Semantic pragmatic disorder affects the use of language in a social context (knowing what to say and when to say it). There is debate about whether semantic pragmatic disorder is part of the autism spectrum, or an entirely separate condition. At the moment, this isn't clear. 

Rapin and Allen originally defined semantic pragmatic disorder (SPD) as a language disorder in 1983. Confusion surrounds the use of diagnostic terminology in the area of SPD, where neurology, psychology, psychiatry and speech and language therapy converge. The most common definitions of SPD are listed below:

  • A component/language style of other disorders such as autismAsperger syndrome or hyperlexia
  • The same as high-functioning autism
  • A separate valid disorder on the autism spectrum
  • A sub-category of specific language impairment that echoes autisticlike behaviours but not part of the autism spectrum.

There is much debate as to whether or not SPD is part of the autism spectrum. Unfortunately no diagnostic criteria exist to confirm this.

What this paper discusses are the characteristics of SPD and how to manage them.

What is semantic pragmatic disorder?

SPD is a language disorder that affects semantic processing and the pragmatics of language use. Pragmatics refers to the use of language in a social context (knowing what to say and when to say it to people). Semantics refers to the meanings of words and phrases.

SPD is a developmental disorder that improves with age. Rates of improvement will depend on the intelligence of the child and the support around them.

Similarities to autism

Children with SPD often appear to have similar features to people with autism. Similarities include:


Problems with understanding

Due to the way that people with SPD process information, they are unable to distinguish between the central meaning of an event and the extra information that surrounds it. For instance, if you were to show a picture book to a child with SPD, they would be more likely to focus on a minute detail of a particular picture, rather than grasp the actual meaning or story behind the picture. Being unable to extract meanings in this type of situation makes it is more difficult for the child with SPD to generalise. This cognitive difficulty can result in the child needing to develop a good memory for details and a need to keep things predictable.  

Predictability is a key concept of SPD. The child with SPD is unable to predict future events and unable to recognise similarities in new situations, often leaving them floundering socially and in a high state of anxiety. Therefore, the child with SPD is often very reluctant when experiencing change.

The difficulties in extracting meanings can be both visual and oral. The more stimulation there is in the immediate environment, the harder it is for a child with SPD to process exactly what is being said to them. This often results in the child failing to respond to any communication directed at them. If a child with SPD is trying to concentrate they will often need to be touched lightly or stood directly in front of before they will respond and before they are able to process any communication.

Children with SPD have a tendency to take everything very literally and have difficulty in understanding what other people are thinking when they are talking. They are therefore unable to understand when people are lying or deceiving them. They can become very distressed when people around them use sarcasm and teasing language. However, they do not have problems with types of communication such as directive language. For example, if a child with SPD were asked to put the red block on top of the yellow cube they would be able to do so.  

Children with SPD may also experience difficulties in grasping time concepts.     

Problems with talking

A child with SPD can give the impression of being very sociable and chatty. Realistically they are likely to have problems talking due to the way they use language. Children with SPD learn language differently from other developing children. They learn language by memorising rather than by learning the meaning behind the word. This results in an inability to use language as fluently and with the same range and flexibility as other children their age. When they memorise whole chunks of language they will often reproduce it in exactly the same tone and with exactly the same intonation as the person they learnt it from. They can therefore seem a lot more socially mature and capable then they actually are.     

If you took a transcript of a child with SPD and analysed their speech it is likely that you would find very little use of emotive language (the way people feel or think) and an awful lot of echoed social phrases/inappropriate comments. This inappropriate use of social language can be very embarrassing and exasperating when really the likelihood is that they are simply repeating something that has been said to them previously, but in the wrong context.

Talking problems in a child with SPD only really show up at a conversational level. Their delayed social development means that they are a lot more interested in themselves than in other people, often talking about something that only interests them or about themselves. Not having sufficient understanding of their social partner means that they will not have the ability to read signs of boredom and assume common knowledge. These inabilities make conversation a one-way thing and can leave the conversational partner both bored and confused.

Semantic pragmatic disorder in the classroom

Many children with SPD are able to cope in the mainstream classroom. This is because they often have a higher level of academic intelligence than their peers. However, there will in most cases be a need for some one-to-one help for the SPD child in the mainstream in the form of a learning support assistant (LSA).

