Chapter 3: The Psychosocial and Other Impact of Pragmatic Disorders (original) (raw)

Chapter 6: Pragmatic Disorders in Complex and Underserved Populations

Pragmatic Disorders, 2014

Keywords: Attention deficit hyperactivity disorder; emotional and behavioural disorders; frontotemporal dementia; non-Alzheimer's dementias; prison population 6.1 Introduction Not all pragmatic disorders have received the level of clinical study of the populations examined in chapter 2. While the pragmatic impairments of clients with right-hemisphere damage or traumatic brain injury are well characterized, relatively little is known about the pragmatic language skills of children with emotional and behavioural disorders or adults with non-Alzheimer's dementias. These children and adults belong to 'complex' populations by virtue of the fact that their pragmatic disturbance occurs in the presence of significant psychiatric and cognitive disorders. Similarly, certain groups of clients with pragmatic impairments are beyond the reach of, or are overlooked by, language services. These groups include adolescents in juvenile detention facilities and adults in prison. These clients belong to an 'underserved' population to the extent that their language needs are inadequately assessed and treated. Although these different clients have not been the focus of extensive academic research or clinical services to date, what is clear is that an array of factors means complex and underserved populations are likely to become an increasingly important part of the caseload of speech and language therapists in years to come. With this consideration in mind, an examination of the pragmatic impairments of these clients now seems timely. 6.2 Emotional and behavioural disorders

Pragmatic disorders and their social impact

2011

Pragmatic disorders in children and adults have been the focus of clinical investigations for approximately 40 years. In that time, clinicians and researchers have established a diverse range of pragmatic phenomena that are disrupted in these disorders. Pragmatic deficits include problems with the use and understanding of speech acts, the processing of non-literal language, failure to adhere to Gricean maxims in conversation and discourse deficits. These deficits are found in several clinical populations including individuals with autistic spectrum disorders, schizophrenia, traumatic brain injury and right-hemisphere damage. However, what is less often investigated is the social impact of pragmatic disorders on the children and adults who are affected by them. In this paper, I examine what is known about pragmatic disorders in these clinical groups. I then consider the wider social consequences of these disorders, where consequences are broadly construed to include factors that act as indicators of social adjustment.

Psychosocial Aspects of Pragmatic Disorders

2017

This chapter considers the everyday psychological and social costs attached to having pragmatic language difficulties. We briefly review key terminology concerning pragmatic language functions, before summarizing features of pragmatic language difficulties that occur in both the developmental period (e.g. associated with language impairment, autism spectrum disorder, hearing impairment, traumatic brain injury, intellectual disability) and in adulthood (e.g. in fronto-temporal dementia, aphasia, and Alzheimer’s disease). We present a schematic model as a means of conceptualizing the elements of pragmatic language competence and its inverse, pragmatic language difficulties, within the broader psycho-social context. We argue that psychological factors such as coping style and self-efficacy for communication need to be considered alongside social factors (such as cultural mores and everyday communication contexts) if the true impact of pragmatic language difficulties is to be both docum...

Pragmatic language impairment and associated behavioural problems

International Journal of Language & Communication Disorders, 2010

Background: Specific language impairment (SLI) is diagnosed when a child shows isolated structural language problems. The diagnosis of pragmatic language impairment (PLI) is given to children who show difficulties with the use of language in context. Unlike children with SLI, these children tend to show relatively intact structural language skills while they do exhibit clear communicative deficits. There is hardly any research on the relationship between pragmatic competence and behavioural problems. Existing research suggests a strong relationship, but has only been executed on clinical SLI samples. Moreover, it is not known whether pragmatic language problems are related to specific types of behavioural problems. Aims: This study aims to clarify the incidence and nature of behavioural problems in children with PLI using a prognostic design in mainstream education. This design should provide valuable insights into the general relationship between PLI and various behavioural problems. Methods & Procedures: Teachers completed the Children's Communication Checklist (CCC) and the Strengths and Difficulties Questionnaire (SDQ) and provided additional data for a sample of 1364 children aged 4 years. Outcomes & Results: Within the community sample, pragmatic competence is highly correlated with behavioural problems. Pragmatic competence is a good predictor of behavioural problems, and once pragmatic competence is accounted for, structural language abilities do not predict behavioural problems. Children with pragmatic language impairment often show behavioural problems, largely of an externalizing nature. The most prominent problems are hyperactivity and the lack of prosocial behaviour, which reach clinical levels for this group. However, all problem levels are elevated compared with normally developing children.

