Theory of Mind and Mind Blindness

We humans are said to have intuition that we can easily decode feelings of another person. It isn’t in the sense that we guess what’s inside of a person’s head but rather we can understand what the other person is thinking through observation of body language, gesture, eye contact and tone of voice as well as language use. These are what we call “reading between the lines” or in other words non-verbal communication (or cues). We, especially most women can easily, decode non-verbal cues while most straight men can decode but not as intuitively  as women do (hence men can’t read women’s minds especially if she’s not in the mood??). When a person has good grasp of looking into human’s minds by just observing non-verbal cues, he or she is said to have good people skills and high empathy. And that’s what needed in order to have a good social life and to carry on with life itself.

This process is called the Theory of Mind.

Image courtesy of Slidshare. Are women really better than men in theory of mind?

But what about mind blindness? Does that mean that the mind can go blind?

A person is said to have mind blindness if he or she fails to understand the mental states of another person especially if he or she cannot interpret non-verbal cues. Just like in the drawing above.

To explain these further let’s truly define theory of mind and mind blindness.

What is theory of mind?

Theory of mind (ToM) is the ability to attribute mental states—beliefs, intents, desires, pretending, knowledge, etc.—to oneself and others and to understand that others have beliefs, desires, intentions, and perspectives that are different from one’s own.[1][2] This means that you as a person can “read” what another person thinks or feels through observation of non-verbal communication like body language and figures of speech. A person who has theory of mind can often develop empathy thus become good at people skills.

Most people (neurotypical) have theory of mind since early chidhood, hence can develop good social skills at a young age. However, people who have autism, Asperger’s syndrome, ADHD, non-verbal disorder and schizophrenia lack theory of mind, meaning they can’t read other people, making socialization difficult for them – a hallmark sign of these disorders.

How is theory of mind developed?

Theory of mind isn’t something that develops overnight. It usually begins in infancy or early childhood where they learn the early skills that they’ll need to develop their theory of mind later on. These skills include the ability to[3][4][5]:

▪ pay attention to people and copy them
▪ recognize others’ emotions and use words to express them (“happy”, “sad”, “mad”)
▪ know that they are different from other people and have different likes/dislikes from others
▪ know that people act according to the things they want
understand the causes and consequences of emotions (If I throw my toy, Mom will be mad)
▪ pretend to be someone else (like a doctor or a cashier) when they play

When they reach the ages 4-5 they really start to think about others’ thoughts and feelings, and this is when true theory of mind emerges. Children develop theory of mind skills in the following order[3][6][7][8]:

▪ Understanding “wanting” – Different people want different things, and to get what they want, people act in different ways.
▪ Understanding “thinking” – Different people have different, but potentially true, beliefs about the same thing. People’s actions are based on what they think is going to happen.
▪ Understanding that “seeing leads to knowing” – If you haven’t seen something, you don’t necessarily know about it (like the Dad in the example above on the telephone). If someone hasn’t seen something, they will need extra information to understand.
▪ Understanding “false beliefs” – Sometimes people believe things that are not true, and they act according to their beliefs, not according to what is really true.
▪ Understanding “hidden feelings” – People can feel a different emotion from the one they display.

When one child finally masters these tasks above, socialization will be easier for her, thus practicing her “theory of mind skills” at home, school and play until she has more than enough theory of mind to deal with people and life in general.

Image from Pinterest. Theory of Mind works like this picture. One person knows that the other person thinks about her.

What if a child has no theory of mind?

Like stated above , not all children have developed theory of mind especially if a child has autism or a learning disability. This makes them look like antisocial or without empathy leaving them socially isolated. This is what we call mind blindness.

What is mind blindness?

Mind blindness is a cognitive disorder where an individual is unable to attribute mental states to the self and other. As a result of this disorder the individual may be unaware of others’ mental states, or incapable in attributing beliefs and desires to others.[9][10] This means that a certain individual with mind blindness has little to no knowledge and understanding of oneself’s emotions as well as the emotions of others ie you cannot comprehend why you best friend cries over a movie character that has died towards the end of the story. Mind blindness is said to be common in autism spectrum disorders like the classic autism and Asperger’s syndrome, schizophrenia, and even depression, dementia and normal aging (that’s why your grandpa is grumpy sometimes).

