Clinical Services - Pragmatic Language Impairment

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Helping children with Pragmatic Language Impairment

Children who have pragmatic language impairments (PLI) most notably have difficulty understanding and using language for conversation and social interactions. They may have difficulty understanding complex language or making inferences to understand the subtle and implied meanings of what is said. They may not understand the unspoken social rules for a range of social contexts, and will appear to find participating in conversations and friendly chatting difficult. Children with PLI may have strong interests in particular subjects and these can dominate their attempts at social interaction, making them appear verbose and dominating the talk. In school this can lead to further difficulties, such as participating in a group and coping with the social demands of the school day.

Children with pragmatic language difficulties require help from a speech and language therapist (SLT) who may work directly with the child, support parents in helping at home and work with teaching staff in school/ college.

The assessment

Firstly the SLT needs to gain a profile of the child’s strengths and weaknesses using a range of standard language and social communication assessments and gain a history of the child’s early development and current functioning reported by the parents. Further observational assessments are necessary to obtain a better understanding of the factors which influence the child’s functional skills. In addition the assessment aims to seek the child’s own views and gain the priorities of their parents and teachers to help guide the intervention.

The intervention

The therapy aims to directly work on the areas identified in the assessment, for example working on the child’s conversation skills, knowing how to respond to others effectively, and how to understand the social situation they are in. These skills may be worked on in individual therapy sessions and modelled to parents and school staff. The child is encouraged to identify for themselves what they would like to do differently and engaged in developing their own self help strategies. Learning how to reflect on their own experiences and gaining insight into why something was successful or not is central to the intervention process. As young people become more aware of their role in the interactions and the changes they can make, parents and carers have a key role in maintaining their self esteem. Close liaison with parents and teachers, therefore, is essential to the effectiveness of intervention. Parents and teachers provide the support that enables the child to become aware of, and confidently make changes to, their habitual interaction style in real life situations.

The SLT will provide 1:1 sessions for the child and may also visit the school to offer training to staff on supporting the child in school.

The therapy is appropriate for children in primary and secondary schools and older students in higher education.

The type of therapy
Therapy for children with a pragmatic language impairment could include:
  1. Starting and maintaining conversations
    Greetings and social chat
    Asking appropriate questions
    Making appropriate responses
    Recognising breakdowns in interaction

  2. Repairing the interaction
    Managing topics in conversation
    Story telling and getting the gist of a story
    Sequencing ideas
    Understanding inference and non-stated meanings
    Understanding non-literal language, sayings, jokes, puns and idioms
    Work on related higher level language skills such as comprehension of stories or events or supporting more basic language skills such as sentence constructions may also be required for some children.

  3. Friendship skills
    Adapting to a peer group – fitting in and standing out
    Making and maintaining friendships
    Developing shared interests

  4. Understanding Emotions
    Understanding the links between events and a change in feelings
    Emotional awareness in self
    Awareness of emotions in others
    Reading social cues
    Understanding and using social responses – e.g. facial expression

  5. Developing self awareness and self-monitoring
    Developing insight into self and others
    Reflecting on and solving personal social problems
    Applying self help strategies in the real world

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