Meeting the challenge of social pragmatics with students on the autism spectrum

Beverly Vicker, CCC-SLP


The purpose of this article is to provide a detailed introduction to the topic of social pragmatics (i.e., what it is, how it relates to social skills, what tools might be used to assess pragmatics and possible approaches to intervention).

Introductory Examples of Typical Social Pragmatic Use in Conversational Settings
Social pragmatics is usually cited as a core challenge for individuals with autism spectrum disorder (ASD). One might ask, however, “What exactly is social pragmatics?” Definitions and classifications vary to some degree in term of what is included or how actions are labeled but the essence of pragmatics is the ability to effectively use and adjust communication messages for a variety of purposes with an array of communication partners within diverse circumstances. Everyone is not automatically born with this ability; the skills develop over time and development is dependent on other factors such as joint attention, perspective taking, comprehension monitoring ability, and social interest.

A few illustrations of pragmatic use in action at this early stage of discussion might help readers to understand aspects of what is meant by the definition. In order to avoid the impact of developmental issues, the examples will include two typical adults who DO NOT have autism spectrum disorder.

Example # 1. Hank sees his friend Terrell as he is climbing the stairs to get to his seat at the baseball stadium. He stops for a few seconds, greets his friend, indicates he will talk to him more after the game and moves onward to his seat. If no one had been climbing the stairs behind him, he might have had a longer conversation with his friend. However, he remained aware of the circumstances (i.e., people behind him wanted to get to their seats before the game started), so he kept the interaction to a minimum while not seeming unfriendly to his friend or obnoxious to the people behind him.

Example # 2. Hank sees his doctor at a party. He does not know him outside of the professional medical setting. He and the doctor exchange a few impersonal comments about the party and the weather before each moves on to talk to other guests. Hank knew he would have committed a social blunder if he had brought up anything relating to his medical care in that situation.

Example # 3. Hank sees his friend Tim at the mall. They talk about general topics in common- their workouts, their jobs, and their vacation plans. Hank and Tim express enough detail about these topics so that the other partner understands the message.

Example # 4. Hank meets his best friend Shawn at a restaurant for lunch. They reminisce about a camping trip that they took together a year ago. The conversation often involves one man bringing up an aspect of the trip and intermittently both may begin to laugh without a lot of exchange of detail. Often they do not even use complete sentences. They both have detailed common memories about the topic.

The subtle differences in the conversational examples almost seem insignificant. They do not represent things that ordinary people consciously think about or notice until certain behaviors occur that violate or breach cultural social pragmatic rules and/or communication partner expectations.

The Specific Elements of Social Pragmatics
For purposes of this article, the classification system used will be the one referenced by Rhea Paul (2009). Specific conversational elements involved in social pragmatics will be listed and examples used, when needed, to help readers understand the standard terminology, scope, and complexity of this topic area. This listing indirectly provides a global guide to assessment/intervention components although in real conversations, the elements do not occur in isolation of each other.

Concern about pragmatic use applies to individuals who use speech, signing, or some other form of augmentative communication. Pragmatics is what helps individuals engage in social connection with others. This need applies regardless of the form of communication used. To keep understanding of the concepts clear, however, the specific elements of pragmatics will be described in terms that would apply to individuals who have an adequate command of verbal communication. Adjustments or earlier steps would need to be considered for those who do not have adequate verbal skills. The specific elements include the following:

Communication Functions
o Intent of Communication. Intent involves the ability to generate message such as requests, comments, questions, persuasion, refusals, negotiations, or other functions as required by a communication situation in daily life at a level appropriate for one’s age and experiences.

o Frequency of Communication. Frequency involves the number of messages offered during a conversation when compared to one’s communication partner. The objective in social conversational situations is to have a balance between partners and appropriate initiation by both.

Discourse Management
(i.e., managing the conversation to keep it flowing and effective)

o Turn Allocation. Turn allocation involves taking a turn in conversation at the appropriate time, i.e. recognition of a signal that a turn has ended as well as limiting one’s talking to one’s turn.

o Topics. Topics involves staying on the topic unless there is a signal by one’s communication partner that he/she is going to change it. It also includes knowing how to smoothly introduce a topic shift.

o Repair of Conversational Breakdowns. Conversational repair involves recognition that there is a breakdown in communication or level of understanding by, or of, the communication partner and the subsequent usage of strategies such as repeat, rephrase, or add information to aid comprehension.

