ASHA Annual National Convention
Boston 2007
Evidence-Based
Assessment of Pragmatics:
Integrating Neurocognitive and
Linguistic Results
Presented By
Ahmed M. Abdelal, Ph.D., CCC-SLP
Visiting Assistant Lecturer,
Bridgewater State College, Bridgewater, MA
Clinician: Schools & Private Practice
email# [email protected]; or [email protected]
Objectives
To identify neurocognitive and
linguistic functions that should be
targeted when assessing pragmatics
 To demonstrate how to interpret
relevant neurocognitive findings
 To demonstrate how to integrate
neurocognitive & linguistic results

Overview




Neurocognitive
Behavioral Inhibition
Executive Functions
Working Memory
Theory of Mind


Linguistic
Grice’s C.P.
Criteria for analyzing
verbal/written
expression
Case Studies
Conclusion
What’s in the Definition

Pragmatics is
“the range of communicative functions
(reason for talking), the frequency of
communication, discourse skills (turn
taking, topic maintenance and change),
and flexibility to modify speech for different
listeners and social situations”
(Paul 2000, p 28).
Components of Pragmatics
 goals
(purpose) for using language,
 the use of the context to determine the form
used to achieve these goals, and
 the rules for carrying out an effective reciprocal
conversation (Lahey 1988; Prutting & Kirchner 1987).
 Pragmatics
embodies knowledge of social and
interpersonal rules, and the ability to apply these
rules in discourse, verbal as well as written
(Halliday 1989, 1987; Halliday & Hasan 1989, 1976).
Pragmatic Competence
In order for speakers to participate in an
organized, clear fashion in discourse, they
have to rely on numerous cognitive and
linguistic resources
(Berman and Verhoeven 2002).
Pragmatic Competence
The speakers’ competence is demonstrated by
their ability to:
 continuously monitor
 the setting [context]
 purpose
 needs of the listeners
 readily make adjustments to the situation.
 Thus,
(Nippold et al (2005)
Pragmatic Competence is the outcome of
the integration of neurocognitive and linguistic
functions
What Impedes Pragmatic Competence
Cognitive rigidity
 Self-centeredness
Difficulty with perspective taking
Difficulty with Behavior Inhibition
Decreased attention
Underdeveloped theory of mind
PRAGMATICS IS
AN EXECUTIVE LANGUAGE
FUNCTION
Pragmatics As An Executive Language Function
 Pragmatics is primarily a function of the
left frontal lobe (LFL) of the brain:
i.e., same region as attention,
motivation and Executive Functions
 Posterior structures of the LFL mediate
proceduralized language forms (i.e., are
independent of attention & monitoring)
Alexander, MD (Cognitive Neurology Conference, Harvard Medical School 2004
Pragmatics As An Executive Language Function
 As
we proceed toward anterior LFL structures
language becomes less proceduralized (less
spontaneous)
 Discourse is the highest & most complex
linguistic function (mostly mediated by prefrontal
cortex)
 Examples:


