Pragmatic Language Disorder: Diagnosis & Treatment

Instructor: Gaines Arnold
This lesson looks at pragmatic language disorder, how the disorder manifests itself and how it can be treated by concerned adults and professionals. The lesson also looks at the difference between pragmatic language disorder and autism spectrum disorder.

Getting the Joke

Alex's friend, Jan, ran up to her on the playground one day and said 'Brian just told me a funny joke! What did the big dog say to the little dog?' Alex just stared at her friend and Jan answered, 'Dog life is ruff-ruff. Isn't that funny?!' Jan ran away to tell another friend the joke, while Alex looked around and thought, 'Dogs can't speak.'

Besides not being able to understand jokes, Alex was also confused when her teacher waved to the children as they left school for home. The other kindergartners would laugh and wave back, but Alex would either look at her teacher in a confused manner, or just walk by not saying anything. In all areas of social communication or instances where there were nuances (such as jokes, sarcasm or lies), Alex could not grasp the subtle, non-concrete meaning.

The Inability to Understand Social Communication

Pragmatic Language Disorder (PLD) (also known as social or pragmatic communication disorder) is defined by the Diagnostic and Statistical Manual (DSM-V) as 'persistent difficulties in the social use of verbal and nonverbal communication…'. The condition is diagnosed early in a child's development; generally recognized before or during a child's fifth year.

The diagnosis covers many facets of communication skill which may elude a child who either does not have the ability to recognize social cues due to a physical impairment or who has not been properly taught how to react appropriately to situations where social communication, interactions in a social situation, is required.

For example, in the above scenario, Alex did not understand the joke her friend told her. This could be due to Alex's immaturity when it comes to understanding certain types of communication (as in she has not been taught the difference between the abstract communication of a joke and strictly factual communication), or she could have a mental deficit that makes it difficult for her to recognize the difference. Whatever the cause, Alex does not understand why the communicated story is funny.

How Does PLD Manifest Itself?

Researchers of pragmatic language disorder have determined many social communication difficulties that may be evidence of PLD. The DSM-V states that sufferers may:

  • Have trouble with greeting people appropriately according to social context. Alex's parents have noticed that she seems to repeat a greeting phrase she learned from a favorite TV show even if it does not apply to the situation.
  • Have difficulty understanding the meaning of sharing. When it was Leah's turn to be the line monitor, Alex was upset and hit Leah rather than going to her place in line.
  • Not understand the need to change language based on the social situation. Alex was upset and visibly angry on the playground and continued to use the same tone and volume when answering her teacher's questions during class time.
  • Have difficulty following the rules of conversation. Alex would often interrupt her classmates or adults, and she would give nonverbal cues that were inconsistent with what she was saying.
  • Be unable to make inferences based on communication. Alex was unable to understand when she was to be quiet based on cues from her teacher, parents or other adults.

This reaches the level of a disorder when it affects the way other people react to the child with pragmatic language disorder, and it meets all the criteria within the DSM-V. The individual is shunned because they are unable to communicate appropriately. He or she may also be thought to have learning deficits, where there are none, because of the difficulties with social communication.

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