pragmatic language impairments
TRANSCRIPT
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Pragmatic language
impairments
1
impairments
Dorothy Bishop
Wellcome Principal Research Fellow
Department of Experimental Psychology
University of Oxford
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Oral communication involves:
COMPREHENSION
♦ decoding speech
sounds
♦ word recognition
EXPRESSION
selecting appropriate
message
translate idea to sentence
retrieve speech forms of ♦ word recognition
♦ remembering and
interpreting word
sequence
retrieve speech forms of
words
program articulators
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The boy is pushing the elephant
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Oral communication involves:
COMPREHENSION
♦ decoding speech
sounds
♦ word recognition
EXPRESSION
selecting appropriate
message
translate idea to sentence
retrieve speech forms of ♦ word recognition
♦ remembering and
interpreting word
sequence
retrieve speech forms of
words
program articulators
� integrating words
with context
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“The fish is on the table”
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“The fish is on the table”
♦ integrating words with
context cooked fish on a plate
come and eat!♦ uncover the speaker’s
intention
see Bishop (1997) Uncommon Understanding
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Textbook view of specific language
impairment (SLI)
� Principal problems with structural aspects of
language (grammar and phonology)
� Nonverbal communication and pragmatics are
an area of strength
for overview see: Bishop, D. V. M. (2002). Speech and
language difficulties. In M. Rutter & E. Taylor (Eds.), Child and
Adolescent Psychiatry: Modern Approaches (pp. 664-681).
Oxford: Blackwell Science.
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• fluent, well-formed sentences
• speaks clearly
• has trouble understanding discourse
“Semantic-pragmatic deficit syndrome”
• has trouble understanding discourse
• speech: loose, tangential, or inappropriate
• train of thought : illogical, difficult to follow
• sociable
Rapin 1982 (p. 145).
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National survey of 242 language-impaired
children
� Random sample of 7-year-olds attending
language units in England
� Direct assessment supplemented by teacher
report
10% fell in cluster corresponding to “semantic-� 10% fell in cluster corresponding to “semantic-
pragmatic disorder”
� pragmatic problems not picked up on
standardized tests
Conti-Ramsden et al, 1997, J Speech, Language & Hearing Research
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Terminology
Conti-Ramsden/Bishop prefer
“Pragmatic Language Impairment (PLI)”
because:
� ‘semantic’ deficit not marked
� not a ‘syndrome’
N.B. not an ‘official’ diagnostic term;
(in current diagnostic systems, the only possible
label for these cases is Pervasive Developmental
Disorder not Otherwise Specified = PDDNOS)
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How to measure pragmatic impairment
1. The hard way:
Analysis of children’s conversations
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� ALICC: Analysis of Language Impaired
Children’s Conversation (Bishop et al. 2000)
� Classify children’s utterances in terms of
whether adequate, immature or pragmatically
inappropriate
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Pragmatically inappropriate responses
extended response that contains material that
is irrelevant, repetitive or bizarre
(child shown photo of boy examined by doctor) A: what
do you think is wrong with that 'boy?do you think is wrong with that 'boy?
C: i think he might have fallen into the 'water, on
january the 'sixth.
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Pragmatically inappropriate responses
tangential response
A: have 'you ever been to the doctor
C: i had a 'apple a day.C: i had a 'apple a day.
the response “no” can be inferred, but only with
some difficulty.
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Pragmatically inappropriate responses
failure to take prior conversation into account
A: how did you ‘get to blackpool?A: how did you ‘get to blackpool?
C: in the 'car.
A: ‘n what about when you went to 'france?
C: it was 'hot.
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How to assess pragmatic difficulties?
an easier way:
ratings by people who know the
child wellchild well
Children’s Communication Checklist,
Bishop (1998)
now superseded by CCC-2 (Bishop, 2003)
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CCC-2 (2003)
� designed to be completed by parents (though
can be used by teachers)
� standardized on 542 children aged 4 to 16 years
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CCC-2: instructions
� This checklist contains a series of statements
describing how children communicate. For each
statement, you are asked to give information
about the child whose name (or code number)
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about the child whose name (or code number)
appears below. You are asked to judge whether
you have observed that behaviour:
� less than once a week (or never)
� at least once a week, but not every day
� once or twice a day
� several times (more than twice) a day (or always)
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CCC-2: sample itemsscales A-D, language form/content
A: Speech. Simplifies words by leaving out some
sounds, e.g. “crocodile” pronounced as “cockodile”, or
“stranger” as “staynger”
B: Syntax. (+) Produces long and complicated
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B: Syntax. (+) Produces long and complicated
sentences such as: "When we went to the park I had a
go on the swings"; "I saw this man standing on the
corner"
C: Semantics. Is vague in choice of words, making it
unclear what s/he is talking about, e.g. saying “that
thing” rather than “kettle”
D: Coherence. (+) Talks clearly about what s/he plans
to do in the future (e.g. what s/he will do tomorrow, or
plans for going on holiday)
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CCC-2: sample itemsscales E-H, pragmatics
E: Inappropriate initiation. Talks repetitively about
things that no-one is interested in
F: Stereotyped language. Repeats back what others
have just said. For instance, if you ask, “what did you
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have just said. For instance, if you ask, “what did you
eat?” might say, “what did I eat?”