The assessment and treatment of pragmatic disorders

Clinical Pragmatics, 2009

At its most general level, the clinical management of clients with pragmatic disorders involves two main types of activity. In order to establish which pragmatic skills are impaired, clinicians must first engage in a process of assessment. Assessment is usually conducted over several sessions and can involve an extensive range of techniques. The results of assessment provide a basis for the planning of intervention as well as a baseline measurement of the client's pragmatic skills. We will see subsequently that this baseline measurement is vital in establishing a client's progress in therapy and in determining the efficacy of a particular programme of intervention. An equally eclectic group of techniques is used in the intervention or treatment of pragmatic disorders. These techniques often reflect the particular experience of a clinician and the availability of resources. Certainly, few of these techniques have been the subject of efficacy studies. There is a very important sense, therefore, in which most interventions of pragmatics lack the type of clinical validation that we have come to expect of interventions in areas such as phonology and syntax. In this section, we examine the full range of methods that are available to the clinician who is charged with the assessment and treatment of pragmatic disorders in children and adults. In doing so, we will make a distinction between formal and informal assessment methods. We will consider the types of clients that may be assessed and treated using these methods. We will also discuss the question of efficacy studies in the area of disordered pragmatics. Before engaging with these issues, however,

Testing Pragmatic Language Disorders: A Culturally-sensitive Assessment

Testing Pragmatic Language Disorders: A Culturally-sensitive Assessment, 2015

Recent years have seen a growing interest in the application of pragmatic aspects of communication in the area of research into language disorders. This has led to the development of a range of different methods of screening to investigate the subjects’ abilities to understand and produce different types of communicative acts in order to assess the presence and extent of pragmatic language disorders (PLDs) in children and young adults. According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), the disorders exhibiting pragmatic language difficulties are autism, Asper- ger syndrome, semantic pragmatic communication disability, non- verbal learning disability, hyperlexia, fragile X syndrome, Rhett syn- drome, attention-deficit/hyperactivity disorder, auditory processing disorder, schizoid personality disorder, social emotional processing disorder, epilepsy, trauma, head injuries and strokes.

Chapter 1: Pragmatics and Language Pathology

Pragmatic Disorders, 2014

Keywords: Discourse cohesion and coherence; implicature; non-literal language; pragmatic assessment and treatment; speech act demonstrate the efficacy of the interventions they offer clients. Speech-language pathology services have not been immune to this wider trend in health care. I will argue in this section that a pragmatic concept, that of functional communication, is typically the basis of the outcome measures that are used to assess the efficacy of interventions. The notion of functional communication embodies a range of communicative behaviours which are pragmatic through and through. As Wright and Newhoff (2005: 241) state, 'functional communication is a product of the effective use of several pragmatic behaviors'. Functional communication includes skills such as the ability to understand directions, to make one's Appears in: Cummings, L. (2014) Pragmatic Disorders, Dordrecht: Springer. needs known, to greet and take leave of others, to relate events, and to respond appropriately to requests. It is the type of communication which permeates our daily interactions with others and without which we are likely to experience considerable personal distress, social exclusion and occupational disadvantage. The centrality of functional communication to measures of the efficacy of therapy will be demonstrated at three levels. Firstly, I examine studies in speech-language pathology that have used functional communication measures to assess the efficacy of interventions, and not just those interventions that have a pragmatic emphasis. Secondly, functional communication measures are also the basis upon which speech-language pathology as a profession is able to demonstrate the benefit of its interventions to clients and, in so doing, secure funding of its services through national health care budgets. In this regard, functional communication measures, as adopted by the American Speech-Language-Hearing Association (ASHA), will be examined. Thirdly, functional communication is also emphasized in international health frameworks which are used to assess disability in individuals who develop illness and sustain injury. One such framework employed by the World Health Organization (WHO) will be discussed. At all three levels, the distinctly pragmatic concept of functional communication can be seen to shape how we conceive of treatment gains and the disability which individuals continue to experience when treatment comes to an end. Efficacy studies in speech-language pathology are now commonplace. Some of these studies have examined the outcome of interventions which have a pragmatic emphasis. Typically, these interventions are undertaken in clients who have pragmatic and social communication difficulties. For example, Adams et al. (2012) assessed the effectiveness of a social

Pragmatic disorders and social functioning: a lifespan perspective

Interdisciplinary Studies in Pragmatics, Culture and Society, 2015

As we pass through life stages, the demands and challenges of the social domain vary enormously. The infant must quickly establish social reciprocity with others in order to ensure he receives food and protection from harm. The child must use whatever social interaction skills are at his disposal in order to access the friendship networks which will sustain his cognitive, social and emotional development. The adolescent is at a critical point in the construction of identity, and social skills both contribute to, and are transformed by, this important milestone in personal development. The adult faces significant social challenges in the workplace, where high-level interpersonal skills are typically a prerequisite of employment. At the same time, new social roles emerge in adulthood in the form of parenthood and through wider societal participation. In advanced adulthood, there are social challenges in the form of reduced opportunities for interaction as one’s friendship network gradually declines. Also, the aging adult must address the adverse social implications of steadily diminishing physical and cognitive skills. The human lifespan, it can be seen, places a range of social demands on the individual, each of which is unique, and all of which must be confronted. Each of these life stages in the social functioning of an individual is compromised by the presence of pragmatic disorders. This is on account of the fact that of all aspects of language, pragmatics is most closely affiliated with the communication processes upon which social relationships are constructed and maintained. This paper will take a lifespan perspective in examining the contribution of pragmatic disorders to impairments of social functioning. This contribution varies not only with different life stages but also with different clinical disorders. The child with an autism spectrum disorder may not be successful in forging the social relationships which are the basis of friendship networks, while the adult who sustains a traumatic brain injury may experience isolation through a progressive loss of social relationships. Pragmatic disorders, which are a prominent clinical feature of clients with both these disorders, will have different social consequences in each of these scenarios. The discussion will consider the factors which exacerbate and mitigate the social consequences of pragmatic disorders at different stages in the lifespan.