What is SPD and how does it differ from other speech and language difficulties?
Why is it such a wordy label?
The term semantic pragmatic disorder (SPD) was coined to identify children who have combinations of receptive and expressive “syntactic” (grammatical) and “phonological” speech sound difficulties, as opposed to those who have difficulties with the communicative use of language. The terminology of communication disorder is split between terms coming from a medical root, such as “dyspraxia”, and those coming from the blossoming of linguistic theory in the 1970s and 1980s, of which SPD is one.
The important thing about any such label is whether or not it helps people understand a child’s difficulties and leads to an appropriate intervention. I know that parents who contact me for help recognise, in their children, the descriptions they have found on internet sites concerned with SPD. They tend to feel that their children are better identified by the behaviours clustered around the “semantic-pragmatic” label, rather than those associated with the autistic spectrum or specific language impairment. Parents can certainly recognise that their children are different from the majority of their peers in playgroup and school.
What are the difficulties associated with this label?
Children who attract this label are those who seem to develop the structure of language pretty well: they can string sentences together from a young age and appear to have a reasonable vocabulary. They are usually intelligible and have no speech-sound difficulties. What might be obvious to those interacting with them is that, despite including long sentences and exhibiting grammatically complex forms, their conversation is mistimed, tangential or inappropriate. Their use of their “good” vocabulary may also be rather odd or inflexible. In addition, they may show a rather literal understanding of idioms; indeed, even everyday idioms like “you’re cool” may be taken literally. Stories with lots of metaphorical phrases, and jokes such as puns, will be beyond them. These children may also not get eye contact, and other social signals such as gestures, “right”.
In reality, speech and language therapists (SLTs) rarely use the term SPD to describe a distinct condition any more, as it is now generally agreed that there is little correlation between semantic and pragmatic behaviours as such: they can exist together but not necessarily. Therefore many people have dropped the “semantic” part of the label in favour of “pragmatic language impairment” (PLI) which describes the difficulty of using communicative language appropriately.
Some of you reading this description may think that these children seem very familiar, but that you know them by another label. Why don’t we want to say that these children are automatically on the high end of the autistic spectrum; isn’t it all very similar?
Outward appearances and root causes
Let’s think about where these behaviours arise from. I have seen children who are processing conversation slowly show all sorts of “unusual” behaviours, such as poor eye contact and laughing late at a joke only when everyone else has started laughing. But isn’t this obviously going to happen when you are struggling to keep up? It doesn’t mean that the person couldn’t learn to respond more appropriately given time and a more specific explanation.
Children with SPD may have the capacity to understand others well in terms of “theory of mind”, the shared perspective that children with marked autistic spectrum disorders (ASD) lack. So what may appear to be a little like high-functioning autism, may have different roots but the same outward behaviours. Children with SPD can show real motivation to get on socially but do not know how to go about it. I have seen children who have been taught, for example, that it is OK to seek clarification in conversation and have been shown how to do it. They looked as if a light has been switched on for them, but they just hadn’t been able to figure it out for themselves. Even being helped to recognise what is an appropriate volume for conversation can really help.
What can we do to help?
SPD is a label that may describe a stage in the child’s development, not a disorder by itself, and his/her needs can evolve. However, it is likely that subtle communication difficulties will remain throughout and cause periods of low self esteem and unhappiness. At the outset, we have to assess all aspects of the child’s communication and determine what small changes might help them cope with work and their social life. This will include looking at the extent to which the motivation to establish joint understanding in conversation exists and could be used as a spring board to developing skills (something that can be missing with ASD). Does the child appear completely single minded in conversation or do they get upset if you don’t understand what they are talking about? Is there some give and take? How flexible is their learning?
Practical information about strategies for dealing with SPD can be found on the websites listed below. However, many of the common classroom management strategies used for any language difficulty will help here. For instance, be very precise with instructions: “put your books in your drawer” will generally work more effectively than simply saying “tidy up time”. Take time to preface an instruction with a child’s name; this will help to direct their focus and make them realise that the instruction applies to them. If you are able to run small groups, or work with an SLT, then social use of language programmes is very suitable for children with SPD. In literacy, although we cannot teach every metaphor that exists, we can help children understand that language is not always what it seems, and help children pre-prepare texts before getting to grips with overall meaning.
The Semantic Pragmatic Support Group points the way to several journal articles and has a very useful section on intervention activities and management for home and school: www.spdsupport.org.uk
RCSLT (Royal College of Speech and Language Therapists) has a useful website: www.rcslt.org
If, as a school, charity or parent, you are seeking an independent SLT (working outside the NHS), go to the Association of SLTs in Independent Practice (ASLTIP) website: www.helpwithtalking.com
Hilary Gardner is an SLT, Vice Chair of ASLTIP and a lecturer in human communication sciences at Sheffield University.
Article first published in SEN Magazine issue 41: July/August 2009.