Reference Work Entry

Comprehensive Guide to Autism

pp 533-550

Pragmatic Language in Autism: An Overview

  • Yan Grace LamAffiliated withDepartment of Psychological Studies, Hong Kong Institute of Education Email author 

Abstract

Pragmatics concerns with the acquisition of knowledge necessary for the appropriate and effective use of language in everyday social contexts. It is well known that pragmatic deficits are symptomatic of children with Autism Spectrum Disorders, but little is known about how they are related to the cardinal features of the disorders.

In this chapter, studies on pragmatic behaviors specific to Autism Spectrum Disorders were reviewed. Issues pertaining to methodologies and interpretation of findings were addressed. Findings from previous studies were discussed in relation to the prevalent cognitive impairments and brain anomalies observed in Autism Spectrum Disorders. Future efforts should be directed to define the domain of inquiry as well as to develop tools that can detect pragmatic skills at different developmental stage.

Abstract

Pragmatics concerns with the acquisition of knowledge necessary for the appropriate and effective use of language in everyday social contexts. It is well known that pragmatic deficits are symptomatic of children with Autism Spectrum Disorders, but little is known about how they are related to the cardinal features of the disorders.

In this chapter, studies on pragmatic behaviors specific to Autism Spectrum Disorders were reviewed. Issues pertaining to methodologies and interpretation of findings were addressed. Findings from previous studies were discussed in relation to the prevalent cognitive impairments and brain anomalies observed in Autism Spectrum Disorders. Future efforts should be directed to define the domain of inquiry as well as to develop tools that can detect pragmatic skills at different developmental stage.

Introduction

The language of children with autism is usually delayed, and useful language may not develop at all. In fact, half of the autism population never develops expressive language (Paul 1987) and a significant majority produces speech that is at times unintelligible, characterized by echolalia, pronominal reversals, and stereotypy (Paul 1995). Sometimes, a word or phrase may be used in limited contexts (e.g., “food” is used only when the child is seated at the dining table), and overgeneralized utterances may be employed to serve the child’s communicative needs (e.g., say “excuse me” every time the child requests for a desired object) (Cantwell et al. 1978). For those children with autism that do develop expressive language, their abnormal use of social language (pragmatics) is the most obvious feature of their condition.

Pragmatics covers such notions as how thoughts are transformed into language during social interaction, the selection of words relative to the social context, and the impact of such choices on the listeners (Thompson 1997; Tager-Flusberg 2000). At a glance, one may argue that pragmatic studies overlap with areas like semantics (which is concerned with speaker’s intentions, the impact of an expression on the listener, and its implication within the cultural context). However, it is possible to differentiate the two. For example, the man who comments that his girlfriend looks “horrible” in her yellow boots has a problem with pragmatics; if instead he had said she looks frightening in her boots, the problem would be one of semantics.

Thompson (1997) suggested central facets of pragmatic competence that could distinguish it from other major areas of linguistic enquiry. First, pragmatic competence requires knowledge of how language is construed and its permissible range of use. Second, it taps the knowledge that we share the world with others. Lastly, it requires picking up cues from the language and social behavior of others and an understanding of the rules that govern behavior in a social context. In other words, pragmatic competence allows an individual to speak intelligibly, to behave appropriately, and to understand the perspective of others. Hence, several cognitive prerequisites are necessary for sophisticated pragmatic development in a child (see Fig. 1).
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Fig. 1

Cognitive prerequisites for pragmatic development in children. Pragmatic abilities are only observable when one is engaged in a social conversation. Other than sound expressive language and comprehension, the cognitive abilities to discern and control one’s behavior decide the level of one’s pragmatic ability

Russell and Grizzle (2008) had meticulously defined pragmatic modes of engagement with illustrative descriptions and examples (see Table 1).
Table 1

Pragmatic modes of engagement (Russell and Grizzle 2008)

 

