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, readinghistory, meteorology, botany, zoology, sports, politics or music.[1] These fields can be a good career choice for people with PLI.


  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/

Little Bookworms (Hyperlexia)

(C) PopCap.

Who has played Bookworm on PC or Game Boy? I do. Anyway…

Bookworms, especially children, are becoming rare (because of game app on tablets). But there are little children who reads materials (books or ebooks) for advanced readers like encyclopedia, dictionaries, and high school and college text books. Parents may feel “blessed” because they have gifted children; what they don’t know that reading too advanced for a child might be a sign of a neurodevelopmental disorder, called hyperlexia.


You read it right. Hyperlexia. Hyperlexia is a syndrome that is characterized by a child’s precocious ability to read (far above what would be expected at their age), significant difficulty in understanding and using verbal language (or a profound nonverbal learning disability) and significant problems during social interactions.[1] It means a child’s advanced reading skills, i.e., a 2-year-old reading books (or ebooks), internet articles, and encyclopedias suitable for adolescents and adults. Summary: a child reading prodigy or bookworm.

Hyperlexia was first named and scientifically described in 1967[2][3] by Silberberg and Silberberg (1967), who defined it as the precocious ability to read words without prior training in learning to read typically before the age of 5.[2]

Image courtesy of wiseGEEK. Hypeerlexia is characterized by reading books with advanced vocabularies without understanding the meaning of them.

What are the characteristics of hyperlexia?

A youngster with the condition will often display a high interest in letters or numbers, and have trouble interacting with others. The condition is usually diagnosed when a child is 18- to 24-months old and shares traits with autism, behavior disorders, emotional disorders, and attention deficit disorder.[4] Hyperlexic children are characterized by having average or above average IQs and word-reading ability well above what would be expected given their age.[2][5] It can be viewed as a superability in which word recognition ability goes far above expected levels of skill.[2][6]

Hyperlexic children are often fascinated by letters or numbers. They are extremely good at decoding language and thus often become very early readers. Some hyperlexic children learn to spell long words (such as elephant) before they are two years old and learn to read whole sentences before they turn three. An fMRI study of a single child showed that hyperlexia may be the neurological opposite of dyslexia.[7]

Despite hyperlexic children’s precocious reading ability, they may struggle to communicate. Often, hyperlexic children will have a precocious ability to read but will learn to speak only by rote and heavy repetition, and may also have difficulty learning the rules of language from examples or from trial and error, which may result in social problems. Their language may develop using echolalia, often repeating words and sentences. Often, the child has a large vocabulary and can identify many objects and pictures, but cannot put their language skills to good use. Spontaneous language is lacking and their pragmatic speech is delayed. Hyperlexic children often struggle with Who? What? Where? Why? and How? questions. Between the ages of 4 and 5 years old, many children make great strides in communicating.[2]

The social skills of a child with hyperlexia often lag tremendously. Hyperlexic children often have far less interest in playing with other children than do their peers.[2]

Are there types of hyperlexia?

Yes, hyperlexia have types, depending on the presenting symptoms. Here they are:

Darold Treffert Types[8]:

  • Type 1: Neurotypical children that are very early readers.
  • Type 2: Children on the autism spectrum that demonstrate very early reading as a splinter skill.
  • Type 3: Very early readers who are not on the autism spectrum though there are some “autistic-like” traits and behaviours which gradually fade as the child gets older.

Rebecca Williamson Brown Types[9]:

  • Type 1: Hyperlexia marked by an accompanying language disorder.
  • Type 2: Hyperlexia marked by an accompanying visual spatial motor disorder.

What causes hyperlexia?

Nothing is known what causes hyperlexia. According to the Center for Speech and Language Disorders (CSLD), “the presence of hyperlexia within the context of another developmental disorder reflects a difference in the neurological organization of the brain. While a cause is not yet known, research in genetics and functional MRI studies may provide some information in the future.”[1]

Maybe hyperlexia is autism?

Some experts say hyperlexia is similar to autism, but others may classify hyperlexia as a separate disorder co-occurring with other neurodiverse conditions.

Another quote from CSLD tells that hyperlexia is present in a lot of autism children and have persistent pragmatic language and social difficulties:

 In working with a large number of children with hyperlexia, we have seen a spectrum of outcomes. Some children, though they may be excellent readers, may exhibit severe and persistent symptoms of autism. Other children have great difficulties developing verbal expressive language, though their written expressive language may exceed their verbal abilities. Some children may do well academically, but may have difficulties socially. It is hard to predict what a child with hyperlexia will be like as a young adult; however, we do know that using writing to supplement their learning leads to better progress.[1]

What are the symptoms of hyperlexia?