Mind-blindness is a state where the ToM has not been developed or lost in an individual. The ToM is implicit in neurotypical individuals. This enables one to make automatic interpretations of events taking into consideration the mental states of people, their desires and beliefs.[9] Researcher Simon Baron-Cohen says that an individual lacking a ToM would perceive the world in a confusing and frightening manner; leading to a withdrawal from society.[9][11]

An alternative to the ToM deficit is that of impairment to read more complex emotions of people (sarcasm, figures of speech). Uta Frith concluded that the processing of complex cognitive emotions is impaired compared to simpler emotions.[12]

In short if you have mind blindness, you are dumb in recognizing and processing emotions of yourself and others, leaving you clueless on how to deal with other people. You will actually depend more on your logical mind to comprehend the world around you. As in my experience before when I was younger, I think like a robot or computer meaning I only have black and white, yes or no thinking. The result is I cannot understand what the other person says, thinks or feels like people are speaking a different language. This caused me to be socially isolated.

Let’s give some examples of situations where mind blindness is present:

Imagine that your friend cried over her dead cat. Of course for most of us that would be a very sad and horrible feeling when you lost your beloved pet knowing that she will never live again. But if you have mind blindness you can’t understand her emotions of grief over the death of her cat. You just might think it’s already dead and cannot come back. You either just ignore her feelings or even you can say why should you cry over a died living thing?

Here’s another situation. You are given by your date a bunch of roses. For most girls it’s really sweet and appropriate to be given flowers by a date to express his admiration and affection for you. But if you have mind blindness you may say why I was given dead plants?

Too bad. When you have mind blindness you do think very literally like a computer which just thinks only a yes/no command and if no it is error. No emotion. No gray areas. This makes a person with mind blindness look either aloof, antisocial or even rude to other people leading him to be socially isolated without ever knowing why. He’s totally clueless how to read people ‘intuitively’ without becoming ‘dry.’

What causes mind blindness?

Mind blindness is said to be caused by deficits in three regions of the brain[9] where ToM is utilized:

The anterior paracingulate cortex is the key region of mentalizing. This cortex is associated with the medial frontal cortex where activation is associated with the mentalization of states.[9][10]

The superior temporal sulcus and the temporal poles aid in the activation of the regions that are associated with the ToM. The superior temporal sulcus is involved in the processing of behavioural information while the temporal poles are involved in the retrieval of personal experiences. The temporal poles provide personal experiences for mentalization such as facial recognition, emotional memory and familiar voices.[9][10]

The amygdala and the orbitofrontal cortex also are a part of the ToM. It is in involved in the interpretation of behaviour which plays an important role in social cognition and therefore contributes to the theory of the mind.

Executive function also plays a role in ToM where it includes skills such as organizing, planning, sustaining attention, and inhibiting inappropriate responses.[]

Huh? Where in the brain they are?

A lot of regions in the brain are involved in ToM but mostly they are found in the frontal and temporal lobes of the cerebrum (the biggest part of the brain). The amygdala is not part of the cerebrum but it is part of the making of ToM and is within the temporal lobes as well.

The anterior paracingulate cortex is located above the anterior corpus callosum (the cingulate gyrus is the red area below while the corpus callosum is the white area below the gyrus) near the frontal lobe.

Image from studyblue.com

The superior temporal sulcus is in the middle portion of the brain on the temporal lobe while the temporal poles are at the ends of the temporal lobe. (Below images courtesy of Wikipedia)

 

 

The amygdala is a tiny thing under the frontal lobe and under the corpus callosum.

Image from brainmadesimple.com. Location of the amygdala

 

The orbitofrontal cortex is located in the most inferior part of the frontal lobe.

Image from Tufts University. The orbital frontal cortex is under the frontal cortex.

Damage or underdevelopment to these areas can cause mind blindness.

How is mind blindness tested?

When a child does not developed normally like having social deficits including no eye contact and non-responsiveness tests are given to rule out a developmental disability or deafness. If she has a suspected developmental disability psychological tests are given of which the most famous is the Sally-Ann(e) test[13].

(C) Psychology Today. Sally-Ann Test.