Register Variation
Politeness. Society requires that one know how to use a polite manner of discourse. This does not just mean adding “please” but knowing how to say something in terms of word choice and sentence form while using suitable vocal tone and gestures/body posture appropriate to the circumstances. For example, imagine a young child wanting a forbidden cookie or a friend wanting a babysitting favor.

Social Role Recognition. Each individual must show awareness of social roles as a guide to their discourse patterns. For example, one would speak differently to a young child vs. an adult, differently to a friend vs. an authority figure such as a judge or police officer, and differently to a same sex, same age relative than to a muscular, opposite sex, scary looking stranger.

Presupposition
(i.e., assumptions about what other people know)
Perspective-Taking. Perspective taking involves knowing that everyone has different thoughts, feelings, and experiences, knowing that this must be taken into account during the conversation, and making a cognitive leap or guess at how the other person might be viewing the situation as one adapts the conversation.

General Rules of Conduct for the Speaker’s Role in Relationship to the Communication Partner
Quantity. Quantity involves the speaker providing enough information so that a communication partner understands but not so much as to assume he knows nothing or needs to know everything about a topic. It also involves a conversational technique called ellipsis which allows a respondent to abbreviate a response since the speaker already knows the framework for the response (For example, it is OK to just answer “chocolate” to the question “What is your favorite flavor of ice cream?” as opposed to repeating the whole sentence frame).

Quality. When the person or his/her communication partner speaks, it is important that what is said is sincere, valid, or true. This is a trust factor that is important in conversations. If one knows that the partner is manipulative or deceptive, then much of what he says may be questioned as being believable. This can cause a breakdown in the conversation.

Relation. It is important that information added during a conversation is relevant to the topic at hand.

Manner. It is important that each communication partner’s contribution to the conversation is clear and concise. The speaker needs to connect information for the listener and not make the listener feel like he must navigate a maze in order to find meaning.

Although the above may represent more than what the average person wants to know about social pragmatics, it does outline the inclusive areas of conversational learning that may be addressed as part of a social pragmatics intervention program during the school years. Social inferencing, or the ability to make assumptions from specific information, may also be included within the realm of pragmatics when the broader term of social communication is used.

Is Pragmatics Different than Social Skills?
Before discussing assessment and intervention for pragmatic skills, it seems appropriate to put pragmatics into a familiar context. If a speech language pathologist focuses on building conversational capabilities, is he or she contributing to the overall development of social skills? Actually pragmatics is a subgroup of the category called social skills. According to Paul (2009) other equivalent aspects of social skills include:

Paralinguistics
(i.e., social meaning that is not language based)
o Prosody. Prosody involves the meaning conveyed by the use of one’s voice. Examples include messages that indicate what is emphasized, what is meant sarcastically, and what might be one’s emotional state.

o Gaze. Eye gaze during conversation can suggest meaning such as interest in the interaction, joint attention to topic, truthfulness and other messages. Eye gaze can also be used to monitor the nonverbal communication of the partner.

o Gestures. Gestures involve body signals that suggest meaning such as “Pay attention to what I am pointing to;” “Wow, what a surprise”; “Oops, I shouldn’t have said that;” or “No, I don’t want that.”

o Proximity. Proximity involves the meaning attributed to use of one’s body in space. It may carry meaning all by itself or be combined with other paralinguistic features. If one stands five feet away from a communication partner, the message may be one of disinterest or discomfort with a conversation. Standing too close to a partner may make the person feel uncomfortable as his/her personal space has been invaded.

Social Behaviors
Conventional Gestures. Conventional gestures are common gestures that have a meaning in a specific culture. Most people will recognize the meaning of a raised hand movement to signal greeting or departure or a raised hand to signal “Call on me” or “I will do it.” A high-five is a common gesture used to connote approval or success. Gestures can also include handshakes, a pat on the back, a social kiss or an European style double kiss on each cheek upon greeting, among other gestures.

Facial Expressions. Facial expressions can carry meanings that amplify or contradict a spoken message. The emotional message of facial expression might also be enhanced by the prosody features of one’s voice.