The input of one-to-one support for a child with SPD in a classroom setting often eliminates some of the problems otherwise experienced. The most common of these problems is motivation. The child with SPD will only work when they want to and appear to have no motivation for the work they are either doing or supposed to be doing. If they do tend to daydream in lessons it is important to insist that they sit at the front row, either at the end or in between two sensible children who will not encourage them to be distracted. They may become very anxious at times such as break and lunchtime and need the support and encouragement of an LSA to build their confidence during free time at school.

In terms of subjects a child with SPD generally struggles with aspects of handwriting, creative stories, reading comprehension and spelling. This is due to their lack of understanding about appropriate language and when to use it, and an inability to comprehend subjects that require abstract understanding. They will often take a topic that a teacher has given them and interpret it in an inappropriate way, a way that interests them from their own perspective rather then the way for which it was intended.

However, there are also areas of the classroom in which they tend to excel. For example, children with SPD are very often good at numbers, sciences and computers.

When teaching a child with SPD it is important to build their understanding of the abstract concepts that they find bewildering. A successful way of doing this is to use direct learning via a multi-sensory approach. Keeping the learning materials very visual is important. Visual exercises to enhance semantic understanding can be particularly beneficial. Notions such as opposites, sorting objects according to similarities/differences, guessing games are easily represented through visual enhancement.

Helping a child with SPD

Some simple techniques can be used to help a child with SPD in the areas of social development, language skills and play skills.

Play skills in a child with SPD are often very creative physically but lack any social aspect. They have difficulty pretending because they find it difficult to put themselves in others situations. This inability often leads to the child performing inappropriate actions on different objects. To overcome these difficulties the child with SPD should be encouraged to develop their social skills through drama and role play. Role play should use real objects as much as possible in the first instance. Once the child has an understanding of this, substitute props that represent the real objects should replace the real objects. 

Language skills in the child with SPD can be enhanced using simple games such as I Spy, visual pairs matching games, rhyming pairs games and board games that involve reading and identifying first and last sounds in words. Encouraging the child to reproduce any written work on a computer can also help to improve language skills. By typing up their written work on to a visual screen it allows the child to correct areas such as sequences of events, spelling and grammar and sentence structure. It also allows them to make sure that they have understood the implication of the question and answered it correctly.

To encourage the childs social development it is important to tell them specifically what good behaviours are and what it involves to achieve them. Praising specific good behaviour and keeping the child free from negative judgements can reiterate this. It is important to avoid large noisy groups which have no structure as much as possible, as it is situations such as these that can cause anxiety and panic. By keeping a certain amount of predictability to the childs daily life it is possible to reduce their anxiety.   Organisational skills can be improved by the use of a wall chart a timetable that indicates what is going to happen throughout the childs day and in what sequence.

Contacts

ICAN
A charity that helps children with speech and language difficulties throughout the UK.
8 Wakley Street
London EC1V 7QE
www.ican.org.uk
www.talkingpoint.org.uk
Tel: 0845 225 4073
Email: info@ican.org.uk

Afasic
2nd Floor
50-52 Great Sutton Street
London EC1V 0DJ
Helpline: 0845 3 55 55 77
Email: info@afasic
Website: www.afasic.org.uk

Royal College of Speech and Language Therapists
2-3 White Hart Yard
London SE1 1NX
Tel: 020 7378 1200
Email: postamaster@rcslt.org.uk
Website: www.rcslt.org

References

Adams C. and Bishop, D.V.M. (1989). Conversational characteristics of children with semantic-pragmatic disorder.   Exchange structure, turntaking, repairs and cohesion. British Journal of Disorders of Communication, 24, pp. 211-239

Bishop, D.V.M. (1989). Autism, Aspergers syndrome and semantic-pragmatic disorder: Where are the boundaries? British Journal of Disorders of Communication, 24, pp. 107-121

Bishop and Rosenbloom (1987). Childhood language disorders: classification and overview in language development and disorder

Brook, S.L. and Bowler, D.M. (1989). Autism by another name?: semantic and pragmatic impairment in children. Journal of Autism and Development Disorders, 22, (1), pp. 61-81

Bishop, D., Hartley, J. and F. Weir Why and when do some language impaired children seem talkative?: a study of initiation in conversations of a child with semantic-pragmatic disorder by in Journal of Autism and Developmental Disorders 24 (2), 177-197

J. Muggleton (1997). What is semantic-pragmatic disorder?