Illustrative descriptions

Positive and negative examples

Precursors/enablers

Nonverbal communication

Probes an individual’s ability to attend to and understand nonverbal behavior as communicative

Maintains eye contact, appropriate body position during conversations

Discourse attentiveness and empathy

Probes an individual’s ability to attend to the communication partner’s experience and/or their communications, and/or engage in empathic listening

With familiar adults, seems inattentive, distant or preoccupied

Speech characteristics and fluency

Probes an individual’s ability to make speech sounds, articulate appropriately, and/or to use prosody

Can vary their tone of voice

Rituals, greetings, and goodbyes

Probes an individual’s ability to participate in communicative games, use typical greetings/farewells, terms of address, ritualistic politeness formulas (e.g., please and thank you)

Makes/responds to greetings to/from others

Vocabulary

Probes an individual’s ability to use vocabulary appropriately and/or to evidence appropriate understanding and use of a certain number or class of words

Student uses age-appropriate (or better) vocabulary words

Comprehensibility

Probes an individual’s ability to engage in understandable communicative discourse

It is hard to make sense of what s/he is saying even though the words are clearly spoken

Basic exchanges/rounds

Conversational turn taking

Probes an individual’s ability to take turns in a communicative exchange, and to assume conversational roles of speaker and listener in an appropriate manner

Observes turn-taking rules in the classroom or in social interactions

Topic control and maintenance

Probes an individual’s ability to initiate, maintain, and/or change topics

Maintains topics using appropriate strategies

Requests

Probes an individual’s ability to formulate requests, questions of various form, and answers

Asks for/responds to requests for clarification during conversations

Speech acts

Probes an individual’s ability to select among and use a variety of speech acts

Apologizes/accepts apologies appropriately

Syntax/grammar

Probes an individual’s ability to formulate grammatical sentences, use proper tenses, or have subject and verbs agree

Leaves off past tense – ed endings on words

Interlocutor variety

Probes an individual’s ability to communicate with a variety of communication partners in a variety of circumstances

Adjust/modifies language-based on the communication situation

Extended literal and nonliteral discourse

Negotiations, directions, and instructions

Probes an individual’s ability to negotiate in conversation, provide directions, instructions, or recipes

Can disagree appropriately and offer compromises

Theory of mind and emotion language

Probes an individual’s ability to use internal state cognitive or emotional language, cognitive or emotional perspective taking, or attributions of intentions, desires, etc.

Offers/responds to expressions of affection, or belief appropriately

Narrative

Probes an individual’s ability to use narratives, stories, scripts, or descriptions in their communicative discourse

Gets the sequence of events muddled up when trying to tell a story

Nonliteral language, use of indirection, and presupposition

Probes an individual’s ability to use indirect and/or nonliteral expressions, and/or to use and understand presupposed knowledge in communication

Understands implied group/school rules

Gricean principles

Probes an individual’s ability to abide the core set of Gricean maxims of quantity (be informative but not more than necessary), quality (do not say what you know is false or what you lack evidence for), relation (be relevant), and manner (avoid obscurity and ambiguity, be brief and orderly), each in accord with the principle of co-operativeness (make your conversational contribution fitting to the accepted purpose or direction of current talk)

Tells people things they already know

Assessment of Pragmatic Language

Russell and Grizzle (2008) summarized most assessment tools used for measuring pragmatics with references to age appropriateness (see Fig. 2; reproduced from Russell and Grizzle 2008).
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Fig. 2

Age appropriateness for pragmatic language questionnaires and tests (Reproduced from Russell and Grizzle 2008). Pragmatic behaviors become sophisticated as an individual maturates. Therefore, it is common that a pragmatic test is administered to individuals of a specific age range

Unlike other language disorders, pragmatic impairments only surface when two people are engaged in social interaction. The best test of pragmatic competence should be during a social conversation in a quasi-experimental environment, but in reality such a setup is rarely encountered.