Social Actions or Behaviors. Social actions that are consistent with the expectations of one’s culture are an important aspect of social skills. Social actions represent responses such as dressing appropriately for an occasion, offering to share something, assisting someone who needs help, patiently waiting for a turn in a game, not talking on a cell phone while in a restaurant, or not making unkind remarks, even if truthful.

Many professionals and parents may be working on a variety of skills that fall within the social skills realm. Given the magnitude of the challenges for students with ASD, there is a need for multiple team members as implementers. Team members will want to be aware of who is working on what so there is consistency of approach and a variety of quality opportunities for frequent practice.

Assessment of Pragmatic Skills
Assessing pragmatic or conversational skills can be a challenge since conversations are dynamic and not static. As researcher, Scott Bellini (2006) suggests, one must consider whether the person has the knowledge to manage a situation such as conversation, or whether it is a performance issue. The old standbys in terms of methods of eliciting information about both still apply ( i.e., information can be gathered by):

1. Formal assessment which involves static, often pictured situations;
2. Observation;
3. Interview of others about cumulative observations;
4. Provision of check lists or self inventories; or
5. Establishment of situations that probe specific skills.

Selective social pragmatic skills are often evaluated within an assessment of the larger category of social skills or language/communication skills. Pragmatic skills are highly dependent on the underlying language comprehension skills and metalinguistic skills of any individual (Adams, 2008). Metalinguistic skills involve the ability to use language to think/talk about language use. It is aso important to consider the individual’s command of semantics, grammar, and receptive/expressive skills when assessing pragmatics.
Tools that can provide some useful information or guidance regarding pragmatics include the following:

• The Conversational Effectiveness Profile which can be accessed at no charge from an article by Timothy Kowalski at http://www.flasha.org/flasha_journal05_112006.pdf (ignore site error message and scroll to pages 29-34.)

• Children’s Communication Skill Checklist-2 (U.S. edition) by D. V. Bishop (Pearson Assessment).

• Test of Social Pragmatics-2 by Phelps-Terasaki & Phelps-Gunn (Western Psychological Service).

• Social Language Development Test- Elementary by Bowers, Huisingh & LoGuidice (LinguiSystems).

• Discourse Skills Checklist (Paul, 2007).

• Pragmatic Language Skills Inventory by Gilliam and Miller (Pro-Ed).

• Yale in vivo Pragmatic Protocol (Paul, 2005).

Information from more than one source will need to be reviewed and priorities for intervention established. A good guide as to what is age appropriate should involve observing typical peers in everyday interactions in the student’s natural school environment. Some peer behavior may be desirable to emulate and others ignored. In the latter instance, the student with ASD will need to learn to cope or tolerate examples of peer immaturity. Interventionists will need to consider what skills are easiest to teach, which should be paired together, which should be taught first, and which will make the biggest impact in terms of improving conversational interaction skills.

While the SLP may provide the focus and guide strategy selection for intervention in the area of pragmatics, he or she should not be the sole implementer. Classroom staff and family members should be providing additional learning opportunities throughout the day/week. All members of a child’s intervention team should also be supporting the development of pragmatics within a broader social skills framework.

Intervention
Several key concepts must be considered as an individualized program is developed for an individual with ASD. These include:

o The extent of a student’s repertoire of knowledge about social situations, social communication, and social strategies.

o The student’s ability to apply his social knowledge in various situations and the conditions under which he/she is both able or unable to perform.

o The cognitive/emotional cost to the student when he must remember many rules or bits of information, apply them appropriately, and then self monitor.

o The need to match strategy to specific challenge.

o The need to consider many underlying or co-occurring elements during the selection/implementation stages such as joint attention ability, executive function, theory of mind ability, language comprehension, and metalinguistic ability.

o The need for planned generalization of skills, particularly to peer situations.

o The need to teach self monitoring if the person with ASD is to develop independent, flexible skills.

o The need for many people to be involved in developing the skills.

o An understanding that acquisition of some skills will be easier than others; some may take a long time to acquire.

o An understanding that multiple strategies may be needed to work on a singular skill.

o An understanding of the complexity and interrelatedness of social pragmatic skills within the social communication/social skills realm.
Many books and articles have been written about social pragmatics, social communication, and the broader umbrella of social skills. Readers are encouraged to become familiar with a variety of sources and materials. Only selective strategies will be mentioned in this brief article.