According to About Parenting, hyperlexia symptoms go like this[10]:

Hyperlexic children memorize phrases, sentences or entire conversations. To express an idea, the children must be able to dissect what they have memorized to create original expressions.

Hyperlexic children have excellent visual and auditory memories, which means they easily remember what they see and hear. They use their memory to help them learn language. They will often exhibit echolalia, which is the repetition of phrases and sentences without understanding the meaning.

Given their difficulty with spoken language, hyperlexic children rarely initiate conversations.[10]

Hyperlexia is considered to be part of the autism spectrum of disorders and like autistic children, children with hyperlexia have problems socializing and behaving appropriately. They also exhibit other characteristics of autism:

  • Self-stimulatory behavior
  • Ritualistic behavior
  • Concrete and literally thinking
  • Difficulty with abstract concepts
  • Normal development until 18-24 months, followed by regression
  • Need to keep routines
  • Difficulty transitioning from one activity to another

Additional characteristics of autism include the following:

  • Sensitivity to sounds, smells, and touch
  • Unusual fears
  • Selective listening (may appear to be deaf)

Image courtesy of Wikipedia/William Adolphe Bouguereau-The Difficult Lesson (1884).

According to the UK’s Special Needs Education (SEN), hyperlexia symptoms are summarized below[11]:

  • A precocious ability to read words, far above what would be expected at their chronological age or an intense fascination with letters or numbers.
  • Significant difficulty in understanding verbal language
  • Abnormal social skills, difficulty in socialising and interacting appropriately with people
  • Learn expressive language in a peculiar way, echo or memorize the sentence structure without understanding the meaning (Echolalia), reverse pronouns.
  • Rarely initiate conversations.
  • An intense need to keep routines, difficulty with transitions, ritualistic behaviour.
  • Auditory, olfactory and / or tactile sensitivity.
  • Self-stimulatory behaviour.
  • Specific, unusual fears.
  • Normal development until 18-24 months, then regression.
  • Strong auditory and visual memory.
  • Difficulty answering “Wh–” questions, such as “what,” “where,” “who,” and “why”.
  • Think in concrete and literal terms, difficulty with abstract concepts.
  • Listen selectively, appear to be deaf.

Can hyperlexia be cured?

No. Hyperlexia cannot be corrected since this is innate to the child. She is born with hyperlexia. Instead, co-existing deevelopmental disorders are managed and therapies are used to improve a child’s communication skill as well as social skills (for management of autism spectrum disorder, click here; see also my articles about stuttering and specific language impairment).

Hyperlexia isn’t necessarily a disorder though research may or may not label this as such. Neurotypical children do also have this (hyperlexia type 1).

For hyperlexia associated with autism and other developmental disorders: thorough psychological evaluation by a psychologist who is familiar with the syndrome of hyperlexia is a crucial first step. Hearing, neurological, psychiatric, blood chemistry, speech and language and genetic evaluations can be performed to rule out other disorders but are not needed to identify hyperlexia.[11]

Intensive speech and language therapy and early intervention programs can help achieve this objective. The child’s reading skills should be used as a primary means of developing language.[11]

It is important to teach the child appropriate social skills. Providing opportunities for the child to interact with children whose behavior is more socially appropriate is one way to accomplish this. Parents, teachers and other professionals should work together to develop programs for each child to reach his /her fullest potential.[11]

Image courtesy of thepaintedlily.blogspot.com. Addicted to books and complicated academic material is not so bad at all. It is actually good that it expands your scope of knowledge.

The only problem hyperlexia may have is its association with “nerds” or “geeks” or maybe too much reading can cause nearsightedness.

(C) Giant Microbes. Do bookworms have hyperlexia?

O too much reading can turn you into bookworms…

Nevertheless, precocious reading can be a good sign as this can make a child smarter.


