Psychosocial Aspects of Pragmatic Disorders

Oral language skills, callous and unemotional traits and high-risk patterns of youth offending

Extensive research has associated adolescent delinquent behavior with verbal deficits, yet for some subgroups of youth offenders better verbal ability has been associated with increased risk. This study examined associations between specific oral language skills and established markers of high-risk youth offending comprising callous and unemotional (CU) traits, early age of the first offence, and violent offending. Measures of language, CU traits, anxiety, as well as official youth justice data, were collected for adolescent male offenders and non-offenders (n = 130; aged 13-19 years; 62% youth offenders). Pragmatic language was found to be differentially associated with distinct variants of CU traits based on high/low levels of anxiety. Furthermore, among youth offenders with primary variant (low anxiety) CU traits, more violent offending was associated with better structural language skills, while earlier age of first offence was associated with better pragmatic language skills.

Comprehension of Spatial Demonstratives in Mandarin-speaking Children on the Autism Spectrum: The Roles of Theory of Mind and Executive Function

The present study aimed to examine whether Mandarin-speaking children on the autism spectrum showed differences in comprehending spatial demonstratives ("this" and "that", and "here" and "there"), as compared to typically developing (TD) children. Another aim of this study was to investigate the roles of theory of mind (ToM) and executive functions (EF) in the comprehension of spatial demonstratives. Twenty-seven autistic children (mean age 6.86) and 27 receptive-vocabulary-matched TD children (mean age 5.82) were recruited. Demonstrative comprehension was assessed based on participants' ability to place objects in certain locations according to experimenters' instructions which involved these demonstratives in three different conditions (same-, opposite-, and spectator-perspective conditions). Four false-belief tasks were administered to measure ToM, and the word-span task and the dimensional change card sort task were used to measure two subcomponents of EF - working memory and mental flexibility - respectively. Children on the autism spectrum were found to score below TD children in the comprehension of spatial demonstratives. In addition, the results showed that ToM and working memory were conducive to the correct interpretation of spatial demonstratives. The two cognitive abilities mutually influenced their respective roles in spatial demonstrative comprehension in the three different conditions. The findings suggest that the comprehension of spatial demonstratives comprehension is an area of need in Mandarin-speaking children on the autism spectrum, and it might be linked to their differences in cognitive abilities.

Temporal processing deficit in children and adolescents with autism spectrum disorder: An online assessment

Objective

The sensory deficit has been considered as one of the core features in children and adolescents with autism spectrum disorder (ASD). The present study aimed to examine the temporal processing of simple and more complex auditory inputs in ASD children and adolescents with an online assessment that can be conducted remotely.

Methods

One hundred fifty-eight children and adolescents aged 5-17 years participated in this study, including 79 ASD participants and 79 typically developing (TD) participants. The online assessment consisted of two temporal-order judgment tasks that required repeating the sequence of two pure tones or consonant-vowel (CV) syllabic pairs at varying interstimulus intervals (ISIs).

Results

Significantly lower accuracy rates were found in ASD than TD participants in the pure tone and the CV conditions with both short and long ISI. In addition, ASD participants (M  =  245.97 ms) showed a significantly higher passing threshold than TD participants (M  =  178.84 ms) in the CV task. Receiver operating characteristic analysis found that the age × ISI passing threshold composite yielded a sensitivity of 74.7% and a specificity of 50.6% at the cutoff point of -0.307 in differentiating ASD participants from TD participants.

Conclusion

In sum, children and adolescents with ASD showed impaired temporal processing of both simple and more complex auditory stimuli, and the online assessment seems to be sensitive in differentiating individuals with ASD from those with TD.

Maternal Pragmatic Language Difficulties in the FMR1 Premutation and the Broad Autism Phenotype: Associations with Individual and Family Outcomes

Broader phenotypes associated with genetic liability, including mild difficulties with pragmatic language skills, have been documented in mothers of children with autism spectrum disorder (ASD) and mothers of children with fragile X syndrome (FXS). This study investigated the relationship between pragmatic difficulties and indicators of maternal well-being and family functioning. Pragmatic difficulty was associated with loneliness in mothers of children with ASD or FXS, and with depression, decreased life satisfaction, and poorer family relationship quality in mothers of children with FXS only. Results inform subtle maternal pragmatic language difficulties as a risk factor that that may contribute to reduced health and well-being, informing tailored support services to better meet the unique needs of families of children with ASD or FXS.

Comparing participation in sports discussion and art therapy groups in ABI

Background:

Social connection is often impacted by acquired brain injury (ABI), contributing to isolation and compromised mental health. Group therapy is thought useful in this context. For those experiencing cognitive communication challenges, finding alternative ways to engage is also valuable. Art therapy may offer pro-social support through shared activity, self-expression, organic subject matter and enduring visual prompts.

