Cognitive approach to assessing pragmatic language comprehension in children with specific language impairment

Pragmatic language impairment in children with specific language impairment has proved difficult to assess, and the nature of their abilities to comprehend pragmatic meaning has not been fully investigated. To develop both a cognitive approach to pragmatic language assessment based on Relevance Theory and an assessment tool for identifying a group of children with pragmatic language impairment from within an specific language impairment group. The authors focused on Relevance Theory's view of the role of context in pragmatic language comprehension using questions of increasing pragmatic complexity in different verbal contexts (scenarios with and without pictures and a story with supporting pictures). The performances of the children with and without pragmatic impairment on the most pragmatically demanding Implicature questions were examined. This study included 99 children: 27 with specific language impairment (including nine pragmatically impaired children) and two groups of typically developing children (32 children aged 5-6 years and 40 children aged 7-11 years). The specific language impairment group performed similarly to their peers when utilizing context in inferring referents, inferring semantic meaning, and generating Implicatures, only when the answer was provided by pictorial context. Both the children with specific language impairment and the 5-6 year olds were not yet competent at utilizing verbal context when answering the most pragmatically demanding questions (targeting Implicature). On these questions the children with pragmatic language impairment performed significantly poorer than the rest of the specific language impairment group and performance scores on Implicature questions were found to identify accurately the children with pragmatic language impairment from the rest of the specific language impairment group (sensitivity = 89%). Children's ability to infer and integrate information in the comprehension of pragmatic meaning was found to be influenced by the available context. As children become more competent they are able to utilize verbal context and integrate information. Children with specific language impairment and those with pragmatic language impairment were found to be developmentally delayed at making inferences, but children with pragmatic language impairment had particular difficulty in integrating contextual information. Findings support the view that a cognitive approach to assessing pragmatic comprehension deficits could provide clinicians with a useful tool.

Autism and diagnostic substitution: evidence from a study of adults with a history of developmental language disorder

Rates of diagnosis of autism have risen since 1980, raising the question of whether some children who previously had other diagnoses are now being diagnosed with autism. We applied contemporary diagnostic criteria for autism to adults with a history of developmental language disorder, to discover whether diagnostic substitution has taken place. A total of 38 adults (aged 15-31y; 31 males, seven females) who had participated in studies of developmental language disorder during childhood were given the Autism Diagnostic Observation Schedule--Generic. Their parents completed the Autism Diagnostic Interview--Revised, which relies largely on symptoms present at age 4 to 5 years to diagnose autism. Eight individuals met criteria for autism on both instruments, and a further four met criteria for milder forms of autistic spectrum disorder. Most individuals with autism had been identified with pragmatic impairments in childhood. Some children who would nowadays be diagnosed unambiguously with autistic disorder had been diagnosed with developmental language disorder in the past. This finding has implications for our understanding of the epidemiology of autism.

Vulnerability to bullying in children with a history of specific speech and language difficulties

This study examined the susceptibility to problems with peer relationships and being bullied in a UK sample of 12‐year‐old children with a history of specific speech and language difficulties. Data were derived from the children’s self‐reports and the reports of parents and teachers using measures of victimisation, emotional and behavioural difficulties, prosocial development and self‐esteem, together with measures of the children’s language development. Similar prevalence rates for victimisation were found compared with matched groups of typically developing children and children with special educational needs related to general learning difficulties. The importance of prosocial skills and their relationship with language development, particularly pragmatic impairment, are explored.