Although social stories and comic strip conversations (Gray, 1994, 2000) are recognized tools for behavioral intervention, they also serve a purpose in building theory of mind skills and a knowledge base about the social world. Direct instruction materials by Michelle Winner and video modeling can also be important resources when addressing a restricted knowledge base. Perspective taking is a complicated but important topic to address through planned instruction but also during incidental opportunities, including the viewing of TV programs and movies, book reading, and real life situations.

Strategies that focus more on performance include video self modeling and peer mediated instruction. In the latter instance, peers are trained to facilitate interaction. The procedure may sometimes be called a Stay-Play-Talk strategy. Although such strategies may appear simple, they require some orchestration by teachers so that prompting of the peers and the target child is closely monitored (Goldstein, Schneider, & Theimann, 2007). Scripts that are eventually faded and role playing can also be used to increase performance (McClannahan & Krantz, 2005).

Most intervention programs will involve a combination of elements. For example, social stories might be used to provide background knowledge about a topic and then an alternation of role playing might help the individual to understand the concepts. Adam (2008), using a program called SCIP, described an activity focused on a child asking too many questions without allowing anyone to answer. As the article described the activity, the child was initially at the receiving end of the barrage of questions; a discussion followed about how the child felt; then the role was reversed; and then another discussion followed. Comic strip conversations might also be used during the discussion component of similar activities.

The use of visual or text supports is also an accepted practice in working on pragmatics; work sheets which promote only a paper and pencil busy task and little understanding or performance practice are not. Visuals or text might provide cues, sequential steps, reminders, or set ups for situations. Cue sheets might list possible topics to bring up for discussion with varying individuals, or provide sample lead in sentences for changing topics or asking to join a group activity.

An important aspect of intervention is also promoting self evaluation/self monitoring. This is crucial for developing independence and flexible application of skills. Of course, caution will be needed so that an individual is not too critical of him/herself. Typical speakers can participate in conversations with relative ease, although they do make mistakes in performance. Individuals with ASD have much to remember and monitor and they do not do well in multi-tasking situations. They are often also dealing with anxiety in social situations. So, the bottom line is that everyone can help the individual with ASD to be as good a conversational partner as he or she can be but everyone must also be accepting of the fact that performance will not always be perfect and that it is OK.

Bibliography
Adam, C. (2008). Intervention for children with pragmatic language impairments. In C. F. Norbury, J. B. Tomblin, & D. V. M. Bishop (Eds.). Understanding developmental language disorders: From theory to practice. (pp. 189-204). New York: Psychology Press.

Bellini, S. (2006). Building social relationships: A systematic approach to teaching social interaction skills to children and adolescents with autism spectrum disorders and other social difficulties. Shawnee Mission, KS: Autism Asperger Publishing Company.

Goldstein, H., Schneider, N. & Thiemann, K. (2007). Peer-mediated social communication intervention. Topics in Language Disorders. 27(2), 182-199.

Gray, C. (1994). Comic strip conversations: Colorful, illustrated interactions with students with autism and related disorders. Jenison, MI: Jenison Public Schools.

Gray. C. (2000). The new social story ™ book. Arlington, TX: Future Horizons.

McClannahan, L. E. & Krantz, P. J. (2005). Teaching conversation to children with autism: Scripts and script fading. Bethesda, MD: Woodbine House.

Paul, R. (2005). Assessing communication in autism spectrum disorders. In F. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.) Handbook of autism and pervasive developmental disorders. Vol. 2 . (pp. 799-816). Hoboken, NJ: John Wiley and Sons.

Paul, R. (2007). Language disorders from infancy through adolescence: Assessment and intervention. St. Louis, MO: Mosby/Elsevier.

Paul, R. (2009). Social skills development in school-age children with high-functioning autism spectrum disorders. Rockville, MD: American Speech Language Hearing Association.

Winner, M. (2005). Think social: A social thinking curriculum for school-age students. San Jose, CA: (www.socialthinking.com).

Winner, M. (2002). Thinking about you thinking about me. San Jose, CA: (www.socialthinking.com.)

Republished courtesy of IRCA


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