Semantic-Pragmatic Disorder | Autism PDD


I've read this label is used a lot in the UK, but not in the US, for some reason. Has anyone encountered this label with their child? I feel like this is a much better description of my daughter than Verbal Apraxia and receptive-expressive language delays. I don't even think she has a real receptive language delay at all. I think the receptive language delay label is something that these kids end up getting because they donít understand how to respond to language, not because they canít comprehend language. I think what she has is a true pragmatic language disorder.

For example- she doesn't seem to understand that she is supposed to answer when someone gives her a direction or asks her a question. She does not seem to understand the concept of reciprocal language interaction. If I talk, then you talk. If I do something, then you do something.  She will sporadically answer me and sporadically follow directions from me, but will almost never do so for a stranger. Her speech therapist picked up on this, and thinks it's her core problem- more so than even pronunciation and vocabulary. During speech therapy, her therapist might ask her to pick up a toy. She responds by glancing at the toy and continuing to do what she had been doing. She understands what the toy is. She doesn't feel any compelling reason to comply with the therapist or acknowledge the request. 

Has anyone worked on this in their own therapy at home? Maybe an ABA program for following directions, or learning to answer a question when someone speaks?

Wondering after reading the insurance thread if INSURANCE might be a reason for this alternative dx ... basically, all verbal kids on the spectrum have some semantic-pragmatic problems.  Calling it an actual diagnosis ... who knows?

But yeah the highly detailed descriptions I read just made yell, "That's HER!"

I live in the US.  My daughter has this dx.  I took her to a clinic in Scottsdale Az. and the specialize in ASD and ADHD...etc.  She was evaluated about 6 months ago and is actually due to go back at the end of this month for a follow up.

Funny thing, I know this is considered HFA to most but on her report from them it says she did not qualify for an ASD dx due to her lack of social impairments.  On paper it says, COMMUNICATION DISORER/ SEMANTIC PRAGMATIC LANGUAGE DISORDER.

We had some speech therapy, it didnt do us much good.  Our therapist was not a good match.  She was too caught up on teaching my daughter "words" - she already knew them.  She is not delayed in receptive or expressive language.  She comes out right on target - its just HOW she communicates with the words she knows that is the problem.  She really, really struggles with syntax and grammar along with semantics and pragamtics.  She does well in answeing questions though and really attempts to just does not sound "right."  She talks A LOT but most of her conversations are memorized.  She lacks the free flow of speech. 

As of now, we have her in preschool, three full time days for peer modeling.  It has helped her a ton.  Its a mainstream class and she is doing really well.  Her teachers love her and she was able to make some friends. 

I am excited/ anxious about kindergarden, I will really see now if she does struggle with social skills. 

I tend to think she is HFA - along with her speech struggles, she has a repetitive movement with her fingers when she is excited.  So, who knows...time will tell.


Any speech therapy for kids on the spectrum includes semantics and pragmatics ... or should!

I am just wondering, the way SPLD is concpetualized in that venn diagram, would our kids still qualify for services, if that were their dx???  And of course, insurance categories ... so maybe that is why it is not used, separately? 

I just got back from a little hallway chat with T's teacher.  She sounded almost as if T was simply "too much work!" for a "regular" classroom ... not in so many words as in her tone.  She also said she never interacts with anyone in the classroom.  Which I first heard, in MARCH. 

Small wonder parents get to sounding TO'd at the teachers!



This isn't a recognized diagnosis in the US - I think it is in Britain.  It's what my girls have, however, and more precisely describes them (botht their impairments and relative strengths) than the overly broad terms employed here (PDD-NOS, autistic disorder).[QUOTE=Bluebird]

Has anyone worked on this in their own therapy at home? Maybe an ABA program for following directions, or learning to answer a question when someone speaks?


Yes. We used ABA for questions and commenting but months after a certain level of understanding language was in place (like follow 3-4 steps command, answer yes/no, lots of requesting). "Where" and "What" are easy but ... "why" it's hard, mostly to make them ask "why". All we did it's ABA .... just a little bit of speech.

It is an interesting chart. It's the best way to conceptualize the many kinds of problems on the autistic spectrum I've ever seen. I don't know why this concept isn't used here.