In fact, the most commonly used means to assess and describe pragmatic behaviors are observation and the coding of behaviors with checklists and behavioral profiles. For example, the Children Communication Checklist of Bishop (1998, 2003) was employed in several studies with autism participants (see Table 2).
Table 2

Tools recently used to measure pragmatic language in autism

Available tools

Studies employed with autism participants

Children’s communication checklist

 

(Bishop 1998, 2003)

Philofsky et al. 2007; Tanaka 2007; Verte et al. 2006; Volden and Philips 2010

The Comprehensive Assessment of Spoken Language (CASL; Carrow-Woolfolk 1999)

Reichow et al. 2008

Pragmatic Rating Scale (PRS; Landa et al. 1992; Landa 2000)

Paul et al. 2009; Lam and Yeung 2012

Test of Pragmatic Language (ToPL; Phelps-Terasaki and Phelps-Gunn 1992)

Volden and Philips 2010; Young et al. 2005

The Strong Narrative Assessment Procedure (SNAP; Strong 1998)

Young et al. 2005

Pragmatic language covers a variety of behaviors. Different measurement tools of pragmatics will, however, be specifically sensitive to a restricted range of pragmatic behaviors

Among the few standardized tests that have been recently used to investigate pragmatic behaviors pertaining to autism, the Pragmatic Rating Scale (PRS) (Landa et al. 1992) is one of the few that can be used in a semi-social setting. Landa et al. (1992) observed that parents of autism children exhibited atypical pragmatic behaviors and eventually developed the PRS to assess social language use in these parents. Therefore, it is particularly suitable for a normal population as well as children with special needs. The PRS categorizes 19 pragmatic anomalies that can be observed during a relatively lengthy interaction. Each behavior is clearly defined to enable consistent ratings by examiners without formal training in speech pathology. Items other than “overly direct” and “indirect” are grouped into three subscales: disinhibited social communication, awkward/inadequate expression, and odd verbal interaction (see Table 3). At this point, it is worth reemphasizing the importance of matching verbal intelligence, as ensured in the current investigation, when addressing complex language ability.
Table 3

Items in three subscales of the pragmatic rating scale

Disinhibited social communication

Awkward/inadequate expression

Odd verbal interaction

“Overly candid”

“Insufficient background information”

“Overly formal”

“Overly talkative”

“Vague”

“Little conversational to-and-fro”

“Overly detailed”

“Awkward expression of ideas”

“Atypical greeting”

“Out-of-synchrony communicative behavior”

“Inadequate clarification”

“Odd humor”

“Abrupt topic change”

“Terse”

“Inappropriate topic”

“Topic preoccupation”

  

“Confusing account”

  

The 19 pragmatic anomalies are grouped into three subscales. The two items which were not included in the PRS subscales are as follows: “overly direct” and “indirect”

Besides the PRS, the Test of Pragmatic Language (ToPL) (Phelps-Terasaki and Phelps-Gunn 1992) measures pragmatic ability in six areas including physical setting, audience, topic, purpose (speech acts), visual-gestural cues, and abstraction. The test includes 44 items, each of which establishes a social context. The examiner displays a picture with a verbal prompt, and the response of the testee to each item is recorded. However, unlike PRS that requires an observation of a 15-min conversational exchange, the ToPL demands a longer observation from 45–60 min. Another standardized tool is the Comprehensive Assessment of Spoken Language (CASL; Carrow-Woolfolk 1999). The test, however, is not designed specifically for pragmatics but included also aspects of semantics and syntax.

The latest attempt to develop measurement tool for pragmatic oddities in autism is perhaps the study of de Villiers and her colleagues (De Villiers et al. 2007). Using a functional linguistic paradigm, they analyzed semi-structured conversations of 46 children and adolescents with high-functioning autism. Several constructs pertaining to pragmatic difficulties in conversation were reduced. This tool illustrated the characteristics of language use in autism and was able to evaluate the change in degree of pragmatic impairments related to the condition.