  1. http://www.csld.org/HyperlexiaDefinition.htm
  2. https://en.wikipedia.org/?title=Hyperlexia
  3. “Hyperlexia–specific word recognition skills in young children”. Exceptional Children 34 (1): 41–2. 1967. PMID 6066378.
  4. http://www.wisegeek.com/what-is-hyperlexia.htm
  5. Tina M. Newman Æ Donna Macomber Adam J. Naples Æ Tammy Babitz Æ Fred Volkmar Æ Elena L. Grigorenko. (2007). Hyperlexia in Children with Autism Spectrum Disorders. 37:760-774-2. J Autism Dev Disord
  6. Grigorenko EL, Klin A, Volkmar F (2003). “Annotation: Hyperlexia: disability or superability?”. J Child Psychol Psychiatry 44 (8): 1079–91. doi:10.1111/1469-7610.00193. PMID 14626452.
  7. Turkeltaub PE, Flowers DL, Verbalis A, Miranda M, Gareau L, Eden GF (2004). “The neural basis of hyperlexic reading: an FMRI case study”. Neuron 41 (1): 11–25. doi:10.1016/S0896-6273(03)00803-1. PMID 14715131.
  8. Treffert, MD, Darold A (2011). “Hyperlexia: Reading Precociousness or Savant Skill? Distinguishing autistic-like behaviors from Autistic Disorder”. Retrieved 2013-01-22. (WebCite archive of 2013-01-22).
  9. http://www.nldline.com/hyperlexia.htm
  10. http://giftedkids.about.com/od/glossary/g/hyperlexia_def.htm
  11. http://www.specialeducationalneeds.co.uk/hyperlexia.html

Further Reading:

  1. https://www.wisconsinmedicalsociety.org/professional/savant-syndrome/resources/articles/hyperlexia-reading-precociousness-or-savant-skill/
  2. http://blogs.scientificamerican.com/mind-guest-blog/oops-when-autism-isnt-autistic-disorder-hyperlexia-and-einstein-syndrome/
  3. http://www.k12academics.com/disorders-disabilities/hyperlexia#.VYULyPk_PIU

Specific Language Impairment

Language is the blood of the soul into which thoughts run and out of which they grow.
– Oliver Wendell Holmes

We use language to share ideas and feelings to each other. In fact, we humans speak the most specialized and complicated language in the animal kingdom. However, not all of us can speak a language the way most people do.

Does this mean fluency?

No. It is more complicated than simple fluency. Language comprises of phonology (pronunciation), syntax (word order), semantics (meaning of words/phrases in a language), prosody (the rhythmic and intonational aspect of language[1]), pragmatics (what words mean in particular situations[1]), sarcasm (the use of words that mean the opposite of what you really want to say especially in order to insult someone, to show irritation, or to be funny[1]), humor, and body language. Not all of us can readily understand, interpret, and express language using all of these. The difficulties in language acquisition and usage are grouped as language disorders. The specific difficulty in receiving and sending language is called specific language impairment.

What is Specific Language Impairment?

Specific language impairment (SLI) is a type of communication/language disorder where a person affected with it cannot comprehend and express language. It is characterized by difficulty with language that is not caused by known neurological, sensory, intellectual, or emotional deficit. It can affect the development of vocabulary, grammar, and discourse skills, with evidence that certain morphemes may be especially difficult to acquire (including past tense, copula be, third person singular). Children with SLI may be intelligent and healthy in all regards except in the difficulty they have with language. They may in fact be extraordinarily bright and have high nonverbal IQs.[2]

Children with SLI are often called ‘late-talkers’ as they typically start to speak later than the typically developing children. While kids learn to talk simple words by 1 year, kids with SLI do the same in 3 years, making them delayed by 2 years against typocal children. Usually, parents and teachers see them as lazy, awkward, or not trying enough; actually, kids with SLI are eager to learn and talk but find it hard to ‘find the right words’ and express their ideas.

SLI has subtypes:

Expressive language disorder – also known as developmental verbal dyspraxia (DVD), where language expression is late and incomplete despite comprehension of language.[3]

Receptive language disorder – here, the child’s most obvious problems are a tendency to speak in short, simplified sentences, with omission of some grammatical features, such as past tense -ed.[3][4] Comprehension of language is affected.

Mixed receptive/expressive language disorder -a combination of both receptive and expressive language disorders.

Phonologic programming deficit syndrome – The child speaks in long but poorly intelligible utterances, producing what sounds like jargon.[3]

Lexical deficit disorder – The child has word finding problems and difficulty putting ideas into words. There is poor comprehension for connected speech.[3]

Pragmatic language impairment – The child speaks in fluent and well-formed utterances with adequate articulation; content of language is unusual; comprehension may be over-literal; language use is odd; the child may chatter incessantly, be poor at turn-taking in conversation and maintaining a topic.[3] Also known as social communication disorder or social (pragmatic) language disorder.

