CommunicatingPragmatic Language

Pragmatic Language Disorder in Children

Little girl offering a flower to an upset boy.
Marcy Willard
Marcy Willard
Last modified 29 Nov 2022
Published 13 Jan 2022

What is Pragmatic Language in Childhood?

Pragmatic language in childhood is social language and includes skills like polite greetings, sharing information, asking questions of others, and engaging with them in conversation. 

In typical child development, spoken language with a conversational partner tends to develop innately. Children learn to chat back and forth about a topic. They share information, ask questions of one another, make inferences and read nonverbal communication and cues from peers. Children learn these skills through observation and practice. 

For some children with a language impairment or a developmental disorder, these skills do not develop naturally. Pragmatic language therapy may be essential for a child to develop these skills when they are less automatic. 

Sometimes, a child psychologist’s clinical evaluation for developmental delays may lead to the discovery of pragmatic language or language comprehension challenges. It is great to discover this information early because so much can be done through language therapy and practice at home to support a child who has this difficulty. 

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Symptoms of Pragmatic Language Issues in Children

  • Struggles with social language: does not understand how to interact with peers in conversation, read communicative intent, or understand nonverbal communication
  • Appears gullible: has difficulty understanding the motives of peers; may be taken advantage of often or be overly sensitive to sarcasm or jokes
  • Gets lost in conversation: seems confused when talking with peers; does not follow back-and-forth conversations
  • Struggles to talk to peers: has trouble joining peers in conversation even though they speak to adults just fine
  • Uses formal vocabulary: may sound too mature for their age
  • Misunderstands non-verbal cues: misses important feedback from peers in terms of body language and eye contact; may talk too long on a topic without noticing others are bored
  • Lectures others: talks on and on without allowing others to get a word in; conversations lack the back-and-forth quality
  • Gets stuck on a topic of interest: gets stuck talking about a topic without bringing you into the conversation or considering if you are interested in what they are sharing

Recognizing pragmatic language challenges

Some children may speak very well but seem unable to talk to friends. They may enjoy facts and details and love books about insects or outer space, but they may express little interest in socializing. They may not seem to read the facial expressions or nonverbal cues, and they may struggle to make inferences from what friends share, only taking information verbatim or in a concrete manner. 

If your child has poor social language, you may hear them say “I don’t know” or “I don’t remember” when you ask about their day or feelings. This challenge relates to an awareness of emotions and putting them into words. 

Your child may do well in structured, school-based tasks. However, they may sit alone at recess when free play, creative social interaction, and problem-solving are involved. You may even see behavior problems in these unstructured times because your child is unsure how to act and react socially. 

All of the above are signs that your child may be struggling with pragmatic skills. Listed below are some recognizable symptoms you can look for in your child. If concerns are noted, there are suggestions in this article to help your child work on these critical skills. 

Phases of Pragmatic Language Development in Childhood

In terms of pragmatic language development, it is important to ensure that your child’s skills are on track with peers their age. A typical trajectory for pragmatic development would look as follows (Linder & Peterson-Smith, 2008, p.264-269) [1]:

Pragmatic skill progression in infants, toddlers, and preschool children

  • 2 months: uses eye contact
  • 3 months: has a social smile
  • 4 months: vocalizes to initiate socializing, social laugh
  • 5 months: shows a preference for familiar faces
  • 6 months: refuses objects or toys they don’t want
  • 7 months: plays simple games like peek-a-boo
  • 8 months: follows the pointing and eye gaze of caregiver
  • 9 months: makes requests and initiates interactions
  • 10 months: initiates games, points to desired objects
  • 11 months: uses gestures and simple words to get another’s attention
  • 12 months: displays shared enjoyment, takes turns
  • 15 months: demonstrates shared joint attention, follows directions to look at something
  • 18 months: responds to simple requests for clarification such as, ‘what?’ or ‘huh’?
  • 24 months: takes one or two turns in a conversation
  • 36 months: uses words to communicate in play, engages in some parallel play but may also interact with peers by sharing toys or commenting on their play

If your baby, toddler, or preschooler’s skills are not developing as shown in the list above, there may be concerns about pragmatic language skills. Keep in mind that pragmatic language skills build on each other over time. As you will see below, communication gets more complex as the child matures.

