Search Results (25)

Many researchers note that mental disorders can be understood as maladaptive attempts to avoid aversive internal experiences, and propose that a functional approach is required to complement topographical classification. Approaches that are based on the function of behavior can identify basic processes for the development of interventions. From this perspective, communication difficulties can be seen as strategies that are based on avoidance that increase distress. Among these problems are problems understanding metaphors, humor, and irony. Relational Frame Theory (RFT) offers a functional framework from which to analyze these processes. All this is the basis of the interventions that are aimed at promoting more adaptive behavior patterns. Moreover, individuals with Social (Pragmatic) Communication Disorder (SPCD) often exhibit impairments in perspective-taking, which RFT interventions aim to address by developing relational framing skills and social cognition. This paper proposes a functional approach and a theoretical framework for understanding interventions in SPCD through RFT. Full article

Background/Objectives: Higher education requires students to communicate in complex academic and social contexts, including oral presentations, group work, help-seeking, assessment, and peer interaction. For students with developmental communication disorders, and communication-related developmental profiles, these demands may create hidden participation vulnerabilities that affect mental health, academic engagement, and belonging. This scoping review mapped empirical evidence among tertiary students, focusing on mental health, academic participation, social belonging, institutional support, and contextual influences. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidance. Five databases, PubMed, PsycINFO, CINAHL, Scopus, and Web of Science, were searched for English-language, peer-reviewed empirical studies published from 2000 onwards. Eligible studies involved university, college, or tertiary students with developmental speech, language, fluency, pragmatic communication, or communication-related developmental profiles, who reported at least one mental health, academic, or social participation outcome. Data were charted and synthesised thematically, with methodological quality appraised using CASP-informed criteria. Results: Twenty-one studies were included. Evidence was strongest for stuttering and fluency-related participation, while research on developmental language disorder, speech sound disorder, pragmatic language impairment, cluttering, and mixed communication profiles was limited. Across studies, communication needs intersected with anxiety, depression, stress, self-efficacy, oral assessment, help-seeking, disclosure, stigma, accommodation access, and belonging. Key limitations included reliance on self-report, cross-sectional or retrospective designs, inconsistent diagnostic confirmation, and limited evidence for intervention. Conclusions: The available evidence suggests that developmental communication disorders and communication-related developmental profiles can function as hidden participation vulnerabilities in higher education. These vulnerabilities are shaped by students’ communication profiles and by communication-intensive university environments. Universities may therefore need communication-accessible teaching, flexible assessment, visible support pathways, and coordinated support across disability services, counselling, academic support, and speech–language pathology. Full article

Standard diagnostic categories (International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM)) were developed as a pragmatic compromise between competing theoretical schools in psychiatry and psychotherapy. Focused on recognizable patterns of symptoms, they produce reliable descriptions and facilitate clinical communication, research, and reimbursement. Such a focus, however, necessarily falls short of the etiological complexity of bodily, personal, interpersonal, and cultural processes that shape human suffering. This article argues that beneath the diversity of approaches seeking to address this gap, a fundamental complementarity emerges—one constitutive of human existence itself: the complementarity between two irreducible ways of being in the world. The first is the organismic–biological dimension, elaborated in Jakob von Uexküll’s biosemiotics: sign-governed, evolutionarily pre-formed processes of meaning-attribution that operate prior to and independent of language. The second is the symbolic–cultural dimension, developed in Ernst Cassirer’s philosophy of symbolic forms: the embedding of human beings in socially created, intersubjectively shared symbol systems through which the world is seen and understood. Although both approaches were published nearly a century ago, this article is not primarily a historical contribution. Rather, it argues that psychopathology and therapy can be understood more fully—and clinical practice enriched—when both dimensions are taken into account as genuinely complementary perspectives. Full article