SLI is considered to be autism’s older brother, dyslexia’s younger brother, and dyspraxia’s twin because of its similiarities with these; however, SLI is one of the most difficult to recognize among learning disabilities. In fact, SLI remains very much a “hidden disability” within the community – poorly understood and rarely discussed.[5]

What causes SLI?

Genetics is one of the causes of SLI. One specific gene mutated for SLI is called CNTNAP2 gene (pronounced “catnap”) on chromosome 7q.[5]

But like autism, it’s unlikely that just one gene causes the majority of SLI cases. Rather, it’s probably the case that multiple gene variants that, when combined (and perhaps in conjunction with environmental factors), cause language difficulties.[5]

The effects of genes involved with SLI are likely to cause a different pattern of brain development. The enduring mystery of SLI is that no clear brain abnormality has been identified as a cause of language difficulties.[5]

How common is SLI?

SLI is so common it affects up to one child in every class and is as common as dyslexia and more common than autism but is barely heard of by the general public.[6]

What are the symptoms of SLI?

People with SLI have the following symptoms[7]:


Noticeably behind other students in speech and/or language skills development
May have a learning disability (difficulties with reading or written language) with average intelligence
Improper use of words and their meanings
Inability to express ideas
Inappropriate use of grammar when talking or writing
Inability to follow directions
Difficulties in understanding and/or using words in context, both verbally and nonverbally
May hear or see a word but not be able to understand its meaning
May have trouble getting others to understand what they are trying to communicate
Has difficulty remembering and using specific words during conversation, or when answering a question
Asks questions and/or responds to questions inappropriately
Has difficulty discriminating likenesses and differences
Has difficulty breaking words into sounds and syllable
Has difficulty with concepts of time, space, quantity, size, and measurement
Has difficulty understanding and using complex sentences
Has problems understanding rules and patterns for word and sentence formation
Cannot identify pronouns
Cannot retell the events in a story in order
Cannot make predictions, make judgments, draw conclusions
Difficulties with figurative language (such as alliteration, similes, metaphors, personification, and idioms)
Cannot give clear directions
Cannot summarize essential details from hearing or reading a passage, nor distinguish relevant from irrelevant information
Has difficulty understanding and solving math word problems (one or multi-step)
Will not initiate conversations
Has difficulty reading what others communicate through facial expressions and body language
Repeats what is said or what is read, vocally or subvocally (under breath)
Uses gestures when talking or in place of talking
Is slow to respond during verbal interaction or following verbal cues
Cannot identify or use different language in written work (expository, descriptive or narrative)
Cannot write an organized paragraph


Noticeably behind other students in speech and/or language skills development
Trouble forming sounds (called articulation or phonological disorders)
Difficulties with the pitch, volume, or quality of the voice
May display stuttering (dysfluency), an interruption in the flow of speech
Omits or substitutes sounds when pronouncing words
May have trouble getting others to understand what they are trying to say
May have trouble with the way their voice sounds
Is echolalic (repeats speech)
Does not use appropriate speaking volume (too loud or too soft)
May have breathy, harsh, husky or monotone voice
Continually sounds congested
Sounds nasal and voice may have a “whining” quality
Has abnormal rhythm or rate of speech
Frequently prolongs or repeats sounds, words, phrases and/or sentences during speech
Has unintelligible (cannot be understood) or indistinct speech

Academics and Behavior:

Overall academic achievement may be lower than expected
Word knowledge may be below expectancy
Word substitutions may occur frequently in reading and writing (when copying)
Hesitates or refuses to participate in activities where speaking is required
Is inattentive and has difficulty with concentration
May not initiate or maintain eye contact
May become easily frustrated
Has difficulty following directions
Must be “shown” what to do
Has trouble understanding information from what is seen, heard or felt
May be embarrassed by speech, regardless of age
Acts impulsively, and may respond before instructions are given out
May isolate themselves from social situations


May be conditions in the student’s medical/developmental history, such as cleft lip and/or palate, cerebral palsy, muscular dystrophy, brain injury or disorder, aphasia, hearing loss, ear surgery, facial abnormalities, or congenital (present at birth) disorders
Has frequent allergy problems or colds
Has oral muscular coordination slower than normal
Displays clumsiness or seems to be uncoordinated

How is SLI diagnosed?

