call girls in green park DELHI š >ą¼9540349809 š genuine Escort Service šāļøāļø
Ā
What is Pragmatic Language Impairment?
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
ā¢ context is important because:
ā most of what we say is ambiguous
ā most of what we intend to communicate is not
explicitly stated
5. inference
what I say: what I mean:
ā¢ time to go to the ā¢ we are going outside
shops. ā¢ you need to get ready
ā¢ remember itās wet ā¢ it is still raining
outside. ā¢ make sure you put on
a waterproof jacket
and your wellington
boots
6. ā¢ 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
ā¢ these children may be referred to as
having āpragmatic language impairmentā;
āsemantic-pragmatic disorderā or āsocial
communication disorderā
7. origins of PLI: āsemantic-pragmatic
disorderā
ā¢ Rapin and Allen (1982)
ā semantic-pragmatic deficit syndrome used as
descriptive term
ā communicative profile more often seen in autistic
disorder, but could occur in other developmental
populations, including SLI
ā¢ Bishop and Edmundson (1987)
ā semantic-pragmatic disorder used as a diagnostic
term
ā 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)
ā¢ Phonology and syntax unimpaired
ā¢ Verbose
ā¢ Comprehension deficits for connected speech
ā¢ Atypical word choices
ā¢ Poor conversation skills
ā¢ Poor topic maintenance
ā¢ Answering beside the point of a question
9. terminology: move from semantic-pragmatic
disorder to pragmatic language impairment
(PLI)
ā¢ Conti-Ramsden et al (1997) investigated
the communication profiles of 7-year-olds
in language units in the UK
ā sub-group scored within normal limits on
standard language measures, including those
tapping semantic skills
ā same group were described by teachers and
clinicians as having significant pragmatic
impairments
ā¢ note that pragmatic difficulties are not often picked
up on standardised tests
10. terminology: move from semantic-pragmatic
disorder to pragmatic language impairment
(PLI)
ā¢ Bishop (1998) developed the Childrenās
Communication Checklist (CCC) as a
standard measure of pragmatic
impairment in clinically referred
populations
ā items tapping lexical-semantic abilities did not
differentiate those children thought to have
pragmatic impairments from cases of more
typical SLI
11. thusā¦
ā¢ semantic and pragmatic impairments do
not necessarily go hand in hand
ā¢ significant numbers of children in
language units (approx. 30%) have
pragmatic language difficulties
ā¢ ādiagnosisā dependent on childās everyday
communication skill rather than
standardised tests (see Adams, 2002 for
more about diagnosis).
12. is PLI a euphemism for autism?
ā¢ considerable academic and clinical debate
about the status of this ādisorderā
ā one view: PLI is just another word for autism
ā another view: PLI represents the middle
ground between SLI and autism
ā and finally: PLI is descriptive not diagnostic
13. Bishop & Norbury (2002)
ā¢ Children aged 6 ā 12
ā¢ Recruited from specialist schools and
units
ā 31 considered PLI (low scores on Childrenās
Communication Checklist)
ā 19 typical SLI (high scores on Childrenās
Communication Checklist)
ā¢ 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 donāt 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
ā¢ Autistic Diagnostic Interview with parents (ADI)
ā Focus largely on early behaviour and development,
but some current functioning as well
ā¢ Autistic Diagnosis Observation Schedule
(ADOS)
ā Focus on current behaviour only
ā¢ Social Communication Questionnaire (SCQ)
ā 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 donāt meet criteria for autism, but do
for atypical autism or PDDNOS
3. PLI can be found in non-autistic children
ā
20. Non-autistic children with PLI
ā¢ tended to use more stereotyped
language and abnormal intonation than
children with more ātypicalā language
impairment, butā¦
ā were interested in being āsocialā (though
question how reciprocal interaction is)
ā very sociable and talkative
ā used non-verbal as well as verbal
communication
ā excessive interests or repetitive behaviours
were not a feature
21. diagnostic status of PLI
depends on diagnostic criteria
for autism spectrum disorder
ā¢ more importantly, pragmatic deficits are
seen in children with AND without
impairments in structural aspects of
language (i.e. vocabulary and grammar)
ā¢ pragmatic deficits that arenāt picked up on
formal tests may be evident in social
interactions
22. intervention
ā¢ there is evidence that interventions
targeting pragmatic language skills are
effective (Adams et al. 2012)
ā¢ see the Social Communication
Intervention Project (SCIP) for details:
ā¢ http://www.psych-sci.manchester.ac.uk/scip/
23. recommended readings:
ā¢ Adams C. (2002). Practitioner review: the assessment of language pragmatics. Journal of Child Psychology and
Psychiatry, 43( 8), 973-87.
ā¢ 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.
ā¢ Bishop DVM, Norbury CF (2002), ā
Exploring the borderlands of autistic disorder and specific language impairment: A study using standardised diagnostic inst
ā, Journal of Child Psychology and Psychiatry. 43: 917-929.Bishop,
ā¢ 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.
ā¢ 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.
ā¢ 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.