Background and Objectives: Williams syndrome (WS) is a rare neurodevelopmental genetic condition traditionally described as being associated with a highly sociable behavioral profile. However, growing evidence indicates that this characterization may oversimplify the socio-cognitive phenotype, as some individuals with WS exhibit socio-communicative and pragmatic difficulties that may overlap with ASD-related features, although these difficulties should not be interpreted as autism-specific. The present systematic review aimed to investigate the presence of autistic traits in WS, to synthesize evidence on pragmatic and socio-communicative difficulties, and to explore their association with adaptive functioning and, indirectly, adaptive and functional outcomes. Materials and Methods: This study follows a systematic search and selection process in accordance with PRISMA 2020 guidelines and employs a systematic review with structured narrative synthesis. A systematic search of PubMed, Scopus, and Web of Science was performed up to December 2022, supplemented by grey literature sources. Nine studies met the predefined inclusion criteria. Due to substantial methodological heterogeneity, findings were synthesized using a structured narrative approach. Study quality was evaluated using adapted criteria addressing research design, sample characteristics, measurement tools, and risk of bias. Results: The findings suggest that autistic traits may constitute a potentially clinically relevant, though not universal, aspect of the WS phenotype. Pragmatic language difficulties were consistently reported, particularly in relation to conversational management, social reciprocity, and context-appropriate language use. These difficulties appear to function as a key mechanism linking socio-cognitive characteristics with functional outcomes. Patterns of adaptive functioning showed both distinctions from and overlaps with autism spectrum disorder (ASD), especially in communication domains. Available genetic and molecular evidence points to a possible contribution of additional modifying factors for phenotypic variability, with possible phenotypic overlap between WS and ASD, particularly in pragmatic language and adaptive communication. Conclusions: The evidence supports a multidimensional and spectrum-based conceptualization of socio-communicative functioning in Williams syndrome. Despite strong social motivation, individuals with WS may experience meaningful pragmatic and adaptive challenges, with implications for assessment and intervention. These findings highlight the importance of multidimensional and individualized clinical approaches. Full article

Background: Communication, language, and speech disorders are highly prevalent in children with cerebral palsy (CP) and substantially impact social, educational, and community participation. However, few studies have systematically characterized communicative and linguistic profiles using standardized assessments. This paper outlines the work of the ‘Italian CP & Language Network’ over the last two years, focusing on identifying research priorities, developing specialized assessment protocols, and proposing a shared classification system for speech and language disorders in children with CP. Methods: A survey was sent to 11 specialized centers to investigate clinical practices and assessment tools. Based on the results and an extensive literature review, the group developed three age- and complexity-based diagnostic protocols and a shared classification system. Results: The survey highlighted high variability in test selection, especially for speech and pragmatic assessment, and a significant need for ad hoc tools for augmentative and alternative communication (AAC). Three standardized protocols were defined: (1) early language (<48 months), (2) school-age language and pragmatics (4–12 years), and (3) minimally verbal children (6–12 years). A multi-level classification system for language and speech disorders was proposed to improve diagnostic consistency. Conclusions: Standardizing assessment is a critical step toward early identification of communicative vulnerabilities to guide tailored interventions and promote participation and quality of life across developmental stages. The group provides a framework for prospective multicenter data collection to correlate linguistic and speech phenotypes with neuroradiological features and motor outcomes. Full article

Background/Objectives: Narrative differences in autism spectrum disorder (ASD) and subtle and parallel differences among their first-degree relatives suggest potential genetic liability to this critical social-communication skill. Effective social-communication relies on coordinating signals across modalities, which is often disrupted in ASD. Therefore, the current study examined the coordination of fundamental skills—gaze and speech—as a potential mechanism underlying narrative and broader pragmatic differences in ASD and their first-degree relatives. Methods: Participants included 35 autistic individuals, 41 non-autistic individuals, 90 parents of autistic individuals, and 34 parents of non-autistic individuals. Participants narrated a wordless picture book presented on an eye-tracker, with gaze and speech simultaneously recorded and subsequently coded. Time series analyses quantified their temporal coordination (i.e., the temporal lead of gaze to speech) and content coordination (i.e., the amount of gaze-speech content correspondence). These metrics were then compared between autistic and non-autistic groups and between parent groups and examined in relation to narrative quality and conversational pragmatic language skills. Results: Autistic individuals showed reduced temporal coordination but increased content coordination relative to non-autistic individuals with no significant differences found between parent groups. In both autistic individuals, and parent groups combined, increased content coordination and reduced temporal coordination were linked to reduced narrative quality and pragmatic language skills, respectively. Conclusions: Reduced temporal and increased content coordination may reflect a localized strategy of labeling items upon visualization. This pattern may indicate more limited visual, linguistic, and cognitive processing and underlie differences in higher-level social-communicative abilities in ASD. To our knowledge, this study is the first to identify multimodal skill coordination as a potential mechanism contributing to higher-level social-communicative differences in ASD and first-degree relatives, implicating mechanism-based interventions to support pragmatic language skills in ASD. Full article

