Have you heard the saying about how only 30% of what we communicate is communicated through what we say? Much of our communication is carried not by the actual words spoken, but by other forms of expression. We rely on a great many non-verbal forms of communication to understand others and to send our own messages. These other aspects of communication are part of what is known as ‘pragmatics’ and include:
• facial expression
• tone of voice
• body language
• eye contact
Pragmatics also incorporates how we use communication for social purposes. That is, how we initiate, respond to, and maintain interaction with others. Pragmatics includes the two-way, back-and-forth process of taking turns on a topic or in shared interaction. So pragmatics also refers to the subtle behaviours that make up interactions, such as:
• getting someone’s attention in an appropriate manner
• timing of the conversation
• positioning oneself at an appropriate distance from the other person
• turn-taking
• staying on the topic or introducing suitable topics
• using interruption appropriately
For most of us, following these conversational rules is ‘second nature’, so we may find that we feel slightly bewildered or irritated by the breach of these rules in others, without quite being able to identify exactly what it is that feels ‘wrong’ with the interaction.
These subtle behaviours all contribute to the mutual satisfaction in interactions between two people. A disorder in the pragmatics of language can therefore have a significant impact on a child’s or adult’s ability to make friends and fit in with other people.
There are various reasons why a child or adult may have difficulties with these aspects of communication. In some cases, the cause is related to other, existing communication difficulties that the person experiences; and so, the social, or pragmatic problem is part and parcel of the overall presentation of the person’s communication difficulty. An example of such a case might be a child who has a sensory problem such as a hearing loss: he may not be able to pick up on the subtle cues of others about how and when to communicate; he may not be able to distinguish short pauses in sentences that allow for interjection, or may need to position himself in a way that feels ‘too close’ for some people, in order to best hear, or see facial expressions.
Most commonly, however, pragmatic difficulties are associated with autism spectrum disorders, including Asperger syndrome. Indeed, difficulty in making mutually satisfying social connections with others is one of the problem areas in autism spectrum conditions.
However, pragmatic problems can also occur independently of autism. Some individuals may have difficulty interpreting and using the social and pragmatic components of communication but not display other features of autism.
Assessment of pragmatics is often accomplished through observation and also by collecting information from those people that spend most time with the individual, such as parents, teachers and care workers.
When the specific pragmatic problems have been identified, a treatment plan can be established. This may include individual therapy, group therapy or use of other media and discussion to support development of pragmatic skills and interaction skills. Usually, the weak or absent skills will be explicitly taught and practised in a way that is respectful of individual needs and preferences. A speech pathologist will aim to elucidate the problem and the needed skill to the person seeking assistance. The speech pathologist will also aim to help the client understand that the identification of, and support for, these problems are not a judgement on character, but rather, are a response to weakness in skills that are known to be needed to oil the wheels of communication, social relationships and of life.