Abstract
Lockton, E., Adams, S., & Collins, A. (2016). Do children with social communication disorder have explicit knowledge of pragmatic rules they break? A comparison of conversational pragmatic ability and metapragmatic awareness. International Journal of Language & Communication Disorders, 51, 508–517.
Background
Pragmatic language difficulties are present in many children with a range of developmental communication problems, including children with specific language impairment (Bishop, 2000), high-functioning autism (Philofsky, Fidler, & Hepburn, 2007), attention-deficit/hyperactivity disorder (ADHD; Staikova, Gomes, Tartter, McCabe, & Halperin, 2013), and social communication disorder (SCD; also known as pragmatic language impairment [PLI]; Adams, 2012; Bishop, 2000). These children have social communication disorder (CwSCD); they have long-term difficulties in participating in social communication such as responding and initiating conversational exchanges, adhering to established topics in verbal interactions, comprehending non-literal language and verbal hints, and using language in peer interactions (Adams, 2012; Brinton, Fujiki, Spencer, & Robinson, 1997).
Speech–language interventions for these children often involve individual or group work on pragmatic rules and behaviors with the children and guidance for parents and educators.
The clinician may facilitate strategies for entering and participating in conversation as part of pragmatic rule learning (Fujiki & Brinton, 2009). Children are initially taught the pragmatic rules, given opportunities to apply these rules in somewhat structured social situations, and then are to self-monitor the use of the skills in natural contexts. Children’s ability to reflect about the conventions of the use of language (or pragmatics) may be one factor that assists in the transition to self-monitoring and generalization.
Metapragmatic awareness (MPA), that is, the ability to reflect explicitly on pragmatic constituents and pragmatic rules, is thought to support the child’s learning about effective pragmatics in social communication by making the rules of pragmatics explicit. Many conversational interventions for children who have language impairments have implicit metapragmatic (MP) content and methods. The intent of MP therapy is to facilitate the links between context/situation and effective language use. MP methods rely heavily on verbal scaffolding to support the acquisition of awareness of pragmatic rules. This is carried out in conjunction with modeling, rehearsal of pragmatic acts, and self-monitoring. Adams and Gaile (2015) describe a specific sequence of MP therapy actions—pragmatic skills are first identified in observational activities, then modeled, role played, sabotaged, and role-reverse sabotaged. This sequence of therapy actions is seen as a preparation for generalization.
Clinicians using these strategies assume that children who have pragmatic deficits have poor MPA. There is, however, no clear evidence that this assumption is valid. From a therapeutic viewpoint, it appears logical to concentrate on aspects of pragmatics that are problematic for an individual with the assumption that she or he lacks knowledge of the pragmatic rule. MP interventions focus solely on creating and expressing explicit knowledge. The emphasis on explicit knowledge and its overlearning in therapy is then the proposed mechanism for MP intervention as a mediator in pragmatics therapy, which should lead to better application of the rule or more reliable application of the rule. Theoretical support for the use of explicit MPA as a method of intervention is provided by the procedural deficit hypothesis (Ullman & Pierpont, 2005). This hypothesis suggests that where language impairment leads to difficulties with implicit learning, explicit rule-based learning procedures may be required to enable the child to learn. Minimal research is available regarding the relationship between pragmatics and MPA. Little is known about MPA in clinical populations. MPA is not routinely assessed as part of preparation for setting therapy targets, and there are no formal tests of MPA.
This study investigated whether there is a relationship between ability to reflect on pragmatic behaviors (MPA) and conversational pragmatic ability in CwSCD. Furthermore, it asked whether CwSCD can demonstrate MPA for the pragmatic rules they themselves violate in conversation. In Word of Mouth 27:5, a study by Collins, Lockton, and Adams (2014) was reviewed. These researchers developed a new task, the Assessment of Metapragmatics (AMP), in which explicit knowledge of a set of pragmatic rules is elicited. In this current study, AMP is used to assess the explicit knowledge of pragmatic rules of CwSCD, and a comparison with the use of those pragmatic rules in conversation is made. The researchers questioned whether CwSCD have difficulty using pragmatic rules because they lack MPA for these rules or because they lack the ability to adhere to these rules, despite age appropriate MPA.
The Study
Participants
The children in the study were 39 CwSCD aged 6;1 to 10;7 years who were participating in the Social Communication Intervention Programme (SCIP; Adams & Gaile, 2015; see http://research.bmh.manchester.ac.uk/scip). Children were identified by their speech-language therapists as having pragmatic or social communication problems. All participants scored in the communication impaired range on the General Communication Composite (GCC)2 of the Children’s Communication Checklist–Second Edition (CCC-2; Bishop, 2003), a measure of functional communication including pragmatics completed by parents. All children also had nonverbal abilities within the normal range as measured on the Raven’s Coloured Progressive Matrices (CPM; Raven, 1998). The CCC-2 Social Interaction Deviance Composite (SIDC), which indicates the presence/absence of a disproportionate difficulty in pragmatics compared with structural aspects of language, was also calculated. An expressive language score was determined from the Clinical Evaluation of Language Fundamentals–4th Edition (CELF-4 UK; Semel, Wiig, & Secord, 2006).