Pragmatic Deficits in Autism

Language comprises important communicative signs and symbols, many of which are abstract. People with autism who do not appreciate abstraction tend to speak in a rigid or overly literal fashion. An example is the child with autism who responded “I cannot smell anything” when you say “I smell a rat.” In our daily life, we often communicate using language that is abstract and relies only on conventions to understand the real meaning behind the words. Idioms, proverbs, and figures of speech are frequently embedded in our conversation and reading materials. Lacking the ability to comprehend abstract meanings, individuals with autism may find themselves overwhelmed in the social world and their problems surface when they try to communicate. In social interaction, we are bound by a large set of rules that determine our choice of language. Yet, improper use of language should not be simply interpreted as a pure pragmatic issue. For example, the above example of the child not understanding the idiom of “smelling a rat” speaks to a “semantic” as well as a “pragmatic” problem in language. If children with autism do not understand abstract and/or multiple meanings (a “semantic” concern), then it is reasonable that they cannot use them appropriately (a “pragmatic” issue). Similarities between individuals with an autistic spectrum disorder and specific pragmatic language learning impairment were reported (Rapin 1987), and comorbidity of autism and semantic-pragmatic disorder (Gagnon et al. 1997) has attracted attention.

Semantic – pragmatic disorder is characterized by a complex expression clearly articulated but without proper understanding of its implications or permissible range of use. While these features may be common to both conditions, pragmatic problems are only a part of the complex autism phenotype. Rapin (1987) found that among 35 children with semantic-pragmatic disorder, 28 also had a diagnosis of autism, a concordance rate of 80 %. However, there are many children with semantic-pragmatic syndrome who do not exhibit characteristic behaviors, such as lack of imaginative play, insistence on sameness, and severe social impairments, as in fully fledged autism. Moreover, pragmatic deviance in autism usually does not violate any rules of syntax, phonology, or semantics (Bartak et al. 1975; Beisler et al. 1987; Ramondo and Milech 1984; Tager-Flusberg 1981, 1989, 1991; Wetherby and Prutting 1984).

Tager-Flusberg (1989) argued that the cardinal feature of language in autism is the lack of “synchrony” between form and function. In contrast to language of normal children, links between different components of the linguistic system in children with autism are weak or even missing. While syntactic and lexical aspects (form) of language in autism are preserved, the aspects of pragmatics (function) are frequently aberrant and disrupted. Pragmatic problems in autism include preoccupation with restricted topics, incorporation of irrelevant details, abrupt changes of topic (Volden et al. 1997), not letting others take their turn (Loveland et al. 1988) and failure to clarify ambiguities (Mesibov et al. 1997). Subsequent studies lent support to these observations. Norbury and Bishop (2003) explored the relationship between structural language ability and pragmatic competence using a wordless picture book. They found that children with autism failed to provide clear and relevant reference to the story when they generated a narrative to the story.

Lam and Yeung (2012) attempted to depict a relatively comprehensive profile of language pragmatics in children with high-functioning autism (HFA) using the Pragmatic Rating Scale (PRS). As predicted, the group with autism demonstrated substantial pragmatic difficulty when compared to their normal counterparts matched stringently on both verbal and nonverbal intelligence. Participants with autism tended to be disinhibited in social communication. When they talked, they were chatterboxes without a pause button, with little idea about turn taking in a conversation. They were excessively detailed in their narration especially on their subjects of interest and had difficulty disengaging from their preferred topics. This repetitive feature has been described as a form of verbal perseveration (Waterhouse and Fein 1982). When the participants with autism decided to change topic, they did not use any device to signal the change or maintain a link between the old and new topics. Similar findings have been reported previously (Tager-Flusberg and Anderson 1991).