The bubbles are a little difficult to interpret in that chart, but basically Semantic-Pragmatic disorder would be an inverse symptom pattern to Asperger's. Good social skills, but serious language deficits.

The term is debatable. Some say it's separate, others say it's just another term for high functioning autism. If you look at the criteria, there's certainly a lot of overlapping stuff going on.

Interesting chart you posted.  While you wait for answers to your question, you might want to have a look at this link, a discussion on this forum from a month or two ago about semantic-pragmatic language disorder. p;KW=semantic+pragmatic

Here's an excellent article about semantic and pragmatic problems with lots of links.  Below I've included a quote on what pragmatics skills include:

Pragmatics skills include:

  1. knowing that you have to answer when a question has been asked; 
  2. being able to participate in a conversation by taking it in turns with the other speaker; 
  3. the ability to notice and respond to the non-verbal aspects of language (reacting appropriately to the other person's body language and 'mood', as well as their words);
  4. awareness that you have to introduce a topic of conversation in order for the listener to fully understand; 
  5. knowing which words or what sort of sentence-type to use when initiating a conversation or responding to something someone has said; 
  6. the ability to maintain a topic (or change topic appropriately, or 'interrupt' politely); 
  7. the ability to maintain appropriate eye-contact (not too much staring, and not too much looking away) during a conversation; and 
  8. the ability to distinguish how to talk and behave towards different communicative partners (formal with some, informal with others).

Here's a two examples of links from the above article: uage-Tips.htm - tips for parents on helping kids with pragmatics. - another good basic explanation of pragmatics.


Here's more information I found on evaluating pragmatics:

1.  A book you can buy:


Q:  I am searching for a useful checklist or assessment tool in determining a student's pragmatic use of language. I realize that this may not be a "qualifying" tool for services but we need to describe skills in this area every so often for kids who are "marginal" on the autism spectrum or who present social delays.

A:  There is an Assessment of Pragmatic Skills that you can find in Assessment in Speech-Language Pathology: A Resource Manual published by Singular Publishing Group. I use this with my graduate students [in speech pathology] and they have found it to be very practical with all populations.


The good news is that you can buy this book used for less than .  I don't know how easy it would be for your average parent to use, but it might be worth a shot. esource-Manual/dp/1565938704

2.  The Childhood Communication Checklist (CCC-2) key=2157

3.  Test of Pragmatic Language: ic.html


Yes, my girls were somewhat lake talkers, though never so delayed that they were flagged at the well baby checkups.  They had words at two, phrases at three, etc.  Their language tested very delayed at three, however, due to an inability to converse in any way with the tester and comprehend verbal instructions (this has gotten much better in the past year and a half).

Their weakness is conversational language - back and forth - give and take, etc.  You really couldn't have any sort back and forth exchange with them when they were just turning four.  Now, at about 4 years, 7 monhts, you can have simple conversations with them, but they don't really make an effort to uphold their end of the conversation;  they can follow the thread of a conversation, but they have to be pulled along.  They've just recently (within the past several months) acquired the ability to discuss events of the day - such as what they did at school, etc - but this information has to be pulled out of them.

The also test within normal range on on some standard language tests (PLS-4), have advanced vocabularies and picture recognition skills, but they have more grammatical errors than a typical four year old (though, I have to say, I was tlaking with a very NT 4 year old the other day, and even typical four year olds make grammer errors, just not as many as my girls).  The main thing you'd notice about them, though, is their inability to hold a conversation and their poor non-verbal communication (not looking at you when speaking, fidgeting around when you're trying to talk with them, etc.).

I never heard of the hyperlexia component of SPLD.  Neither of my girls are hyperlexic, though Evie is starting to read.  Both have really good pronunciation and speak clearly and with normal cadence.  Abbie tends to talk too loudly, though.  Both are very pedantic with their speaking patterns, overly precise and overly decriptive, using long descriptions when talking about familiar objects.


