Semantic pragmatic disorder

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Semantic-Pragmatic Disorder (SPD) 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).

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[edit] 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.][1] Today this definition has been expanded and refined by therapists who use it to refer to communication disorders that involve difficulty understanding the meaning of words, grammar, syntax, prosody, eye gaze, body language, gestures, or social context. While children on the autistic spectrum do 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.

[edit] Characteristics

Individuals with SPD have particular trouble understanding the meaning of what others are saying, and they are challenged to use 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.[2] 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.[3][4]

[edit] 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 is more to do with communication and information processing than language. For example, children with semantic pragmatic disorder will find 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.

[edit] How to help

Speech and Language Therapist Margo Sharp provides many techniques to help children with SPD. To aid the SPD child with social development, you should provide clear behavior expectations, make dinner time a pleasant experience, and assist him with his communication with others. Encourage him to share by identifying his needs first, the other child’s needs, and then insist that he share. Help the SPD child in his language development by granting him time to reply to questions/conversations. Provide him with extra hands on experience of topics being covered at school. Assist him by participating in a home/school journal to help him in his conversation and writing skills. Remember, he takes your words literally when you are conversing with him. [5]