Pragmatic Disorders and Social Communication

Abstract

As social animals, humans must establish mutually sustaining relationships with each other. Social communication is the principal mechanism by means of which this is achieved. This chapter examines the nature of social communication and the role of pragmatics in this form of communication. It is argued that a range of language and cognitive skills underlie social communication. Chief among these skills is pragmatic competence in the use and understanding of linguistic utterances. To the extent that pragmatics plays an important role in social communication, we may expect social communication to be disrupted in clients with pragmatic language disorders. This expectation is confirmed by studies that have investigated social communication skills in clients with clinical conditions in which there are marked pragmatic impairments (e.g. autism spectrum disorders). A previously somewhat neglected area of clinical investigation, social communication is increasingly finding its way into the assessment and treatment of clients with pragmatic disorders. This chapter examines some of the instruments and techniques which are used for this purpose. The chapter concludes with a discussion of how future research can usefully contribute to an understanding of social communication, both on its own terms and as a clinical construct.

Notes

• 1. Of course, a range of skills beyond the three domains listed are also necessary for social communication. A speaker must be able to decode language, attend to and perceive auditory and visual stimuli, and retrieve information from memory in order to engage in social communication. However, these skills are not in any way unique to social communication—they are fundamental to a number of behaviours—and so will not be discussed further in this context.

• 2. This tendency is exemplified by Russell (2007) who states that ‘[s]ocial communication or pragmatic impairments are characterized […] as involving inappropriate or ineffective use of language and gesture in social contexts’ (483).

• 3. Consensus on a definition of social cognition is hard to find. But there is general agreement that theory of mind is a central topic of social cognitive research. For a brief overview of social cognition, and its relation to pragmatics, the reader is referred to Scott-Phillips (2010).

• 4. Social models of disability and functioning are now integral to internationally recognized classification systems such as the International Classification of Functioning, Disability and Health (ICF) (World Health Organization 2001). The ICF uses a biopsychosocial model of disability which is an integration of medical and social models of disability.

• 5. A diagnosis of social communication disorder specifically excludes individuals with autism spectrum disorder (ASD). This is because children with social communication disorder lack the additional difficulties seen in ASD (e.g. repetitive behaviours and restricted interests).

• 6. The assumption of most clinical studies is that ToM deficits play a causal role in the social communication difficulties of patients. However, some investigations have considered a different relationship between ToM and social communication. Milders et al. (2006) ask if more limited opportunities for social communication following TBI might not lead to a deterioration in ToM skill: ‘changes in patients’ social interactions and reduced social communication might affect ToM ability, and ToM deficits occurring shortly after injury may further deteriorate as a result of the patients’ impoverished social environment’ (2006, p. 400). Milders et al. did find ToM impairments in their patients with TBI both shortly after injury and at 1-year follow-up. However, ToM skills did not deteriorate during this time, leading these investigators to conclude that the ToM impairments of these patients were a direct consequence of brain damage, and not the result of any changes in the social environment during the year to follow-up.

• 7. In describing their motivation for using the SDI, Hooker and Park (2002) capture a problem of most clinical measures which assess social functioning—their failure to assess communication as an independent aspect of social functioning. Hooker and Park (2002, p. 43) state that ‘whereas previous measures have embedded communication problems into other measures of functioning—such as relationship problems—this measure [the SDI] has a specific communication subscale’.

• 8. Solomon et al. (2011) found that individuals (aged 11–18 years) at clinical high risk for psychosis and individuals (aged 14–20 years) with first episode psychosis displayed significantly poorer scores than typically developing individuals on the Communication subscale of the Social Responsiveness Scale (Constantino 2002). However, the pragmatic language skills of clinical subjects, as measured on the Scripted Language, Context and Non-Verbal Communication subscales of the CCC-2 (Bishop 2003), were comparable to those of typically developing individuals.

• 9. It is worth remarking that the number of studies which examine this relationship in adults is very small indeed. Typically, adult studies neglect social communication in favour of social integration and social functioning, with pragmatic language skills related to the latter social constructs rather than to the former one. Social integration is often investigated in adults with TBI. In this way, Galski et al. (1998) reported that discourse and pragmatic behaviours correlated with social integration in 30 patients with TBI more strongly than age, gender, education and other conventional psychosocial factors. Also, Struchen et al. (2011) reported that two social communication measures contributed significantly to social integration in 184 adults with TBI.