Comments made by participants with autism were usually overly candid, expressing intimate information or making highly critical comments about people or situations. In this case, failure to take into account the listener’s feelings and emotion may be one of the more straightforward reasons for tactless remarks. Besides this kind of inappropriateness, the verbal responses of children with autism were frequently tangential; seldom did they address a question directly (Lam and Yeung 2012; Tager-Flusberg and Anderson 1991). When a child with autism attempted to initiate a conversation, the presentation of information was generally disorganized or fragmented, without cohesive ties relating current information to previous discourse. Their speech was vague and lacked sufficient background information, making it difficult for the listeners to follow.

It is, however, noteworthy that an earlier study employing the same measurement tool suggested that teenagers with autism differed on only one third of the PRS items when compared to their typically developing controls (Paul et al. 2009). Compared to young children aged 7–12 in Lam and Yeung’s study (2012), Paul et al. employed older participants with autism aged 12–18. The argument that pragmatic oddities in autism are eventually compensated by developmental maturation seems plausible. However, further empirical support is necessary to substantiate such claim.

Relationship Between Cognitive and Pragmatic Deficits in Autism

A number of investigations into language development in autism have focused on understanding the cognitive basis of pragmatic disability. In particular the contribution of a “theory of mind” deficit to pragmatic style in autism has been described (Tager-Flusberg 1989, 1992, 1993, 1994, 2000; Tager-Flusberg and Sullivan 1994a, b, 1995). Tager-Flusberg’s series of studies spotted out the importance of matching the comparison groups on verbal intelligence (especially in Tager-Flusberg and Sullivan 1994a or b). A recent study also suggested the impact of nonverbal intelligence on these tasks (Buitelaar et al. 1999).

An interesting study (Volden et al. 1997) examined the relationship between perspective-taking ability (a measure of “theory of mind” ability) and the pragmatic skill of referential communication. A sample stimulus of the perspective-taking test was illustrated in Fig. 3. A relatively small sample of ten intellectually able individuals with HFA aged 13–24 years was matched on age and gender to their normal counterparts assumed to have similar verbal skills. Although their perspective-taking abilities were relatively intact, the autism group exhibited significant communication difficulty (see also Volden and Lord 1991). These results were taken to imply that a deficiency other than in “theory of mind” might impact upon pragmatics in autism. Although the perspective-taking test used is not a conventional measure of “theory of mind” capacity, this small study addressed a very important issue about exactly what the cognitive basis of pragmatics in autism could be. At the very least, a more comprehensive exploration of “theory of mind” skills in a larger sample would help define the link between “mentalizing” and pragmatics in autism.
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Fig. 3

Sample stimulus of the perspective-taking test. The participant was shown that the two stimulus cards were identical before a black screen was lowered between him/her and the experimenter so that neither could see the other’s card. The participant was told to choose one of the figures. The participants would then answer a series of standardized questions. The response to each question provided insight to whether the participant could correctly evaluate the amount of knowledge currently available to the experimenter

The extent to which executive dysfunction and emotion perception impairment lead to pragmatic difficulties in autism has rarely been addressed. Certainly executive functions, including planning and flexible thinking, are necessary in conversation, as is an ability to perceive and interpret emotional information. The Wisconsin Card Sorting Test is one of the tests most wildly used to measure executive function (see Fig. 4). For measuring emotion perception ability, a test stimulus of the Emotion Perception Test (Lam 2003) was illustrated in Fig. 5.
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Fig. 4

The Wisconsin card sorting test apparatus. A sorting board consisting of four double compartments separated by quarter-inch partitions. Two packs of cards were used for WCST, each comprised four stimulus cards and 64 response cards. The 64 response cards showed 1–4 identical figures of a single color printed on white card stock. The four colors were red, green, yellow, and blue. The four types of figure were triangles, stars, crosses, and circles. Each card could thus be categorized according to the color, the type of figures, or the number of figures

