The fuzzy boundaries of the social (pragmatic) communication disorder (SPCD): Why the picture is still so confusing?

Introduction: Since the introduction of Social (Pragmatic) Communication Disorder (SPCD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) in 2013, a debate has arisen in the scientific community about its usefulness in differential diagnosis for other clinical categories such as Autism Spectrum Disorder (ASD) and Specific Language Impairment (SLI). Indeed, SPCD criteria share a common deficit in communication and pragmatic skills with these diagnostic entities. Available assessment tools seem scarce and not sensitive enough to clarify diagnostic criteria and clinical boundaries. This study aims to review the existing literature on diagnostic screening for SPCD to highlight confounding variables in the domains examined, overlap with other diagnostic entities, and lack of specificity of available assessment tools in identifying the core deficits of the disorder. Methods: The search strategy was defined by combining the following keywords: "social pragmatic communication disorder," "DSM-5," "differential diagnosis," and "child." The search was performed in three databases: Medline (PubMed), Scopus, and Web of Science. All studies published between 2013 and April 2023, written in English, and with a major focus on SPCD were included in the review. Results: After the screening for the eligibility, 18 studies were included in the review. Most of these studies aimed to investigate the differential diagnosis between SPCD and other diagnostic categories (e.g., specific language impairment and autism spectrum disorder). Of these researches, only 6 were ad hoc experimental studies, while the others were based on previously collected databases. Conclusions: SPCD seems to have its own peculiarities and characteristics, indicating its clinical relevance, as emphasized by the DSM-5. However, the lack of specific instruments and a number of confounding variables make it difficult to identify and differentiate SPCD from other diagnostic entities. Further research is needed to overcome the lack of specific clinical instruments and lack of empirical studies.

Efforts for the Correct Comprehension of Deceitful and Ironic Communicative Intentions in Schizophrenia: A Functional Magnetic Resonance Imaging Study on the Role of the Left Middle Temporal Gyrus.

Deficits in social cognition and more specifically in communication have an important impact on the real-life functioning of people with schizophrenia (SZ). In particular, patients have severe problems in communicative-pragmatics, for example, in correctly inferring the speaker's communicative intention in everyday conversational interactions. This limit is associated with morphological and functional alteration of the left middle temporal gyrus (L-MTG), a cerebral area involved in various communicative processes, in particular in the distinction of ironic communicative intention from sincere and deceitful ones. We performed an fMRI study on 20 patients with SZ and 20 matched healthy controls (HCs) while performing a pragmatic task testing the comprehension of sincere, deceitful, and ironic communicative intentions. We considered the L-MTG as the region of interest. SZ patients showed difficulties in the correct comprehension of all types of communicative intentions and, when correctly answering to the task, they exhibited a higher activation of the L-MTG, as compared to HC, under all experimental conditions. This greater involvement of the L-MTG in the group of patients could depend on different factors, such as the increasing inferential effort required in correctly understanding the speaker's communicative intentions, and the higher integrative semantic processes involved in sentence processing. Future studies with a larger sample size and functional connectivity analysis are needed to study deeper the specific role of the L-MTG in pragmatic processes in SZ, also in relation to other brain areas.

Children with hearing impairment and early cochlear implant: A pragmatic assessment.

Extensive research has demonstrated the benefits of cochlear implants (CI) in contributing to improve the linguistic skills of children with hearing impairment; however, few studies have focused on the development of pragmatic ability and its relationship with age of implantation. Pragmatics is the ability to use language in different contexts and its development has crucial implications, e.g., social inclusion and professional attainments. In this study, we conducted a comprehensive assessment of pragmatic ability using the Language Pragmatic Abilities (APL Medea), a battery composed by five different tasks: Comprehension of Metaphors, Implicit meaning, Comics, Situations and Colors Game (a perspective taking task). Eighteen children with early CI, belonging to 3 different age groups (6; 11-7; 11, 8; 0-8; 11 and 9; 0-9; 11 years-old), and twenty-four children with typical development (Control Group) participated to the study. We also investigated how the precocity of CI, i.e., age of first implantation, may affect the pragmatic development. Globally, children with CI obtained lower scores in the APL Medea battery than typically hearing children. However, focusing on the Medea tasks separately, children with CIs differed from their hearing peers only in Comics and Colors Game tasks. Finally, age of implantation was a moderate but significant predictor of pragmatic performance.

Mindreading abilities and borderline personality disorder: A comprehensive assessment using the Theory of Mind Assessment Scale.

Numerous studies have examined mindreading in borderline personality disorder (BPD). However, the empirical data obtained to date have not facilitated the development of a clear clinical profile of mindreading impairment in BPD due to a lack of consistency or incongruence across studies. One possible explanation for these inconsistencies and divergences in the current literature may lie in the multidimensional character of the mindreading construct; moreover, the heterogeneity of the experimental measures used to assess individuals with BPD mindreading skills may also need to be taken into account. The aim of the present study is to investigate mindreading skills and impairments in patients with BPD through direct comparison of a wide range of mindreading dimensions using a comprehensive semistructured interview, the Theory of Mind Assessment Scale (Th.o.m.a.s.) (Bosco et al., 2009). Our results show that the performance of patients with BPD differs from that of healthy controls only in certain specific dimensions of mindreading. The difficulties encountered by the patients with BPD typically emerge when mindreading tasks require them to disentangle their own subjective mindreading from that of another person, in other words, when they were required to assume an allocentric perspective.