• 10. The reader is referred to Chap. 3, this volume and to Chap. 5 in Cummings (2009) for discussion of the cognitive substrates of pragmatic disorders.

• 11. Given the widespread clinical use of functional communication measures, a question of some interest is the exact relationship between functional communication and social communication. Although there is no definitive answer to this question—and the author is not aware of any research that has addressed this relationship—it is clear that both notions are taken to include similar behaviours. The National Joint Committee for the Communication Needs of Persons with Severe Disabilities defines functional communication skills as 'forms of behavior that express needs, wants, feelings, and preferences that others can understand [...] Functional communication skills vary in their form and may include personalized movements, gestures, verbalizations, signs, pictures, words, and augmentative and alternative communication devices.

• 12. Few studies have attempted to establish the prevalence of social communication disorders in the general population. One exception is Skuse et al. (2009) who estimated the prevalence of social communication disorders in a general population of 8,094 children (4,167 boys and 3,927 girls) who were part of the Avon Longitudinal Study of Parents and Children (Golding et al. 2001). Social communication disorders were assessed on the Social Communication Disorders Checklist (SCDC) (Skuse et al. 2005). The 12 individual symptoms rated by parents on the SCDC revealed that these symptoms were ‘very or often true’ in 0.7–3.9 % of girls, and in 2.3–6.2 % of boys. Boys had mean scores on the SCDC which were 30 % higher than those of girls. There was a large and significant association between SCDC scores and the pragmatic competence score on the Children’s Communication Checklist (Bishop 1998). Social communication deficits correlated positively with peer relationship problems for both boys and girls, with SCDC scores contributing 4.4 % of the variance for boys and 1.9 % of the variance for girls.

• 13. For reviews of social communication assessments and treatments in children, the reader is referred to Landa (2005) and Gerber et al. (2012), respectively.

• 14. The issue of the reliability of carers and parents as informants has been examined by comparing their ratings of clients’ social communication skills with those of professionals, typically speech and language therapists and teachers. Bishop et al. (2006) examined inter-rater reliability between parent and teacher ratings on the Children’s Communication Checklist. Inter-rater reliability was generally weak with correlations exceeding 0.5 on only the speech, syntax and coherence scales and on the General Communication Composite of the checklist. Bishop and Baird (2001) found that correlations between ratings for parents and professionals on the individual pragmatic scales of the checklist ranged from 0.30 to 0.58, with a correlation of 0.46 for the pragmatic composite. When the checklist was completed by teachers and speech and language therapists, Bishop (1998) reported inter-rater reliability and internal consistency of around 0.80 on the five pragmatic subscales. These findings clearly indicate that clinicians need to be somewhat circumspect about the judgements and reports of informants in matters relating to social communication.

• 15. The adult version of the CCC—the Communication Checklist-Adult (CC-A) (Whitehouse and Bishop 2009)—is a 70-item questionnaire which is completed by a respondent who has regular contact with the individual undergoing assessment. It is suitable for use with adults who have a developmental disorder such as specific language impairment, ASD, Down’s syndrome, fragile X syndrome, and learning difficulties, but may also be used with adults who have an acquired disorder such as a head injury.

• 16. That Andreasen (1986) intended the TLC to represent a shift away from viewing linguistic abnormalities in schizophrenia as the manifestation of thought disorder towards viewing them as a communication disorder is evident in the following comments: ‘The various disorders which comprised the concept of “formal thought disorder” can be better conceptualized as “disorders of thought, language, and communication”. If viewed from an empirical perspective, most of them are in fact disorders of communication, and the notion of thought need only be invoked to explain a few of them’ (473).

• 17. Adams (2005, p. 181) defines social communication as ‘the interdependence of social interaction, social cognition, pragmatics and language processing’.

• 18. Kopelowicz et al. (2006) convey something of this breadth when they state that social skills comprise ‘the full range of human social performance’ (S12). Their list of these skills is particularly comprehensive and covers many of the same behaviours (e.g. social perception) that are integral to social communication: ‘verbal, nonverbal, and paralinguistic behaviors; accurate social perception; effective processing of social information to make decisions and responses that conform to the normative, reasonable expectations of situations, and rules of society; assertiveness; conversational skills; skills related to management and stabilization of one’s mental disorder and expressions of empathy, affection, sadness, and other emotions that are appropriate to the context and expectations of others’ (S12).