Pragmatic language is a core component of school-based social participation, yet children with Autism Spectrum Disorder (ASD) and Social Communication Disorder (SCD) frequently experience persistent difficulties in using language appropriately across everyday learning contexts. This study investigated the effectiveness of a culturally adapted, school-based immersive Virtual Reality (VR) learning program designed to enhance pragmatic language and social communication skills among Thai primary school children. Eleven participants aged 7–12 years completed a three-week, ten-session VR program that simulated authentic classroom, playground, and canteen interactions aligned with Thai sociocultural norms. Outcomes were measured using the Social Communication Questionnaire (SCQ) and the Pragmatic Behavior Observation Checklist (PBOC). While SCQ scores showed a small, non-significant reduction (p = 0.092), PBOC results demonstrated significant improvements in three foundational pragmatic domains: Initiation and Responsiveness (p = 0.032), Turn-Taking and Conversational Flow (p = 0.037), and Politeness and Register (p = 0.010). Other domains showed no significant changes. These findings suggest that immersive, culturally relevant VR environments can support early gains in core pragmatic language behaviors within educational settings, although broader social communication outcomes may require longer or more intensive learning experiences. Full article

Figurative language (metaphor, idiom, irony/sarcasm) is central to pragmatic communication but is frequently challenging for children and adolescents with autism spectrum disorder (ASD). A scoping review was conducted to map pedagogical and clinical interventions that target figurative-language skills in school-age learners with ASD and to summarize reported outcomes. Following a PCC (Population–Concept–Context) framework and PRISMA-ScR reporting, systematic searches were performed in ERIC and Google Scholar (2010–2025). Eligibility required an ASD sample (ages 5–18), an intervention explicitly addressing figurative-language comprehension, and empirical outcome data from educational or related practice settings. Seven studies met inclusion criteria: five targeting metaphors, one targeting idioms, and one targeting sarcasm/irony. Interventions were predominantly delivered one-to-one or in small groups and emphasized structured, explicit instruction with visual scaffolds and stepwise prompting. Across studies, participants demonstrated clear gains on trained items. Generalization beyond trained material was most often observed for metaphor and sarcasm interventions, particularly when instruction highlighted underlying semantic relations or cue-based pragmatic signals; by contrast, the idiom program yielded item-specific learning with minimal near-term transfer. Limited follow-up data suggested short-term maintenance where assessed. Reported variability across individuals was substantial, underscoring the influence of underlying structural-language skills and social-pragmatic demands. Overall, the evidence indicates that figurative-language skills in ASD are amenable to targeted intervention; effective programs tend to combine explicit teaching, visual supports, multiple exemplars, and planned generalization opportunities. Given small samples and methodological heterogeneity, further classroom-based trials with longer follow-up and detailed learner profiles are needed. The findings support integrating figurative-language goals within individualized education and speech-language therapy plans, while aligning instructional complexity with each learner’s linguistic and pragmatic profile. Full article