Method:

A multiple A-B-A single case experimental design compared participation in sports discussion and art therapy groups on a long-stay secure unit. Nine individuals with ABI and complex combinations of communication, cognitive and mental health needs were studied. It was hypothesised that for some individuals, participation would be greater in art therapy than sports discussion groups.

Results:

Results from six individuals with at least five measurement points per phase are reported. Tau statistics revealed significant interphase differences for three individuals. Significantly less participation was recorded for two individuals in art than sports discussion, however they still appeared invested in the art groups. The remaining participant, with the most severe communication difficulties, avoided all baseline sports discussion groups, but participated in almost all art groups, with significant increase between initial sports discussion and art phases.

Conclusion:

Further research is warranted regarding the potential art therapy offers for group engagement, particularly where complex challenges render traditional talking-style groups less appropriate. Furthermore, disparate and complex needs in severe ABI require diverse, well-designed groups offering different opportunities and responding to individual strengths and motivations. More research into such approaches may increase group participation in this challenging cohort.

Evolución de la competencia comunicativa mediante intervención pragmática en retraso del lenguaje: estudio de caso

En el presente trabajo se describe la eficacia de la evaluación e intervención pragmática en un caso de retraso del lenguaje secundario a daño cerebral infantil. La intervención logopédica adoptó un marco teórico de psicolingüística cognitiva funcional y se centró en potenciar las habilidades pragmáticas comunicativas mediante la estimulación de las categorías pragmáticas interactivas en contextos conversacionales naturales. Mediante el PREP-R (Protocolo Rápido de Evaluación Pragmática Revisado) se ha hecho un seguimiento de la orientación comunicativa de los turnos, la predictibilidad, la eficacia comunicativa, la habilidad pragmática (general, específica y gramatical) y los elementos que componen el acto comunicativo para establecer el perfil comunicativo específico de la paciente y proponer una intervención funcional ajustada a las necesidades del caso.

What is the contribution of executive functions to communicative-pragmatic skills? Insights from aging and different types of pragmatic inference

The role of executive functions in supporting the pragmatics of communication has been extensively examined in clinical populations, but is still under-explored in healthy aging. In this study we addressed the role of executive skills, including inhibition, working memory, and cognitive flexibility, in older adults' communicative-pragmatic abilities. Pragmatics was extensively assessed by measuring the understanding of figurative language, narrative texts, humor, and implicatures. A hierarchical regression analysis using composite scores evidenced a global effect of executive functions on communicative-pragmatic abilities, beyond demographic and theory of mind aspects. More fine-grained analyses showed that working memory was the strongest predictor of all pragmatic tasks. Specifically, comprehending narratives and humor seemed to capitalize primarily upon working memory, whereas figurative language and implicatures relied on working memory and to some extent cognitive flexibility. Conversely, inhibition did not stand out as a robust predictor of pragmatics. We argue that working memory allows for the simultaneous consideration of multiple pieces of information needed for pragmatic inferencing, and that only once working memory has played its role other executive aspects, such as cognitive flexibility and inhibition, might come into play. Overall, this study highlights the diverse role of executive skills in pragmatics in aging, and more generally contributes to shed light on pragmatic competence in older adults.

The oral language and reading comprehension skills of adolescents in flexible learning programmes

Purpose: Access to flexible learning programmes (FLPs) for students who have been excluded or diverted from mainstream school settings is increasing internationally. While still technically "engaged with education" such students face long-term vulnerability with respect to acquiring marketable employment skills post-school. Language and literacy skills are central to such training; hence, this study describes the oral language and reading comprehension profiles of a sample of flexible learning programmes (FLP) students.Method: Fifty young people (mean age 16 years) enrolled in three FLPs in Victoria, Australia were assessed by a speech-language pathologist in order to profile their oral language and reading comprehension skills.Result: Seventy-two percent of participants had oral language skills that placed them in an at-risk range on standardised measures, and 47.5% had reading comprehension ages of ≤12 years. A moderate significant association existed between oral language and reading comprehension skills.Conclusion: Language and reading comprehension difficulties are prevalent in this population and may be missed in the context of the mental health and adjustment difficulties experienced by this group, but are likely to be key to academic engagement and success. Speech-language pathology scope of practice needs to include FLP settings.

Friendships after severe traumatic brain injury: a survey of current speech pathology practice

OBJECTIVE

To investigate current speech pathology practice regarding working with friends.

METHOD

An online survey was conducted with 68 speech pathologists who worked with TBI across metropolitan and rural settings in Australia. The survey investigated the reasons speech pathologists work with friends, barriers to working with friends and perceptions of successful friendships post TBI. Descriptive statistics and content analysis of open ended responses were used to analyze the data.