I never heard of the hyperlexia component either but it is reassuring in a way if she takes off in her language..What I notice more and more with her is before school started she would speak only little as possibe and no more than 3 words at a time if she could get away with she is stringing long sentences that are mixed with mumbling at the same time like a baby jargoning or something..I dont correct this yet as I want her to practice:)  She also hates to express what she knows but I know she comprehends what she reads.  Any expressive demands shut her down and the reply "I dont know" gets used over and over till the demands stop..doesn't mean she doesn't know..she just hates to perform what she knows.  They are going to test her in the next to weeks the GLAD test for talented and gifted and I just know the verbal part is going to be nil I should count my blessings thought so not complain:) My son has wonderful word and sentence skills, he has "passed" all of the language pragmatics and semantics tests way beyond his age. Oh, how impressed the school was to tell me this.......but they don't go home with him and hear the same sentences about the same obsessive objects, hear him never give me an idea about a story we read (but can tell you every concret question I ask of him), answer a "what do you think will happen" with I don't know, never have a real give and take conversation about something I am interested in, take everything literally that is being said.

These kids with PDD, ASD can not make inferences, and do you realize that past 1st grade the testing is full of inference questions not just the concrete questions these kids master without a blink of an eye.

No one will believe us that these kids need help beyond the easy stuff.

I take it your speech therapy is private ... could that be a motive for saying not ASD?  ie she does not qualify for public-funded services, but we can help her?

I truly am taking a shot in the dark, there.  I have no idea!

We did not qualify for any services.  Nothing.  We paid out of pocket for speech and it was soooooo expensive.  On top of that we where paying for preschool, that alone is a huge cost.  Her speech therapy only lasted a few months.  I was so dissapointed.  We showed our therapist ALL of her speech and language assessments and all said she was not delayed in expressive or recpetive language.  She even gave her a test of her own, of course, it had the same outcome.  She looked puzzled and said well, we will have to take baby steps and see where it goes...she started therapy just as if she had a delay.  My daughter was BORED and I could see it was pointless.  We took her out.  How many times was she supposed to label pictures for this lady to understand, she knew them...  it was a joke.  All the tests prior to this therapist noted that my dd could use a social group therapy to bulid her pragmatic skills.  We enrolled her a few times but every single time the class was about to start it ended up cancelled due to lack of participation.  We felt that we had no choice but to bump up her preschool hours and have her hang out with kids helped sooo much but she has a long road ahead of her still.  I feel like I am at a loss, what do I do?  How does she get help with pragmatics?  I do my best to help her myself, but, I am treading water and she is sinking... 

Just curious as too what test do they do to test pragmatics.. I sent Sarah's teacher the link of sematic pragmatic disorder and although she stated it sounded just like Sarah..she didn't know the name of test to assess her but told me I could get an independent test outside of school??  I am afraid she will lose her IEP because of her mastering the speech goals and speech is the only thing she gets but her pragmatics & social skills still lack back and forth conversation beyond a few questions and answers..usually she will only answer if it is 3 words or less and much prompting

[QUOTE=ShelleyR]Just curious as too what test do they do to test pragmatics.. I sent Sarah's teacher the link of sematic pragmatic disorder and although she stated it sounded just like Sarah..she didn't know the name of test to assess her but told me I could get an independent test outside of school??  [/QUOTE]

A good Speech-Language Pathologist who has experience working with children on the autistic spectrum can assess her pragmatics. Pragmatics is how you use language, so the therapist will just work on those goals instead of the more rudimentary speech goals she was working on before.

Interesting thing about Semantic-Pragmatic disorder is that its symptom pattern begins with a late-talking toddler and then progresses into hyperlexia and complex speech with overly literal interpretations of language and poor use of paraglinguistic and nonverbal communication. It's associated with an under-functioning right hemisphere.

I was surprised to read that. If this does describe my daughter then I can expect her to be able to talk very well in a couple of years, but not be able to use language as appropriately as other kids.



I am curious about late talkers - did your children talk late?  Mine had first words on time.  She has followed a path...although I dont remember spontaniously putting words together at two...if at all it would have been at the end of her second year, close to her third b-day.  But, she was saying sentences at three and even now at almost five, she is meeting "milestones" such as using the right amount of words in a sentence.  She always had tons of words.  She could tell us what she wanted...likes "Wiggles" meant she wanted to watch them...she just did not say, "want Wiggles" and such.  So, communicating was not "too hard."  She always got the point accross.  She has had a-typical development though...mixed in with her development she has had bouts of immediate echolalia (the just last one or two words we would say, not out of context sentences or words)  and she learned to speak to us through memorizing.  The echolalia resolved itself by 3.5 and she finally mastered pronouns before her fourth birthday.  She used to mix up he/she and she called herself "you."