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Fig. 5

Sample stimulus of the emotion perception test. In each test trial, a target face was shown on the left with four other faces (response choices) on the right. All test trials employed the distracting factor of “identity,” i.e., one of the response faces was the same person as in the target picture but expressed a different emotion. Participants were told to match the target face to one of the four response choices that should “feel the same way”

Previous studies have attempted to account for pragmatic deficits in autism in the light of one single impairment (e.g., Eisenmajer and Prior 1991; Ozonoff and Miller 1996; Shields 1991; Shields et al. 1996a, b; Tager-Flusberg and Sullivan 1995; Hale and Tager-Flusberg 2005; Joseph et al. 2005; Landa and Goldberg 2005), but it is possible that a configuration of neuropsychological impairments best describes how pragmatic problems present.

Lam (2003) attempted to explain pragmatic behaviors in autism in the light of specific cognitive and found that that executive function stood out as the best predictor of pragmatic competence, although “theory of mind” was also strongly implicated. Emotion perception ability turned out to be least informative regarding pragmatic competence; yet, once again, only limited conclusions should be drawn regarding the contribution of emotion perception to pragmatics as only one test was used to tap emotion perception ability in that study.

That executive function was a somewhat better predictor of pragmatics in autism than “theory of mind” was unexpected, given that the latter was more able to discriminate autism participants from their normal controls. It is tempting to assume that the most specific and discriminatory neuropsychological process uncovered should account for the majority of symptoms in autism, but clearly this is not the case. Similarly, executive dysfunction does not account for all pragmatic difficulties in autism; rather it just explains relatively more than the “theory of mind” deficit. Thus, although executive dysfunction appears to be a nonspecific outcome of autism, it does make an important impact upon the severity of pragmatic symptoms in autism (many of which are also not specific to the condition).

Pragmatic competence was strongly associated with the performances on both “theory of mind” and executive function tasks in children with autism only; these were not observed in normal controls matched on verbal IQ (Lam 2003). In fact, pragmatic skills were not correlated with any cognitive or intelligence domain in the normal children. This may suggest that pragmatics draws evenly on a range of cognitive functions in normal children, but that fairly well-circumscribed deficits in autism disrupt social language. In the end, there is likely to be a higher-order biological substrate to which we can attribute primary and secondary deficits in autism.

Brain Anomalies and Pragmatic Difficulties in Autism

Most aspects of language comprehension and production are governed by the left hemisphere (Carter 1998; Joseph 1996; Temple 1993). In broad terms, Wernicke’s area (left temporal) is responsible for language comprehension, Broca’s area (left frontal) governs language production (Carter 1998; Joseph 1996), and many dysphasias can be explained by lesions encompassing these regions. However, such a “simple” description is not sufficient to account for pragmatic deficits.

Patients who have sustained unilateral right-hemisphere damage exhibit pragmatic difficulties (Denckla 1983; Joanette et al. 1990; Molloy et al. 1990). Rumsey and Hanahan (1990) investigated the potential contribution of the right hemisphere to pragmatic difficulty in autism, using tests sensitive to right-hemisphere dysfunction (designed by Weylman et al. 1988). Although individuals with autism performed more poorly than controls on these tasks, the small sample sizes (n = 8 and n = 7) and significant group differences in overall intellectual ability make interpretation of the results difficult. A later study (Ozonoff and Miller 1996) with a larger sample size (n = 16 per group) did replicate these results, but the nature of errors committed by those with autism was different to patients with right-hemisphere lesions. In the assessment of humor, participants with autism appeared to appreciate that jokes should end in surprisingly humorous ways but still preferred straightforward endings which were consistent with the former part of the story. On the contrary, patients who had sustained right-hemisphere damage tended to choose a surprise ending which did not necessarily fit the story (Bihrle et al. 1986). Moreover, people with autism also failed to make correct inferences and understand indirect requests. Thus, right-hemisphere damage and autism appear to have differing impacts upon pragmatics; therefore, taking pragmatics as a purely right-hemisphere process may be overly restrictive.

