Manual Pragmatic Impairment

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Background Pragmatic language refers to how language is used socially to achieve some purpose in communication.

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Pragmatic language impairment can be a disorder by itself, or as a sign of other accompanying disorders. Hearing-impaired children show less clear pragmatic communication functions. Knowledge of pragmatic abilities in children with hearing loss HL is lacking relative to that of children with normal hearing NH. Aim The aim of this study was to examine the pragmatic language ability in Arabic-speaking children with sensorineural hearing loss in order to apply a proper intervention program to guard against the effect of early pragmatic language skill disorders on later academic and social abilities.

Participants and methods Twenty-seven children with HL were subjected to pragmatic language assessment using the Arabic version of the Test of Pragmatic Language, 2nd edition and both the Observational Rating Scale and the Pragmatic Profile subtests of the Clinical Evaluation of Language Fundamental, 4th edition.

The results obtained were compared with the results of 27 age-matched and sex-matched NH children. Results The results of this study revealed significantly lower pragmatic abilities in children with HL compared with children with NH.

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Male children were significantly more impaired compared with female children. There were significant correlations between the pragmatic variables and the degree of HL, speech discrimination ability, and the duration of auditory deprivation. Conclusion HL children had significantly lower pragmatic skills compared with NH children, with greater affection correlated with increasing severity of HL and the duration of auditory deprivation. The higher susceptibility to pragmatic impairment in this category of children as well as the importance of pragmatic skills for further social communicative and academic careers should be considered in their rehabilitative plan.

Users Online: Pragmatic abilities of children with hearing loss using cochlear implants or hearing aids compared to hearing children.

J Deaf Stud Deaf Educ ;— Adams C. Practitioner review: the assessment of language pragmatics. J Child Psychol Psychiatry ;— Concurrent validity of a pragmatic protocol. Lang Speech Hear Serv Sch. Ninio A, Snow CE. Pragmatic development. Essays in developmental science. Boulder, CO: Westview Press Coulter L. Sematic pragmatic disorder with application of selected pragmatic concepts.

Why pragmatic impairment? A case study in the comprehension of inferential meaning.

Int J Lang Commun Disord ;— Rinaldi W. Pragmatic comprehension in secondary school-aged students with specific developmental language disorder.

Gallagher TM. Top Lang Disord ;— Perkins MR. Written information with a consent form was sent to parents of all patients referred to a child psychiatry clinic over a month period, restricted to the age groups between 8 and 13 years. For those who were included and agreed to participate, the WISC, CBCL, and TRF results, information on age and referral reasons were collected as part of the clinical activity and transferred to the research database. CCC was collected by mail from parents and teachers.


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Seven participants were excluded based on these criteria: 1 possible intellectual disability based on previous or present clinical diagnosis or total IQ-score below 70 based on WISC-III; 2 possible autism spectrum problems based on referral hypotheses or clinical diagnosis in CAMHS. These exclusion criteria were used to ensure a focus on mental health problems rather than general developmental problems. Benasich et al. In addition to excluding individuals, we controlled for the influence of both general and verbal intelligence in the most central analyses without finding any influence.

Group differences on continuous scales were tested with SPSS Multivariate Linear Model GLM and related by using one or two combined grouping variables and continuous or dichotomous covariates. Analyses of ASEBA scale scores were repeated using unadjusted raw-scores instead of T-scores to ensure that scoring did not alter the conclusions. All other analyses were done using SPSS. A separation in two age-groups 8 to 10 and 11 to 13 years of age was used to compare our results with previous studies using only the first age-span in the Norwegian community and psychiatry samples These rates were not significantly associated with age or gender.

A ROC-curve shows sensitivity of 0. This association was not moderated by gender, age, or intelligence in regression models. The mean teacher reported PC-scores or PLI prevalence were not different from the parental reports and was not associated with gender or age. The parent reports in the present study indicate that pragmatic skills tend to be lower and PLI rates highly prevalent among children with mental health problems, compared to children in the community.

The results also indicate two components, first a moderate negative association between pragmatic skills and mental health problems in general and more so for internalized and non-externalized problems. These problems significant correlations between problem-specific symptom levels and PC-scores, as well as highest PLI prevalence among those with clinical symptom levels.

In contrast, no significant correlations were found between PC-scores and the level of attention problems, rule-breaking behavior, and the potentially stress-related somatic symptoms. However, children with these problems also showed a significantly higher prevalence of PLI than found in a community study Parents and teachers reported the same rate of PLI and rate of externalized problems.

As in earlier studies, they only agreed moderately on who has PLI 27 , and teachers generally seemed less able to detect internalized symptoms. The levels of parent-reported PLI that we found among children referred to child psychiatry were similar to those reported in Canada 2 and in another Norwegian study According to our two-component hypothesis, the association between ADHD and pragmatic language reported by Helland et al.

The stable association with behavioral problems reported by others 32 probably reflects an impact mediated by social skills and social problems. We have found no studies using the ASEBA problem scales in relation to pragmatic language in a psychiatric sample. However, in a general language impaired sample, Coster et al. A study using the SDQ among language impaired children 3 found longitudinal decrease in the associations to conduct and emotional problems but an increase in associated social problems, whereas a group with behavioral problems diagnosed with Kiddie-SADS in a community study 32 found consistent presence of PLI across five years in preadolescence.