Constructing sentences from scrambled words is
posterior (Broca’s)
Constructing stories from scrambled sentences is a
medial frontal skill
(Alexander 2004)
Pragmatics as an Executive Language Function
 Discourse requires “integration of other
functions with language: intentions
(‘memory for the future’), social
knowledge, episodic memory recollection
and theory of mind”
 Integration involves both hemispheres
(Alexander, MD 2004)
Pragmatics as an Executive Language Function
“The left frontal lobe regulates execution of
actions plans- scripts- for language. Regulation
means activation, selection, monitoring, and
sustaining attention to the unfolding complex
language. The disorders of language due to
frontal lesions represent loss of schemas,
scripts or action plans at various levels of
production…. discourse deficits are at boundary
of attentional deficits.”
(Alexander, MD 2004)
Linguistic & Neurocognitive Resources
 linguistic knowledge
 Syntax & Semantics
 Registers
 Speech acts
 Behavioral Inhibition
 executive functions
 working memory (WM)
 sustained attention
 theory of mind
 experiential knowledge.
These resources have to be integrated
Behavior Inhibition
 Avoiding inappropriate verbal and
nonverbal behavior
 Suppresses response to internal and
external distractions
 Suppresses self-distracting behavior (often
motor)
 Enhances ability to focus on relevant
stimuli
Executive Functions
 Setting
goals & subgoals
 Anticipating outcomes
 Monitoring performance
 Sequencing subroutines
 Recruiting automatized procedures
 Recognizing errors
 Keeping task goals in mind
 Affirming correct completion of a task
(Alexander 2004)
Working Memory
Working Memory:
Non-verbal: internalization of sensory-motor
activity
Verbal: internalization of speech (your inner
voice)
Cognitive Manipulation Skills/Reconstitution
Verbal Working Memory
Rehearsal System (Phonological Loop)
for syllables & digits
sentences
sounds (Phonemic Buffer)
Cognitive Manipulation: analysis,
synthesis, spatial processing,
reassembling info., and creating novel
ideas
Assessing Verbal Working Memory
Immediate Recall:
Digits
Sentences
Words
(CELF-4)
(CELF-4)
(TAPS-3)
 Sustained Attention & Cognitive Manipulation:
Recalling Numbers Backwards (CELF-4)
Timed Retrieval of familiar information (CELF-4)
What Verbal Working Memory Scores Tell Us
Immediate Recall assesses:
 Ability to sustain information for online
processing
 Ability to retrieve previous parts of
information during conversation
 Ability to retrieve what you want to say
 Ability to retrieve past experiences and
scripts to predict consequences
What Verbal Working Memory Scores Tell Us
Cognitive Manipulation:
Sustained attention during verbal tasks
(conversation, reading, listening)
Spatial processing
Analysis (breaking down information)
Evaluation & decision making
Synthesis/reassembly
Novel ideas & modifying behavior
Theory of Mind
Theory of Mind
is
Social Perspective Taking
Theory of Mind
“This theory, or concept, of mind supports
the social engagement that is at the heart
of interpersonal relationships because
successful communication depends on how
adequately conversational partners are
able to infer the motivations underlying
each other’s mental states”
(Silliman, et al LSHSS, vol 34, July 2003)
Theory of Mind Impairment in PDD Spectrum
“Across the [ASD] spectrum, there is
consensus that a common feature is
disruptions in the social perspective
taking that is the core of verbal
communication”
(Silliman, et al LSHSS, vol 34, July 2003)
Assessing Theory of Mind
Implicit False Belief:
This is a story about Frank and his Dad.
Today is Frank’s birthday. Frank wants to go to a baseball
game for his birthday. He does not want a surprise party for his
birthday. Frank hates surprise parties. He gets embarrassed
when everyone looks at him and yells “Surprise!” Frank’s Dad
is giving him a surprise birthday party. Dad bought Frank
balloons and a birthday cake and hid them in the living room.
Dad does not know that Frank gets embarrassed at surprise
parties. Dad thinks Frank would be glad to have a surprise
party. Frank and Dad are in the kitchen talking about his
birthday. Frank says, “Dad I really want to go to a baseball
game for my birthday.” Now remember, Dad wants the party to
be a surprise, so he says, “Frank, that’s a good idea. I will
Think about it.”
(Silliman, et al LSHSS, vol 34, July 2003- Appendix B)
Assessing Theory of Mind
Second-Order Question:
 What does Dad say? (If necessary, fill in: Frank
will be ____. Forced choice: Does Dad say,
“Frank will be glad to have a surprise party” or
“Frank will be embarrassed to have a surprise
party”?).

Justification Question: Why does Dad say that?
(Silliman, et al LSHSS, vol 34, July 2003- Appendix B)
False Belief Task Effective with ASD
“In preadolescents, adolescents, and
young adults with ASD, including those
with Asperger’s syndrome, a reliable
finding has been disrupted performance
on the standard False belief tasks”
(Silliman, et al LSHSS, vol 34, July 2003- Appendix B)
H.P. GRICE’S
COOPERATIVE PRINCIPLE
Provides
Functional Criteria
for
Evaluating Pragmatics
H.P. Grice’s Cooperative Principle
A principle that governs discourse
states that the speaker and listener expect
that each will make a “conversational
contribution such as is required, at the
stage at which it occurs, by the accepted
purpose or direction of the talk exchange.”