Procedures
Conversational pragmatics was measured using the Targeted Observation of Pragmatics in Children’s Conversation (TOPICC; Adams, Lockton, Gaile, & Freed, 2011)—a semi-structured task that provides a direct observational measure of pragmatics in conversation (see the Resource Review in this issue of Word of Mouth). Each participant was video-recorded conversing with the researchers for 10 min. Conversations were supported with a standard series of three photographs of events and series of question prompts. The TOPICC coding scheme rates 12 aspects of pragmatics, identified in previous work as vulnerable in CwSCD, such as responsiveness, information, turn clashes, and cohesive devices. The coding scheme provided scores in relation to the child’s level of impairment (relative to expectations for that age) for each aspect of conversational pragmatics; a score of 0 was given where impairment was never or only occasionally observed, making only a slight impact on the quality interaction; and a score of 1 was given where moderate or marked impairment was observed to make a significant impact on the interaction.
MPA was assessed using the AMP, in which explicit knowledge of a set of pragmatic rules is evaluated (Collins et al., 2014). In the AMP task, the participant watches a series of short dramatized films depicting naturalistic social interactions between two children. In each interaction, one child makes a pragmatic rule violation, such as being overtalkative, and the other child displays a typical reaction to that violation. After watching each film twice, the participant was asked a series of questions designed to elicit their awareness of the pragmatic error. Three different question frames (Descriptive, Reflective, Rule) were used to give participants successive opportunities to understand what was being asked of them and to demonstrate MPA and explicitation: Descriptive question: Something went wrong in the conversation; What went wrong? Reflective question: Why is that wrong? Rule question: What could the boy have done differently?
Results
A total of 59% of the children in the study demonstrated moderate or marked impairment in one or more of the 12 TOPICC pragmatic behaviors.
Expressive language scores were significant predictors of scores on the TOPICC. Adding AMP scores did not explain any more variance on the TOPICC. This suggests that the ability to reflect on pragmatic rules does not significantly affect behavioral pragmatic impairment.
Moderate or significant pragmatic impairment as measured by the TOPICC was most frequently observed in nonverbal behaviors (41% of children), difficulties in responding to questions (39% of children), and in terms of giving too little information (33% of children).
Some children who had SCD showed a disparity between the use of pragmatic rules in conversation and ability to reflect on the same pragmatic rules. In 51% of occasions where a child showed moderate or marked impairment in a pragmatic behavior on TOPICC, the same child was able to demonstrate MP awareness in their AMP responses for the corresponding pragmatic item. On 25% of occasions, this awareness was at the most sophisticated level of MP. Of 33 children who demonstrated moderate or marked impairment in at least one pragmatic behavior on TOPICC, the majority (69.7%) were able to demonstrate some MP awareness of the same behavior in at least one corresponding AMP item.
The findings from this study showed that some children can identify and express sophisticated knowledge of pragmatic rules, but do not use these rules in their own interactions. Children may possess MP knowledge but not the social understanding to motivate its conversational use. Without an understanding of the thoughts, intentions, and emotions of others in relation to pragmatic behavior, a child may not appreciate the social consequences of violating pragmatic rules. The results of this study suggest that some children who have SCD can recognize when pragmatic rules are being flouted, but may be unable to monitor or regulate this in their own talk. This suggests that for some children who have SCD, it may be more beneficial for intervention to focus on self-monitoring rather than teaching pragmatic rules, which are already understood but not used.
Approximately 30% of children who demonstrated moderate or marked impairment in at least one pragmatic behavior on TOPICC were unable to demonstrate any MP awareness of the same behaviors in any corresponding AMP items. It might be argued that these children need training in the pragmatic rules to support application of these rules. However, these same students were likely to have lower expressive language skills. Their deficits on both TOPICC and AMP items may have been related more to their general linguistic deficits.
Comments
The American Speech-Language-Hearing Association (ASHA) adopted the International Classification of Functioning (ICF) as the framework for assessment and intervention in the Scope of Practice (ASHA, 2016) and in the Preferred Practice Patterns for the Profession of Speech-Language Pathology (ASHA, 2004). The ICF distinguishes between capacity and performance. Capacity involves having skills or knowledge to do an activity in a “standardized environment.” It represents what a person can do under ideal conditions. Formal standardized tests typically access capacity. In contrast, performance refers to what a person does in real-life situations. The results of this study indicate that children may have pragmatic capacity but they fail to use this capacity to perform appropriately in real-life interactions. This should serve as a caution to speech-language pathologists; a child’s display of skills in a structured situation is no guarantee that the child can use these skills in real-life situations.
Therapeutically, the distinction between a child’s MPA (a capacity skill) and scores on the TOPICC (performance) is critical for intervention planning. If a child with an SCD had difficulty in adhering to a specific pragmatic rule in a conversation, but demonstrates MPA for the pragmatic rule, intervention could focus on self-detection and self-correction of rule violation or perhaps on motivation to self-regulate and adhere to the rule. If the child does not have MPA for the specific pragmatic rule that he or she is violating, intervention might focus on raising the child’s awareness of the rule before behavior is changed.