Longitudinal studies suggest that the combination of language impairments tend to persist through development and precede and predict mental health problems rather than follow from them 3 , 34 - 36 , although general language problems and social problems also predict future PLI 26 , and that children with language problems show an increase in social and emotional problems through childhood Language, communication, social and emotional development are closely connected throughout child development, and considering them as separate well-defined phenomena could lead to oversimplification.

They are rather aspects of developmental adaptation connected to emotions and self-regulation as possible driving forces according to Bloom Bishop and Baird 27 have maintained that pragmatic language functioning might also be situationally influenced. The strong association between pragmatic skills and mental health problems may arise from simple content overlap between the scales regarding social functioning, however, this interpretation does not hold since the PC items and most of the CBCL problem scales do not include social items.

In this perspective, the strong associations and high rates of ve, the strong associations and high rates of PLI we found in groups with social problems and social withdrawal may be interpreted as results of reduced social interaction and communicative behavior secondary to social problems and emotional problems. However, deteriorating relationships through the years of development may trigger or worsen emotional problems, behavioral and social problems as well as withdrawal, resulting in a further reduction of communication activity in a vicious circle.

The possibility of mutually maintaining effects between poor pragmatic skills and mental health should be studied as individual trajectories rather than longitudinal group differences. Another model worth evaluating is the potential for good pragmatic skills as a protective factor against mental health problems rather than considering pragmatic language problems as a risk factor. A routine evaluation of language and communicative skills has not been a standard element of child psychiatric assessments in Norway or most other countries 2 , 17 , 39 - More important, the effectiveness of common treatment methods for improving communication and social function should be evaluated Finding more comorbidity with PLI than linear associations with PC-scores could indicate a third confounding or mediating factor common for PLI and all mental health problems rather than a direct association.

However, internalized and social problems may be directly associated to pragmatic skills. The scatterplot in Figure 2 indicates that pragmatic skills is a protective factor against mental health problems, rather than that PLI is a risk factor for or consequence of mental health problems.

This clinically meaningful approach could be utilized in prevention as well as treatment, but should be studied more closely longitudinally. Cutoff-line for PLI and regression line for the correlation.

Social (pragmatic) communication disorder: a research review of this new DSM-5 diagnostic category

Using a combined dimensional and categorical approach and a simultaneous differentiation between several dimensions of mental health problems expands and clarifies the relationship between pragmatic skills and mental health. The sample is a strongly selected sample especially suited to highlight the study aim, but not representing the population variation in any of the focused variables, limiting the possibility for general extrapolations.

The sample is, however, a fair representation of mental health problems referred to child psychiatry and has a larger sample than most studies of PLI and mental health. The high prevalence of PLI may reflect a referral practice disproportionally selecting children with combined problems. The lack of a control sample is compensated by comparing to results from reference samples.

Excluding autism and intellectual disability focuses the study more clearly on more common mental health problems with a less strong genetic determination, instead of the less frequent an more genetically determined developmental problems. However, this exclusion implies that the sample is not fully representing the variation among children with PLI. Excluding possible autism based of symptom could have led to over-exclusion of social problems, but resulted only in exclusion of two participants. The limited age distribution implies that the influence of age could not be fully evaluated, although analyses were controlled for age.

The gender imbalance is also problematic for extrapolation to the total population but is typical for CAMHS clinics.

However, control for gender in the analyses did not reveal any gender influence. The way of excluding developmental problems may have missed cases with subthreshold disorders, but exclusion based on subclinical symptoms would have excluded cases with social problems with special interest for the study aim. Several earlier studies have not differentiated PLI from other language difficulties and general learning problems or autistic problems, or separated such developmental problems from emotional, social, and behavioral problems.

The strength of our study is including all these mental health problems and studying linear associations rather than simple comorbidity. The primary weakness is the cross-sectional design, leaving the process of influence to speculation. The CCC has not been broadly standardized or validated in Norway, and the basis for choosing the cut-off of is limited, but strengthened by the results of the study.

Why pragmatic impairment? A case study in the comprehension of inferential meaning

The primary argument for using this cut-off was the possibility for comparing with other studies, and is balanced by also analyzing the continuous PC-scores. We therefore maintain that the results are not merely a product of the cut-off point. Pragmatic skills and mental health problems show general as well as specific associations. PLI seems highly comorbid with mental health problems in general, and low PC-scores show especially strong associations specifically with social problems and withdrawal, but also anxiety and rumination.

Despite comorbidity between PLI and externalizing problems, there is no significant association between PC-scores and externalizing symptom scores, indicating a third common or mediating factor between pragmatic skills and mental health problems. Much earlier research did not differentiate between pragmatic and specific language problems, did not compare specific categories of mental health problems, did not focus on children without more pervasive developmental disorders such as autism and intellectual disability and did not use a combination of dimensional and categorical approach.

These differences in specification may in part explain the inconsistent reports regarding symptom associations and comorbidity reported from research on language impairment and mental health problems. The high prevalence of PLI among children who are referred to child psychiatry suggests the need to introduce a standard evaluation of language and communication skills to be used before referring a child to psychiatry or as a mandatory element of clinical assessment procedures.

The study complies with the Helsinki Declaration. Thanks to the clinicians at Levanger hospital recruiting patient and their parents for the study and contributing in the data-collection as part of their daily clinical work. We use cookies to personalise content and ads, to provide social media features and to analyse our traffic.

Why pragmatic impairment? A case study in the comprehension of inferential meaning.

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