Pragmatic skill progression in older children 

  • Kindergarten: Once children reach elementary school, the skills should evolve. You would want your kindergarten child to play games with peers, such as a card game like Uno or a board game like Jenga. You would expect them to play tag on the playground using some back-and-forth social language to establish the rules. Children this age read one another’s emotions on faces and know when and how to enter games and join other children.
  • 1st grade-2nd grade: As children advance in elementary school, we expect them to understand jokes and sarcasm and to be able to discern whether or not they should take statements literally. For example, we would expect a 2nd grader to know that ‘button your lip’ means being quiet, not actually buttoning your lip. 
  • 3rd-5th grade: In the later years of elementary school, kids have established deeper and longer-lasting friendships; those relationships require lots of social communication. These conversations include inside jokes, gentle teasing, sharing and keeping secrets, and telling stories. 
  • Middle school and high school: Teens and pre-teens have even higher expectations in terms of pragmatic social skills. They need to learn how to ‘read the room’ to know if their voice should be loud or soft. Teens are expected to understand how different people like to talk; some friends joke around while others might be more serious. They also need to pick up on non-verbal communication skills, such as another child in their midst suddenly becoming quiet. This behavior in the other child might mean that their feelings have been hurt or they don’t understand the conversation. A teenager with good social communication skills can pick up and respond to subtle social cues in conversations.

These pragmatic language skills build on each other throughout childhood. As a parent, you want to watch to see if your child’s skills are coming along typically. If there are concerns, this article can provide some ideas and next steps to advance your child’s skills.

Causes of Pragmatic Language Issues in Children

Clinically, social communication is called pragmatic language. Pragmatic language refers to the social aspects of speech, such as conversation, reading nonverbal cues, and maintaining a back-and-forth flow of information.  If your child is struggling, here are some of the potential causes of these challenges.

  1. Poor perspective-taking: This skill is the ability to understand and relate to another person’s thoughts, interests, and ideas. It requires noticing when a peer is disinterested by reading nonverbal cues like shifting eye contact, appearing squirmy, or not responding to what has been said. To have conversations, an individual must be able to do the following: 
  • think of relevant things to share
  • draw on experiences
  • pay attention
  • take turns
  • formulate questions
  • know when and how to end the conversation politely. 
  1. Immature Social Development: Social communication is much more complex than vocabulary. Even very bright individuals can have difficulties with pragmatic communication. In that case, speech therapy is often required to get along with peers, do well in school, and support long-term success and happiness.

The primary reason your child may struggle with social communication is that these skills simply don’t come naturally. For most individuals, social development follows a typical course from the early childhood play skills, to the BFFs in 3rd grade, and on into high school and adulthood, where relationships deepen. 

For some children, this ‘natural’ progression does not happen. Instead, the child struggles to make friends and socialize with peers. There are many reasons why this can occur, and it can certainly be the case in supportive, loving homes. Parents, listen closely! It is not your fault! Some kids simply socialize naturally, and some kids simply don’t. For those who don’t, there is a lot of help available. 

  1. Social cognition problems: Social ‘cognition’ refers to understanding social relationships and social interactions. This skill includes picking up on social cues and comprehending social language, such as idioms, sarcasm, and humor. If your child is struggling with the cognition of these important and nuanced social skills, interpersonal interactions will likely feel confusing and frustrating. Often, direct teaching of these skills can help a child with challenges in social cognition learn to pick up social cues and interact with others more effectively.
  2. Developmental disabilities: Although there are many more typically developing children with social skills issues, sometimes social deficits signify one of the following disabilities. 
  3. Social Pragmatic Language Disorder: Challenges with pragmatic language issues, in the absence of an actual language disorder, are likely related to autism, anxiety, or ADHD. A new disorder could explain these challenges,  called Social Pragmatic Communication Disorder, a new (DSM-5) diagnosis closely related to autism but without the restricted and repetitive or sensory symptoms.
  4. Autism Spectrum Disorder includes challenges in social communication and restricted and repetitive patterns of behavior or interests. Social communication challenges in autism often include difficulty with social communication, back-and-forth conversation, and reciprocity. Many individuals with ASD speak very well. They may use formal language, recall detailed information, and try to converse. Conversations that veer off-topic or miss the point are common for ASD. For example, if a peer is sharing an emotional story about her dog dying, a child with Autism may ask, “what breed was it?” or say, “oh, that’s the life cycle” instead of saying, “I’m so sorry, that is sad.” This example shows the social language and perspective-taking that may be missing in autism. Want to know if your child’s challenges are a sign of Autism Spectrum Disorder? Cadey courses are taught by licensed psychologists and walk you through the symptoms of autism and how they may present in your child. Sign up today.
  5. Attention Deficit Hyperactivity Disorder (ADHD) can cause pragmatic language challenges because of the interplay of inattention, impulsivity, and hyperactivity. A child with ADHD may cut a peer off, invade personal space, forget what is being discussed, or share information quickly in a stream of consciousness. All of these behaviors impact conversation. Individuals with ADHD do not necessarily have these challenges, but they could.
  6. Social anxiety could impact pragmatics because the level of anxiety your child feels could render them unable to think of a response, leading to short answers and social avoidance. Anxiety could result in challenges with executive functioning or working memory. It can be hard to read social cues if you are not thinking clearly. Sometimes, an evaluation may be necessary to look at these potential factors that could impact language.
  7. Quirky kiddo: Some children really can only enjoy certain types of people, prefer being alone a lot, or have mild social anxiety in specific situations. They may avoid big parties, loud concerts, or assemblies. Perhaps you have a quirky kid with peculiar interests and a unique interaction style. If your child is happy and healthy, these social patterns are fine! Research shows that all people really need is one good friend and one close relationship at home. No matter how quirky your child is, there has to be one other kid who is just as quirky and needs a friend just as much. Help your child make connections with others and do not stress if your child prefers the company of just one or two friends instead of having several. 

