Understanding Pragmatic Language Disorder in Teens : Guiding Parents

Pragmatic language disorder, also known as social pragmatic communication disorder (SPCD) refers to marked challenges with both verbal and nonverbal communication or language skills used in social settings.

Read on to learn more about pragmatic language disorder, including its causes, symptoms, treatments, and more.

Pragmatic language is the use of appropriate communication or language in social situations. For example, knowing when, what, and how to say. Various skills are involved in the Pragmatic language. Using appropriate language for different purposes, such as:

• Greeting (Saying “Hello. How are you?”)
• Informing (Saying, “I am leaving now.”)
• Demanding (Saying, “Good-bye, pick up the ball)
• Stating (“I am going to the park”)

Changing language depending on the person you are talking with, such as:

• Talking to a teacher Versus talking to a baby
• Speaking in a classroom versus talking in the playground
• Talking to a family member versus talking to a stranger

Following rules for conversation, such as:

• Introducing new topics
• Staying on topic
• Continuing the same topic as the other speaker
• Talking turns while talking
• Using and understanding nonverbal signs like eye contact, facial expression, body language, and so on.
• Respecting personal space

Pragmatic language disorder is a condition in which the affected individual has difficulty communicating both verbally and nonverbally in different social circumstances.

Pragmatic language disorder might be linked with other communication disorders. However, as of 2013, this condition is now considered a separate category as defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.⁽¹⁾

Difficulties with language pragmatics and social communication are generally associated with other conditions like Attention-deficit/hyperactivity disorder (ADHD), aphasia, dementia, cerebral palsy, Autism spectrum disorder (ASD), Down syndrome, Fetal alcohol syndrome, traumatic brain injuries, spoken language disorders, and written language disorders. With all these conditions, trouble with social communication could be one part of a bigger picture.

At present, researchers do not know what exactly causes this disorder to develop on its own.  However, Pragmatic language disorder is specifically related to a disruption in the language centers of our brain.

Although the exact cause of pragmatic language disorder is unknown, some researchers believe that it might have a genetic component and may also run in families who have a history of pragmatic language disorder.⁽²⁾

Some signs of this disorder overlap with neurodevelopmental disorders like autism and ADHD. Pragmatic language disorder was earlier thought to coexist with ADHD and other neurological and genetic conditions.⁽³⁾ However, now it is known that pragmatic language disorder is not caused by autism, ADHD, or any other neurodevelopmental condition.

Children should have time to sufficiently develop their language skills before pragmatic language disorder can be detected. Therefore, a diagnosis of the condition should not be made until they are at least four to five years old.⁽²⁾

Children or individuals with pragmatic language disorder would demonstrate the following symptoms.

• They might have a general language delay.
• They can have trouble understanding the meaning of what others are saying to them.
• It would also be difficult for them to use language appropriately to get their needs met and to interact effectively with others.
• Children with pragmatic language disorder also have difficulty using language socially, and this could keep them away from working together with others at school or taking part in social functions or get-togethers.
• Due to the difficulties in using language appropriately, they might also turn rude at times and have difficulties keeping friends.
• Such children will not understand when to take turns while talking and not understand how to read nonverbal signs that the listener sends them. There would also be difficulty for them to be on the topic and send appropriate communication.

Treatment for Pragmatic language disorder could be multifaceted. While planning for its treatment, certain things should be considered. These include:

• Considering differences in cultural and societal norms.
• Understanding the importance of involving both, the affected individual and their family members.
• Focusing on functional outcomes.
• Tailoring goals to address patient’s individual needs.

There are several treatment options for pragmatic language disorder. Some treatment approaches might work better for some individuals than others. Let us now learn about these treatment options.

Behavioral treatments and interventions work by adjusting existing behaviors or teaching new appropriate behaviors. This is usually done by identifying positive behaviors. Behavioral therapies can be done in one-on-one or peer group settings.

Speech therapy or speech and language therapy focuses on communication and social interaction. This treatment approach helps individuals who have communication disorders. ⁽⁴⁾ Speech-language pathologists (SLPs) play a major role in the diagnosis and treatment of those people who are affected by pragmatic language disorder or social communication disorder.

Social communication treatments are various methods that help in improving social skills. These include:

Comic strip conversations show a conversation between two or more individuals in a visual format. This helps the reader to slow down and understand the information provided within the conversation.

The SCORE skills strategy is a small-group program that helps individuals focus on five skills; including sharing ideas, offering help or encouragement, complimenting others, recommending changes kindly, and exercising self-control.

This intervention program focuses on clearly understanding the intentions of communication. Such interventions include learning social scripts and reflecting on past encounters.

Social scripts are used for teaching children how to use language during social interactions. These scripts are used less and less as children gradually adjust to such interactions.

Social skills groups are the groups that use role-play scenarios to help people understand how to appropriately interact.

Although different types of treatments, therapies, and interventions can help treat pragmatic language disorders, there are also certain things parents can do to help the affected children at home to reinforce what they have learned. These things include:

• Ask them to tell you a story and ask them questions when you feel you require more information. Help your children understand why you need this information.
• Practice nonverbal cues like smiling, crossing your arms, frowning, and rolling your eyes with your children, and ask them to tell you what each of these signs means and how they are important.
• Help them understand the topics in conversations and stories that they participate in, listen to, or read.
• Practice beginning conversations with a greeting and appropriately ending conversations.
• Role-play several situations in which your child has to explain the same thing to different people. Talk to them about how they have to adjust their language while talking to different people.

Pragmatic language disorder is a type of communication disorder when people cannot communicate effectively in social settings. Although some of its symptoms overlap with other neurodevelopmental disorders like ADHD or autism, now it is a separate disorder.

If you suspect you or your loved ones are having trouble with social communication and need treatment, then consult with a doctor or specialist for help with the next steps.

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