Given that pragmatic deficits and executive/frontal dysfunction are both universally found in autism (Happe and Frith 1996; Landa et al. 1992; Pennington and Ozonoff 1996; Piven et al. 1997; Tager-Flusberg 2000), a shifting of attention to whether frontal lobe processes are important for pragmatic miscommunication in autism might therefore be useful. Pragmatic disorder has been documented in patients with prefrontal injury (Alexander et al. 1989; Carter 1998; Damasio and Maurer 1978; Gedye 1991; Novoa and Ardila 1987; Ozonoff 1995) and closed head injury (McDonald 1992, 1993; McDonald and Van-Sommers 1993; McDonald and Pearce 1995), and it is suggested that pragmatic deficits in autism may also be attributed to a distributed brain abnormality comprising the frontal lobe circuitry.

A suggestion that pragmatic communication was the manifestation of specific brain anomaly can be dated back to the early 1980s. Denckla (1983) pointed out the striking similarities in cognitive, affective, and communicative features between individuals with autism and those with right-hemispheric dysfunction. Common features include being overly literal, preoccupation with socially inappropriate topics, and tangentiality (Denckla 1983). Moreover, both groups have difficulty interpreting emotionally laden information (Temples 1993).

Right-hemispheric dysfunction appears to be crucial in the depiction of a pragmatic deficit (Joanette et al. 1990; Molloy et al. 1990; Ozonoff and Miller 1995, 1996; Rumsey and Hanahan 1990), but neuropathology in autism is usually found in limbic fronto-striatal circuits and the cerebellum (Abell et al. 1999; Carper and Courchesne 2000; Courchesne et al. 1988; McAlonan et al. 2002; Murphy et al. 2002; Piven et al. 1996). Consistent with a fronto-limbic model of autism (Damasio and Maurer 1978), neuropsychological impairments in autism have been mapped: executive function is largely dependent upon dorsolateral frontal lobe integrity (Fuster 2000; Joseph 1996); the left medial prefrontal lobe appears important for “theory of mind” (Happe 1999; Happe and Frith 1996); and orbitofrontal-medial temporal circuits are involved in emotional understanding (Baron-Cohen et al. 2000; Rolls 2000). Thus, it is a little difficult to reconcile what is known of the neuroanatomy of autism with a right-hemisphere concept of pragmatic language. The frontal lobes have such priority in models of autism that perhaps their contribution to pragmatics has not been fully realized.

If it is accepted that an intact frontal lobe is a necessary condition for effective pragmatic communication, cognitive deficits pertaining to frontal lobe dysfunction should be the most credible predictors of pragmatic abnormalities in autism. However, it is most likely that a distributed brain system involving the temporal region and limbic system works in concert with the frontal lobe to produce adequate pragmatic skills.

Implications for Further Research

In the research literature on autism, the nature of pragmatic difficulties related to the condition was relatively underexplored and thus not well defined. Pragmatics refers to the appropriate and effective use of language in social contexts, and more than often, such use is culturally bound. Hence, proper pragmatics in one language can be perceived as problematic in another. To solve this problem, we must define the domain of inquiry across cultures and, whenever necessary, supplement it with cultural sensitive notations. Moreover, tools designed to measure social use of language must assess both expressive and receptive pragmatics as they may imply different underlying cognitive mechanisms at work. For example, Martin and McDonald (2003) suggested that executive functions may have an impact on the production of pragmatic language (expression), whereas specific cognitive processes such as weak central coherence or “theory of mind” may affect how pragmatic language is processed.

Few reliable tools have been developed to assess pragmatic language, fewer even for measurement specific to the autism population, and rare with normative data for the population. The studies investigating pragmatics in autism have not only employed different methodologies but also participants varying in age. This has broadened our sight on how pragmatics can be prescribed but at the same time complicated the interpretation of the findings. With no or incomplete normative data, comparisons among these studies remain highly speculative. For the few tests that specifically measure pragmatics, only ToPL and CCC provide normative data from early childhood to adolescence. Yet, the normative sample was not reported to include individuals with ASD.

