Semantic Pragmatic Disorder : A Cognitive Science Prespective


Published on

A cognitive scientist's perspective of semantic-pragmatic disorder.

Published in: Technology, Health & Medicine

Semantic Pragmatic Disorder : A Cognitive Science Prespective

  1. 1. Semantic Pragmatic Disorder Sweta Vajjhala (ID: 68) CS 3790: Dr. Arriaga April 24, 2008
  2. 2. Vajjhala (ID: 68) 2 Introduction & Symptoms Albert Einstein. Vincent Van Gogh. Temple Grandin. The first thing that comes to mind when hearing these names is the category of “famous people.” However, they have much more in common than that. In their childhood years, these people were considered “weird” and lacking social skills. During the times of Van Gogh and Einstein, many would have doubted that they, along with Temple Grandin, were actually suffering from an autism-spectrum disorder. Temple Grandin, who is now a successful associate professor at a university, has shared her story with many others, explaining what it means to be labeled as someone with a specific type of autism- spectrum disorder, called semantic-pragmatic disorder. This label has changed her life in many ways and had many implications. However, while discussing the implications of the disorder, it is important to understand what semantic-pragmatic disorder is, its symptoms, how it is diagnosed and the controversies surrounding diagnosis, and finally, some further implications of the disorder that are beyond the fields of just psychology and cognitive science. The term “semantic-pragmatic disorder” was first coined in 1983 by Rapin and Allen. At the time, it referred to a person who displayed mild autistic features and had some language development problems. Today, however, that view has changed drastically. Semantic-pragmatic disorder is not a language disorder but a communication disorder. Someone that has semantic- pragmatic disorder has difficulty processing information. In other words, it is difficult for that person to extract the central meaning or the saliency of a particular event. Because of this, people with semantic-pragmatic disorder tend to prefer routine lives, since it is hard for them to grasp new situations. As a result of this, people with semantic-pragmatic disorder will cling to older situations and have very predictable actions in similar situations (Semantic Pragmatic Disorder, 2002). Children with semantic-pragmatic disorder were often good at math, science, and computers, in school, but they experienced difficulty in writing, comprehension of critical reading, or even playing with other children. Moreover, when asked to participate in role- playing, these children will act exactly as they are supposed to in the role, but they are not actually pretending: they feel as if they are in the role themselves. For example, Sally has semantic-pragmatic disorder, and she is in Drama Club at her school. She plays the part of a secretary in the club’s latest play. Sally expresses the correct emotions as written in the script
  3. 3. Vajjhala (ID: 68) 3 and she even feels that she is the secretary, but when asked who she really is (while playing the role of secretary), she responds with the name of the secretary, not her own name. This example shows that Sally cannot distinguish between the role-playing character and herself, which is a big symptom of semantic-pragmatic disorder (Semantic Pragmatic Disorder, 2002). This also shows that people with the disorder are often unable to understand how others think or anticipate other’s actions. Because they can only be in one role at a time, disorder victims cannot anticipate other’s thoughts while trying to respond with their own. Thus, this becomes yet another identifiable symptom of semantic-pragmatic disorder. Anatomy There has been a lot of controversy about the different parts of the brain that semantic- pragmatic disorder can affect. According to Shields, the semantic-pragmatic disorder is most probably a right-hemisphere disorder. Specifically, the disorder takes place in the non-dominant part of the right cerebral hemisphere. This is the part of the brain where language processing takes place. Although the ability to talk is controlled mostly by the left hemisphere, language comprehension takes place in the right hemisphere of the brain. As stated by Shields, “whilst the right hemisphere is more literal and concrete in linguistic capacity, it has been suggested that it is better equipped to process abstract rather than concrete images” (1991, p. 383). This leads to the suggestion that processing can take place in the right hemisphere, as well, rather than the popular idea that it takes place only in the left brain. Shields mentioned that, in 1978, Myers found that patients with lesions showed abnormal behavior when communicating or trying to participate in activities with other people (1991, p. 387). Another theory proposes that people who suffer from semantic-pragmatic disorder have problems with the synaptic connections. Friedenberg & Silverman discuss, in their sixth chapter, how learning and memory takes place at the synaptic level. They state that “If a group of neurons is repeatedly activated, the synaptic connections between them will be strengthened. This circuit will then contain the new information” (2006, p. 189). For people with the semantic-pragmatic disorder, these connections never actually get made. Since these are the connections that are pertinent in learning, it also explains why people with semantic-pragmatic disorder take a longer time to process conversations that take place.