The image above asks where will Sally look for the ball. To be able to pass this test, the child must answer that Sally will look for the basket and not in the box. Below is the more detailed Sally-Ann(e) test including the answers:

(c) EducateAutism.com

If the child has a wrong answer she is now confirmed with mind blindness, a hallmark sign of autism disorder.

It is very important therefore to assess whether a child has developed ToM or not. This is to assess if her brain is developing typically or not. This is to ensure that proper care is utilized to the child and develop specific plans of therapy or lesson plan to the child whether with ToM or with mind blindness.

If someone is mind blind, how is it managed?

As soon as mind blindness is confirmed (usually with the diagnosis of autism/Asperger’s) , affected kids and teens  can learn to compensate for mindblindness and alexithymia with the parent’s help and a lifetime of constant counseling by therapists.[15]

To help a mind blind child (or teen ot adult) parents and/or therapists must understand that their Aspergers kids must be taught to use logic to make sense of the world and the people in it, one personal situation at a time.[15] This is to compensate for the child’s lack of social intelligence and to take advantage of his strength in his logical mind to be taught social skills and management of emotions literally as if they are academic subjects.

My Aspergers Child website has general tips of teaching ToM to people with mind blindness[15]:

1. Every human behavior has a reason behind it, even if I don’t see it.
2. Most people usually talk about the things they want, and openly say what they believe.
3. Some people are so messed up that it is just not possible to figure them out. Know when to give up.
4. When somebody’s behavior flies in the face of logic, concentrate on that person’s feelings.
5. Women talk more than men and focus on feelings more.

These are the more general tips. For more specific tips click on their article page here.

Conclusion

Theory of mind is an important tool for us in order to deal with the world. It enables us to navigate the social world, assess and recongnize our own feelings as well as the feelings and thinking of other people, and most of all enable us to cooperate with people as if they are our own family. However some people in neurodiversity lack ToM and therefore have mind blindness which can adversely affect their dealing with themselves as well as other people which could bring bad results such as social isolation and depression. It is therefore important that when a child shows lack of interest in the world to be assessed right away for mind blindness and help teach theory of mind through years of therapy and love and support. With enough support neurodiverse people can navigate the world more easily.

Reference:

1. https://en.m.wikipedia.org/wiki/Theory_of_mind
2. Premack, D. G.; Woodruff, G. (1978). “Does the chimpanzee have a theory of mind?”. Behavioral and Brain Sciences 1 (4): 515–526. doi:10.1017/S0140525X00076512
3. http://www.hanen.org/helpful-info/articles/tuning-in-to-others-how-young-children-develop.aspx
4. Westby, C. & Robinson, L. (2014). A developmental perspective for promoting theory of mind. Topics in Language Disorders, 34(4), 362-383.
5. de Villiers, J. G. & de Villiers, P. A. (2014). The role of language in theory of mind development. Topics in Language Disorders, 34(4), 313-328.
6. Sussman, F. (2006). TalkAbility™ – People skills for verbal children on the autism spectrum: A guide for parents. Toronto, ON: Hanen Early Language Program.
7. Wellman, H. M. & Liu, D. (2004). Scaling theory of mind tasks. Child Development, 75, 759-763.
8. Peterson, C. C., Wellman, H. M. & Slaughter, V. (2012). The mind behind the message: Advancing theory-of-mind scales for typically developing children, and those with deafness, autism, or asperger syndrome. Child Development, 83(2), 469-485.
9. https://en.m.wikipedia.org/wiki/Mind-blindness
10. Gallagher, Helen L.; Frith, Christopher D. (1 February 2003). “Functional imaging of ‘theory of mind'”. Trends in Cognitive Sciences 7 (2): 77–83. doi:10.1016/S1364-6613(02)00025-6. PMID 12584026.
11. Baron-Cohen, Simon (1990). “Autism: a specific cognitive disorder of ‘mind-blindness'”. International Review of Psychiatry 2: 81–90. doi:10.3109/09540269009028274.
12. Frith, Uta (1 December 2001). “Mind Blindness and the Brain in Autism” (PDF). Neuron 32 (6): 969–979. doi:10.1016/S0896-6273(01)00552-9. PMID 11754830. Retrieved 19 February 2012.
13. Baron-Cohen S, Leslie AM, Frith U (1985). “Does the autistic child have a ‘theory of mind’?” (PDF).Cognition 21 (1): 37–46. doi:10.1016/0010-0277(85)90022-8. PMID 2934210. Retrieved2008-02-16.
14. https://www.autismspeaks.org/family-services/tool-kits/asperger-syndrome-and-high-functioning-autism-tool-kit/executive-functioni
15. http://www.myaspergerschild.com/2011/04/coping-with-mind-blindness-and.html