(H.P. Grice “Logic and Conversation” in Cole P., & Morgan 1975, pp 41-58)
Components of the CP
 Quantity (Be Informative):
 Provide just the needed information: no less no more
 Quality (Be Truthful):
 Say only what you believe to be true, and what you
can support by adequate evidence
 Relation (Relevance) (Be Relevant):
 Stay on topic
 Manner (Be Clear, Brief, and Orderly):

Be brief & direct: avoid ambiguity and obscurity
Communication Breakdown: Quality & Manner





Speaker offers nothing new or informative 
Listener will lose interest and stop paying
attention
Speaker extremely brief  some listeners
excluded
Speaker excessive  knowledgeable listeners
bored and inattentive
Degree of brevity is determined by amount of
knowledge Speaker presumes Listener to have
Speaker has to establish a balance
Thomas Ritter (2000) “The Cooperative Principle.”
Communication Breakdown: Relevance
 Relevance requires Speaker to:
 prioritize information units before saying them
 Know what order they should be in
 Determine appropriate time to provide them
 Relevance sometimes requires sacrificing one
element for another that is more important
 Speaker with inappropriate skills may attempt to
contribute everything at once, or choose the
wrong items because of failure to understand its
relevance. Thomas Ritter (2000) “The
Cooperative Principle.”
Communication Breakdown: Quality



When broken, speaker loses credibility, which
will impact social relationships
Quality often manipulated to create humor
This is often broken by individuals with:

ADHD (lying is one of the criteria)
Asperger’s (authoritative/pedantic style)
Psychotic disorders associated with confabulations

Other groups?!


Communication Breakdown: Relevance
 Can lead to a complete Comm.
Breakdown when:
 Speaker perceives that s/he is being relevant
to topic, but what is said is not relevant to the
listener
 This discrepancy between perspectives of
listener and speaker occurs when
 The speaker is egocentric, or does not know the amount
or nature of the speaker’s background knowledge
(Ismail S. Talib: Further Lectures on Pragmatics)
 Thus, an effective speaker has to have a
well developed Theory of Mind
In order to avoid a
communication breakdown, or
repair one, a speaker has to
possess the required
neurocognitive functions
Case Studies
Case # 1 Nick- 14:5 Male
Language-Based Pragmatic Deficits
Case # 2 Beaver- 8:10 Male
multiple neurocognitive disabilities
(ADHD, Asperger’s, Anxiety Disorder, Mood Disorder)
& associated pragmatic deficits
Teachers’ feedback points to some Executive Functioning Difficulties, an
underdeveloped theory of mind, & Language-Based Pragmatic impairment



Can be very assertive in asking for what he
needs.
Interacts inappropriately with adults: “trying to
surprise me, pulling back papers I am trying to
collect, etc.”)
Significant difficulty with written language,


