Expert: James Michael Roan - 10/25/2006

Question
Hi
I have an almost 3 year old son who was diagnosed with PDD (though the Development Pediatritian is not 100% sure).  She also gave him a pragmatic language disorder dx that I am not sure about.  He does not listen well.  I feel that if he would only listen, everything else would just melt away.  He communicates well and likes people.  He interacts fine with us and adults in general and with his 8 month old baby sister (though he can push her at times).  He is not comfortable around peers and this started when he was pushed on two consecutive visits to the park at 20 months by peers that he approached.  However, he likes them but just isn't able to intereact properly but doesn't mind when they come up to him, etc. I feel he is very high functioning.  His language problem is getting stuck on saying the same thing (though with variation).  For example this morning he went on for about 10 minutes on getting a certain type of cookie at the grocery store.  He doesn't always do this but it is annoying.  He will also sometimes just say something just for he sake of saying it like he thinking out loud.  I used to think he had an over active imagination but apparently this is considered a pragmatic problem.  We can have a back and forth coversation with him.  He says hello and goodbye without prompting.  The other night he had a conversation with an imaginary wolf that was leaving for his dinner.  He ran to the window and said "Hello wolf.  How are we doing. You have to go home for your dinner.  I'm going to have a bath.  See you tomorrow.  Bye."  He will be going to a special class next month and will be receiving ST for pragmatics.  I was just wondering if you think his pragmatic language will become un-noticeable eventually? I really am not quite sure if he does have a pragmatic problem.  I am finding it hard to believe after some reserach I did.  I was also thinking he might have a mild case of Asperger's but he does not have a single area of interest and plays with a large variety of toys.  He does like to talk a lot but I guess its more quantity than quality but he can be very amusing.  He also does not take things literally.  I can say things like "I will eat your toes, etc" and he knows that's a joke.  He asks lots of questions and anwers all types of questions including why questions.  He has no problem understanding everything we say and can easily follow muli-step reqeusts.
Anyway, any insight into pragmatics would be greatly appreciated.  

Answer
Hi Sally;

Pragmatics or pragmatic language refers to social language, but there is a lot more to it than that. It is not the language that is the issue, it is the lack of social cognition or social thinking that is the real issue here. To quote Michelle Garcia-Winner: "It's about you thinking about me." In other words, when there is a social cognition delay you see higher than usual volume, egocentric speech or one-sided conversations, unusual prosody, etc., because the individual is not as concerned about the listener's needs as they are about their need to share. Like all attributes, Asperger's Syndrome is a continuum. There are many children who are subclinical Asperger's, meaning they meet some but not all clinical criteria for a diagnosis. The partial solution is to teach social thinking not social language.

Michelle-Garcia Winner is a good place to begin on the social thinking journey as is any research or books from Dr. Simon Baron-Cohen who is known for "theory of mind," or the ability to infer what the other is thinking based on tone and rhythm of speech, facial expression, eye contact, and body language.

Does this help?

Kind Regards,
James