Emotional Intelligence in Neurodiversity

Happy Hearts Day! Hmm, want your heart to be happy? Have a high emotional intelligence. Eh??

It’s a happy Valentines’ Day to all. Yeah it’s kinda sweet this mushy season especially if you’re with someone special. Oh, it’s quite common in neurodiversity to find a someone special. Believe me. But, like me, am six years single since my last relationship and haven’t found another one, it’s okay. Don’t fret. Don’t be jealous. Maybe for us neurodiverse people (and all people of course) we need to learn more about emotional and social intelligence before we worry about finding that special someone.

What is emotional intelligence?

Emotional intelligence (EI) or emotional quotient (EQ) is the knowledge of awareness and dealing with emotions or feelings. It is the capability of individuals to recognize their own, and other people’s emotions, to discriminate between different feelings and label them appropriately, and to use emotional information to guide thinking and behavior.[1]

Usually most people do acquire emotional intelligence as they learn to navigate the world from their childhood ie by slowly learning to control their feelings like learning to delay gratification by not whining or throwing tantrums as they get older. Or when they become adults they try to calm down when being nagged by an angry employer or lover and not just shout back and curse them unless they cause so much harm or have an emergency situation.

Now, the problem with neurodiverse people, people with learning disabilities and developmental disorders and people with extremes in intelligence, their emotional intelligence is usually less developed than most people or the typically developing people. Why is this that so? Because these people usually has atypical or not so usual brain development ie too rapid cognitive development like giftedness, errors in brain chemicals that govern the brain and its activities like in ADHD or lack of theory of mind or the ability to read other people in cases of autism spectrum disorders, these can cause less development of the emotional intelligence.

What is the implication of the lack of EQ to neurodiverse people?

The thing here is because neurodiverse people have less developed EQs, their dealing with emotions is much harder to control. Let’s give child prodigies as example. Usually parents of child prodigies just harness their children’s area of gift (usually classical music or math) and they train these kids harshly as if they’re robots that do nothing but practice all day or study without teaching them to be more aware of themselves – their strengths and weaknesses. Now prodigies do excel in their gifts, but that cannot be sustained. Why? Because these kids tend to become their own uinverse thanks to parents who want them to be always the winner and being a loser means they’re rubbish and a loser anyway, they tend to lash out when they lose or may become withdrawn and quiet, not able to deal with their own emotions. This is not good as it can result in having emotional problems later on in life.

People in neurodiversity have more problems picking up and understanding emotions but this is not due to their laziness or sort but because of the brain structure. In children in ADHD, some brain parits are actually smaller than the brains of children without ADHD. Overall rain size is generally 5% smaller in affected children than children without ADHD.[2] This means that the part of brain dealing with emotions is somewhat less developed. This makes children with ADHD less attuned with their own feelings and just blurt out hurtful words or become too emotional that is not appropriate for their age ie a middle schooler throwing tantrums and behaving like a 2-year-old.

Image courtesy of quotesgram.com. Oh! this dog is too cranky. People with lower EQ have much more tendency to be cranky all of the time especially when they can’t get  what they want.

What are the complications of having a low EQ?

Psychological problems may arise from not being aware of their feelings. they may become more obsessed with numbing their emotions by having a vice (illegal drugs, casual sex)  or become more dependent too other people (as security blanket – hmm I’m guilty of this as I used my mom as my security blanket to hide my emotional inadequacy). Also, by not being aware of your emotions, you’ll also never to learn to be aware and support other people’s feelings. You become more selfish and childish in your ways just trying to consider only yourself not other people. That is so bad. People will get avoid and dislike you, which si the reason why a lot of neurodiverse people are single or have turbulent relationship history.

