Pragmatic Language

Is your child:

• Struggling with social language?
• Appearing gullible?
• Not following the give and take of conversation?
• Struggling to talk to peers, in spite of adequate expressive language?
• Using a formal vocabulary that sounds too mature for his or her age?
• Unable to read nonverbal cues?
• Having trouble interpreting another person’s intent?
• Lecturing others?
• Getting stuck on a topic?

Some children may speak very well but seem unable talk to friends. They may enjoy facts and details and love books about insects or outer space, but they may express little interest in socializing.

If your child has poor social language, you may hear him say “I don’t know” or “I don’t remember” any time you ask about his day or his feelings. He may do well in structured, school-based tasks but may sit alone at recess.

She may say she has lots of friends but may not be able to tell you much about them.

He may say he has friends in class but may not remember their names.

She may know her friends’ heights and eye color but may not recall what they like to do for fun.

Your child may boss other kids around or lecture on a topic without stopping to assess whether anyone is listening. Perhaps, your child never asks how you are or fails to carry on a back-and-forth conversation.

Maybe you sit with your child and watch endless hours of a video game that he just has to show you, feeling like an audience member rather than an engaged participant in a back-and-forth exchange. You may find yourself getting really bored as you listen to your child going on and on about something.

You may find yourself describing your child as literal and inflexible. Your child may have trouble with phrases like ‘zip your lip,’ not understanding that these phrases are figures of speech and are not meant to be taken literally. You may note that your child’s pretend play is not well coordinated or reciprocal. For example, your child may pretend to be a character in a video game, but he may be unable to engage with a playmate or to incorporate other’s suggestions into play.

Clinically, social communication is called pragmatic language.

Pragmatic language refers to the social aspects of speech, such as conversation, reciprocity, reading nonverbal cues, and maintaining a back-and-forth flow of information.

Reciprocity means exchanging information for mutual benefit and requires perspective taking on both sides.

A child must understand what a peer is saying and also take into account his or her interest in a topic. He must know when a peer is disinterested by reading cues like shifting eye contact, appearing squirmy or not responding to what has been said.

She must be able to allow the friend to talk as well, to ask her questions and to stay on topic. In order to have conversations, an individual must be able to do the following:

• think of relevant things to share
• draw on experiences
• pay attention
• take turns
• formulate questions
• know when and how to end the conversation in a polite way.

Social communication is much more complex than vocabulary. Having a good vocabulary requires only memory and learning skills.

In terms of pragmatic language development, it is important to ensure that your child’s skills are on track with peers his or her age. A typical trajectory for pragmatic development would look as follows (Linder & Peterson-Smith, 2008, p.264-269) [4]:

• 2 months: eye contact
• 3 months: social smile
• 4 months: vocalizes to initiate socializing, social laugh
• 5 months: shows preference for familiar faces
• 6 months: refuses objects or toys he or she doesn’t want
• 7 months: plays simple games like peek-a-boo
• 8 months: follows the pointing and eye gaze of caregiver
• 9 months: makes requests and initiates interactions
• 10 months: initiates games, points to desired objects
• 11 months: uses gestures and simple words to get another’s attention
• 12 months: shared enjoyment, takes turns
• 15 months: shared joint attention, follows directions to look at something
• 18 months: responds to simple requests for clarification such as, ‘what?’ or ‘huh’?
• 24 months: takes one to two turns in a conversation

If your child’s skills are not developing as shown in the list above, there may be concerns about your child’s pragmatic language skills.

Challenges with pragmatic language, in the absence of a true language disorder, are likely related to autism, anxiety, or ADHD. A new disorder could explain these challenges,  called Social Pragmatic Communication Disorder, which is a new (DSM-5) diagnosis closely related to autism but without the restricted and repetitive or sensory symptoms.

Autism Spectrum Disorders include challenges in social communication and restricted and repetitive patterns of behavior or interests. Social communication challenges in autism often include difficulty with social communication, back-and-forth conversation and reciprocity. Many individuals with ASD speak very well. They may use formal language and recall detailed information, and they may try to converse.

Conversations that veer off topic or miss the point are common for ASD. For example, if a peer is sharing an emotional story about her dog dying, a child with Autism may ask “what breed was it?” or say “oh, that’s the life cycle” instead of saying “I’m so sorry, that is sad.” This example shows the social language and perspective taking that may be missing in autism.

Attention Deficit Hyperactivity Disorder (ADHD) can be the cause of pragmatic language challenges because of the interplay of inattention, impulsivity and hyperactivity. A child with ADHD may cut a peer off, invade personal space, forget what is being discussed or share information quickly in a stream of consciousness. All of these behaviors impact conversation. Individuals with ADHD do not necessarily have these challenges, but they could.

Social anxiety could impact pragmatics because the level of anxiety your child feels could render him or her unable to think of a response, leading to short answers and social avoidance. Sometimes, an evaluation may be necessary to look at each of these potential factors that could impact language.

In order to improve pragmatic language, a parent can do a number of things.

