What Is a Pragmatic Language Disorder?

A child's inability to properly engage with people or interact socially may be due, in part, to a pragmatic language disorder or a pragmatic language deficit.

What is a pragmatic language disorder?

Pragmatic language is the use of appropriate verbal or nonverbal communication in social situations: knowing what to say, how to say it and when to say it. Children with a pragmatic language disorder may not understand the subtle cues of discourse and attempt to dominate a conversation, say nothing, speak out of turn or say something that is not related to the topic. For these children, it is actually difficult for them to learn the rules of social interaction.

In 2013, the American Psychiatric Association (APA) formally recognized pragmatic language deficit in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A pragmatic language disorder can stand alone, be part of an autistic spectrum disorder, or it can be one aspect of an expressive and receptive language disorder. In this way, mental health practitioners can more effectively distinguish between a child who is on the autism spectrum from one who has a pragmatic language disorder.

At this time, researchers do not yet know the cause of pragmatic language deficit, and more research needs to be done. Some researchers believe it has something to do with executive functions in the brain, or an inability to process verbal and visual clues simultaneously and may involve difficulty in perspective taking, i.e. - putting oneself in their conversational partner's shoes.

Signs and symptoms of a pragmatic language disorder

A delay in attaining language milestones

• Difficulty greeting people.
• Difficulty initiating a conversation.
• Difficulty introducing new topics in a conversation.
• Knowing how to continue a conversation.
• Repairing or rewording when not understood.
• Using and understanding nonverbal signals (eye contact, direction of eye gaze, facial expressions, body language).
• Respecting personal space.
• Monopolizing a conversation even after being asked to stop.
• Going off-topic during conversations.
• Inability to adapt speaking style to different listeners.
• Speaking inappropriately in the wrong situations.
• Difficulty understanding riddles, jokes and sarcasm.

Obviously, difficulty with any of these symptoms can be very concerning for a parent. Not only might this challenge affect academic performance, but it could also affect the quality of their child's social development and personal relationships as well.

Diagnosis

Different disciplines may be involved in diagnosing a pragmatic language deficit, but the involvement of a certified speech therapist in the process is critical:

• The symptoms should be seen by the specialist during the early ages of the child, although the full weight of the actions might not occur until many years later.
• The child should be evaluated by a certified speech language pathologist in many different settings.
• Formal one-on-one testing should be conducted between the child and the speech therapist.
• These observations and one-on-one tests will observe the child in many unique settings, where her/his verbal and non-verbal communications skills can be examined.
• An evaluation by a pediatric neurologist, psychologist or developmental pediatrician is often helpful in differentiating between a pragmatic language disorder and other diagnoses.