Not good right? Now, what are the characteristics of people with high emotional intelligence and how neurodiverse people can learn from them?

Daniel Goleman, an American psychologist, developed a framework of five elements that define emotional intelligence[3]:

1. Self-Awareness – People with high EI are usually very self-aware . They understand their emotions, and because of this, they don’t let their feelings rule them. They’re confident – because they trust their intuition and don’t let their emotions get out of control.[4]
2. Self-Regulation – This is the ability to control emotions and impulses. People who self-regulate typically don’t allow themselves to become too angry or jealous, and they don’t make impulsive, careless decisions. They think before they act. Characteristics of self-regulation are thoughtfulness, comfort with change,integrity , and the ability to say no.[4]
3. Motivation – People with a high degree of EI are usually motivated . They’re willing to defer immediate results for long-term success. They’re highly productive, love a challenge, and are very effective in whatever they do.[4]
4. Empathy – This is perhaps the second-most important element of EI. Empathy is the ability to identify with and understand the wants, needs, and viewpoints of those around you. People with empathy are good at recognizing the feelings of others, even when those feelings may not be obvious. As a result, empathetic people are usually excellent at managing relationships , listening , and relating to others. They avoid stereotyping and judging too quickly, and they live their lives in a very open, honest way.[4]
5. Social Skills – It’s usually easy to talk to and like people with good social skills, another sign of high EI. Those with strong social skills are typically team players. Rather than focus on their own success first, they help others develop and shine. They can manage disputes, are excellent communicators, and are masters at building and maintaining relationships.[4]

All these five are needed in order to have a high emotional intelligence. Easier read than applied, right? Especially if you have a learning disability right?

Yes. That’s only a part, but trust me, all people do have to learn how to have emotional intelligence. In short everybody. But also we need also EQ, needed it more than IQ in order to be more satisfied in life and in ourselves.

How to increase your EQ?

Awareness and acceptance are the key elements in developing your EQ. To develop your EQ you just first be aware of what are you feeling. Note your emotional reactions to events throughout the day. It’s easy to put your feelings about what you experience throughout the day on the back burner. But taking time to acknowledge how you feel about experiences is essential to improving your EQ.[5]

Pay attention to your body. Instead of ignoring the physical manifestations of your emotions, start listening to them. Our minds and bodies are not separate; they affect each other quite deeply.[5]

Wikihow gives some examples of feelings with physical signs[5]:

Stress might feel like a knot in your stomach, tight chest, or quick breathing.
Sadness might feel like waking up with slow, heavy limbs.
Joy or pleasure might feel like butterflies, your stomach, a racing heart or increased energy.

Observe how your emotions and behavior are connected.[5] For example when you see your crush, what do you do, do you hide? Become speechless and run away? Or when you’re angry, you throw things like I used to do. This is very important especially for people who can’t fully express themselves verbally (autism, expressive language disorders and the like) as behavior can make or break in dealing with other people. Especially if a person behaves destructively. She can hurt herself as well as other people. This can cause social isolation and can lead to more severe psychological problems like depression.

And accept your feelings wholeheartedly. No judging. Even if you feel ashamed (I’m still guilty of this but am trying to fight it). Feel it. Accept your feelings as your own. But please don’t wallow on them.

Practice deciding how to behave. You can’t help what emotions you feel, but you can decide how you want to react to them. If you have an issue with lashing out in anger or shutting down when you’re hurt, think about how you’d rather react.[5] It’s actually hard. Promise, but really practice makes perfect. And when you fail to do, don’t punish yourself. Don’t also use escapist behaviors like binge eating/drinking, compulsive gambling etc.

More tips[5]:

Be open-minded and agreeable. Consider other people’s point of view. Not just me, myself and I. That’s emotional immaturity.

Improve your empathy skills. Instead of just pitying another person who has problems, imagine yourself in that situation that person has as if it’s your own. Very hard because you have Asperger’s? Yeah hard, but you must. Now when you imagine that you have that problem, it’s much easier for you to understand and support your loved one in trial.

