Semantic and Pragmatic
Difficulties
presentation by Glenn Major
speech
Form
Content
Phonology
syntax
Semantics
Language
Use
Pragmatics
Children with Semantic and Pragmatic Difficulties
Can 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
From Bishop’s [1989] model differentiating SPD, AS and Autism
Severe difficulties
autism
Meaningful
verbal
communication
Semantic
Pragmatic
difficulties
Asperger
Syndrome
Mild difficulties
Mild difficulties
Severe difficulties
Social
relationships
and interests
1.
2.
3.
4.
•
•
•
The Tetrad of Impairment
Problems with social interaction and relationships
Problems with communication
Lack of flexibility in thinking and behaviour
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
Rambling and disorganised story
linguistic
socio-cognitive
Poor
narrative
structure
Not being able
to prioritise
main points
History lesson about Henry VIII
“draw the ruler”
child draws measuring stick
linguistic
Not
understanding
‘ruler’
socio-cognitive
Can’t take
context into
account
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 asking for help
linguistic
socio-cognitive
Not knowing
question form
Using too
quiet a voice
to be heard –
perceives not
getting help
“he went up there with it”
linguistic
socio-cognitive
Word finding
difficulty
Not knowing
how much
information to
give
Comic Strip Conversations
Thinking
Saying
Interrupting
Different colours are used to show feelings and to distinguish between
thoughts, feelings, facts and questions. A combination of colours
indicates confusion.
Conversation Colours
GREEN: Good ideas, happy, friendly
RED:
bad ideas, teasing, anger, unfriendly
BLUE:
sad, uncomfortable
PURPLE:
proud
YELLOW:
frightened
BLACK:
facts, things that we know
ORANGE:
questions
COMBINATIONS OF COLOURS: confused
Executive Functioning
Executive 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
Child jumps in with an answer
without thinking
linguistic
Poor inner
language for
problem
solving
socio-cognitive
Poor executive
functioning,
impulsecontrol
child pushes another boy to get
the drink he wants
linguistic
socio-cognitive
Hasn’t got the
language to
ask?
Can’t inhibit
physical
reaction
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
Annoyed Scale
8
Stabs hand with compass
mad
7
Ankle kicked at football
angry
6
Computer switched off during a game
cross
5
Someone stares at you and calls you thick
annoyed
4
Pushed into girls
fed up
3
Horrible food for lunch
irritated
2
You can’t find your magazine
bothered
1
It’s raining on the way to youth club
furious
Annoyed scales used in conflict resolution
Jim
Tom
furious
8
8
furious
mad
7
7
mad
angry
6
6
angry
cross
5
5
cross
annoyed
4
4
annoyed
fed up
3
3
fed up
irritated
2
2
irritated
bothered
1
1
bothered
Group working role cards
Leader
You are responsible for:
•Making sure everyone does their
job and helps
Making sure the group
completes the task on time
Reporter
You are responsible for
•Making notes about what the
group does
Reporting what the group has
done at the end of the task
Ideas person
You are responsible for:
•Thinking up ideas to help the
group solve problems
Explaining your ideas to the
leader
Challenger
You are responsible for:
•Trying to think of what might go
wrong
Explaining your ideas to the
leader
Helper
You are responsible for
•Looking out for who has too
much to do and offering help
Telling the leader who you have
decided to help
Coach
You are responsible for
•Finding ways to encourage
others.
Making sure everyone works
well together
Common, correct
terminology
Scientific or
medical term
Slang or street
language
horse
stomach
boy
Equine
stomach,
abdomen
male
nag
tummy, gut
lad, kid, youth,
bloke
Knockers, boobs,
tits, jugs
breasts
mammary glands
gee gee
tum tum
wee man
(Scotland)
boobies, titties
Playground
Lessons
?
Euphemisms or
baby talk
good
?