G: Use of context. Gets confused when a word is used
with a different meaning from usual: e.g. might fail to
understand if an unfriendly person was described as
‘cold’ (and would assume they were shivering!)
H: Nonverbal communication. Ignores conversational
overtures from others (e.g. if asked, "what are you
making?" does not look up and just continues
working)
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CCC-2: sample itemsscales I-J, autistic-like features
I: Social relations. (+) Talks about his/her friends;
shows interest in what they do and say
J: Interests. Shows interest in things or activities that
most people would find unusual, such as traffic lights,
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most people would find unusual, such as traffic lights,
washing machines, lamp-posts
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General communication composite (GCC)
very good discrimination between impaired and
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unimpaired children
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GCC: Parent
140
120
100
80
60
10th centile
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211314191316N =
Diagnostic group
controlASPHFAPLI+PLISLI
GCC: Parent
40
20
0
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Social-Interaction Deviance Composite
(SIDC)
- A: speech
- B: syntax
- C: semantics
A negative score on the
SIDC indicates
DISPROPORTIONATE
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- C: semantics
- D: coherence
+ E: inappropriate initiation
+ H: non-verbal communication
+ I: social relations
+ J: interests
DISPROPORTIONATE
social and pragmatic
difficulties in relation to
structural language
abilities
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Distribution of SIDC ratings
40
30
20
10
0
-10
-20
r = .79
26
912121012 912121012N =
Diagnostic group
ASPHFAPLI+PLISLI
Distribution of SIDC ratings
-20
-30
-40
-50
Parent
Teacher
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CCC-2: overview
�GCC is sensitive indicator of communication
difficulties in children
Can use SIDC to identify children with
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� Can use SIDC to identify children with
disproportionate pragmatic problems
� Differentiation between SLI/PLI seems more
a matter of degree than a sharp divide
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Implications for assessment
� Need to be aware that standard psychometric
tests are often insensitive to pragmatic
impairments
� Informal observation of a child in a relatively
unstructured conversational setting may be
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unstructured conversational setting may be
informative
� Checklist report by teacher or parent provides
valuable information
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Questions about PLI
� Is it a separate subtype of communication
impairment?
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autistic
disorderSLI
PLI
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Questions about PLI
� Is it a subgroup of SLI or autistic disorder?
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autistic
disorder SLI
PLIPLI
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Questions about PLI
� Are all these disorders on a continuum?
31
autistic
disorder PLI SLI
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Bishop & Norbury (2002)Standard diagnostic procedures for autistic
disorder given to group with SLI or PLI
� Autism diagnostic interview (ADI-R): with parents,
approx 3 hours
� focus on behaviour at age 4-5 years� focus on behaviour at age 4-5 years
� Autism diagnostic observation schedule (ADOS-G): with
child, 45 mins
� focus on current behaviour
� observe child in various situations designed to elicit autistic
behaviours (e.g. playing with toys, interacting with adult)
� Social communication questionnaire (SCQ): completed
by parents, 40 items (based on ADI-R)
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Bishop & Norbury: Conclusions - 1
� Heterogeneity of children with communication
impairments
Changing clinical picture with age� Changing clinical picture with age
� Some children with clinical picture of PLI
would merit diagnosis of autism or PDDNOS,
but not all
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Bishop & Norbury: Conclusions - 2
� non-autistic children with PLI
� sociable, talkative
� use nonverbal as well as verbal communication,
produce stereotyped language with abnormal � produce stereotyped language with abnormal
(often exaggerated) intonation
� good reciprocal social interaction
� repetitive behaviours not a feature
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Bishop & Norbury: Conclusions - 3
� current categorical diagnosis not well suited to
capturing clinical variation
� i.e. no clear dividing line between PLI and i.e. no clear dividing line between PLI and
other communication problems
� rather, pragmatic impairment can accompany
a range of other problems
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Possibilities for intervention
� Virtually no scientific evaluation of different
approaches
� Very little known about long-term outcome
(though we plan to do a follow-up study).
Anecdotal evidence suggests very variable
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Anecdotal evidence suggests very variable
outcome.
� UK experience: children with PLI can do well in
specialised placement for children with
communication problems OR in mainstream
schools with support
� But staff need to be aware of nature of
problems: danger children will be thought “mad
or bad”
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for references see:
epwww.psych.ox.ac.uk/oscci