Pragma-c Deficit Pragma-c deficit characteris-cs Idiosyncra-c style Persistence Lack of kindness Lack of empathy Lack of social knowledge Distrust Aggressiveness Torque in teasing Shyness Dependence Pragma-cs deficit causes Au-sm Language Impairments Learning Difficul-es Right hemisphere stroke Ins-tu-onaliza-on Low social economic status Personality Disorders 1
Pragma-c Deficit Severity Severe (au-sm, psychosis) Moderate (Language Impairments, Cogni-ve Difficul-es, Right hemisphere stroke etc.) Mild (between us) Communica-on Dance (Banathy 1992) Hearing of music/ Inten-on Steps/ Verbal and Non Verbal abili-es Holding/ Adap-ve behaviors Dancing floor/ Context of Communica-on Hearing of music/ Inten-on Lack of interest for others Lack of Joint a[en-on Lack of inten-on for expression of feelings Lack of understanding of inten-on of others 2
Steps/ Verbal and Non Verbal abili-es Language development (vocabulary, morpho - syntac-c abili-es) Non verbal abili-es (eye contact, facial expressions, turn taking) Conversa-on abili-es Narra-ve abili-es Idioms understanding, humor, metaphors Meta linguis-c abili-es Holding/ Adap-ve behaviors Difficul-es in social interac-on due to adap-ve difficul-es may be faced up in people with: Stu[ering Ar-cula-on disorders Phonological disorder Language Impairments Hearing impairments Visual impairments Dancing floor/ Context of Communica-on Non appropriate behaviors in the school place Non appropriate behaviors in public places Lack of understanding the rules of social interac-on Lack of understanding the code for interac-on in different places with different peoples AUTISM 3
Social Communica-on Disorder (SCD) an impairment of pragma-cs and is diagnosed based on difficulty in the social uses of verbal and nonverbal communica-on in naturalis-c contexts, which affects the development of social rela-onships and discourse comprehension and cannot be explained by low abili-es in the domains of word structure and grammar or general cogni-ve ability. B. The low social communica-on abili-es result in func-onal limita-ons in effec-ve communica-on, social par-cipa-on, academic achievement, or occupa-onal performance, alone or in any combina-on. C. Rule out Au-sm Spectrum Disorder (ASD). Au-sm Spectrum Disorder by defini-on encompasses pragma-c communica-on problems, but also includes restricted, repe--ve pa[erns of behavior, interests or ac-vi-es as part of the au-sm spectrum. Therefore, ASD needs to be ruled out for SCD to be diagnosed. D. Symptoms must be present in early childhood (but may not become fully manifest un-l social demands exceed limited capaci-es). The new DSM-5 category requires persistent difficul-es in verbal and nonverbal communica-on in social secngs, manifested by all of the following There are deficits in social communica-on, such as gree-ng or sharing informa-on in an appropriate manner. There is difficulty with changing communica-on to match the listener (e.g., an adult versus a child) or the context (e.g., classroom versus playground). Stereotypic or formal language may be inappropriately used for informal conversa-on. There is difficulty with the rules governing conversa-on, such as speaking in turn, repea-ng informa-on if not clearly understood, and regula-ng conversa-on in response to verbal and nonverbal informa-on from others. 4
Inference of what is not explicitly stated may not be made, or language with ambiguous meaning may not be correctly interpreted, such as metaphors or jests. These problems must cause func-onal limita-ons in effec-ve communica-on, social par-cipa-on, rela-onships and academic or occupa-onal performance, either individually or in combina-on. The symptoms must begin in the early developmental period, when language is usually acquired, and must not be be[er accounted for by another mental disorder or a general medical or neurological condi-on. In par-cular, cogni-ve impairment causing low abili-es in the domains of word structure and grammar cannot be the cause, and developmental delay, intellectual disability and au-sm spectrum disorder must be excluded. Aims of the study Collec-on of data related to pragma-c abili-es of children with au-sm and mild learning difficul-es (mental retarda-on). Comparison of pragma-c abili-es of children with ASD with children with Down syndrome and mild learning difficul-es (mental retarda-on) and also with children with typical development Collec-on of data related to typical development of Greek children Examina-on of the nature of pragma-c abili-es in children with ASD Par-cipants 12 boys with au-sm 12 boys with Down syndrome 22 boys with typical development Prerequisites: Their na-ve language was Greek The au-sm and Down syndrome subjects had mild learning difficul-es 5
Diagnos-c tools Criteria of DSM-IV for diagnosis of ASD (APA 1994) Revised-Au-sm Diagnos-c Interview (ADI-R) (Le- Couter, Ru[er, Lord 1995) Childhood Au-sm Ra-ng Scale (CARS) (Schopler, Reichler, Renner 1972) WISC-R (Wechler 1974) Pragma-cs Profile of Early Communica-on Skills (Dewart & Summers 1988). Test of Recep-ve and Expressive Language Abili-es (Vogindroukas, Grigoriadou 2009) PPECS Is an informal interview with parents concentrated on four main areas of pragma-cs, 1. Communica-ve inten-on 2. Response to communica-on 3. Par-cipa-on in social interac-on 4. Communica-on context There are 33 ques-ons which exam 43 pragma-c abili-es, the ques-ons are amplified by examples to s-mulate discussion. Ages of the par-cipants Age in months TD 66 ASD 84 DS 96 6