Objectives: Individuals with Autism Spectrum Disorder (ASD) exhibit difficulties in the social use of language, regardless of age, cognitive abilities, and symptom severity. The left Broca’s area and adjacent cortex are crucial for socio-pragmatic language, particularly in retrieving and integrating context-dependent words. Neuroimaging studies in ASD have shown hypoactivation of the Broca’s area and an aberrant pattern of functional connectivity between language-related regions, suggesting their potential involvement in socio-communicative deficits. Given the potential of tDCS to modulate brain activity, its application targeting Broca’s areas in addition to psychological intervention may represent a promising approach for enhancing socio-communicative skills in ASD. Thus, this study aims to investigate the effect of concomitant anodal tDCS and cognitive behavioral-oriented training (CBT) on pragmatic and communicative skills in young adults with ASD. Methods: A sample of 10 ASD individuals (18–25 years) underwent treatment with both active and sham tDCS targeting the left Broca’s area during concomitant CBT. Each condition was delivered for five consecutive days, and the order of the conditions was blindly randomized. Results: Active tDCS significantly improved global communicative and pragmatic abilities compared to sham. A negative correlation was observed between communicative skills improvement and Intelligence Quotient (IQ); no significant association was found between IQ and ASD symptoms’ severity. Conclusions: Multisession tDCS targeting the left Broca’s area, combined with CBT, may enhance social language in terms of both production and comprehension of non-literal meanings, supporting Broca’s area as a central neural hub for social language. Full article

Selective Mutism (SM) is a childhood anxiety disorder characterized by the persistent inability to speak in specific social settings while being able to speak freely in more comfortable environments, such as at home with family. This condition often leads to significant impairments in social, academic, and occupational functions. This article presents a novel treatment methodology that integrates the physiology of vocal production with pragmatic language instruction through teletherapy, administered to two adolescents diagnosed with selective mutism (SM). The frequency of speaking on the Selective Mutism Questionnaire increased from 35% to 86% and from 25% to 55% for the two children. Pragmatic language skills on the Social Communication Skills: Pragmatics Checklist improved from 47% to 96% and 13% to 40% after treatment. It is crucial to emphasize vocal control for speech initiation and pragmatic language for verbal expression. Detailed strategies, specific activities, and treatment outcomes are provided. Full article

Background/Objectives: Communication disorders in childhood, including expressive, receptive, pragmatic, and fluency impairments, have been consistently linked to mental health challenges such as anxiety, depression, and behavioural difficulties. However, existing research remains fragmented across diagnostic categories and developmental stages. This scoping review aimed to synthesise empirical evidence on the relationship between communication disorders and mental health outcomes in children and adolescents and to identify key patterns and implications for practice and policy. Methods: Following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) and Arksey and O’Malley’s framework, this review included empirical studies published in English between 2000 and 2024. Five databases were searched, and ten studies met the inclusion criteria. Data were charted and thematically analysed to explore associations across communication profiles and emotional–behavioural outcomes. Results: Four interconnected themes were identified: (1) emotional and behavioural manifestations of communication disorders; (2) social burden linked to pragmatic and expressive difficulties; (3) family and environmental stressors exacerbating child-level challenges; and (4) a lack of integrated care models addressing both communication and mental health needs. The findings highlight that communication disorders frequently co-occur with emotional difficulties, often embedded within broader social and systemic contexts. Conclusions: This review underscores the need for developmentally informed, culturally responsive, and interdisciplinary service models that address both communication and mental health in children. Early identification, family-centred care, and policy reforms are critical to reducing inequities and improving outcomes for this underserved population. Full article

Background/Objectives: Hearing loss in childhood is associated with significant challenges in linguistic and cognitive development, particularly affecting language skills such as syntax, semantics, and pragmatics, which are essential for effective communication and social integration. This study aimed to analyze how different types and degrees of hearing loss impact linguistic development in children, and to identify clinical factors—such as age at diagnosis and years of language intervention—that may predict language performance. Methods: This study included a sample of 140 children aged 6 to 12, categorized into seven groups based on their hearing condition: unilateral and bilateral conductive, unilateral and bilateral sensorineural, unilateral and bilateral mixed hearing loss, and a control group with no hearing loss. Linguistic development was assessed using the Clinical Evaluation of Language Fundamentals-5 (CELF-5), a validated tool for diagnosing language disorders. Statistical analyses, including MANOVA and multiple regression, were conducted to evaluate differences in linguistic skills across groups and to determine the predictive value of clinical variables on total language performance. Results: The analysis revealed statistically significant differences across groups in all assessed linguistic domains (p < 0.001), with children with severe or bilateral hearing loss exhibiting notably lower scores compared to normohearing peers. The multiple regression analysis indicated that type of hearing loss was the strongest predictor of total linguistic performance (β = −0.674), followed by age at diagnosis (β = −0.285) and age of hearing device adaptation (β = −0.220). Years of language intervention also contributed significantly (β = 0.198) but to a lesser extent. Conclusions: This study highlights the critical impact of early and comprehensive auditory and language intervention on linguistic outcomes for children with hearing impairments. Early diagnosis and timely adaptation of hearing aids or cochlear implants are essential in mitigating language deficits, particularly in areas like syntax and pragmatic skills. These findings support the need for specialized, long-term interventions tailored to the severity and type of hearing loss to improve language development in this population. Full article

