Clinical Pragmatics

Pragmatic difficulties

When a child cannot communicate in the way expected for his/her age, both through gestures and language, it is critical to use a neurolinguistic approach of his/her communicative competence. This approach considers the assessment and treatment of all aspects of language (phonology, morphology, syntax, lexical-semantics and pragmatics) by taking into account the various cognitive processes underlying them. On the other hand, whatever the origin of language difficulties, these may have different degrees and types of pragmatic consequences, in connection with other children (Klecan-Aker & Lopez, B., 1984; Fujikiet al, 1990) as well as with adults (family, teachers, etc.) (Conti-Ramsden, 1995;Redmond & Rice, 1998).

Hence the importance of preventive work, which centers mainly on the assessment of parameters of the socio-communicative development during the early years of life.

Reaching a differential diagnosis of the communication pathology implies discriminating the type of difficulty and the scope of pragmatic failures both in connection with the development of these basic speech acts and with the early discourse skills. On the other hand, it is necessary to deal with the pragmatic aspect from a stage prior to discourse in patients who have lost their language function, that is, from basic speech acts, in order to recover the minimum communication circuits.

Pragmatic difficulties

The ICRA Method claims that all the linguistic development a person can attain is based on the seven basic speech acts: we reject, we make a statement, we give new information, we request information through questions, we make assertions, we request objects and actions that we need and we summon another person through greeting or calling. From these, what follows is a progressive development of lexical-grammatical and pragmatic increasing complexity including the deployment of acts of indirect speech and a move to the discourse level implied by the development of cohesion and coherence, now from the most basic speech act.

The speech act in clinical attention

Then the systematic study of speech acts appears as an important tool in the clinical speech and language approach in order to be more accurate in the analysis of language in young children with difficulties in the development of communicative competence. Thus, a clearer orientation is obtained for the differential diagnosis and the subsequent treatment. The results of the psychometric analysis indicate that the ICRA-A Battery provides the speech and language pathologist with the resources and strategies required.

Pragmatic difficulties

We consider that, when the child achieves these basic speech acts, the first stage of verbal communication circuit is opened, as the illocutionary, locutionary and perlocutionary forces typical of each of these speech acts provide a genuinely relevant communicative potential that goes beyond isolated transmission.

In a communicative system, structure is a logical principle; it conveys meaning. Nothing is by chance. In this principle of logic order, the minimum part represents the whole, its “DNA”. The smallest part keeps or contains the logic of the whole.

We see that this principle is clearly accomplished in the speech act. Its three forces (illocutionary, locutionary and perlocutionary) are present in the minimum speech act (e.g. “No”) as well as in full discourse. Hence our claim that it is necessary to work on basic speech acts of language development in order to open the minimum communication circuit.

All of this becomes significant, especially in connection with differential diagnosis at an early age, because having PRAGMATIC DIFFICULTIES is not a requirement sufficient to include a patient in a certain diagnosis (for example, Autism Spectrum Disorder). It is only a necessary requirement. It appears to be obvious but clinical evidence shows otherwise.

Pragmatic difficulties

Definition of pragmatic failures

Within the ICRA Method, pragmatic failures are understood as difficulties in the use of nonverbal and verbal language affecting its adjustment to the communicative situation.

This lack of adjustment may correspond to intrinsic characteristics of certain language pathologies with an underlying pragmatic compromise; be a consequence of other factors such as poor social skills, a sensory processing deficit, and/or an executive function disorder that impacts on the pragmatic aspect; or it may be presented as a co-morbidity. In all cases, the common element is that communicative interaction is directly or indirectly affected.

Besides, it is necessary to analyze the relationship between these failures and the compromise of other aspects of language. This is established within the framework of the neurolinguistic assessment.