The Impact of Pragmatic Disorders

Abstract

Pragmatic disorders can have serious, adverse consequences for the children and adults who experience them. Pragmatic impairment in children can lead to educational underachievement, failure to establish social relationships with others, and a range of psychological difficulties. As children with pragmatic disorders progress into adolescence and adulthood, their problems are frequently compounded by additional difficulties including a lack of vocational opportunity, difficulty forming personal relationships, participation in criminal activity and the development of substance use disorders. Notwithstanding the significant impact of pragmatic disorders on the lives of affected individuals, these various outcomes are seldom the focus of clinicians and researchers who work with this client group. This chapter addresses this important, but neglected area by examining the impact of pragmatic disorders along a number of parameters. These parameters are (1) psychological impact, which ranges from minor problems such as low self-esteem through to severe psychiatric disturbances; (2) social impact, which includes problems relating to social adjustment and integration; (3) academic impact, which includes performance on a range of indicators of academic achievement; (4) occupational and vocational impact; (5) behavioural impact, which includes externalizing problems such as conduct disorder; and (6) forensic impact, which includes engagement in juvenile delinquency, the use of illicit substances and other forms of criminal behaviour.

Notes

• 1. These interrelationships are amply demonstrated in a recent study by Wadman et al. (2011) of emotional health symptoms (depression and anxiety) in 16-year-olds with specific language impairment. These investigators found that adolescents with SLI experienced significantly more depressive and anxiety symptoms than typically developing 16-year-olds. Also, compared to typically developing controls, adolescents with SLI had significantly lower academic achievement (measured as GCSE/GNVQ points), significantly higher behaviour scores (indicating conduct problems, hyperactivity and peer problems), and reported significantly more bullying. While receptive language ability was weakly correlated with depressive symptoms in these adolescents with SLI, stronger correlations were obtained between depressive symptoms and academic achievement, hyperactivity, conduct problems, peer problems and bullying and depressive symptoms in these subjects. Clearly, each of these separate impacts of specific language impairment contributed to the development of depressive symptoms (psychological impact) in these adolescents with SLI.

• 2. Jerome et al. (2002) reported significantly poorer self-esteem in 34 children with SLI aged 10–13 years than in a group of typically developing children. Low self-esteem in the children with SLI was most evident in the domains of scholastic competence, social acceptance and behavioural conduct. Language impairment accounted for 62, 22 and 15 % of variability in self-esteem ratings in these domains, respectively. There were no significant differences in self-esteem ratings between typically developing children and younger children with SLI aged 6–9 years.

• 3. The specific feature of formal thought disorder (FTD) which was found to be related to parent reports of child stress and anxiety in this study was loose associations. However, Solomon et al. (2008) relate FTD more generally to pragmatic impairments when they state that ‘FTD is in many ways similar to the pragmatic language impairments and unusual verbal behavior that is part of the core diagnostic criteria for autism’ (1475). For discussion of the pragmatic character of FTD in the context of schizophrenia, the reader is referred to Cummings (2013b).

• 4. A similar finding is reported by Bruce et al. (2006). In a study of 76 children diagnosed with ADHD, Bruce et al. (2006, p. 52) stated that ‘[p]roblems with language and pragmatics […] seem to be associated with the typical problems with learning and social skills in children with ADHD’.

• 5. It is worth noting that the ability to represent the mental states of others—a key cognitive skill required for the pragmatic interpretation of utterances—has also been found to be related to social functioning in adults with schizophrenia (Lysaker et al. 2011). For detailed discussion of the role of theory of mind in pragmatic interpretation, the reader is referred to Cummings (2013a).

• 6. There is also evidence of literacy difficulties in children who have a primary diagnosis of pragmatic language impairment. Freed et al. (2011) examined literacy skills in 59 primary school-aged children with pragmatic language impairment. Impaired reading accuracy ability was identified in just over 40 % of these children. On reading comprehension ability, 40.7 % of children with PLI attained scores that were at least one standard deviation below the mean. Written expression scores at least one standard deviation below population norms were identified in just over 40 % of these children. Freed et al. (2011, p. 345) concluded that ‘[t]he clinical implication […] is that in a sub-group of children (PLI) with mainly normal structural language abilities, there is still considerable risk of literacy difficulties’.

• 7. Significant language impairments have also been reported in children with behaviour problems, raising interesting questions about the nature of the relationship between language disorder and behavioural difficulties. Ripley and Yuill (2005) studied 19 boys aged 8–16 years who had been excluded from school. Exclusions were related to verbal and physical aggression, failure to follow rules and possession of an offensive weapon, among other things. Excluded boys performed significantly more poorly on measures of expressive language (but not receptive language) than a control group of non-excluded boys. Among excluded boys, those attending primary school had poorer auditory working memory than controls.

• 8. It will be recalled that a gainful employment rate of 62 % was obtained in the subjects with aphasia in this study. Hinckley (2002, p. 554) remarked that this ‘employment rate was […] unusually high compared to other reports for adults with chronic aphasia’.