“ his writing skills being “of much younger grade.” …
lengthy writing tasks are particularly difficult for him.
Fairly well-organized: always comes to class
with the necessary materials; always takes
notes
Teachers’ feedback points to Executive Functioning Difficulties, an
underdeveloped theory of mind, & Language-Based Pragmatic impairment
Evades responsibilities in class
Lacks independence:
“whenever we are writing in class, he’ll often
ask, ‘What should I write next?’ If I give him a
suggestion, instead of thinking about it, Nick
will write what I say verbatim”; When I move
away from his desk he will stop writing”
Comprehends the plot of what he reads
even though he does not go beyond a very
literal level.
Nick (14:5) Scores
Verbal Working Memory Scores
Area/Subtest
Raw Scores
Scaled Scores
%-ile
Interpretation
Number Repetition- Forward
7
6
9
Below Average
Number Repetition-Backward
6
10
50
Average
Familiar Sequences
67
12
75
High Average
Recalling Sentences
31
1
0.1
Below Average
TAPS-R Auditory Word Memory
10
84
14
Below Average
PPVT-III-A
Raw score
134
Standard Score
85
Percentile Rank
16
Interpretation
Borderline
Subtest
Raw Score
Scaled Score
Percentile
Interpretation
1. Formulated Sentences (FS)
39
5
5
Below Average
2. Understanding Paragraphs (UP)
8
5
5
Below Average
3. Word Definitions
10
4
2
Below Average
Evidence of a Moderate-Severe Mixed Receptive-Expressive Language Disorder.
Impaired Syntax & Semantics impede emergence of Appropriate Discourse skills
CASL Scores
Subtest
Raw Scores
Standard Scores
%-ile
Interpretation
1. Antonyms
29
82
12
Below Average
2. Synonyms
28
90 *
25
Average
3. Sentence Completion
33
79
8
Below Average
4. Idiomatic Language
8
77
6
Below Average
5. Syntax Construction
38
84
14
Below Average
6. Paragraph Comprehension
NA
NA
NA
NA
7. Grammatical Morphemes
35
96
39
Average
8. Sentence Comprehension
7
74
4
Below Average
9. Grammaticality Judgment
59
90 *
25
Average
10. Nonliteral Language
12
69 *
2
Below Average
11. Meaning from Context
10
85 *
16
Borderline
12. Inference
23
75
5
Below Average
13. Ambiguous Sentences
6
82
12
Below Average
14. Pragmatic Judgment
59
97
42
Average
Core Language Composite
334
65
1
Below Average
CP Components in Nick’s Discourse
 Quantity: language economy OK
 Quality:

No evidence of problem in this area
 Relevance:


Distractible, & often gets off topic/task
Makes very inappropriate jokes
 Manner:


Basic conversational speech is Ok, but
academic language often ambiguous
Significant discourse organization difficulties
Proximics & Register in Nick’s Discourse
 Proximics: OK
 Register- Significantly impaired
 Acts & speaks like a much younger child
 Attempts at practical jokes with teachers/
adults as if they were peers
 Examples: “The speech teacher is a
monkey”; “My priority is to kill you.” [was laughing]

If someone laughs at his jokes, he does not
know when to stop (Theory of Mind/recall)
Treatment Areas





Vocabulary (incl. multiple meaning words)
Syntactic and semantic development
Did not target immediate recall directly: No
evidence in the research to support recall
drills!
Relevance & Manner in verbal & written
discourse
Register
Beaver: Age 8:10 (4th Gr.)
FSIQ= 147
Neuopsychological Findings:
Significant Sensory Integration Deficits
ADHD/Combined
ODD
Anxiety Disorder
Mood Disorder
Beaver: Observations
 self-distracting

whistling, singing, making strange noises, playing with his
hands, and covering his mouth with both hands and twisting his
neck.
 Inconsistent

behaviors :
response to distractions:
either hyposensitive to them, or
hypersensitive
 Can
be completely self-absorbed
 Cannot accept losing in a game, or being
wrong!
Primary Focus of Assessment was Pragmatics. Primary tool used to
analyze discourse skills: Cooperative Principle
Test of Problem Solving (TOPS)- Elementary Edition
Area
RS
%ile
Explaining Inferences
14
52
Determining Causes
14
66
Negative Why Questions
13
44
Determining Solutions
11
33
Avoiding Problems
17
91
Total Score
69
62
Oral Expression Scale
Listening Comprehension Scale
CELF-4 PP: 119
5:6-5:11
Raw score
66
Raw score
80
Standard Score
100
Standard Score
133
Percentile Rank
50
Percentile Rank
99
Subtest
RS
SS
%ile
Concepts and Directions (CD)
27
14
91
Formulated Sentences (FS)
40
15
95
Beaver: Additional Characteristics
 Significant cognitive rigidity & Underdeveloped
Theory of Mind that explain:
 The pedantic style (little professor)
 The adherence to routines & difficulty with transitions
 Difficulty accepting perspectives of others
 Refusal to accept correction
 Argumentative (e.g., working on the /s/ sound)
 At times oblivious to presence of others
 This made it very hard for him to engage in
reciprocal communication interactions
The CP Components in Beaver’s Discourse
 Quantity & Relevance:
 yes/no questions &
 Questions eliciting 1-word responses
 Student’s responses to 8 out of 10 items were marked
by a tendency to use redundancies and/or diversion
from the topic.
 Example
 Q: “What is the capital of the United States?”
 R: “Capital of the United States is known as Washington DC.
The Declaration of Independence was created in 1876, which
actually relates to the Rug Rats’ Discover America; now on DVD
and VHS.”
 Q: “What State do we live in?
 R: ”We live in MA, USA; otherwise known as Carver”)
Quality