Pragmatic abilities in adults with and without dyslexia: a pilot study

This study examines well-compensated adults with dyslexia to see if they experience more problems with pragmatic awareness than the normal population. Social interaction requires an individual to process language at speed by using working memory efficiently, in order to understand the intended, rather than literal, meaning between speaker and hearer. Previous studies have shown evidence amongst the dyslexic population of poor working memory capacity, slower speed of processing and automatization deficit. It is proposed that a dyslexic may not be able to interpret pragmatic content as efficiently as non-dyslexics, due to the need for fast processing in such circumstances, resulting in resource overload and over-intensity of memory. The study compares the score results of 20 dyslexic and 20 non-dyslexic adults on the Dyslexia Adult Screening Test (DAST), the Right Hemisphere Language Battery and the author's own pragmatic competence questionnaire. The results for all three measures indicate a statistically significant difference in pragmatic competence between the two groups and appear to demonstrate a correlation between dyslexia and pragmatic impairment. Consideration of individual subtest items on the DAST lend support to the argument that this may be due to deficits in working memory, processing and automatization.

Brief Report: A Scale for Rating Conversational Impairment in Autism Spectrum Disorder

There are few well-standardized measures of conversational breakdown in Autism Spectrum Disorders (ASD). The study's objective was to develop a scale for measuring pragmatic impairments in conversations of individuals with ASD. We analyzed 46 semi-structured conversations of children and adolescents with high-functioning ASD using a functional linguistic paradigm. Five constructs were developed that assessed difficulties related to the pragmatics of conversation: atypical intonation; semantic drift; terseness; pedantic speech; perseveration. The scale shows good inter-rater reliability and variation in the scales is not simply a reflection of IQ or language competence. This tool represents a way of characterizing language use in ASD and is an initial step towards developing a tool to evaluate change in degree of social impairments in conversation.

Social Cognition Deficit in Schizophrenia: Accounting for Pragmatic Deficits in Communication Abilities?

Schizophrenic individuals show impairments in language affecting what is referred to as the pragmatic component of language, typically the processing of non-literal language (e.g., irony, metaphor, indirect request). Such non-literal utterances require the ability to process the speakers utterance beyond its literal meaning in order to allow one to grasp the speakers intention by reference to the contextual information. This paper gives a selective literature review showing that different cognitive processes-specific to language or not-may underlie the processing of pragmatic aspects of language, and particularly of non-literal language in schizophrenia. Indeed, the fact that many other disorders (e.g., right hemisphere lesion, traumatic brain injury, autism) are characterized by pragmatic impairments may reflect a heterogeneous range of underlying functional deficits that have to be determined. Evidence is reviewed suggesting that cooccurrence of a deficit in non-literal language understanding and a deficit in theory of mind may be accounted for by an impairment in context processing associated with a lack of flexibility.

A Relevance-Theoretic Account of the Development and Deficits of Theory of Mind in Normally Developing Children and Individuals with Autism

This paper argues that positing a Theory of Mind and mindreading abilities in particular is necessary in order to be able to account for the development and possible impairments of communication in normally developing children and individuals with autism. To account for the different impairments that people diagnosed with Autism Spectrum Disorder (ASD) exhibit, what is needed is a refinement of the levels or degrees of mind-reading abilities that are usually posited in the literature. Instead of the two-tiered system of first-and second-order mind-reading abilities, there is a need to propose several other layers of meta-representation to account for the comprehension of different communicative events, such as metaphors, under-and overstatements, direct and indirect speech acts, lies, deceits, humour, jokes, irony and sarcasm. This paper assumes a relevancetheoretic perspective to explain deficits in communicative abilities in individuals with ASD. It suggests that the pragmatic impairments specific to autism can be accounted for by the role of context retrieval in the comprehension and production process, especially those related to knowledge about the speaker.

Neural basis of irony comprehension in children with autism: the role of prosody and context

