Pragmatic Speech Disorder

How we tailor therapy to help your child learn pragmatic skills

What does Pragmatics mean?

Pragmatics is a broad term used to describe our social skills, such as:

• Eye contact

• Body language and gestures

• Proximity (how we position ourselves physically)

• Facial expressions

• Initiating, maintaining and changing topics in conversation

• Choosing appropriate topics in conversation

• Responding to others

• Pauses

• Repairing the conversation

• Using intonation to convey meaning

• Interrupting

• Taking turns

Your child will use pragmatic skills from as early as 12 months old. For example, when a child responds verbally to you (this includes babbling and indistinguishable noises) they are demonstrating pragmatics. However, we use these social skills for the rest of our lives. The classic example of the importance of pragmatics is meeting somebody who invades your personal space. Not standing too close to somebody is an unwritten social skill, and yet it is a behaviour we must learn in childhood.

What are the norms for Pragmatic development?

8-12 months

• Uses gestures and vocalisations to request objects, refuse, comment and play games.

• Plays for up to 2.5 minutes at one time.

12-18 months

• Plays for up to 5 minutes at one time.

• Uses words to request objects, refuse, comment and play games.

18-24 months

• Plays for up to 7.5 minutes at one time.

• Can request information, answer questions, and acknowledge others.

24-30 months

• Can hold a conversation on one topic for a longer period of time.

• Uses symbolic play, talks about absent objects, uses humour such as lying and teasing.

• Tells a narrative mostly comprised of descriptions (which may not contain a beginning, middle or an end).

30-36 months

• Can continue holding a topic for longer, and adding more information to the conversation.

• Asks for clarification (e.g. asking for more information if they do not understand).

• Increases use of language in play.

• Narratives become more sequential (cause and effect).

42-48 months

• Talks about past events.

• Makes predictions.

• Expresses empathy.

• Maintains interactions.

48-60 months

• Responds to requests for clarification, such as changing what they have said or repeating themselves to aid understanding.

• Narratives develop into chains, without conflict or resolution.

5-7 years

• Narratives develop a focus, conflict and resolution.

7-9 years

• Adds motivations and character reactions to narratives.

• Language is used for social status.

9-12 years

• Understands non-literal use of language (e.g. riddles and jokes).

• Language is used to create social bonds.

What causes Pragmatic Speech Disorder?

The following conditions can result in Pragmatic Speech Disorder, however, pragmatic difficulties can occur in isolation with no obvious cause:

• Autism Spectrum Disorder

• Intellectual disability

• Language disorders

• Specific Learning disorders

How do Speech Pathologists assess Pragmatics?

Similar to other areas of communication, children are expected develop pragmatic skills at certain times. A Speech Pathologist may observe your child in natural conversation or a play session, to identify whether or not they have reached these milestones. They will observe how your child interacts with others and how they can improve.

How does Speakable treat Pragmatic Speech Disorder?

Pragmatics is one area of communication development which is mostly tailored to the individual. In other words, therapy will target the specific skills the child is having difficulty grasping. Depending on the child’s age, the Speech Pathologist may model the behaviours and use repetition, or they may explicitly teach the skill, by explaining it in the gentlest way possible.

What can I do?

As with most communication disorders, the caregivers have the opportunity to demonstrate the skills the child needs to learn. You can help by selecting a skill and modelling it in every day life through repetition and oral explanations.

For example, if your child is not making eye contact, you can model this throughout the day:

1. Provide praise and say, “I really like the way you looked at me when you spoke to me.”

2. Prompt them to increase the behaviour, “Look at my eyes when you’re speaking. Well done!”

3. Model it yourself and narrate the action, by saying “I am looking at Grandpa in the eyes when we’re talking. This way he knows I am listening to him. Watch me.”

It is also recommended you ask your Speech Pathologist for activities to do at home with your child. It is well documented that family participation greatly increases a child’s chances of success in therapy.

Where can I get more information?

See the American Speech-Language-Hearing Association’s explanation of Pragmatics by clicking here.

See Caroline Bowen’s detailed explanation of Pragmatics by clicking here.

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