Furthermore, the inquiry of pragmatic deviance in autism must address developmental concerns. If language skills accelerate with age, then it is especially true for pragmatics as social experiences enhance the ability to make social inferences. Thus, longitudinal study is extremely helpful to examine whether the pragmatic deficits manifested in childhood persist into adulthood. Also, rules that govern the employment of speech may differ as a child grows older, and pragmatic behaviors to look for in an older child may not be readily observable in younger ones. Hence, there is a great need to develop assessment tools that can detect how pragmatic skills advance as a child maturates and determine what behaviors to look for in a specific developmental stage.

As mentioned earlier, pragmatic deficits are not specific to autism. It is, therefore, important to demarcate pragmatic deficits specific to autism by comparing the conditions in autism against those found in other clinical groups (e.g., Philofsky et al. 2007).

Finally, the relationship between pragmatic and cognitive deficits in autism demands more rigorous examination. If one speaks one’s thoughts, then meticulous analysis on pragmatics must benefit our understanding of the cognitive processes involved especially for disorders like autism. For example, if the same cognitive substrate governs both pragmatics and executive functions, then as executive malfunctioning alleviates with age, we should expect the same for the pragmatic problems. Furthermore, efforts should be directed to explore how different cognitive skills (e.g., planning, inhibition, making inferences) are related to pragmatic difficulty in autism.

Key Terms

  • Emotion perception. The ability to perceive and interpret emotional information.

  • Executive function. An “umbrella” term covering a range of cognitive abilities mediated by the frontal lobes: planning, impulse control, inhibition, maintenance of goal-directed behavior, organized search, and flexible use of feedback.

  • Mentalize. The ability to form mental representations of the mental states of others.

  • Pragmatics. An area of linguistics that studies the rules that govern language use in social contexts and how context contributes to meaning.

  • Semantic-pragmatic disorder. A disorder characterized by impoverished understanding of complex but clearly articulated expressions and failure to perceive its implications or permissible range of use.

  • Theory of mind. The ability to understand the mental state of others that will enable individuals to predict the behavior of others and/or to respond appropriately.

Key Facts of Pragmatic Characteristics in Autism

  • A significant majority of the autism population never develops expressive language or produces speech that is at times unintelligible.

  • For those children with autism that do develop expressive language, their abnormal use of social language (pragmatics) is the most obvious feature of their condition.

  • Pragmatic deviance in autism usually does not violate any rules of syntax, phonology, or semantics.

Key Facts of Findings Related to Pragmatic Deficits in Autism

  • A number of investigations into language development in autism have focused on understanding the cognitive basis of pragmatic disability, in particular the contribution of a “theory of mind” deficit, executive dysfunction, emotion perception deficit, and a weak central coherence.

  • Pragmatic deficits and executive/frontal dysfunction are both universally found in autism.

  • Patients who have sustained unilateral right-hemisphere damage exhibit pragmatic difficulties.

  • Few assessment tools were developed to measure pragmatics and even fewer provide normative data beyond adolescence.

  • Until now, no measurement of pragmatics specific to autism was norm referenced.

Summary Points

  • The chapter attempted to describe the pragmatic deficits observed in autism and how these could be related to autism-related symptoms.

  • Studies investigating pragmatics in autism were reviewed.

  • Issues pertaining to methodologies were discussed, and the need to address developmental concern was emphasized.

  • Prevalent cognitive impairments and brain anomalies pertaining to autism were discussed in relation to the pragmatic oddities observed in various studies.

  • Directions for further research were implicated, as well as the development for more sensitive tools to address cultural and developmental issues.

Copyright information

© Springer Science+Business Media New York 2014
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