While individuals with autism spectrum disorders (ASD) are typically impaired in interpreting the communicative intent of others, little is known about the neural bases of higher-level pragmatic impairments. Here, we used functional MRI (fMRI) to examine the neural circuitry underlying deficits in understanding irony in high-functioning children with ASD. Participants listened to short scenarios and decided whether the speaker was sincere or ironic. Three types of scenarios were used in which we varied the information available to guide this decision. Scenarios included (i) both knowledge of the event outcome and strong prosodic cues (sincere or sarcastic intonation), (ii) prosodic cues only or (iii) knowledge of the event outcome only. Although children with ASD performed well above chance, they were less accurate than typically developing (TD) children at interpreting the communicative intent behind a potentially ironic remark, particularly with regard to taking advantage of available contextual information. In contrast to prior research showing hypoactivation of regions involved in understanding the mental states of others, children with ASD showed significantly greater activity than TD children in the right inferior frontal gyrus (IFG) as well as in bilateral temporal regions. Increased activity in the ASD group fell within the network recruited in the TD group and may reflect more effortful processing needed to interpret the intended meaning of an utterance. These results confirm that children with ASD have difficulty interpreting the communicative intent of others and suggest that these individuals can recruit regions activated as part of the normative neural circuitry when task demands require explicit attention to socially relevant cues.

Pragmatic difficulties in children with autism associated with childhood epilepsy

The intention of this study was to examine specific pragmatic functions in 35 children, aged 6-11 years, with a history of epilepsy (mean length of duration 6.5 years), who demonstrated autistic features, ASD or autistic regression. The children's ability to recognize and convey communicative intentions, conversational engagement and paralinguistic features were investigated using the Pragmatics Profile of Everyday Communication Skills in Children using semi-structured key-worker interviews. The association between weak or abnormal prosody and epileptic focus was also examined. Findings demonstrate a strong association between early onset epilepsy with autism or autistic regression and additional pragmatic impairment. A number of children exhibited weak or abnormal prosody in association with temporal lobe EEG abnormalities, particularly in the non-dominant hemisphere. Consideration is given to recent studies of the converse--the presence of a reducing prevalence of epilepsy in the autism population and acknowledgment of implications for learning within the autistic population.

The effects of age and education on pragmatic features of verbal communication: Evidence from the Italian version of the Right Hemisphere Language Battery (I-RHLB)

Background : The field of pragmatic impairments of verbal communication in cerebrally damaged subjects dates back almost three decades. However, a systematic investigation of pragmatic competences has never been completed in a large sample of normal adults controlling for age and education factors. Aims : We aimed to examine the effects of age and education on the main features of pragmatics of verbal communication in a large sample of normal healthy subjects. Methods & Procedures : We developed an Italian version of the Right Hemisphere Language Battery devised by Bryan (1995) and administered it to 440 normal volunteers. Ages ranged from 20 to 79 years, and education corresponded to Italian levels of education. Outcomes & Results : We found that ageing and low education influenced performance on almost all the subtests of the I-RHLB. In particular, performance dropped at 70–79 years, particularly in those with the lowest level of education. Conclusions : These results suggest that processing of the pragmatic features of verbal communication parallels the decline of other cognitive functions associated with ageing and low education that previous studies have already established.

Pragmatic ability and disability as emergent phenomena

A holistic approach to pragmatic ability and disability is outlined which takes account both of the behaviour of individuals involved in the communicative process, and also of the underlying factors which contribute to such behaviour. Rather than being seen as resulting directly from a dysfunction in some kind of discrete pragmatic “module” or behavioural mechanism, pragmatic impairment and also normal pragmatic functioning are instead viewed as the emergent consequence of interactions between linguistic, cognitive and sensorimotor processes which take place both within and between individuals.

Topic repetitiveness after traumatic brain injury: An emergent, jointly managed behaviour

Topic repetitiveness is a common component of pragmatic impairment and a powerful contributor to social exclusion. Despite this, description, characterization and intervention remain underdeveloped. This article explores the nature of repetitiveness in traumatic brain injury (TBI). A case study of one individual after TBI provides the basis for a conceptualization of topic repetitiveness in terms of two major strands of thinking in pragmatics. Firstly, it is viewed as an emergent response to underlying deficits in non‐linguistic abilities. Secondly, it is described in terms of joint management of topic development between the person with TBI and his interlocutor.

