Pragmatic and Discourse Disorders A Workbook

For many individuals, pragmatic and discourse skills do not develop along normal lines. For these children and adults with developmental pragmatic and discourse disorders, a large range of conditions, illnesses and events in the period from conception through birth to the first months and years of life can compromise the acquisition of these skills. Genetic syndromes such as Down' syndrome, Williams syndrome and fragile X syndrome can cause intellectual disability of varying severity. In cases of severe or profound intellectual disability, language may fail to develop altogether. Even mild to moderate intellectual disability can have adverse implications for the development of language in general, and pragmatic and discourse skills in particular. Exposure to teratogens such as alcohol, illicit substances (e.g. cocaine) and lead during the embryological period can compromise neurodevelopment and can cause long-term language impairment (Cummings, 2008). Pragmatic and discourse disorders may be found alongside structural language deficits in children who have experienced prenatal exposure to these noxious substances. Prenatal infections such as rubella, cytomegalovirus, toxoplasmosis and human immunodeficiency virus (HIV), pose a risk to neurodevelopment and may be possible factors in the aetiology of pragmatic and discourse disorders.

Even if prenatal neurodevelopment has not been compromised by any of these challenges, events in the postnatal period can pose a risk to the development of pragmatic and discourse skills. These events include infections such as meningitis, and traumatic brain injuries which are most often sustained through falls, road traffic accidents or child abuse. It is also in the postnatal period that the first signs of autism spectrum disorder begin to emerge. Children and adults with these neurodevelopmental disorders often experience severe impairments of pragmatics and discourse, and have been the focus of considerable research. Two clinical populations which have been less extensively studied, but in which there is evidence of pragmatic and discourse disorder, are children with epilepsy and children with cerebral and other neoplasms. One epileptic syndrome in particular, Landau–Kleffner syndrome, has implications for pragmatic and discourse skills. In childhood cancer, postnatal neurodevelopment can be compromised by cranial irradiation and by the neurotoxic effects of chemotherapy drugs. Finally, there is a significant group of children for whom pragmatic and discourse skills are compromised in the absence of any clear aetiology. These children with so-called pragmatic language impairment form a distinct subgroup within the specific language impairment (SLI) population.