Read people’s body language. How? Observe how people act and they say and compare them to see if there’s any discrepancy. Hard? Literally study people as if they’re academic subjects. Also you can watch your favorite television show and observe how characters behave.Here you’ll learn about body language and you can compare a sincere person or not.

Practice being emotionally honest. Don’t ever lie about your feelings like telling “I’m fine” but in fact you’re cranky. That’ll lower your EQ and you are being dishonest to yourself and other people.

See where you have room for improvement. Being intellectually capable is important in life, but being emotionally intelligent is just as essential. Having high emotional intelligence can lead to better relationships and job opportunities.

Be more light-hearted at home and at work. When you’re optimistic, it’s easier to see the beauty in life and everyday objects and spread that feeling to those around you. Practice this everyday and poof all people will be drawn to you. Be negative and people will avoid you for good.

Hope this will help all of us here, whether neurodiverse or neurotypical. Maybe that special someone will come to you and have a sweeter Valentine’s day or even if not, at least you’ll become more content with your emotions and life as well.♡

Reference:

1. https://en.wikipedia.org/wiki/Emotional_intelligence
2. http://www.additudemag.com/adhd-web/article/5008.html
3. http://www.danielgoleman.info/topics/emotional-intelligence/
4. https://www.mindtools.com/pages/article/newCDV_59.htm
5. http://m.wikihow.com/Develop-Emotional-Intelligence

Pragmatic Language Impairment

Last time, I wrote about specific language impairment (SLI), which is a disorder affecting not a person’s speech ability (that’s speaking) but the disorder of language comprehension and expression (the way a person uses language). Now, maybe you read the latest DSM edition, DSM-5, where you encounter the disorder pragmatic language impairment or social (pragmatic) communication disorder[1].

Is this disorder the same as the specific language impairment (SLI)?

No. Actually, in my SLI article, pragmatic language impairment is under the more general SLI (For more about SLI and its subtypes, click my article here).

Now, what is pragmatic language impairment?

Pragmatic language impairment (PLI), also known as social (pragmatic) communication disorder (SCD), nonverbal learning disorder (NVLD) or semantic-pragmatic disorder (SPD not to be confused with sensory processing disorder), is an impairment in understanding pragmatic aspects of language.[1] Pragmatic language impairments are related to autism and Asperger syndrome, but also could be related to other non-autistic disabilities such as ADHD and intellectual disabilities.[1][2] People with these impairments have special challenges with the semantic aspect of language (the meaning of what is being said) and the pragmatics of language (using language appropriately in social situations).[1] This means a person having PLI can understand language literally but not figuratively. They also have difficulty in expressing language despite being able to speak and they are often mistaken as either shy, rude, or nervous even if they’re not feeling that way.

Image courtesy of speechbuddy.com. Pragmatic language impairment makes a child find it hard to understand and express social language that makes her mistaken as shy, rude, or nervous.

What are the symptoms of PLI?

According to Wikipedia, people with PLI have particular trouble understanding the meaning of what others are saying, and they are challenged in using language appropriately to get their needs met and interact with others.[1] Symptoms of PLI include[1]:

• delayed language development
• aphasic speech (such as word search pauses, jargoning, word order errors, word category errors, verb tense errors)
• stuttering or cluttering speech
• repeating words or phrases
• difficulty with pronouns or pronoun reversal
• difficulty understanding questions
• difficulty understanding choices and making decisions.
• difficulty following conversations or stories. Conversations are “off-topic” or “one-sided”.
• difficulty extracting the key points from a conversation or story; they tend to get lost in the details
• difficulty with verb tenses
• difficulty explaining or describing an event
• tendency to be concrete or prefer facts to stories
• difficulty understanding satire or jokes
• difficulty understanding contextual cues
• difficulty in reading comprehension
• difficulty with reading body language
• difficulty in making and maintaining friendships and relationships because of delayed language development.
• difficulty in distinguishing offensive remarks
• difficulty with organizational skills

Oh… it’s really difficult, right? But wait, in order to better understand PLI, first, I’ll tell you what is the so-called “pragmatic language.” What is it by the way?

What is pragmatic language?

