Pragmatic Language Impairment & Autism

Instructor: Lisa Millraney

Lisa has 27 years of experience treating speech, language, memory and swallowing disorders in a variety of settings. She has a master's degree in speech pathology from Vanderbilt University.

In this lesson, we will learn what pragmatic language impairment is and how it relates to people with autism. We will discuss its characteristics and effects, and how people with autism can work to improve their communication skills with the support of those around them.

Pragmatic Language Impairment--Where It Appears

The autism spectrum includes individuals with a wide range of abilities and challenges. One element most if not all have in common, however, is difficulty understanding and using language appropriately in a social setting. This problem is most commonly known as pragmatic language impairment.

Pragmatic language impairment, or PLI, also appears as part of other conditions, such as ADHD or developmental disability, and can even appear in populations such as children adopted from other countries. It can also be diagnosed as a separate condition if it appears in isolation, without other elements common to autism. If a child demonstrates trouble with social language, but does not show repetitive behaviors or limited range of interests, they may be diagnosed with PLI rather than autism, though doing so is still not universally accepted among experts. When diagnosed as a stand-alone condition, it is sometimes called social communication disorder.

So Just What Is PLI?

As its name implies, PLI is a difficulty with pragmatics, the nonverbal element of communication that governs how we connect with each other. Children with pragmatic language impairment possess all the tools of language. They have adequate vocabularies, can pronounce all the sounds of their native tongue clearly, and understand and use grammar effectively. However, they struggle with how to utilize these tools in interactions with others. They grasp what is taught explicitly, but the rules of pragmatics are unspoken. Most children pick them up automatically as they mature, by observing those around them. Children with PLI don't 'get' those rules.

For example, let's look at Barry. Barry is a bright eleven-year-old with high functioning autism. He makes good grades in school, and can reel off information he is asked to memorize, especially in history class. US presidents are his specialty, and he can talk about the trivia of the most obscure of them for hours. In fact, sometimes he does, and never perceives that those around him are not as interested in his obsession.

Barry doesn't have many friends in school or his neighborhood. Besides his single-minded focus on his favorite topic, he doesn't know how to start a conversation. He tends to just walk up to a classmate and say things like ''Hey, on Christmas Eve 1851 the Library of Congress caught fire, and President Millard Fillmore helped fight the fire all night and all day Christmas Day.'' That sort of opening obviously doesn't make for instant friendships. Similarly, if Barry gets bored or the topic changes, he just walks away without a goodbye.

Barry takes things literally, too. When other students in his history class talked about an upcoming test, one said sarcastically, ''Oh, I'm sure looking forward to this exam.'' Barry was delighted to share how he too was excited to demonstrate his knowledge about the Articles of Confederation on the test.

The other kids rolled their eyes and made faces, but Barry didn't--couldn't--decipher the meaning behind that. Their nonverbal communication meant as little to him as if they had suddenly switched to a foreign language.

Though Barry has other characteristic behaviors of autism, it's the PLI that really cuts him off from his peers, and it worries his parents. They talk with his teachers, and with Beth, the school's speech pathologist, asking what can be done to help Barry.

Taking on PLI

Beth takes a multi-directional approach to Barry's PLI. They do role-playing exercises that target rules like turn-taking, staying on topic, and social introductions. Like most kids, Barry likes computer games, so Beth sets up games identifying various facial expressions and matching them to the wearer's feelings and meanings.

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