Tor: Case study of a boy with autism between the age of three and eight

Longitudinal data are presented on a boy between the ages of three and eight. At age three he received a diagnosis of language impairment and at age six a diagnosis of high-functioning autism. Results are presented from extensive assessments at four points in time, including interviews with his mother and teachers. The results indicate that the boy s core problem was poor language comprehension, especially evident in group situations. The results also show that symptoms of his pragmatic impairment varied over time, partly as a function of contextual demands. A dimensional approach to capture pragmatic difficulties in children is suggested.

Italian Right Hemisphere Language Battery: the normative study

Clinical neurolinguistics still lacks consolidated and standardised tools for the assessment of impairments of pragmatics of verbal communication. In the present paper we present norms of the Italian version of the Right Hemisphere Language Battery (Batteria del Linguaggio dell'Emisfero Destro, BaLED) originally devised by Bryan. The normative study has been conducted with the recruitment of 440 healthy subjects. The battery of tests was not intended to be cognitively oriented, by providing evidence of the cognitive impairments underpinning verbal pragmatic deficits; on the contrary, it permits the detection of the presence/absence of impairments in processing the main pragmatic features of verbal communication traditionally associated with right hemisphere lesions. Thus, apart from being a clinical tool for diagnosing pragmatic impairments of verbal communication, the BaLED represents a useful initial battery of tests for clinical assessment and for selecting specific populations of neurological patients suitable for investigation in further experimental studies.

Interpersonal compensation for pragmatic impairments in Japanese children with Asperger syndrome or high-functioning autism

Possibility and characteristics of interpersonal compensation for pragmatic impairments seen in children with Asperger syndrome or high-functioning autism was investigated by conducting videotape analysis on conversational breakdowns reported by adults. Results revealed that various types of pragmatic impairment triggered communicative breakdowns. Adults were likely to compensate for pragmatic impairment; however, the rate of adults' skipping breakdowns and moving on was different between the initial and second-round analyses. The number of compensation strategy types adopted was relatively small compared to that of pragmatic impairment, and the rate of successful compensation seemed to be influenced by whether the adult experienced videotape analyses once or twice. The results of skipping-moving on and the rate of success in compensation suggest repeating videotape analysis might have some significance for clinical practice.

Thought disorder, pragmatic language impairment, and generalized cognitive decline in schizophrenia

Background Schizophrenia is associated with pragmatic language impairment (PLI), a reduced ability to communicate intention in a rule-governed fashion. Two explanations for PLI include that PLI is equivalent to thought disorder and that PLI is secondary to generalized cognitive decline. Objectives The aims of this study were to demonstrate PLI in schizophrenia and to test which of these explanations best accounts for the relationships among thought disorder, PLI, and generalized cognitive decline. Method Schizophrenia ( n=20) and control ( n=26) participants provided speech samples that were scored for thought disorder (type–token ratio and Cloze procedure) and PLI [Profile of Pragmatic Impairment in Communication (PPIC)]. Generalized cognitive decline was determined from discrepancies between current and premorbid verbal IQ. Results Patients with schizophrenia exhibited significant PLI and generalized cognitive decline. There was no evidence of an association between thought disorder and PLI. Moreover, generalized cognitive decline predicted PLI ( r 2=0.33 to 0.59) but not thought disorder ( r 2=0.02 to 0.06). Conclusions The results conformed to a predicted pattern of associations based on the notion that PLI in schizophrenia is secondary to generalized cognitive decline.

Clinical assessment of pragmatic language impairment: A generalisability study of older people with Alzheimer's disease

