Pragmatic language impairment, also known as semantic-pragmatic disorder (SPD), may be a type of autism, although some psychologists think this is a language disorder. Children with this disorder typically learn to speak later than their non-disordered peers, or even their peers with high-functioning forms of autism. It is believed that pragmatic language impairment results from a brain dysfunction related to speech and understanding speech, so that these children have problems both with understanding what is said to them and with forming speech of their own. They are generally only able to understand direct speech, and usually have problems comprehending nuanced speech, such as joking. They cannot typically make the connection between the speaker's words and the speaker's thoughts, and they usually have problems intuiting any shared understanding between themselves and others they are speaking with.
In very early childhood, people with pragmatic language impairment generally have problems learning language and usually don't appear to understand what is said to them. They may pay more attention to insignificant sounds on the periphery, for instance, than to the speech of a parent or caregiver. These children may often fail to recognize their own names, and may sometimes fail to respond to sound or speech altogether in the manner that a deaf child would.
While children with SPD generally learn to talk later than their peers, they can eventually become quite talkative. The problem generally is with the way these children talk. They are considered very prone to repeat things they hear in conversation, television programs or films. They may say things that are entirely inappropriate to the conversation at hand. Children with pragmatic language impairment usually don't use language in a way that expresses their thoughts or emotions, the way children without this disorder learn to do.
When those with SPD do engage in conversation, they often speak only about things that pertain to their own interests. They are usually unable to pick up on their conversational partner's verbal and nonverbal cues and may leave others confused or disinterested. Though they are typically able to understand instructions and other types of direct speech, they have problems understanding many of the thought processes behind others' speech, and will generally fail to intuit the speaker's emotional state. Often, children with this language disorder have problems learning to spell, read, and write, especially creatively.
Children who suffer from pragmatic language impairment often have symptoms similar to those of many disorders on the autism spectrum. This is why experts remain unsure as to whether SPD is a a type of autism or a specific language impairment. These children often have problems interpreting input from their senses, and may be disturbed by extreme sensory input such as loud noises. They are generally quite happy to do things on their own, and may display little creativity. They often have problems relating to others, and may display behavioral difficulties.