Pragmatics or social language use is the application of using language in social communication and situations. This means more than the proper way of saying hello and goodbye. Let’s quote from American Speech-Language-Hearing Association (ASHA)[3]:

You have invited your friend over for dinner. Your child sees your friend reach for some cookies and says, “Better not take those, or you’ll get even bigger.” You’re embarrassed that your child could speak so rudely. However, you should consider that your child may not know how to use language appropriately in social situations and did not mean harm by the comment.

An individual may say words clearly and use long, complex sentences with correct grammar, but still have a communication problem – if he or she has not mastered the rules for social language known as pragmatics. Adults may also have difficulty with pragmatics, for example, as a result of a brain injury or stroke.

Now, pragmatics have these properties[3]:

Three Major Communication Skills:

• Using language for different purposes, such as
  • greeting (e.g., hello, goodbye)
  • informing (e.g., I’m going to get a cookie)
  • demanding (e.g., Give me a cookie)
  • promising (e.g., I’m going to get you a cookie)
  • requesting (e.g., I would like a cookie, please)
• Changing language according to the needs of a listener or situation, such as
  • talking differently to a baby than to an adult
  • giving background information to an unfamiliar listener
  • speaking differently in a classroom than on a playground
• Following rules for conversations and storytelling, such as
  • taking turns in conversation
  • introducing topics of conversation
  • staying on topic
  • rephrasing when misunderstood
  • how to use verbal and nonverbal signals
  • how close to stand to someone when speaking
  • how to use facial expressions and eye contact

Now, as ASHA has stated in their pragmatics article, these communication rules vary across cultures. This mieans, if a person with PLI lives in cultures with stricter social hierarchy and high nonverbal gestures (Asia, Arab countries) have a double whammy when it comes to PLI symptoms as people with PLI cannot read hidden social rules that makes them mistaken as rude or not respectful. If he or she is mistaken as rude in Western cultures (I will specify Anglo-Germanic culture as the main Western culture), then he or she will be more mistaken as very rude and insubordinate to social superiors in higher context cultures such as Asian and Arab cultures. This could be damaging to the person with PLI as no one can understand that the person with PLI has not mastered the “social aspects of language” and he or she does not look to have any noticeable learning disability (dyslexia) or neurological disorder (Tourette syndrome).

Image courtesy of talkingtalk.co.za. Children with PLI don’t know how to choose appropriate words at appropriate times. In this drawing, a mother tells her friend about her son swearing sentences.

People with PLI have fluent, complex and clearly articulated expressive language but exhibit problems with the way their language is used. These children typically are verbose. However, they usually have problems understanding and producing connected discourse, instead giving conversational responses that are socially inappropriate, tangential and/or stereotyped. They often develop obsessional interests but not as strong or eccentric as people with Asperger’s Syndrome or autism.[1]  This makes PLI often confused or mistaken as autism spectrum.

Is PLI a form of autism?

There is a debate whether PLI is a relative or is part of autism spectrum or not because of its symptom similarities. Nevertheless, PLI is distinguished from autism by the absence of any history (current or past) of restricted/repetitive patterns of interest or behavior.[1][4]

How is PLI presented?

PLI has more to do with communication and information processing than language. For example, children with semantic pragmatic disorder will often fail to grasp the central meaning or saliency of events. This then leads to an excessive preference for routine and “sameness” (seen in autism and Asperger’s Syndrome), as PLI children struggle to generalize and grasp the meaning of situations that are new; it also means that more difficulties occur in a stimulating environment than in a one-to-one setting.[1]

A further problem caused by PLI is the assumption of literal communication. This would mean that obvious, concrete instructions are clearly understood and carried out, whereas simple but non-literal expressions such as jokes, sarcasm and general social chatting are difficult and can lead to misinterpretation. Lies are also a confusing concept to children with PLI as it involves knowing what the speaker is thinking, intending and truly meaning beyond a literal interpretation.[1]

In short, people with PLI are often hypersensitive and look “immature” compared to their peers. They are often subjects to social isolation and bullying.

Image courtesy of PsychCentral. Children with PLI use language literally that they become sensitive to sarcasm or joke and may be subjects to bullying and social isolation.

Other features of PLI are the following[5]:

They often do not assume prior knowledge. So for example, one boy explained to me in minute detail how to wash a car, wrongly assuming that I needed (and wanted) the information and that I had never washed a car.

