Semantic Pragmatic Disorder (SPD) is a communication disorder (Semantic = the relationship between words or sentences and their meanings; Pragmatic = making language work in context). It is believed that people with SPD are unable to process all the information given from certain situations.
The disorder relates in some way to Autism because children with SPD have difficulties in the same three areas call 'The Triad': social skills, communication and inflexibility of thought. It is often described as the 'outer spectrum of Autism', but all children with features of Autism will have semantic and pragmatic difficulties with language. It is always best to have a specialist medical consultation to exclude Autism or find out where a child might be along the ASD spectrum and if there are any additional problems such as ADHD or dyslexia.
Children with SPD may behave very differently at home or at school, so both parents' and teachers' concerns should always be taken seriously. At every moment we are automatically absorbing information, processing and analysing it, discarding what is irrelevent and storing what is important. We use this to build up a bank or memory of words and meanings, like time and feeling words, which have no visual reference.
When we speak to someone we use our past experiences to interpret their intentions and their wants and we imagine what might happen next. People who have difficulty with this form of processing will have problems with determining appropriate responses. They may appear rude or outspoken and be unaware when the other persons wants to end the conversation.
Children with SPD will talk at length on topics like dinosaurs or Star Wars and are often genuinely surprised when they find not everyone is so enthusiastic. They can cope with straightforward instructions such as 'Give me the red book', but may have difficulties in responding to 'What have you been doing today?' as it is not explicit enough. They will relate best to sensitive adults but need a helping hand with peer relationships.
Children with SPD may show some of the following features (but not all) in their early years.
When talking they may:
• sound very grown up
• speak fluently but on their terms
• have difficulty giving specific information on one event
• give no appropriate eye contact/facial expression change
In learning, they may:
• have problems with abstract concepts (next week; guess)
• be late or very early readers, but show little understanding
• have some motor skills problems (writing, drawing, bike riding, dressing, sports)
• be easily distracted in a busy environment
• struggle with team events and games
Behaviourially, they can:
• appear rude, arrogant, gauche
• embarrass others
• be over-active or too passive
• insist on following rules and expect others to
• be isolated - won't ask for help or for children to play with them
• be over-friendly
Other possible features may include:
• dislike of crowds
• food fads
• problems with social events (school breaks, parties)
• over sensitive to some noises and tastes
In school, children with SPD need:
• a quiet, orderly working environment with visual clues
• predictability to reduce anxieties - turn-taking, changes in routine clearly signalled
• clear rules on how to behave using concrete language they can understand
• simple, specific instructions spoken slowly - 'put the toys in the box' not 'tidy up'
• as much as possible written down - clear timetable, instructions, messages
• small work groups, good role models, special small communication group activities
• time to reply when asked a question (but tactfully replying for them, on occasions, can help
• help with socialising - specific games, role-play
• constant positive reminders supported by visual/written information
• a home/school diary - on a daily basis if possible - with regular information on topic work to facilitate pre-tutoring and shared information
• constant encouragement and praise
• try to respond to what is intended, not what is actually said
• explain sarcasm, metaphors, jokes when you use them
• employ 'mapping' technique (matching your words to the child's thoughts)
• double check understanding by asking a child what is expected of them
• utilise special 'interests' rather that ignoring or banning them
• increase self-esteem by giving regular little jobs to do
• allow a child to observe other children carrying out a task first
• teach the meanings of useful idiomatic expressions and appropriate playground language
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