SLI is defined purely in behavioural terms: there is no biological test for SLI. There are three points that need to be met for a diagnosis of SLI:

The child has language difficulties that interfere with daily life or academic progress
Other causes are excluded: the problems cannot be explained in terms of hearing loss, general developmental delay, autism, or physical difficulty in speaking
Performance on a standardized language test (see Assessment, below) is significantly below age level.[3]

EpiSLI criterion is also used, based on five composite scores representing performance in three domains of language (vocabulary, grammar, and narration) and two modalities (comprehension and production). Children scoring in the lowest 10% on two or more composite scores are identified as having language disorder.[3][8]

Furthermore, specific language impairment does not involve global developmental delays; children with SLI function within the typical range in non-linguistic areas, such as nonverbal social interaction, play, and self-help skills (e.g., feeding and dressing themselves). Children with autism spectrum disorders have core impairments in social interaction and communication, including both nonverbal and verbal skills, as well as certain characteristic behaviors (e.g., repetitive movements, lack of pretend play, and inflexible adherence to routines) that are not found in youngsters with SLI.[9]

How is SLI managed?

Intervention is usually carried out by speech and language therapists, who use a wide range of techniques to stimulate language learning.[3] The intervention is interwoven into natural episodes of communication, and the therapist builds on the child’s utterances, rather than dictating what will be talked about. In addition, there has been a move away from a focus solely on grammar and phonology toward interventions that develop children’s social use of language, often working in small groups that may include typically developing as well as language-impaired peers.[3][10]

Fast ForWord[11] is also used as a therapy for children with SLI. Fast ForWord is a family of educational software products intended to enhance cognitive skills of children, especially focused on developing “phonological awareness.”[11][12] Here, Fast ForWord uses computerized exercises in which children identify computer-generated speech sounds (although the latest versions of the product apparently includes others kinds of computerized training as well). In the speech-sound drills, the training program starts off with sounds that have been altered by computer processing. These processed sounds preserve the frequency content of normal speech sounds, but are slowed down and have artificially exaggerated differences. These changes make the task easier for children with slower than normal temporal processing, but paradoxically are more difficult to discriminate for temporal processing normals. As the subject progresses, these differences are reduced to make the games more challenging.[11]

What happens if SLI is not managed?

Complications arise when SLI is not identified and intervened. Primarily, a child’s academic and social life will be adversely affected. Children with SLI are less likely to complete secondary school, and are more likely to experience long periods of unemployment during adulthood. What’s more, individuals with SLI have greater difficulties forming close friendships and romantic relationships.[5]

The impact on mental health is significant, and adults with SLI are at a disturbingly high risk (around 50%) for depressive and anxiety disorders.[5]

Early identification and intervention is very important so as to address the very specific problems children with SLI.

And remember, if you see a person who talks erratically, that doesn’t necessarily mean he or she is dumb, liar, or immature. Maybe he or she has specific language impairment.

1. Merriam-Webster Dictionary 2015.
2. http://www.asha.org/Publications/leader/2001/010626/sli.htm
3. http://en.m.wikipedia.org/wiki/Specific_language_impairment
4. Leonard, Laurence B. (1998). Children with specific language impairment. Cambridge, Mass: The MIT Press. ISBN 0-585-27859-8. OCLC 45728290.
5. http://theconversation.com/autisms-hidden-older-brother-specific-language-impairment-6295
6. http://www.huffingtonpost.co.uk/claire-mitchell/specific-language-impairm_b_1576898.html
7. http://www.do2learn.com/disabilities/CharacteristicsAndStrategies/SpeechLanguageImpairment_Characteristics.html
8. Tomblin JB, Records NL, Zhang X (December 1996). “A system for the diagnosis of specific language impairment in kindergarten children”. J Speech Hear Res 39 (6): 1284–94. doi:10.1044/jshr.3906.1284. PMID 8959613.
9. http://www.gemmlearning.com/can-help/speech-language/delay-info/specific-language-impairment/
10. Gallagher, T. (1996). Social-interactional approaches to child language intervention. In J. Beitchman, N. J. Cohen, M. M. Konstantareas & R. Tannock (Eds.), Language, Learning and Behavior Disorders: Developmental, Biological and Clinical Perspectives (pp. 493–514). New York: Cambridge University Press.
11. http://en.m.wikipedia.org/wiki/Fast_Forword
12. Begley, S.; Check, E. (1 Jan 2000). “Rewiring your gray matter”. Newsweek: 63. Retrieved 2010-02-05.