What is Semantic-pragmatic Disorder?
by Julia Muggleton
The term 'semantic pragmatic disorder' has been around for nearly l5 years. Originally it was only used to describe children who were not autistic.
Features it includes are:-
delayed language development
learning to talk by memorising phrases, instead of putting words together freely
repeating phrases out of context, especially snippets remembered from television programmes
muddling up 'I' and 'you'
problems with understanding questions, particularly questions involving 'how' and 'why'
difficulty following conversations
Children with this disorder have problems understanding the meaning of what other people say, and they do not understand how to use speech appropriately themselves.
Soon both research and practical experience yielded two important findings:
Many people who definitely are autistic have this kind of language disorder (Dustin Hoffman's character Raymond in the film 'Rainman' being a typical example).
Most of the children diagnosed as having semantic pragmatic disorder do also have some mild autistic features. For example, they usually have difficulty understanding social situations and expectations, they like to stick fairly rigidly to routines, and they lack imaginative play.
For a while some language therapists maintained there was still an important difference between children with semantic pragmatic disorder and children who were truly autistic. They believed the autistic features seen in children with semantic pragmatic disorder were only a result of their difficulty with language.
However, further research has shown that there is probably a single underlying cognitive impairment which produces both the autistic features and the semantic pragmatic disorder . The fact that children with semantic pragmatic disorder have problems understanding the meaning and significance of events, as well the meaning and significance of speech, seems to bear this out.
Eventually the idea of an autistic continuum was used to explain the situation. All the children on the continuum have semantic pragmatic difficulties, but the degree of their other autistic impairments can be severe or moderate or mild. This parallels the autistic continuum relating Asperger syndrome, where all the children have a marked social impairment but those with Asperger syndrome have only a relatively mild and subtle language impairment.
It seems that children who are diagnosed as having a semantic pragmatic disorder might more accurately be described as high-functioning autistic. Clinicians tend to give all autistic children who have good intelligence the label Asperger syndrome, even if a child actually has very limited speech. But there are important differences between bright autistic children with semantic pragmatic difficulties and bright autistic children with Asperger syndrome. Children with semantic pragmatic difficulties have usually learnt to talk late, whereas (according to diagnostic guidelines) children with Asperger syndrome were able to talk in sentences by the age of three. Also children with semantic pragmatic difficulties do better on performance IQ tests than verbal IQ tests, whereas with children with Asperger syndrome the results tend to be the other way round. However, if a child with semantic pragmatic difficulties eventually becomes a fluent talker, the difference between the labels 'high functioning autistic' and ' Asperger syndrome' becomes fairly academic.
There is another aspect to the issue of labelling which is altogether more emotive. Many parents feel much more able to cope with the idea of their child having semantic pragmatic language disorder than with the idea of their child being a high functioning autistic. But many other parents find the label semantic pragmatic disorder frustrating and baffling, as they only begin to really understand their child's behaviour when they realise he or she has a form of autism.
Yet another issue is the provision of resources. It is a sad truth that many high functioning autistic children are denied the kind of educational language provision they desperately need, purely because of the word 'autism'. These children are more likely to be accepted into language units and schools when they have the label of semantic pragmatic language disorder. Perhaps the only real solution is to educate the educators, so they begin to understand the wide spectrum of autistic disorders, and to forget dated stereotypes. Even better, perhaps they could learn to look beyond the label and to see the child.
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ADHD/ADD
What is ADHD: A General Overview
Attention Deficit Hyperactivity Disorder (ADHD) is a disorder characterized by a persistent pattern of inattention and/or hyperactivity/impulsivity that occurs in academic, occupational, or social settings. Problems with attention include making careless mistakes, failing to complete tasks, problems staying organized and keeping track of things, becoming easily distracted, etc. Problems with hyperactivity can include excessive fidgetiness and squirminess, running or climbing when it is not appropriate, excessive talking, and being constantly on the go. Impulsivity can show up as impatience, difficulty awaiting one's turn, blurting out answers, and frequent interrupting. Although many individuals with ADHD display both inattentive and hyperactive/impulsive symptoms, some individuals show symptoms from one group but not the other. For more detailed information on ADHD symptoms and diagnostic criteria click here.
"But don't all children show these kinds of behaviors?"
Because most individuals - especially children - display these behaviors from time to time, it can be difficult to differentiate behaviors that reflect ADHD from those that are a normal part of growing up. The key distinction is that for individuals with ADHD, problems with attention and/or hyperactivity/impulsivity are substantially more persistent, severe, and intense. There is a difference between an energetic child and one whose activity level causes persistent problems; between a friendly, talkative child and a child whose excessive talking is an ongoing source of difficulty; and between a child who sometimes has difficulty completing homework or chores and a child who requires constant monitoring and supervision to get things done. The difference is that for a child with ADHD these behaviors cause significant impairment in daily functioning. When such impairment is not evident, and the behaviors occur only occasionally, they are more likely to reflect typical childhood behavior.
"How come a child with ADHD can play Nintendo for hours but can't concentrate on homework for ten minutes?"
One perplexing aspect of ADHD is that a child's symptoms can vary considerably at different times and in different settings. For example, it is common for parents to wonder how their child can have ADHD when that child focuses intently when watching TV or playing Nintendo. Similarly, when engaged in free play activities, children with ADHD are often indistinguishable from their peers. In other settings, however, particularly those where activity must be restricted and attention sustained to tasks that seem uninteresting, the symptoms are quite evident.
For children with ADHD, this variability in symptoms does not indicate laziness or defiance (although these can be issues that must also be dealt with). Instead, it demonstrates that ADHD symptoms are simply more likely to be evident in some settings rather than others. Unfortunately, the classroom is one setting where ADHD symptoms are very likely to be prominent, and sometimes this explains the very different views that parents and teachers have of the same child.