  4. 4. Vajjhala (ID: 68) 4 From the cognitive standpoint, people with semantic-pragmatic disorder lack a process of inference. Although information can be encoded and decoded in the brain and specific sounds or styles of writing can be deciphered, but the intention of the message is lost. Inference is a central process needed in order to fully appreciate both the superficial and deeper meanings of a message that is given to the brain. The parsing of the language and the intention are both present, but they are not interconnected in the brain of a semantic-pragmatic person. Friedenberg & Silverman, in their discussion about attention in chapter 4, discussed the multimode model of attention, which “arises from the view that selection can be based on multiple modes, for example, the physical and the semantic” (2006, p. 116-117). This view implies that the attentional selection process is a lot more flexible than previously assumed, and that it can happen either early or late and in multiple modes. Research has shown that semantic pragmatic disorder victims cannot integrate multimodal perceptual information. This could mean that their multimode model of attention is not as complete as a normal person’s model. Since the multimodal method is also supported through neurophysiology, because it can be measured through a recording of event-related potentials (ERPs). Therefore, this measurement can be used as a form of diagnosis: lower ERPs could indicate semantic-pragmatic disorder in a person, while having higher ERPs would be a control number, or the normal amount. Diagnosis & Controversies Surrounding Diagnoses Being able to diagnose semantic-pragmatic disorder has been very difficult for multiple reasons. As a result of this, diagnosis of the disorder has been marred by much controversy, especially in the last few years. Scheeringa discovered that, because of a “lack of suitable instruments,” it is very difficult to diagnose semantic-pragmatic disorder. This is because the disorder is often diagnosed on a subjective basis, which includes rating people on conversational skills or interpretations of characteristics. According to the results of a study by Scheeringa showed that “Children with S-P disorder made more utterances that initiated rather than responded or acknowledged. However, they did not produce more utterances per turn, or make longer utterances” (2001, p. 78). From this, Scheeringa deduced that it is still very much difficulty to correctly diagnose a person with semantic-pragmatic disorder, because there are many possible other disorders they could have, including Asperger’s syndrome or a higher level of autism.
  5. 5. Vajjhala (ID: 68) 5 Other researchers seem to agree with Scheeringa and remain skeptical about techniques of diagnosis for the semantic-pragmatic disorder. In Bishop’s “Autism, Asperger’s syndrome and semantic-pragmatic disorder: Where are the boundaries?”, he argues that the similarity between the three disorders (Asperger’s syndrome, autism, and semantic-pragmatic disorder) have caused a major issue in labeling and misdiagnosis. This labeling has also really de-individualized a person, by giving them an excuse for any action which he/she performs. Despite all of the controversy, there has been some diagnosis standards developed for being able to diagnosis semantic-pragmatic disorder (1989, p. 118). Different age groups have different diagnoses for the semantic-pragmatic disorder. From 8 different case studies, Bishop stated that Kanner found that there are 5 major characteristic features of semantic-pragmatic disorder: the inability to relate to people, failure to develop speech or abnormal (largely non-communicative) use of language of those who did speak, abnormal responses to environmental objects and events, good cognitive potential with excellent rote memory, and normal physical status (fine muscle coordination) (1989, p. 113). Kanner’s results hold consistent with a lot of the symptoms that were also found for semantic-pragmatic disorder. Moreover, this proves to show that the disorder is most probably a communication disorder, rather than a language one, because of the fact that speech does develop, but it is largely non-communicative. As a child gets older, it becomes harder to diagnose the disorder, because usually, children with the disorder often end up developing fluent, complex speech with clear articulation. Usually, the diagnosis of semantic-pragmatic disorder takes place between the age of 30 months and 5 years. During this time period, the biggest characteristic that can be seen is insistence of routine. For example, each day, when the child wakes up, he will first brush his teeth, then shower, then eat breakfast, then leave for school with his mother at exactly 7:04AM. If, for example, his mother was running late and they happened to leave at 7:06AM, the child would get very agitated and nervous, because the routine has been disrupted, and thus, he will not know what to do, so he panics. In the same time period, impaired social development and delayed language development may be noted. Infants that have semantic-pragmatic disorder are often very quiet babies, rarely interacting with others around them and almost never asking for attention.