Language has been her main issue.  I have always mentioned this to doctors, they test her and say she is on target for her age.  It has always been very hard for me to explain, she just does not freely talk but she is also constantly talking to us....  I know, confusing.  The best way to put it, is she talks AT us all the time.  She loves to chat but conversations are hard.  She also has poor grammar and she does not respond well to modeling.  If she says..."Where Mommy at is she?"  And we say, do you mean, Where is Mommy at?  She will say, "yeah, where Mommy at is she?"  We have asked her to say "Where is Mommy at?" and she will keep repeating it her way.  Language is just very, very hard for her.

My child was not a late talker. She talked early. She lost her langauge somewhere between 15 and 20 months after multiple ear infections, antibiotics, and severe food allergies.

I know that the first langauge test my daughter had was useless in giving anyone a good picture of her needs because of her age and unwillingness to do what the therapist asked her to do. Because she would not point to a picture, she was classified as being one year behind in her receptive langauge. This is supposed to mean she can't understand the langauge being spoken to her. It's simply not true that she doesn't understand language, and this has emerged in therpay. She also has a normal vocabulary for her age but cannot pronounce her words clearly.

So, in other words, I don't trust the traditional tests of expressive/receptive language to tell me what I need to know about my daughter's langague. In her case, her problem is reciprocal social langauge use and motor problems that create the pronunciation problems.

My sister's son, who is 8, is not ASD though when he was 6 there was some discussion of Asperger's because he did demonstrate some ASD traits in some situations but they've since ruled that out.  He could be a very mild PDD-NOS, hard to tell.  He currently has an IEP for a pragmatic speech delay and receives pull-out speech therapy. 

M was a late talker, didn't talk until after 3.  Progressed to complex speech quickly and definitely has overly literal interpretations of language.  In addition, he's a VERY sensetive child who cries easily, which has made him a target of some not so kind kids in his class. 

I'll give you a nightmare example of how his pragmatic speech issue manifests itself.  One morning M woke up with a red and swollen eye.  My sister thought it might have been a clogged tear duct and decided to wait and see for a day before she took him to the doctor. M goes to school and the teacher asks him "what happened to your eye."  M says "I don't know."  Teacher keeps asking in different ways, M keeps saying "I don't know."  (Note, this is a LITERAL child.  He DOESN'T know what happened to his eye and he is too LITERAL to invent something or speculate.)  I bet if they had asked him "what does your mom THINK it is" he would have said "my mom thinks it's an infection."  But they didn't ask him that, they just kept asking "what happened" and he just kept saying "I don't know."  After pestering him repeatedly with this question, the teacher then shifted gears and asked him "did your daddy hit you" and M says "yes."

Next thing you know the police are at the school, and protective services shows up at the house with a bunch of cops and starts grilling my brother-in-law (who is immediately a suspicious character because he is hispanic and a stay-at-home-dad - don't get me started on that one) who is home with their 2 year old.  Once the social worker questioned M a zillion different ways and determined that M was indeed not being abused and that he lied to the teacher when he said "yes", all ended well.

At the end of this awful day when my sister was putting M to bed, she simply asked him "why did you say yes when Mrs. X asked you if daddy hit you" and he said "because that's what I thought she wanted me to say."

(I won't bore you with all the follow up and the issues with the teacher not being familiar with the IEP or understanding how a pragmatic speech issue can impact a child's ability to answer questions when interrogated, etc.  There was a lot of additional fallout following this incident.)

Wow, how terrible for your family. I'm so glad it was worked out quickly, though.

My brother is a wonderful stay at home dad to his four kids, ages 9, 5, 3, and 1. You are so right that people automatically assume a father is not doing what they are "supposed" to be doing if they choose to stay home- no matter how well they do the job. And then the opposite judgements are made against mothers, even if they have no choice but to work. Somehow they aren't doing what they are "supposed" to be doing, even when in truth they're great parents.


Adam was recently tested for Pragmatics in speech. I don't have the test name with me.  But it was done throught he school.  He scored the pragmatic speech of a 5 year old.  (He is 12).  He is now in speech therapy at school specifically for pragmatics, and seems to be improving. 

I wish I could remember the test name, but I am sure that the SLP should know the test.  It wasn't even a question once I asked for it of course.