Background/Objectives: Children with Autism Spectrum Disorder (ASD) face challenges in social communication due to difficulties in considering context, processing information, and interpreting social cues. This study aims to explore the neural processes related to pragmatic language communication in children with ASD and address the research question of how functional brain connectivity operates during complex pragmatic language tasks. Methods: We examined differences in brain functional connectivity between children with ASD and typically developing peers while they engaged in video recordings of spoken language tasks. We focused on two types of speech acts: semantic and pragmatic. Results: Our results showed differences between groups during the pragmatic and semantic language processing, indicating more idiosyncratic connectivity in children with ASD in the Left Somatomotor and Left Limbic networks, suggesting that these networks play a role in task-dependent functional connectivity. Additionally, these functional differences were mainly localized to the left hemisphere. Full article

Background: Social Communication Disorder (SCD), introduced in the DSM-5, is distinguished from Autism Spectrum Disorder (ASD) by the absence of restricted and repetitive behaviors or interests (RRBIs). Aim: To compare the adaptive, sensory, communication, and cognitive profiles of children with ASD and SCD. Methods: The assessments of nine children with SCD and ten with ASD were compared with either Fisher’s Exact Test or the Mann–Whitney Test. Assessments included the Vineland Adaptive Behavior Scales, the Autism Diagnostic Observation Schedule (ADOS), the Short Sensory Profile, Bishop’s Children’s Communication Checklist, a pragmatics evaluation, and the Wechsler Intelligence Scale for Children IV. Results: The total ADOS score and the second subtotal “Restricted and Repetitive Behaviors” were significantly higher (p = 0.022) in the ASD group than in the SCD group. The Vineland standard score for the “Socialization” domain was significantly lower (p = 0.037) in the ASD group (mean: 51 +/− 19) than in the SCD group (mean: 80 +/− 28). The working memory index score was also significantly lower (p = 0.013) in the ASD group compared to the SCD group. Conclusions: While ASD and SCD share similarities in communication and pragmatic difficulties, some distinctions have been identified, e.g. in executive functioning and the impact on socialization, which may be linked to the absence of RRBIs in SCD. These findings highlight the challenges posed by this nosographic separation during diagnostic evaluations due to the scarcity of discriminative tools. Full article

Pragmatic language impairment (PLI) is a complex and wide-ranging condition affecting numerous individuals worldwide, yet its exact prevalence and scope remain uncertain due to its interconnections with other conditions and symptoms, such as neurodevelopmental disorders, learning disabilities, developmental dysphasia, and aphasia. This study presents a comprehensive review of PLI, tracing its historical, current, and future trajectories through the lens of both bibliometric and scientometric indicators. The study analysed a substantial corpus of 3852 documents related to PLI, including sources from Scopus, Web of Science, and Lens, spanning the period from 1977 to 2022. This investigation utilised advanced software tools such as CiteSpace 5.8.R3 and VOSviewer 1.6.18 to detect patterns, connections, and bursts in scholarly works related to PLI. Key findings of this review include the identification of major clusters in the PLI literature, which include social communication disorder, traumatic brain injury, autism spectrum disorder, and inferential meaning. These clusters represent significant sub-themes within the PLI research body, with repetitive mentions of autism spectrum disorder suggesting its critical overlap with PLI. Other noteworthy clusters included Asperger’s syndrome, behavioural problems, belief reports, and diagnostic observation schedule scores, all of which contribute to the nuanced understanding of PLI. The study provides a comprehensive overview of PLI development, drawing on theoretical, historical, and empirical evidence. Full article