  6. 6. Vajjhala (ID: 68) 6 Rinaldi found that another big way to diagnose people with the disorder was to test the level of understanding of communicative intent. He measured communicative intent by seeing how well both normal and semantic-pragmatic people were able to determine the meaning of a speaker’s message based on the tone. Some of the different tones included sarcasm, deception, or humor. From his studies, Rinaldi found that a person with semantic-pragmatic disorder “were less able than both comparison groups [control groups] to use context to understand implied meanings. Non-impaired children were also more able to rule out literal interpretations when they did not know the non-literal meaning” (2000, p. 19). This form of diagnosis would not only differentiate between normal and semantic-pragmatic disorder people but also between semantic- pragmatic disorder patients and autism. This distinction can be made because autism victims would not even be able to understand the literal meaning, since autism is more a language disorder than a communication disorder. There are 3 big criticisms associated with these various forms of diagnosis. The first is the fact that different psychologists and scientists use different diagnostic criteria to make the diagnosis. As stated above, since there is so much subjectivity in rating a conversation as “normal” or “abnormal”, and the scale for conversation-ratings has not been fully developed yet. Therefore, this places a lot of bias in the diagnosis itself. The second criticism is the subjectivity of the symptoms that are used in the diagnostic criteria. Lastly, clinical changes take place with age. Therefore, semantic-pragmatic disorder is harder to diagnose when as a person grows older. Some points that are in favor of semantic-pragmatic disorder are the fact that it is 5 times as common as autism. (Bishop, 1989, p. 111) This may make it a little bit easier to diagnose someone as having semantic-pragmatic disorder, rather than being autistic. Moreover, this label is often more acceptable for parents of the person being diagnosed, especially if he/she is a child. Additional Implications & Conclusion In addition to the inferences aforementioned throughout this paper, there are many different ones in various related fields regarding the semantic-pragmatic disorder. One of them involves the effects that it has on speech and language therapy. For a disorder as severe as autism, speech and language are usually not able to be learned by an autistic person, regardless of how much effort he/she may put into learning those subjects. For semantic-pragmatic disorder patients, however, speech can be developed, which means that the patients can be helped with various techniques of speech therapy.
  7. 7. Vajjhala (ID: 68) 7 Semantic-pragmatic disorder is becoming more and more common today between children today. Moreover, only 5% of funding from state governments is given towards helping special education children in general. Because it is becoming more common, maybe more funding can be given to help these children. Some of the money could be used to provide speech or language therapy in schools themselves, so that the children have an opportunity to at least try to overcome some of their learning deficit. The controversies regarding diagnosing the disorder could also have both positive and negative effects. If therapists, doctors, and psychologists have been misdiagnosing many patients and giving them the wrong label, then the victims of the disorder are most probably not receiving the treatment that they should be in order to help them develop their lacking abilities. Being able to have a more objective criteria for properly diagnosing semantic-pragmatic disorder would allow patients to get the correct and necessary type of help for this disorder. From a cognitive science aspect, being able to model all of this in a computer could really prove to be helpful for one day curing semantic-pragmatic disorder. By trying to further develop the mind-as-a-computer metaphor, it would force researchers to really consider which parts of the brain and its mental processes are different between normal people and those who have semantic-pragmatic disorder. Finding these differences could ultimately lead to a possible treatment, or maybe even a permanent cure. Being diagnosed at a later age than most, Temple Grandin has still been able to become one of the most successful semantic-pragmatic people in the world. She is currently a distinguished associate professor at Colorado State University. Moreover, she has had successful corporate relations with big companies, including Burger King, McDonald’s, and Swift (Dr. Temple Grandin, 2005). In her time, she shares her story with others, in the hope that one day, people will understand what it is like to have semantic-pragmatic disorder, and to promote research and help millions of others who are just like her, but maybe not as successful. With some more funding for research and proper tests for diagnoses and maybe narrowing down the list of specifically-defined symptoms, all semantic-pragmatic people can one day be helped and possibly considered normal.
  8. 8. Vajjhala (ID: 68) 8 References 1. Bishop, D. V. M. (1989). Autism, Asperger's syndrome and semantic-pragmatic disorder: Where are the boundaries? British Journal of Disorders of Communication, 24(2), 107- 121. 2. Dr. Temple Grandin. (2005). Retrieved April 3, 2008, from Future Horizons, Inc. Web site: 3. Friedenberg, J., & Silverman, G. (2006). The neuroscience approach: Mind as brain. In J. Brace-Thompson, M. Beth Crouppen, & S. Robinson (Eds.), Cognitive science: An introduction to the study of mind (pp. 163-203). Thousand Oaks: Sage Publications, Inc. 4. Friedenberg, J., & Silverman, G. (2006). The cognitive approach I: History, vision, and attention. In J. Brace-Thompson, M. Beth Crouppen, & S. Robinson (Eds.), Cognitive science: An introduction to the study of mind (pp. 95-123). Thousand Oaks: Sage Publications, Inc. 5. Rinaldi, W. (2000). Pragmatic comprehension in secondary school-aged students with specific language disorders. International Journal of Language & Communication Disorders, 35(1), 1-29. 6. Scheeringa, M. S. (2001). The differential diagnosis of impaired: Reciprocal social interaction in children: A review of disorders. Child Psychiatry and Human Development, 32(1), 71-89. 7. Semantic pragmatic disorder. (2002, October). Retrieved March 23, 2008, from Heathlands Language Unit Web site: 8. Shields, J. (1991). Semantic-pragmatic disorder: A right hemisphere syndrome? British Journal of Disorders of Communication, 26(1), 383-392. Retrieved March 23, 2008, from