Semantic and Pragmatic Difficulties

presentation by Glenn Major

speechForm

Phonology syntax

Content

Semantics

Use

Pragmatics

Language

Children with Semantic and Pragmatic DifficultiesCan have difficulty

• Assimilating and assigning meaning to information and experiences

• Initiating, maintaining and finishing a conversation• Understanding and relating new (particularly abstract) word

meanings and concepts• Interacting with peers and/or adults• Using and interpreting non-verbal language appropriately• Understanding their own or other’s thoughts and/or

feelings• Choosing the appropriate style or register of speech• Give the right amount of information• Repairing conversational breakdown• Inferential meaning

They may• Use fluent, well-formed sentences• Be verbose with adequate speech

articulation• Have a good vocabulary, but not always

use words appropriately• Use familiar, learnt scripts (sometimes

from videos or cartoons)• Say more than they actually understand

• Defined by Rapin and Allen in 1983 as Semantic and Pragmatic Syndrome – severe receptive deficits and expressive deviations

• Bishop and Rosenbloom (1987) modified the term to Semantic and Pragmatic Disorder

• Shields (1996) compared children with SPD, ASD and SLI. Found SPD and ASD groups the same, SLI better on Theory of Mind tasks

• Gagnon (1997) found no differential symptoms between SPD and ASD – questioned use of diagnostic category

• Shields (1998) found children with SPD continued to have social difficulties, even after language improved

• Rapin and Allen (1998) explained their current position:• SPD occurs most often within autism • Questioned use of SPD diagnosis to avoid upsetting

parents with the ‘A’ word

• National autistic society does not recognise SPD as diagnostic term

• DSM 1V does not recognise SPD• Bishop (1998 onwards) now refers to Pragmatic

Language Impairment (PLI):• PLI Pure involves only pragmatic language difficulties• PLI Plus involves pragmatic language difficulties plus

autistic traits

Semantic Pragmatic difficulties

Asperger Syndrome

autism

Meaningful verbal

communication

Social relationshipsand interests

Mild difficulties

Mild difficulties Severe difficulties

Severe difficultiesFrom Bishop’s [1989] model differentiating SPD, AS and Autism

The Tetrad of Impairment1. Problems with social interaction and relationships2. Problems with communication3. Lack of flexibility in thinking and behaviour4. Sensory processing problems• In high functioning autism, semantic pragmatic

difficulties and Asperger Syndrome, intellectual capacity is within the normal range

• High functioning autism, semantic pragmatic difficulties and Asperger Syndrome can also include motor clumsiness and problems with handwriting. Also organisational skills

• Estimates are that 1 in 100 is affected by autistic spectrum disorder

The procedure is actually quite simple. First you arrange things into groups. Of course, one pile may be sufficient depending on how much there is to do. If you have to go somewhere else due to lack of facilities, that is the next step; otherwise you are pretty well set. It is important not to overdo things. That is, better to do too few things at once rather than too many. Otherwise complications can arise. A mistake can prove expensive as well. At first the whole procedure will seem complicated. Soon, however, it will become just another facet of life. It is difficult to foresee any end to the necessity for this task in the immediate future, but one can never tell. After the procedure is completed, one arranges the materials into different groups again. Then they can be put into their appropriate places. Eventually, they will be used once more, and the whole cycle will have to be repeated. However, that is part of life

• Often things are arranged into groups depending on their colour

• Most people have the facilities in their own homes

• In the past this procedure took much longer before facilities were mechanised

Central Coherence

The ability to draw together diverse information to construct higher level meaning in context

•Seeing detail rather than the whole•Incoming information is not linked in a meaningful way

Difficulties with central coherence can lead to •Cognitive overload •Difficulty with study skills•Insistence on routine•Having to complete the whole routine•Specific interests

Poor narrative structure

Not being able to

prioritise main points

Rambling and disorganised story

linguistic socio-cognitive

Not understandin

g ‘ruler’

Can’t take context into

account

History lesson about Henry VIII

“draw the ruler”child draws measuring stick

linguistic socio-cognitive

Theory of Mind

Not understanding others’ intentions, thoughts, beliefs, desires, attitudes, and emotions

Not understanding that others don’t know what you know

A difficulty unique to autism?

Link between theory of mind, social interaction and rigidity of thought

Not knowing question form

Using too quiet a voiceto be heard – perceives not getting help

Not asking for help

linguistic socio-cognitive

Word finding difficulty

Not knowing how much information

to give

“he went up there with it”

linguistic socio-cognitive

Thinking Saying InterruptingDifferent colours are used to show feelings and to distinguish between thoughts, feelings, facts and questions. A combination of colours indicates confusion.Conversation ColoursGREEN: Good ideas, happy, friendlyRED: bad ideas, teasing, anger, unfriendlyBLUE: sad, uncomfortablePURPLE: proudYELLOW: frightenedBLACK: facts, things that we knowORANGE: questionsCOMBINATIONS OF COLOURS: confused

Comic Strip Conversations

Executive FunctioningExecutive Functioning is the way that people monitor and control their actions. Without executive functioning, you have bad organisational skills; you are unable to lay out a logical plan.

A broad category including•working memory•planning•cognitive flexibility•inhibitory control

Link between theory of mind and executive function

Behaviour and lack of inhibitory control

How we can help

Poor inner language for

problem solving

Poor executive

functioning, impulse-control

Child jumps in with an answer without thinking

linguistic socio-cognitive

Hasn’t got the language

to ask?

Can’t inhibit physical reaction

child pushes another boy to get

the drink he wants

linguistic socio-cognitive

Developing Pragmatics

• Understanding when & why things go wrong and the need to do something

• Raise awareness of and teach the skill or strategy– Highlight the skill – flag up– Observe– Commentary: why this is important– Make the links – doing the skill and outcome – Component parts of the skill– Rules (if possible)– Observe/discuss – different situations

• Practise – increasingly less control, increasingly in context• Feedback and evaluate• Praise when right as well as saying when it’s wrong• Lighter touch guidance – prompts

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bothered

irritated

fed up

annoyed

cross

angry

mad

furious

It’s raining on the way to youth club

You can’t find your magazine

Someone stares at you and calls you thick

Horrible food for lunch

Ankle kicked at football

Computer switched off during a game

Pushed into girls

Stabs hand with compass

Annoyed Scale

Tom Jim

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bothered

irritated

fed up

annoyed

cross

angry

mad

furious 8

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1

furious

mad

angry

cross

annoyed

fed up

irritated

bothered

Annoyed scales used in conflict resolution

CoachYou are responsible for•Finding ways to encourage others.Making sure everyone works well together

LeaderYou are responsible for:•Making sure everyone does their job and helpsMaking sure the group completes the task on time

ReporterYou are responsible for•Making notes about what the group doesReporting what the group has done at the end of the task

Ideas personYou are responsible for:•Thinking up ideas to help the group solve problemsExplaining your ideas to the leader

ChallengerYou are responsible for: •Trying to think of what might go wrongExplaining your ideas to the leader

HelperYou are responsible for•Looking out for who has too much to do and offering helpTelling the leader who you have decided to help

Group working role cards

Common, correct terminology

Scientific or medical term

Slang or street language

Euphemisms or baby talk

horsestomach

boy

breasts

Equinestomach, abdomen

male

mammary glands

nagtummy, gut

lad, kid, youth, bloke

Knockers, boobs, tits, jugs

gee geetum tumwee man

(Scotland)boobies, titties

? ?

Lessons Playground

good