National Autistic Society (Surrey Branch)

What is Semantic-pragmatic Disorder?

by Julia Muggleton

The term 'semantic pragmatic disorder' has been around for nearly l5 years. Originally it was only used to describe children who were not autistic.

Features it includes are:-

• delayed language development
• learning to talk by memorising phrases, instead of putting words together freely
• repeating phrases out of context, especially snippets remembered from television programmes
• muddling up 'I' and 'you'
• problems with understanding questions, particularly questions involving 'how' and 'why'
• difficulty following conversations

Children with this disorder have problems understanding the meaning of what other people say, and they do not understand how to use speech appropriately themselves.

Soon both research and practical experience yielded two important findings:

1. Many people who definitely are autistic have this kind of language disorder (Dustin Hoffman's character Raymond in the film 'Rainman' being a typical example).
2. Most of the children diagnosed as having semantic pragmatic disorder do also have some mild autistic features. For example, they usually have difficulty understanding social situations and expectations, they like to stick fairly rigidly to routines, and they lack imaginative play.

For a while some language therapists maintained there was still an important difference between children with semantic pragmatic disorder and children who were truly autistic. They believed the autistic features seen in children with semantic pragmatic disorder were only a result of their difficulty with language.

However, further research has shown that there is probably a single underlying cognitive impairment which produces both the autistic features and the semantic pragmatic disorder . The fact that children with semantic pragmatic disorder have problems understanding the meaning and significance of events, as well the meaning and significance of speech, seems to bear this out.

Eventually the idea of an autistic continuum was used to explain the situation. All the children on the continuum have semantic pragmatic difficulties, but the degree of their other autistic impairments can be severe or moderate or mild. This parallels the autistic continuum relating Asperger syndrome, where all the children have a marked social impairment but those with Asperger syndrome have only a relatively mild and subtle language impairment.

It seems that children who are diagnosed as having a semantic pragmatic disorder might more accurately be described as high-functioning autistic. Clinicians tend to give all autistic children who have good intelligence the label Asperger syndrome, even if a child actually has very limited speech. But there are important differences between bright autistic children with semantic pragmatic difficulties and bright autistic children with Asperger syndrome. Children with semantic pragmatic difficulties have usually learnt to talk late, whereas (according to diagnostic guidelines) children with Asperger syndrome were able to talk in sentences by the age of three. Also children with semantic pragmatic difficulties do better on performance IQ tests than verbal IQ tests, whereas with children with Asperger syndrome the results tend to be the other way round. However, if a child with semantic pragmatic difficulties eventually becomes a fluent talker, the difference between the labels 'high functioning autistic' and ' Asperger syndrome' becomes fairly academic.

There is another aspect to the issue of labelling which is altogether more emotive. Many parents feel much more able to cope with the idea of their child having semantic pragmatic language disorder than with the idea of their child being a high functioning autistic. But many other parents find the label semantic pragmatic disorder frustrating and baffling, as they only begin to really understand their child's behaviour when they realise he or she has a form of autism.

Yet another issue is the provision of resources. It is a sad truth that many high functioning autistic children are denied the kind of educational language provision they desperately need, purely because of the word 'autism'. These children are more likely to be accepted into language units and schools when they have the label of semantic pragmatic language disorder. Perhaps the only real solution is to educate the educators, so they begin to understand the wide spectrum of autistic disorders, and to forget dated stereotypes. Even better, perhaps they could learn to look beyond the label and to see the child.

Further reading:

• Autism, Asperger's syndrome and semantic-pragmatic disorder: Where are the boundaries? by D.V.M. Bishop Department of Psychology, University of Manchester (British Journal of Disorders of Communication 24, 107-121 (1989)). Available by post for a small charge from the National Autistic Society 393 City Road, London, EC1V 1NG, United Kingdom. Tel: +44 (0)20 7833 2299; Fax: +44 (0)20 7833 9666 Email: nas@nas.org.uk Also available on the Internet at http://www.mugsy.org/bishop.htm.
• Semantic Pragmatic Disorder by Margo Sharp Speech and Language Therapist October 1992. Available through the Semantic Pragmatic Group at AFASIC - Association for all Speech-Impaired Children 347 Central Market, Smithfield, London EClA 9NH Tel: 0171 236 3632 / 6487. Also available on the Internet at http://www.hyperlexia.org/sp1.html.
• Questioning the validity of the semantic-paragmatic diagnosis by Louise Gagnon, Laurent Mottron & Yves Joanette. Published in Autism - The International Journal of Research and Practice Volume 1 1997. Published by Sage Publications in association with the National Autistic Society, 393 City Road, London EC1V 1NE. Telephone 0171-833-2299. Fax 0171-833-9666. An extract of this article is on the internet at http://www.mugsy.org/spd4.htm.
• The Handbook of Autism : A Guide for Parents and Professionals, by Maureen Aarons and Tessa Gittens ISBN 0-415-05566-0.

© Julia Muggleton 1997

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