What to Do About Social Communication Skills In Childhood

There’s good news! Children can be taught social communication skills. To improve pragmatic language, a parent can access a lot of strategies and resources listed below.

First, use and model social and emotional language for your child. Talk about your feelings, and share about your day and how you cope. “Work was stressful for mom today, so I’m going to take a walk. Would you like to come too?”

Second, get your child enrolled in social activities that are low risk, like a Lego club, cooking class, robotics club, swimming, and the like. Find something with team aspects but is not as competitive as a typical team sport (like soccer or softball). Start with something that has a structure but is about individual performance. Pay attention to who the coach or adult sponsor is, and seek those individuals who are accepting, warm, and not competitive.

Third, practice social conversation with your child, and provide feedback like, “you could ask Sally what she did this weekend.” Provide a bit of structure to family discussions instead of simply asking, “how was your day?” as that question may get little response. Opportunities to play with an adult guiding the conversation can really help your child learn new skills.

Fourth, provide breaks and downtime. Give your child time to relax after school, and then have a few prompts you discuss, like “who I sat with at lunch” or “what game we played in PE.”

Finally, if your child continues to struggle, seek out a social group, social skills therapy and see what supports your child’s school has available. We have seen children make significant gains in pragmatic language skills with practice.

When to Seek Help for Pragmatic Language Challenges

The biggest sign that it is time to seek help is when your child consistently struggles to make friends. You may notice your child is confused or frustrated frequently during social interactions. You may see your child having one of these challenges: 

  • She may say she has lots of friends but may not be able to tell you much about them. 
  • She may know her friends’ heights and eye color but may not recall what they like to do for fun. 
  • He may say he has friends in class but may not remember their names. 
  • Your child may boss other kids around or lecture on a topic without stopping to assess whether anyone is listening. 
  • Your child never asks how others are doing or fails to carry on a back-and-forth conversation.

If any of the above challenges are happening fairly frequently, it would be good to seek help. Many school-based and community-based speech therapists treat pragmatic language, and it is generally readily amenable to intervention.

Further Resources on Pragmatic Language

  • Psychologist or neuropsychologist: to consider pragmatic symptoms in a developmental context, a comprehensive evaluation could include social skills and language evaluation as well as a look at verbal and nonverbal abilities as well as problem-solving skills
  • School psychologist: to test IQ or intelligence, anxiety, social skills and consider the academic impact
  • Speech and language pathologist: to provide language assessment and then therapy, at-school therapy can happen at lunchtime or during recess for a natural social environment. This therapy may be in a group, or the therapist may come into the classroom to facilitate social learning
  • Social group: to work on social communication. Often facilitated by a social worker, counselor, or psychologist, a group with other children with an emphasis on social and conversation skills can help. Make sure your child is matched by approximate age and children have similar language skills and ideally some peer models as well

Similar Conditions to Pragmatic Language Problems

  • Social skills: children with poor pragmatic language are likely to have overall social skill difficulties
  • Social anxiety: children with poor pragmatic skills may be very nervous in social situations
  • General anxiety: children with poor pragmatic skills may have anxiety
  • Expressive language: children with poor pragmatic skills may not be able to express their thoughts and ideas due to a language problem
  • Receptive language: children with poor pragmatic skills may have difficulty understanding what others are saying
  • Attention problem: children with poor attention skills may have trouble with pragmatic language due to the tendency to miss social cues and not listen during social interactions
  • Hyperactivity: children with poor pragmatics who are hyperactive may not be able to communicate socially due to excessive movement
  • Conversation: children with poor pragmatic skills are likely to struggle with conversations

References on Pragmatic Language In Childhood

[1] Linder Ed.D., Toni & Petersen-Smith Ph.D., Ann (2008) Administration Guide for TPBA2 & TPBI2 (Play-Based Tpba, Tpbi, Tpbc).

Book Resources on Pragmatic Language In Childhood

Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.

Jed Baker’s series of books for social skills and behavioral supports. He specializes in ADHD and Autism Spectrum Disorder. Link: www.jedbaker.com

Philofsky, A., Fidler, D. J., & Hepburn, S. (2007). Pragmatic Language Profiles of School-Age Children With Autism Spectrum Disorders and Williams Syndrome. American Journal of Speech-Language Pathology, 16(4), 368-380. doi:10.1044/1058-0360(2007/040)

Barton, Erin E & Harn, Beth (2012). Educating Young Children with Autism Spectrum Disorders. Sage.

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