IQ results of ASD group and Down Syndrome group ASD IQ DS IQ 1.α 60 1.σν 65 2.α 61 2.σν 55 3.α 59 3.σν 69 4.α 55 4.σν 57 5.α 57 5.σν 60 6.α 65 6.σν 61 7.α 69 7.σν 66 8.α 65 8.σν 67 9.α 67 9.σν 59 10.α 56 10.σν 66 11.α 69 11.σν 68 12.α 55 12.σν 58 t:1,717, t: 0,525, df: 22, -0,525<1,717,p<0,05 No significant differences Verbal abili-es results of ASD and Down syndrome group Verbal AbiliCes SD ASD 5,16 0,78 Down syndrome 4,49 0,679 t : 1,17, df: 22, p<0,05 No significant differences Verbal abili-es results of ASD and Typical Development group Verbal AbiliCes SD ASD 5,16 0,78 TD 4,49 1,049 t = 1,17 df: 32 p < 0,05 No significant differences 7
Total pragma-c impairment results TD, 5.1 DS; 15,3 ASD, 51.2 Inten-on for communica-on abili-es 1. Seeking a[en-on of an adult 120% 2. Direc-ng a[en-on 3. Object request 100% 4. Ac-on request 5. Verbal request for help 80% 6. Repe--on of request for ac-on 60% 7. Request for informa1on 10. Departure gree1ng 11. Expression of emo1on 8. Refusal 9. Arrival gree-ng 40% 20% 12. Naming of objects 0% 13. Commen-ng on object 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 14. Commen-ng on absence of an object 15. Expression of independence ASD DS TD 16. Conveying Informa1on to the interlocutor Communica-on responsiveness abili-es 1. Seeking a[en-on of the child 120% 2. Interest in communica1on 3. Understanding of poin-ng 100% 4. Understanding of the inten-on of speaker in single direc-on 80% 60% 5. Understanding of the inten-on of speaker in a single ques-on 40% 20% 6. Understanding of the indirect request 0% 7. Understanding of humor 8. Nego1a1on 9. Understanding the wai-ng -me limit 1 2 3 4 5 6 7 8 9 ASD DS TD 8
Conversa-on abili-es 1. Opening a communica1on event 120% 2. Maintaining a conversa1on 3. 100% Informa1on to interlocuter about the topic 4. Repairing of conversa1on 5. Asking for clarifica1on 80% 60% 6. Closing of conversa1on 40% 7. Overhearing of conversa1on 20% 8. Par1cipa1on in conversa1on 0% 1 2 3 4 5 6 7 8 ASD DS TD Differences in communica-on context 1. Changes in way of 120% speaking according to the listener 100% 2. Choosing of 80% conversa1on topic 3. Using of speech in 60% play 1me 4. Associa1on with peers 40% 5. Communica-on 20% through books 6. Social contracts 0% 1 2 3 4 5 6 ASD DS TD Down Syndrome difficul-es Associa-on with peers Par-cipa-on in conversa-on Informa-on to the interlocutor about the topic of conversa-on Asking for clarifica-on Nego-a-on Arrival gree-ng 9
Typical development (66m) difficul-es Arrival gree-ng Nego-a-on Conclusions I Pragma-c abili-es are impaired in ASD Pragma-c abili-es in ASD influenced by the nature of the au-s-c disorder and not by the low IQ Down syndrome also has pragma-c difficul-es probably caused by low IQ Greek children aged 66m present some pragma-c difficul-es caused by their age level Conclusion II But children with au-sm show a significant number of pragma-c abili-es. They are able to: Seek a[en-on of an adult Direct a[en-on Request Object Request Ac-on TD, Request for help verbally 94.8 Name objects Comment on object Comment on absence of an object Express independence Understand poin-ng Understand the inten-on of speaker in single direc-on Understand the inten-on of speaker in a single ques-on Understand indirect requests ASD, 48.7 DS, 84.6 10
This finding is in agreement with findings from other research which conclude that the statement that children with au-sm are presented as non communica-ve is not valid (Cantwell & Baker 1987, Wetherby 1986) Conclusion III The pragma-cs abili-es in children with ASD mostly relate to helping their needs and not to social communica-on needs Also the qualita-ve analysis of the results shows some differences between the three groups of par-cipants which relate to the way of using these abili-es Examples Asking for help: they ask for help in the same way in all situa-ons and without conveying more informa-on about the reason which leads them to ask for help Refusing: they don t always refuse by using the appropriate phrases, but mostly by pushing away the object or by going away from the place Expression of independence: most of the par-cipants use phrases which are different from the control groups phrases. The control groups par-cipants use phrases such as alone, I can do this myself. Children with ASD give direc-ons to the adults in order to do something alone such as go away leave me 11
Last thoughts Regarding the nature of the pragma-c difficul-es in children with ASD we conclude that these are observed as much in verbal communica-on as in non verbal According to our knowledge of au-sm perhaps we can use the term pre verbal pragma-cs in order to understand be[er the nature of pragma-c difficul-es in au-sm and also the concept of spectrum 12