First, use and model social and emotional language for your child. Talk about your own feelings, and share about your day and how you cope. “Work was stressful for mom today, so I’m going to take a walk. Would you like to come too?”

Second, get your child enrolled in social activities that are low risk, like a Lego club, cooking class, robotics club, swimming, and the like. Find something that has team aspects but is not as competitive as a typical team sport (like soccer or softball). Start with something that has a structure but is about individual performance. Pay attention to who the coach or adult sponsor is, and seek those individuals who are accepting, warm, and not competitive.

Third, practice social conversation with your child, and provide feedback like, “you could ask Sally what she did this weekend.” Provide a bit of structure to family discussions instead of simply asking, “how was your day?” as that question may get little response. Opportunities to play with an adult guiding the conversation can really help your child learn new skills.

Fourth, provide breaks and down time. Give your child time to relax after school, and then have a framework you discuss, like “who I sat with at lunch” or “what game we played in PE”.

Finally, if your child continues to struggle, seek out a social group, social skills therapy and see what supports your child’s school has available. With practice, the authors of Cleape have seen children make great gains in pragmatic language skills.

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• Social skills (Socializing): children with poor pragmatic language are likely to have overall social skill difficulties
• Social anxiety: children with poor pragmatic skills may be very nervous in social situations
• General anxiety: children with poor pragmatic skills may have anxiety
• Expressive language: children with poor pragmatic skills may not be able to express their thoughts and ideas due to a language problem
• Receptive language: children with poor pragmatic skills may have difficulty understanding what others are saying
• Attention problem (Focusing): children with poor attention skills may have trouble with pragmatic language due to the tendency to miss social cues and not listen during social interactions
• Hyperactivity: children who are hyperactive may not be able to communicate socially due to excessive movement
• Conversation: children with poor pragmatic skills are likely to struggle with conversations

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this information does not serve as a diagnosis in any way. See the ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Language Disorder: challenges with expressive or receptive language as well as conversational speech
• Autism Spectrum Disorder: deficits in social communication and restricted interests or behaviors. Social perspective taking challenges impact conversation and social aspects of language, even if your child is cognitively gifted.
• ADHD: challenges with attention or impulsivity that lead to failing to read others’ cues, interrupting, violating personal space, etc. These challenges can certainly interfere with conversational and social speech.
• Social Anxiety Disorder (Anxiety Disorders): significant anxiety in social settings that renders a child mute or limits social and conversational skills
• Intellectual Disability: individuals with low IQ scores often have difficulties with verbal comprehension, particularly for more abstract information, and thus conversation skills can be impacted as it is hard to know what to say
• Social Pragmatic Communication Disorder: similar to autism but without the restricted repetitive behaviors or interests. Often, children say, “I don’t know” frequently and fail to share information despite being very bright

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• Clear Child Psychology: to obtain a customized profile of concerns for your child or consult ‘live’ with a psychologist
• Psychologist or Neuropsychologist: to consider symptoms in mental health context, seek a comprehensive evaluation
• School Psychologist: to test IQ, anxiety, social skills and consider academic impact
• Speech and Language Pathologist: to provide language assessment and then therapy, at school therapy can happen at lunch-time or during recess for a natural social environment. May be in a group or the therapist may come into the classroom to facilitate social learning
• Social Group: Often facilitated by a social worker, counselor or psychologist, a group with other children with an emphasis on social and conversation skills. Make sure your child is matched by approximate age and children have similar language skills for the most success in these groups

These professionals may recommend or administer the following tests for this symptom:

• ADOS-2: test of social communication issues associated with autism
• CELF-5 (including the pragmatics profile): test of language ability
• Child Interview or self-report rating scales: tests for emotional or psychological problems
• Parent and teacher rating scales: tests of emotions, behavior, and social skills such as: BASC-3, SRS, SCQ, Conner’s-3
• TOVA: test of attention
• WISC-V: test of cognitive ability (IQ test)

[1] Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.

• Springer
• Amazon

[2] Jed Baker series of books for social skills and behavioral supports, specializes in ADHD and Autism Spectrum Disorder

Link: www.jedbaker.com

[3] Philofsky, A., Fidler, D. J., & Hepburn, S. (2007). Pragmatic Language Profiles of School-Age Children With Autism Spectrum Disorders and Williams Syndrome. American Journal of Speech-Language Pathology, 16(4), 368-380. doi:10.1044/1058-0360(2007/040)

[4] Linder Ed.D., Toni & Petersen-Smith Ph.D., Ann (2008) Administration Guide for TPBA2 & TPBI2 (Play-Based Tpba, Tpbi, Tpbc).

Amazon: https://www.amazon.com/Administration-Guide-TPBA2-TPBI2-Play-Based/dp/1557668736/

[5] Barton, Erin E & Harn, Beth (2012). Educating Young Children with Autism Spectrum Disorders.

Sage: http://sk.sagepub.com/books/educating-young-children-with-autism-spectrum-disorders

http://www.nasponline.org/books-and-products/products/books/titles/educating-young-children-with-autism

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Previously licensed on: October 22, 2016
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