RESULTS

There were more speech pathologists (40%) who did not include friends compared to those who did. Friends were most commonly included in the rehabilitation process, through the provision of education programs. The primary rationale for working with friends was to prevent negative psychosocial outcomes for the person with TBI. There were numerous barriers to working with friends, most commonly the inability to access friends.

CONCLUSIONS

Making and keeping friends are a significant part of most people's lives. Therefore, it is important to consider their role in contributing to improved outcomes for people with TBI. With communication partner training being an integral component to recovery and maintenance of relationships post TBI, the development of targeted education and training materials is warranted, to enable the inclusion of friends in the rehabilitation process.

Narrative language skills of maltreated children living in out-of-home care

Purpose: Children's narrative accounts of their experiences are central to the prosecution of perpetrators of alleged maltreatment. We describe the narrative language skills of children who were placed in out-of-home care (OOHC) following substantiated maltreatment. It was hypothesised that (i) children with such histories would display narrative language skills that fall significantly below published age-expected norms, (ii) narrative language skills and core language skills would be positively correlated and (iii) narrative language skills would be associated with measures of socio-economic disadvantage.Method: Eighty-three children (40 males and 43 females) aged 5;3 to 12;10 (M = 7.9, SD = 2.3) from English-speaking home backgrounds were assessed using the Test of Narrative Language and the Clinical Evaluation of Language Fundamentals (CELF-4) Core Language Score. The Raven's Coloured Progressive Matrices, a measure of nonverbal intelligence, was employed as a covariate.Result: Forty-two percent of children scored in the below-average range on the Narrative Language Index Ability Index. The same proportion scored at/above age-expected levels on the Narrative Comprehension subtest, and 19% scored at/above age-expected levels on Oral Narration. There was a significant correlation between CELF-4 Core Language Scores and the Narrative Language Index Ability Index. Female carers' education was significantly positively associated with overall narrative language scores; however, household income and index of socio-economic disadvantage were not significantly associated with narrative language scores.Conclusion: Children who are victims of substantiated maltreatment should be considered at-risk for compromised ability to provide a narrative account of their experiences. The heterogeneity and often scant oral narrative language skills of these children highlights the importance of police/human services training on best-practice forensic interviewing. Policy and practice implications for speech-language pathology early intervention to support the needs of at-risk children are also discussed.

Loss of friendship following traumatic brain injury: A model grounded in the experience of adults with severe injury

Relationships make important contributions to wellbeing and maintenance of self-worth. For those who sustain traumatic brain injury (TBI), life is frequently characterized by declining interpersonal relationships. The aim of this study was to understand the post-injury experience of friendship from the perspective of adults with severe TBI. Participants were 23 adults who had sustained severe TBI on average 10 years earlier; the majority was between 25 and 45 years old. The experience of friendship was explored using a convergent mixed methods design (quantitative self-report measures and in-depth interviews). Qualitative analysis of interview transcripts employed open and focussed coding to reveal themes and categories. Participants nominated on average 3.35 (SD 2.19) friends. When paid carers and family members were excluded, the mean dropped to 1.52 (SD 1.38). Exploratory correlations between number of friends and quality of life, depression and strong-tie support revealed significant associations of moderate to large effects. The post-injury experience of friendship was broadly conceptualized as "going downhill" with four overlapping phases: losing contact, being misunderstood, wanting to share and hanging on. Participants' stories illustrated how rehabilitation can focus on friendship by supporting established relationships and facilitating access to activities that afford interpersonal encounters and opportunities to share experiences.

“So that's the way it is for me — always being left out.” Acquired Pragmatic Language Impairment and Social Functioning following Traumatic Brain Injury

Our ability to interact appropriately in everyday interpersonal situations is fundamental to successful social integration. Impaired pragmatic competence correlates significantly and substantially with indices of social function across several domains for adults with acquired neurological disorders. In particular, evidence supports the negative impact of pragmatic impairments on the development and maintenance of relationships and community integration more generally.

Pragmatic language competence sits in a complex, multifactorial space characterised by interacting associations with cognitive and psychological functions and social and environmental parameters. This complexity is evident in much of the research seeking to unravel the nature and magnitude of interactions between pragmatic language competence and social outcomes in adults with acquired neurological disorders.

Over recent years our understanding of the impact of pragmatic impairments on social outcome has benefited substantially from inclusion of the insider's perspective in our research evidence base. Indeed, a methodological inclusion of constructivist paradigms has enabled the development of a rich understanding of the devastating social impact of impaired pragmatic competence.

The aim of this paper is to review pragmatic language impairment in the context of traumatic brain injury (TBI) and detail its impact on social functioning from the perspectives of people with TBI and their intimate partners/spouses and friends. With these perspectives as background, the paper concludes with consideration of therapeutic developments and a brief look at a novel intervention designed to reduce the negative impact of pragmatic deficits and improve functional language use following TBI.