What is Semantic-Pragmatic Disorder?
The term “semantic-pragmatic disorder” or SPD for short is coined about fifteen years ago by Rapin and Allen (1983). It is defined as a syndrome. According to The American Heritage Dictionary (2005), a syndrome is a group of signs and symptoms that collectively indicate or characterize a disease, pscyhological disorder, or other abnormal condition. Often than not, SPD co-exists with hyperlexia and/or autism spectrum disorder (or ASD for short), especially in a group of children with mild autistic features. However, strictly speaking, we should not because of that view that SPD is seen as a subtype of ASD.
Today, with more research studies done over the past decade, there is a better understanding of SPD than before. Children with SPD display many problems than just speaking and comprehending words. A speech-language therapist would see it as a communication disorder but an academic language therapist would view it as a language disorder. Children with SPD encounter problems in processing information as well as difficulty in extracting the central meaning or the saliency of an event both aurally and visually (Sharp, 2003). They have the tendency to focus on detail instead.
It has been found that the more stimulating the environment becomes the more difficult it is for a child with SPD finds extracting information. Hence, it is important for parents and teachers to take note of this oddity: children with SPD are always more sociable with friends at home or in a formal one-to-one situation (e.g., during a testing session) than in a busy classroom.
In general, many children with SPD do well in their studies; sometimes way above their chronological age level on formal language tests. However, this does not mean they do not have comprehension problems or what is termed as hyperlexia. When they were younger, they displayed signs of speech delay. Because some of these children do show autistic-like symptoms, often they have been diagnosed to be autistic. While many severely autistic children fail to develop meaningful speech, children with SPD do develop meaningful speech but much later. Their difficulties in understanding language are usually fairly subtle by the time they are five years old (Sharp, 2003). The main difference between a child with ASD per se and another with SPD per se is that while both of them have VIQ < PIQ, the former has a higher Autism Quotient (AQ), often 90 or higher than the latter; and also, the latter would eventually develop meaningful speech and often has a better prognosis than the former. On the other hand, a child with SPD could be mistaken for one with Asperger's Syndrome or Non-Verbal Learning Disability (NVLD for short; sometimes also known as Right Hemisphere Learning Disorder). The main difference between the two is that the former has VIQ < PIQ with obvious speech delay and lower AQ (unless it co-exists with ASD), while the latter with Asperger's Syndrome has VIQ > PIQ without speech delay and an AQ of between 80 and 89. When a child with SPD reaches eight years old, he/she would be communicating quite normally and in fact, better than the other with Asperger’s Syndrome.
I would say, based on my past three decades of experience as a speech-language therapist, SPD has three main subtypes: one with ASD (classical autism) or Kanner’s Syndrome (also known as infantile autism syndrome) or even a shadow syndrome of ASD (Ratey and Johnson, 1997), another with non-autistic disorder (e.g., Asperger’s Syndrome), and the third one is SPD per se. In addition, it can also co-exist with other developmental disorders (e.g., hyperlexia and attention deficit/hyperactivity disorder or ADHD for short).
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