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Semantic-Pragmatic Disorder

What is Semantic Pragmatic Disorder?

‘Semantic Pragmatic Disorder’ is a term which has been used, mostly in the UK and by speech and language therapists, for the last 10 -–15 years.

The term was originally used to describe a developmental language disorder, affecting two aspects of communication: ‘semantics’ and ‘pragmatics’.

Problems with the meanings of language may be called ‘semantic’ difficulties, whilst difficulties with the appropriate use of language are referred to as ‘pragmatic’.

Semantic Pragmatic Disorder is not an illness. It is a developmental disorder which prevents the person from using language in an appropriate manner and creates difficulty in understanding the meaning of the spoken word.

In recent years, there has been debate about whether or not ‘Semantic Pragmatic Disorder’ is an accurate diagnosis or merely a descriptive term for the nature of communication difficulty found in verbal people with autism.

Recent research findings suggest that the disorder does belong within the autistic spectrum, with a single underlying cognitive impairment producing both Semantic Pragmatic Disorder and autistic features.

What are the features of Semantic Pragmatic Disorder?

Features include:

Delayed language development
Problems with understanding questions
Mixing up ‘I’ and ‘you’
Repeating phrases out of context
Difficulty in following conversations
Difficulty in following instructions
Can appear to be aggressive, selfish, bossy, over-confident, shy or withdrawn
Because of poor comprehension, children are often singled out as having behavioural problems
Unable to share or take turns
Often very good at maths, science and IT, but struggle writing a coherent sentence

What causes Semantic Pragmatic Disorder? It is now believed that there is a family link between these Autistic Spectrum Disorders. It has often been found that having identified one child on the Autistic Continuum, there is also another child in the family who has milder communication difficulties, particularly if they are male.

As can probably be deduced, evidence is pointing to a disorder that is genetic in origin.

It is thought that the situation is much more complex than one parent passing on a defective gene and that two ‘healthy’ parents can produce a child with a communication problem.

Much is still to be learned about the inherited aspects, but what is apparent is that boys are much more likely to have communication problems than girls are: something in the region of 6:1.

Some parents refer to difficulties at birth, but it is difficult to accept that any resulting brain injury could be so specific and it is far more likely that it is the genetic mix that caused the birth difficulty in the first place.

Current Thinking on Semantic Pragmatic Disorder.

Nowadays there is a greater understanding of the nature of the disorder. It is accepted that children with Semantic Pragmatic Disorder have many more problems than just speaking and understanding words, consequently it is described as a communication disorder rather than a language disorder. The difficulty seems to be the way in which children with S.P.D. process information. They find it much more difficult to extract the saliency or core meaning of an event, focussing instead on the surrounding detail. Such a child will fail to grasp the situation or storyline but will be able to recall minute superficial and largely irrelevant details.

All of us are constantly extracting information from our surroundings and we search for similarities and differences so that we can understand and anticipate. Obviously children who experience difficulties in extracting information will find it even more difficult to grasp the meaning of new situations and will cling to familiar routines and patterns. In an effort to maintain predictability and sameness, children with S.P.D. will follow routines slavishly, insisting on eating certain foods, wearing particular clothes, following regular known routes and developing obsessional behaviours.

Because of their difficulty in extracting both visual and aural meanings from their surroundings, the more stimulating the environment becomes, the more difficulty they will have with understanding and coping with it. This is particularly true in relation to other people. People have minds and wills, which allow them to operate independently and as such, are much less predictable than objects or machines and present a greater challenge to the person with S.P.D. Children with the disorder are often more sociable with friends at home or in a formal 1:1 assessment situation than in a busy classroom – a discrepancy which puzzles many observers.

For further information contact: The National Autistic Society Web Address: http://www.oneworld.org/autism

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