Background: The Profile of Pragmatic Impairment in Communication (PPIC) is a clinical rating scale designed for the assessment of multiple facets of pragmatic language impairment in neuropsychiatric disorders. The PPIC has its origin in Grice's analysis of implicature and the Gricean principle of co‐operation and conversational maxims.Aims: We sought to evaluate the psychometric properties of the PPIC and to generate a profile of pragmatic language impairment associated with Alzheimer's disease (AD).Methods & Procedures: Speech samples were solicited from patients with AD (n = 13) and age‐matched healthy volunteers (n = 13) using several structured/semi‐structured tasks. Three trained raters made blind ratings on the PPIC on two occasions. Other raters evaluated mental status, aphasia, and communicative effectiveness. A generalisability analysis was conducted.Outcomes & Results: Good to excellent generalisability coefficients (0.86–0.94) were observed on most PPIC scales. PPIC ratings were strongly related to mental status and communicative effectiveness but not associated with aphasia. Diagnosis of AD made no substantive contribution to the prediction of PPIC ratings independently of mental status impairment.Conclusions: Results demonstrate evidence of good to excellent reliability, convergent validity, and discriminant validity of most PPIC scales. The observed associations are consistent with the view that pragmatic language impairment in AD is primarily a function of cognitive decline.

Children's Communication Checklist (CCC) scores in 11-year-old children with communication impairments.

The pragmatic skills of children with communication disorders and their assessment are currently an issue for speech and language therapy and educational placement. To explore whether different subgroups of children with communication disorders score differently on the Children's Communication Checklist (CCC) and to study how they compare with published normative data. A sample of 161 eleven-year-old children with a history of communication disorders was assessed using the CCC. The main use of this questionnaire was to establish whether pragmatic impairments were part of a child's communication difficulty. Although the checklist was originally designed for research purposes, normative data for this scale have been recently published as well as group data from a number of different clinical groups. Whilst the present CCC data have been previously reported descriptively for a wider sample, they have not been examined in terms of subgroups or compared directly with normative information and similarly diagnosed individuals from other studies. Of the children assessed, 52 (33%) scored in the normal range (within 1 SD) on the pragmatic scale, 40 (26%) fell between 1 and 2 SD below the normative mean, and 64 (41%) scored below 2 SD of the mean of typically developing children (aged 6-16 years). Thus, the majority (67%) scored out of the normal range for pragmatic skill at 11 years of age. The cohort was separated into four diagnostic subcategories: those with a definite diagnosis of autistic spectrum disorder (n=15); those with typical specific language impairment (n=82); generally impaired (n=37); and those with a clinical history of primary pragmatic language impairment (independent of CCC score, n=27). Findings show that those generally impaired and with specific language impairment were less impaired than the other groups on the CCC pragmatic scale. There was a significant trend for those with autistic spectrum disorders to score lowest through pragmatic language impairment, generally impairment to specific language impairment. It is argued that a cut-off of 140 may prove more useful at this age than the 132 level previously published for 8 year olds. Results suggest that the CCC can be used as a clinical tool, but in conjunction with other reliable measures.

Fragile X Syndrome and Speech and Language

Fragile X Syndrome and Speech and Language

Textpragmatic impairments of figure-ground distinction in right-brain damaged stroke patients compared with aphasics and healthy controls

Abstract Following previously published work on aphasic texts and unpublished pilot studies on textpragmatic impairments in right-brain damaged stroke patients (RBDs), we present an exploratory study on textpragmatic dimensions of several text classes produced by RBDs as compared with aphasics and healthy controls. In contrast to the main thrust of published research on (text)pragmatic impairments in RBDs, we assume for them the existence of a specific major impairment of figure-ground segregation, with consequences in defective textual organization, in inferencing, and in metalinguistic behavior. In this way we explain the RBDs’ deficits in producing (but not in comprehending) the essential textual core and emotional elements, and essential inferences. Difficulties in figure-ground distinction also result in RBDs’ insecurity about how well they solve discursive problems. These deficits appeared in the tests that we administered to 4 RBDs, 5 controls, 3 Broca and 2 Wernicke aphasics. Subjects had to carry out the following tasks: (a) oral production of a longer and a shorter picture story, (b) oral and written reproduction of a longer and a shorter oral narrative, (c) productions of telegraphic versions, of titles and of punch lines for (a) and (b). Differences in the RBDs’ performances in these distinct tasks are traced back to different cognitive demands on oral vs. written vs. reductive reproduction vs. picture story telling.