Semantic pragmatic disorder

Semantic-Pragmatic Disorder (SPD) is a developmental disorder that many experts believe is closely related to autism and Asperger's Syndrome. The name refers to the fact that people with SPD have special challenges with the semantic aspect of language (the meaning of what is being said) and the pragmatics of language (using language appropriately in social situations).

The term has been around for years, but is more widely used in England than in America, where it is just starting to be recognized. It was first coined by Rapin and Allen in 1983. There is some debate about whether SPD is a diagnostic category unto itself, or merely a subtly different flavor of high-functioning autism. There is emerging agreement among experts that most people who exhibit this language disorder are, in fact, on the autism spectrum, and many children with SPD are given the label of Asperger's Syndrome, apparently because AS has become the catch-all diagnostic label for autistic people who are verbal and have normal IQs. However, people with the SPD label have features that differ from both classic Asperger's syndrome and classic autism. Some experts believe that people with SPD have better social functioning than the typical Asperger's person, while having greater impairment in language use and development.

Characteristics
As discussed above, people with SPD have particular trouble understanding the meaning of what others are saying, and they are challenged to use language appropriately to get their needs met and interact with others. [Young] children with the disorder are often observed to:


 * have delayed language development
 * have comprehension problems, although they can often superficially improve with speech therapy.
 * learn language by memorizing whole phrases and then figuring out what the phrases mean (rather than figuring out what words mean and then starting to put them together).
 * repeat phrases that have been memorized from TV shows or read-aloud storybooks. The phrases may be repeated out of context, or sometimes in context; as the child figures out what the phrase means, he or she can often use it correctly, but to a slightly odd conversational effect -- as if he or she has been scripted.
 * confuse pronouns like "I" and "you," or "he" and "she."
 * have difficulty understanding questions; early on, there may even be difficulty understanding what a question is. I.e., the SPD child does not grasp that an upward inflection means a question is being asked.
 * have difficulty following conversations or stories
 * have difficulty extracting the key points from a conversation or story; they tend to get lost in the details.

People with SPD often share additional characteristics consistent with high-functioning autism. For example, they may dislike or avoid eye contact. Many have rigid habits, a shallower range of interests than most people (often with a deep knowledge of their areas of interest), sensory and eating sensitivities, coordination and muscle-tone issues. They may also display striking abilities in an area like mathematics, computer science, geography, astronomy, reading, or music.

SPD was originally defined in the literature on Language Disorder in 1983, by Rapin and Allen, although at that time it was classified as a syndrome. They referred to a group of children who presented with mild autistic features and specific semantic pragmatic language problems. More recently, the term "pragmatic language impariment" (PLI) has been proposed.

Clinical profile
According to Bishop & Norbury (2002), children with semantic-pragmatic disorder have fluent, complex and clearly articulated expressive language but exhibit problems with the way their language is used. These children typically:
 * are verbose
 * have problems understanding and producing connected discourse
 * give conversational responses that are socially inappropriate, tangential and/or stereotyped
 * develop obsessional interests

The current view, therefore, is that the disorder is more to do with communication and information processing than language. For example, children with semantic pragmatic disorder will find often fail to grasp the central meaning or saliency of events. This then leads to an excessive preference for routine and 'sameness' (seen in autism) as SPD children struggle to generalize and grasp the meaning of situations that are new; it also means that more difficulties occur in a stimulating environment than in a one-to-one setting.

A further problem caused by SPD is the assumption of literal communication. This would mean that obvious, concrete instructions are clearly understood and carried out, whereas simple but non-literal expressions such as jokes, sarcasm and general social chatting are difficult and can lead to misinterpretation. Lies are also a confusing concept to children with SPD as it involves knowing what the speaker is thinking, intending and truly meaning beyond a literal interpretation.

Relationship to autism
There is a great deal of debate over the relationship between semantic-pragmatic disorder and autistic disorder as the clinical profile of semantic-pragmatic disorder is often seen in children with high-functioning autism.

Related disorders
Hyperlexia is a similar but different disorder where main characteristics are an above average ability to read with a below average ability to understand spoken and/or written language.