On the other hand, they may assume prior knowledge that the listener could not possibly have, and launch into a long disquisition without describing in sufficient detail the participants, location and general background of their story.

They can go on far too long telling stories, and include so much detail that the listener becomes disinterested.

Complications of PLI

Usually, when a person with PLI isn’t understood when communicating, this person (or child) may act out (yelling, kicking or throwing objects), which can be mistaken as misbehaving to parents, teachers, and peers (or colleagues). PLI deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.[6]

How is PLI diagnosed?

Delays in speech and language are hallmark signs of alarm to be brought in developmental pediatricians or language therapists. However, parents and doctors may not recognize the signs until years later.[7]

The American Speech-Language-Hearing Association (ASHA) recommends evaluating children in many different settings.[7][8] An evaluation by a speech-language pathologist, also referred to as a speech therapist, might include:

• Observing your child in the classroom and at home
• Interviewing your child’s teacher or caregiver or having her fill out a questionnaire
• Performing formal one-on-one testing to assess your child’s language and communication skills

How is PLI Managed?

Since, PLI does not have any cure, management of the disorder is important as soon as possible to make improvements in the person’s communication skills.

Speech and language therapy is applied to the child with PLI. A speech therapist can work one-on-one with your child, helping him practice turn-taking, introducing and ending topics and other conversational skills. The therapist may use role-playing games and visuals, such as comic strips, to help your child learn strategies to manage social situations. The therapist also can train you in how to reinforce these skills at home.[7]

Special education is also preferred as it customizes the child’s learning. This may involve individualized education and speech therapy as well.

Unfortunately, the process of obtaining appropriate social pragmatic assessment in a school setting is often fraught with numerous difficulties. For one, due to financial constraints, not all school districts possess the appropriate, up to date pragmatic language testing instruments.[9] This makes PLI one of the most difficult disorders to understand. That’s why early identification, awareness, and most of all acceptance, are important in managing pragmatic language

Related disorders of PLI

PLI is not a lone neurodiverse condition. It is often presented with hyperlexia, dyspraxia, and higher functioning autism spectrum disorders such as Asperger syndrome and PDD-NOS.

Remember, if a child or adult has “immature” speech, that doesn’t necessarily mean he or she’s unprofessional or just kidding to a serious listener. It doesn’t necessarily mean also he or she has a very bad character. Maybe you should think first whether this person has pragmatic language impairment.

Also, if a person has PLI, this doesn’t necessarily mean he is weak all throughout. In fact, a person with PLI has super strength in analytical fields like mathematics, computer science, geography, astronomy, reading, history, meteorology, botany, zoology, sports, politics or music.[1] These fields can be a good career choice for people with PLI.

References:

1. https://en.wikipedia.org/wiki/Pragmatic_language_impairment
2. Ahmed Mohammed Alduais, Rasha Mohammed Shoeib, Fayza Saleh Al Hammadi, Khalid Hassan Al Malki, Farah Hameid Alenezi (2012). “Measuring Pragmatic Language in Children with Developmental Dysphasia: Comparing Results of Arabic Versions of TOPL-2 and CELF-4 (PP and ORS Subtests)”.International Journal of Linguistics 4 (2): 475–494.doi:10.5296/ijl.v4i2.1685.
3. http://www.asha.org/public/speech/development/Pragmatics/
4. American Psychiatric Association, ed. (2013). “Social (Pragmatic) Communication Disorder, 315.39 (F80.89)”. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Publishing. pp. 47–49.
5. http://speech-language-therapy.com/~speech/index.php?option=com_content&view=article&id=103:spd&catid=11:admin&Itemid=120
6. http://psychcentral.com/disorders/social-pragmatic-communication-disorder/
7. https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/communication-disorders/understanding-social-communication-disorder
8. “Guidelines for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders Across the Life Span [Guidelines].” American Speech-Language-Hearing Association. 2006. http://www.asha.org/policy/gl2006-00049/#sec1.9.4
9. http://www.smartspeechtherapy.com/what-are-social-pragmatic-language-deficits-and-how-do-they-impact-international-adoptees-years-post-adoption/