Semantic pragmatic disorder

Semantic-Pragmatic Disorder (SPD) or pragmatic language impairment (PLI) is a developmental disorder that many experts believe is closely related to autism and Asperger's Syndrome. The name refers to the fact that people with SPD have special challenges with the semantic aspect of language (the meaning of what is being said) and the pragmatics of language (using language appropriately in social situations).

History

In 1983, Rapin and Allen suggested the term "semantic pragmatic disorder" to describe the communicative behavior of children who presented traits such as pathological talkativeness, deficient access to vocabulary and discourse comprehension, atypical choice of terms and inappropriate conversational skills. [Rapin I, Allen D (1983). Developmental language disorders: Nosologic considerations. In U. Kirk (Ed.), "Neuropsychology of language, reading, and spelling" (pp. 155–184). : Academic Press.] This definition has been expanded and refined by therapists who use it to refer to communication disorders that involve difficulty in understanding the meaning of words, grammar, syntax, prosody, eye gaze, body language, gestures, or social context. While autistic children exhibit semantic-pragmatic language disorder, this type of communication disorder can also be found in individuals with other types of disorders including auditory processing disorders, neuropathies, encephalopathies and certain genetic disorders. See Bishop DV, Norbury CF. (2002).Exploring the borderlands of autistic disorder and specific language impairment: a study using standardised diagnostic instruments. J Child Psychol Psychiatry. Oct;43(7):917-29.

Characteristics

Individuals with SPD have particular trouble understanding the meaning of what others are saying, and they are challenged in using language appropriately to get their needs met and interact with others. Children with the disorder often exhibit:

* delayed language development
* aphasic speech (word search pauses, jargoning, echolalia, word order errors, word category errors, verb tense errors or dysfluency)
* difficulty with pronouns or pronoun reversal
* difficulty understanding questions
* difficulty understanding choices
* difficulty following conversations or stories
* difficulty extracting the key points from a conversation or story; they tend to get lost in the details
* difficulty with verb tenses
* difficulty explaining or describing an event
* tendency to be concrete or prefer facts to stories
* have difficulty understanding satire or jokes
* have difficulty understanding contextual cues

People with SPD often share additional characteristics consistent with high-functioning autism. For example, they may dislike or avoid eye contact. Many have rigid habits, a shallower range of interests than most people (often with a deep knowledge of their areas of interest), sensory and eating sensitivities, coordination and muscle-tone issues. They may also display striking abilities in an area like mathematics, computer science, geography, astronomy, reading, or music.

SPD was originally defined in the literature on Language Disorder in 1983, by Rapin and Allen, although at that time it was classified as a syndrome. [Rapin I, Allen D (1983). Developmental language disorders: Nosologic considerations. In U. Kirk (Ed.), "Neuropsychology of language, reading, and spelling" (pp. 155–184). : Academic Press.] They referred to a group of children who presented with mild autistic features and specific semantic pragmatic language problems. More recently, the term "pragmatic language impairment" (PLI) has been proposed. [cite journal |author=Conti-Ramsden G, Botting N |title=Classification of children with specific language impairment: longitudinal considerations |journal=J. Speech Lang. Hear. Res. |volume=42 |issue=5 |pages=1195–204 |year=1999 |pmid=10515515] [ Bishop DVM (2000). Pragmatic language impairment: A correlate of SLI, a distinct subgroup, or part of the autistic continuum? In DVM Bishop & LB Leonard (Eds.), "Speech and language impairments in children: Causes, characteristics, intervention and outcome" (pp. 99–113). Hove, UK: Psychology Press.]

Clinical profile

According to Bishop & Norbury (2002), children with semantic-pragmatic disorder have fluent, complex and clearly articulated expressive language but exhibit problems with the way their language is used.These children typically:
* are verbose
* have problems understanding and producing connected discourse
* give conversational responses that are socially inappropriate, tangential and/or stereotyped
* develop obsessional interests

The current view, therefore, is that the disorder has more to do with communication and information processing than language. For example, children with semantic pragmatic disorder will often fail to grasp the central meaning or saliency of events. This then leads to an excessive preference for routine and 'sameness' (seen in autism) as SPD children struggle to generalize and grasp the meaning of situations that are new; it also means that more difficulties occur in a stimulating environment than in a one-to-one setting.

A further problem caused by SPD is the assumption of literal communication. This would mean that obvious, concrete instructions are clearly understood and carried out, whereas simple but non-literal expressions such as jokes, sarcasm and general social chatting are difficult and can lead to misinterpretation. Lies are also a confusing concept to children with SPD as it involves knowing what the speaker is thinking, intending and truly meaning beyond a literal interpretation.

Relationship to autism

There is debate over the relationship between semantic-pragmatic disorder and autistic disorder as the clinical profile of semantic-pragmatic disorder is often seen in children with high-functioning autism.

Related disorders

Hyperlexia is a similar but different disorder where main characteristics are an above–average ability to read with a below–average ability to understand spoken and/or written language.

ee also

* Autism
* High-functioning autism
* Hyperlexia
* PDD not otherwise specified
* Specific language impairment

References

External links

* [http://www.spdsupport.org.uk SPD Support - UK Support Group]
* [http://www.hyperlexia.org/sp1.html Semantic Pragmatic Disorder] - A paper prepared by Heathlands Language Unit staff for parents and teachers involved in the care of children with Semantic-Pragmatic Difficulties
*http://psyweb.psy.ox.ac.uk/oscci/presentations.htm/pragmatics.htm - Page about research into pragmatic impairments. Part of the Oxford Study of Children's Communication Impairments and including work by Professor Dorothy Bishop.
*http://www.hyperlexia.org/sp1.html
* [http://www.ican.org.uk/ I CAN] - information on speech, language and communication in children