Pragmatic and Discourse Disorders A Workbook

Although the conditions examined in earlier chapters represent the most common pragmatic and discourse disorders, they are by no means exhaustive of the populations in which there are deficits of pragmatics and discourse. As our understanding of these disorders develops, it is becoming increasingly clear to researchers and clinicians that pragmatic and discourse skills are also disrupted in a number of other populations. These populations have been largely overlooked to date by clinical pragmatists. This has occurred for a number of reasons. In some cases, the implications for communication of a particular disorder are believed to involve speech development or aspects of language that are related to academic performance (e.g. writing, reading) and not pragmatic and discourse skills. This is the case in children and adults with congenital hearing loss and illiteracy, respectively.

In other cases, pragmatic and discourse disorders have been overlooked because outcomes have been based on measures that do not address these aspects of language. In children who have undergone early corrective heart surgery, for example, developmental outcomes have been based on standardised tests of intelligence, standardised measures of academic skills and neuropsychological measures. When language skills have been assessed in these children, assessment has typically focused on structural language skills. In still other cases, pragmatic and discourse impairments in certain clients are only just beginning to attract the attention of researchers and clinicians. For example, we currently know very little about age-related changes in the pragmatic abilities of normal, elderly people or the pragmatic and discourse skills of non-verbal communicators who use augmentative and alternative communication systems. In all these disorders and populations, a range of pragmatic and discourse impairments still await detailed examination.

The task of this chapter is to begin this examination through a series of data analysis exercises on just five populations: children who have undergone early corrective heart surgery; individuals with functional illiteracy; children and adults with congenital hearing loss; users of augmentative and alternative communication; and elderly people who are undergoing normal, age-related changes in their pragmatic abilities. These populations are by no means exhaustive of those clients with pragmatic and discourse disorders who have not been extensively examined to date.