Pragmatic Disorders Across the Life Span

Abstract

There is now an extensive empirical literature on the nature and extent of pragmatic disorders in a range of clinical populations. This chapter attempts to organize the findings of this large and growing body of work by examining pragmatic disorders according to four key time periods during the human life span: the developmental period; older childhood and adolescence; early to late adulthood; and advanced adulthood. The clinical disorder included in this wide-ranging survey are specific language impairment, autism spectrum disorders, emotional and behavioural disorders, and intellectual disability, all conditions which have their onset in the developmental period. In older childhood and adolescence, a traumatic brain injury or the development of a brain tumour may place a child at risk of pragmatic disorder. In early to late adulthood, the onset of mental illnesses such as schizophrenia, traumatic brain injury and neurodegenerative disorders such as Parkinson’s disease may all compromise an individual’s pragmatic language skills. In advanced adulthood, cerebrovascular accidents (or strokes) are significant causes of left- and right-hemisphere damage in adults, while several cerebral pathologies are associated with the development of different dementias. The implications of these increasingly common diseases and events for pragmatic language skills are also considered.

Notes

• 1. Several clinical conditions which have marked pragmatic disorders (e.g. autism spectrum disorder, or ADS) are more commonly found in males than in females (see Sect. 3.3.1 in Cummings (2008) for a discussion of sex ratios in ASD). To this extent, more males than females do have pragmatic disorders. However, apart from these specific populations, there is no evidence to suggest that being male per se places one at greater risk of having a pragmatic disorder.

• 2. It should be noted that substantial investigation of the genetic basis of SLI has been undertaken in recent years. For reviews, the reader is referred to Bishop (2009) and Newbury and Monaco (2010).

• 3. Katsos et al. are testing these children’s understanding of scalar implicatures. A scalar implicature is a type of generalized conversational implicature. In the utterance ‘Mike attended some of the classes’ there is a scalar implicature to the effect that he did not attend all the classes. The terms <all, most, many, some> differ in informational strength, with ‘all’ the semantically strongest and ‘some’ the semantically weakest terms in the set. By asserting the weakest term ‘some’, a speaker may be taken to implicate ‘not all/most/many’.

• 4. In DSM-5, ADHD is included in the category Neurodevelopmental disorder while selective mutism is a specifier in the category Social anxiety disorder (Social phobia). Conduct disorder occurs alongside a number of other conditions (e.g. oppositional defiant disorder) in the category Disruptive, Impulse Control, and Conduct disorders.

• 5. The presence of hydrocephaly has been identified as a factor in reduced language outcomes (Lewis and Murdoch 2011a).

• 6. Di Rocco et al. (2011) identified pre-surgical language impairment in children with posterior fossa tumours. Moreover, pre-surgical language impairment was found to be a risk factor for the development of cerebellar mutism syndrome following surgery.

• 7. It is important to note that the treatment of childhood brain tumours does not always result in language impairments. Docking et al. (2005) found that six children treated for brainstem tumour demonstrated intact language and phonological awareness abilities. In a later study, Docking et al. (2007) reported intact abilities in receptive language (including vocabulary), expressive language and naming in four children treated with surgery and/or radiotherapy for cerebellar tumour. Richter et al. (2005) found no signs of aphasia in 12 children and adolescents who underwent surgery for cerebellar astrocytoma. Frank et al. (2007) found preserved naming and verb generation accuracy in nine children and adolescents following surgery for cerebellar tumours. Lewis and Murdoch (2011b) reported intact language skills and semantic processing in a 14-year-old female who received fractionated cranial radiation dosages for treatment of medulloblastoma at 10 years and 3 months. In other cases, treatment has actually resulted in improvements in language function. Mabbott et al. (2007) found improvement in receptive language in a preschool child who received surgery, chemotherapy, stem cell transplant and radiation for the treatment of medulloblastoma.

• 8. Many higher-level pragmatic and discourse impairments in childhood TBI are related to memory deficits and other executive function disorders in this population (see Chap. 3, this volume). The relationship of pragmatic and discourse impairments to executive function deficits, often in the absence of structural language problems, is the basis for the use of the term ‘cognitive communication disorder’ in relation to the communication difficulties of both children and adults with TBI.

• 9. It should be noted, however, that the exact nature of the inferences involved in utterance interpretation is still unknown. The reader is referred to chap. 3 in Cummings (2005) for further discussion.

• 10. Not all language levels are impaired in individuals with aphasia. El Hachioui et al. (2012) examined phonology, syntax and semantics in 141 subjects with acute stroke-induced aphasia. In 22.4 % of subjects, deficits were found in only one of three linguistic levels. Phonology was the language level most likely to be disrupted (16.3 %) followed by syntax (3.4 %) and semantics (2.7 %). Also, the recovery of language levels does not follow a parallel course, with evidence of earlier recovery (up to 7 weeks post-stroke) for syntax and semantics and somewhat later recovery (up to 4 months) for phonology.

• 11. Myers (1979) had her subjects with RHD describe the cookie theft picture from the Boston Diagnostic Aphasia Examination (Goodglass and Kaplan 1972).

• 12. This ‘indirect’ approach to the epidemiology of pragmatic disorders is necessitated by the lack of epidemiological work on communication disorders. Some indication of the extent to which epidemiology has been neglected in the study of communication disorders is apparent from a workshop held in March 2005 by the National Institute on Deafness and Other Communication Disorders (NIDCD). At this workshop, it was reported that only 1.1 % of all NIDCD funded grants are associated with epidemiology.