What Is Pragmatic Language Disorder?

Medically Reviewed by Dany Paul Baby, MD on November 14, 2022
4 min read

Social communication disorder, also called pragmatic language disorder, is a new entry to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Before that, the idea of social communication difficulties existed as a criterion for other disorders, but it never stood on its own. The update allows for more appropriate care for people who have trouble communicating socially.

Pragmatic language disorder is a condition in which someone has difficulty communicating both verbally and nonverbally in social situations. 

Language pragmatics is the use of appropriate communication methods in social settings. This includes things like knowing what to say, how to say it, and when to say it.

Pragmatic language is made up of three major skills:

  • Using language for a specific purpose, like to say hello or goodbye or to make a request or statement
  • Changing your language depending on the person you’re talking to or the situation you’re in, like speaking differently to a teacher than to a baby or in a classroom than on the playground
  • Following social rules for conversations, like taking turns talking, staying on topic, respecting personal space, and using and understanding body language

Difficulties with language pragmatics and social communication are often associated with other specific conditions, like: 

With these conditions, trouble with social communication is one part of a bigger picture. The American Psychiatric Association stresses that social communication disorder should only be used as a diagnosis after ruling out other conditions, like ASD.

Pragmatic language disorder is caused by a disruption in the language centers of the brain. Currently, researchers don’t know what causes pragmatic language disorder to develop on its own.

Pragmatic language disorder characteristics include:

  • Speech and language delays
  • Difficulty understanding what others mean when they speak
  • Difficulty using language appropriately to interact with others
  • Trouble using social language, which make you seem rude

Common social communication disorder examples include:

  • Failure to realize that the listener may have no background knowledge on a topic
  • Failure to stay on topic — this can cause you to say unrelated things during a conversation
  • Not being able to understand the main idea within a conversation or story
  • Not noticing or understanding nonverbal cues, like body language
  • Not understanding abstract language — this includes jokes, figures of speech, and sarcasm
  • Not understanding that conversations involve taking turns — you may interrupt or speak out of turn
  • Not understanding the importance of background information — you may speak out of context

The intervention goals for social communication disorder include:

  • Taking advantage of the strengths and addressing the weaknesses of underlying functions that may affect social communication
  • Encouraging activities and participation in social situations by helping the person gain new skills
  • Addressing barriers to successful participation and enhancing the things that facilitate successful communication

Treatment for pragmatic language disorder may be multifaceted. Treatment planning needs to consider: 

  • Considering differences in cultural and societal norms
  • Focusing on functional outcomes
  • Tailoring goals to address each patient's individual needs
  • Understanding the importance of involving both the individual and their family

There are many treatment options available for pragmatic language disorder. Some options may work better for some people than others. 

Behavioral interventions. Behavioral treatments and interventions work by adjusting existing behaviors or teaching new behaviors. This is often done by identifying positive behaviors, in this case, social skills, and reinforcing those behaviors. Behavioral therapies and approaches can be done in one-on-one or peer group settings.

Social communication treatments. Social communication treatments use different methods to improve social skills. These include:

  • Comic strip conversations: Comic strip conversations show a conversation between two or more people in a visual format. This allows the reader to slow down and understand the information within the conversation.
  • SCORE skills strategy: The SCORE skills strategy is a small group program that helps participants focus on five skills: sharing ideas, complimenting others, offering help or encouragement, recommending changes kindly, and exercising self-control.
  • Social communication intervention: This intervention program focuses on understanding the goals of communication. This includes learning social scripts and reflecting on past encounters.
  • Social Communication Intervention Project: The Social Communication Intervention Project is a program that teaches school-age kids how to understand social cues, process language, and use language pragmatics.
  • Social scripts: Social scripts are used to teach kids how to use language during social interactions. As children adjust to these interactions, these scripts are used less and less.
  • Social skills groups: These groups use role-play scenarios to help individuals understand how to interact appropriately.
  • Social stories: Social stories are a highly structured intervention tool that uses stories to explain social situations to kids, helping them learn appropriate behaviors and responses.

While different types of therapies and interventions can be great for children with pragmatic language disorders, there are also things parents can do to help at home to reinforce what kids have learned. These include:

  • Ask your child to tell you a story, and ask questions when you feel you need more information. Help your child understand why you need this information.
  • Help your child understand the topics in conversations and stories that they hear, read, or participate in.
  • Practice nonverbal cues like smiling, frowning, crossing your arms, and rolling your eyes. Have your child tell you what each one means. Explain how these cues are important.
  • Practice starting conversations with a greeting and ending conversations appropriately.
  • Role-play situations in which your child has to explain the same thing to different people. Talk about how they may have to adjust their language depending on who they’re speaking to.
  • Tell your child a story but don’t give enough information, like using pronouns instead of names. Have your child tell you what information they need to understand the story.