Story retelling task: Columbus & The King
Student related inaccurate historical
information authoritatively:


“Columbus discovered that the earth was round.
…After discovering America he went back to Britain.”
Extremely disorganized, and almost always get
off a topic at hand into a topic of fixation: e.g.,
could not produce realistic stories
Relevance




Spontaneous Narrative:
used a listing/cataloging method to describe a
game (Kirby Dreamland) and how it can be played.
Stated all 5 “main” components of this game, and
then discussed the individual subcomponents of each. He
then began shifting back and forth between main
components and their subsidiary elements without using
specific referents. Eventually, the increasing number of
details and steps (as well as the back-forth shifting among
these details) led to confusion and lack of coherence.
Could not construct a realistic narrative/story
Quantity & Manner in Written Output
 Method:
 spontaneous written language sample
 Tool:
 Test of Written Language-3rd Edition-TOWL-3
 Output:
 “Sir we’ve found a plate numbers k1i256r77b1y11what the heck is that?” Little did he know that was
Kirby traveling 540,000,000,000,000,000,000,000,
000,000,000,000,000,000 miles per hour here to save
the world from the N.M.E.! But king DEDEDE (Their all
capital because he thinks he’s so important) wants
Kirby out of Dreamland.”
Quantity & Manner in Written Output
 Manner: ambiguity noted
 Quantity: Unbalanced
 Perseverating on insignificant details while
 Sacrificing significant ones:
 Narrative only includes 4 meaningful info
units that would have made an adequate
beginning of a narrative:
 Someone found plates of some vehicle?
 Kirby traveling at great speed unnoticed
 Kirby trying to save the world from the evil king
 The evil king does not want Kirby in Dreamland
Beaver: Proximics & Register
 Proximics: significantly impaired
 Register: speaks to peers as if he were a
mature adult (using very sophisticated
language & vocabulary)
 Speaks in a pedantic manner
 Often rude to adults and peers
Beaver: Theory of Mind
 Severely underdeveloped
 Cognitive rigidity impedes the ability to
accept other people’s perspectives
 Has to follow routines
 Does not seem to care at all about how
others might feel (e.g., when he uses
offensive words)
Areas Targeted for Intervention
All CP components in verbal & written output
 Proximics
 Register
 Theory of mind
Used SGM formats, clinician generated sociopragmatic stories, video taping, etc
About 2 years before substantial gains were
noticeable: attention and decreased
neurocognitive functions were an obstacle

Conclusion
A Functional
Comprehensive
Assessment of
Pragmatic Skills??
Conclusion
 Vocabulary, language form & content
 Internalization of pragmatic principles &
(social problem solving?)
 CASL Pragmatic Judgment
 Test of Problem Solving? Caution!
 Test of Pragmatic Skills??
 Your own assessment of discourse using the
Cooperative Principle components
Conclusion
 Application of pragmatic skills in various settings
 CELF-4 Pragmatics Profile (5:0-21:11)
 Responsiveness & Assertiveness In
Conversational Skills Rating Scale (Preschool:
Age) Girolametto 1997, in Paul 2000, p. 335)
 Prutting & Kirchner ‘s Pragmatic Protocol (1983)
 Peanut Butter Protocol (Creaghead 1984)
 Your own questionnaire?
Conclusion
 Behavioral Inhibition & Executive
Functions
•
•
•
•
Neurppsych./Psych. Reports
Clinical observations
Teacher’s input
Parents’ input
Conclusion
 VWM & Cognitive Manipulation



CELF-4
TAPS-3
Children’s Memory Scale
 Theory Mind


Clinical observation
Clinician designed tasks (modeled after
Silliman et al 2003)