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: what I mean:
• time to go to the • we are going outside
shops. • you need to get ready
• remember it’s wet • it is still raining
outside. • 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?
children from PLI group
ADOS-G
autistic PDDNOS none
autistic
ADI/
SCQ
PDDNOS
none

18. How many meet criteria for autism?
children from SLI-T group
ADOS-G
autistic PDDNOS none
autistic
ADI/
SCQ
PDDNOS
none

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

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 inst
“, 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.