3.12 Pragmatic Language Impairment & Autism
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.
When Barry is doing well in the therapy setting, Beth takes their show on the road. She trains his teachers in how to model good social interaction skills, and how to work those into lessons in their subjects.
She also teaches Barry’s parents how to carry his new learning over at home. Barry’s mom and stepfather learn to model social skills too. They start conversations about what characters on the TV shows they watch, or people in the news, might be thinking or feeling, based on their body language or tone of voice. Barry’s stepdad was never as proud of his boy as the day they were watching a politician’s press conference and Barry suddenly said, ”Dad, I don’t think he’s telling the truth! See, he’s shifting his feet like his shoes don’t fit. And he’s perspiring like Richard Nixon during the 1960 presidential debate. Miss Beth says when people look uncomfortable, sometimes that means they are lying.”
Eventually, Barry got comfortable enough with his new skills of interpretation that he took a giant leap and joined the school history club. There he found a whole group of self-proclaimed history geeks, and his fondness for stories about Jimmy Carter’s speed reading and John Quincy Adams’ skinny-dipping in the Potomac fit right in. For the first time, Barry felt like he belonged!
Pragmatic language impairment (PLI) is a term used for difficulty understanding and using the rules of pragmatics, the unspoken elements of language. People with autism experience problems in this area and need to be taught skills like turn taking, topic maintenance, and reading body language and facial expressions. Children may have trouble with pragmatics without displaying other signs of autism, and in this case may be diagnosed with social communication disorder.