Do executive function and theory of mind predict pragmatic abilities following traumatic brain injury? An analysis of sincere, deceitful and ironic communicative acts.

Quality of life and social integration are strongly influenced by the ability to communicate and previous research has shown that pragmatic ability can be specifically impaired in individuals with traumatic brain injury (TBI). In addition, TBI usually results in damage to the frontotemporal lobes with a consequent impairment of cognitive functions, i.e., attention, memory, executive function (EF) and theory of mind (ToM). The role of the underlying cognitive deficits in determining the communicative-pragmatic difficulties of an individual with TBI is not yet completely clear. This study examined the relationship between the ability to understand and produce various kinds of communicative acts, (i.e., sincere, deceitful and ironic) and the above-mentioned cognitive and ToM abilities following TBI. Thirty-five individuals with TBI and thirty-five healthy controls were given tasks assessing their ability to comprehend and produce sincere, deceitful and ironic communicative acts belonging to the linguistic and extralinguistic scales of the Assessment Battery for Communication (ABaCo), together with a series of EF and ToM tasks. The results showed that, when compared to healthy individuals, participants with TBI performed poorly overall in the comprehension and production of all the pragmatic phenomena investigated, (i.e., sincere, deceitful and ironic communicative acts), and they also exhibited impaired performance at the level of all the cognitive functions examined. Individuals with TBI also showed a decreasing trend in performance in dealing with sincere, deceitful and ironic communicative acts, on both the comprehension and production subscales of the linguistic and extralinguistic scales. Furthermore, a hierarchical regression analysis revealed that - in patients with TBI but not in the controls - EF had a significant effect on the comprehension of linguistic and extralinguistic irony only, while the percentage of explained variance increased with the inclusion of theory of mind. Indeed, ToM had a significant role in determining patients' performance in the extralinguistic production of sincere and deceitful communicative acts, linguistic and extralinguistic comprehension of deceit and the linguistic production of irony. However, with regard to the performance of patients with TBI in the various pragmatic tasks investigated, (i.e., sincere, deceitful and ironic communicative acts), EF was able to explain the pattern of patients' scores in the linguistic and extralinguistic comprehension but not in production ability. Furthermore, ToM seemed not to be able to explain the decreasing trend in the performance of patients in managing the various kinds of communicative acts investigated.

Improvement of Communication Skills after Traumatic Brain Injury: The Efficacy of the Cognitive Pragmatic Treatment Program using the Communicative Activities of Daily Living.

OBJECTIVE: The pragmatic impairment often characterizing individuals after a traumatic brain injury (TBI) significantly limits their independence, preventing social participation. Rehabilitation programs aim to improve the impaired capacities to help participants communicate effectively, increasing their self-perceived life quality. The aim of this study was to verify the effectiveness of the Cognitive Pragmatic Treatment (CPT) in improving communication abilities after TBI, thus enabling better management of communication activities in daily living. METHOD: Nineteen individuals with TBI in a post-acute phase completed the CPT, a group-based training program designed to improve pragmatic abilities. Pre- and post-training, participants were administered the Communication Activities of Daily Living (CADL-2), and the equivalent forms of the Assessment Battery for Communication (ABaCo). RESULTS: Comparison of pre- and post-training performance showed an overall improvement in pragmatic abilities. Post-training, participants scored higher in communication skills on both the CADL-2 and ABaCo, with such scores remaining constant at a 3-month follow-up assessment. CONCLUSIONS: This study showed that the CPT was effective in improving the participants' communicative abilities. The possibility that the benefits of the CPT may generalize to everyday communicative interactions is discussed.

Communicative impairment in traumatic brain injury: a complete pragmatic assessment.

The aim of the present study was to examine the communicative abilities of traumatic brain injury patients (TBI). We wish to provide a complete assessment of their communicative ability/disability using a new experimental protocol, the Assessment Battery of Communication, (ABaCo) comprising five scales--linguistic, extralinguistic, paralinguistic, context and conversational--which investigate all the main pragmatic elements involved in a communicative exchange. The ABaCo was administered to 21 TBI subjects and to a control group. The results showed that performance by TBI patients was worse than that of controls on all scales; moreover they showed a trend of increasing difficulty in understanding and producing different pragmatic phenomena, i.e., standard communication acts, deceits and ironies, whether such phenomena are expressed through the linguistic or extralinguistic modality.

Developmental pragmatics in normal and abnormal children.

We propose a critical review of current theories of developmental pragmatics. The underlying assumption is that such a theory ought to account for both normal and abnormal development. From a clinical point of view, we are concerned with the effects of brain damage on the emergence of pragmatic competence. In particular, the paper deals with direct speech acts, indirect speech acts, irony, and deceit in children with head injury, closed head injury, hydrocephalus, focal brain damage, and autism. Since no single theory covers systematically the emergence of pragmatic capacity in normal children, it is not surprising that we have not found a systematic account of deficits in the communicative performance of brain injured children. In our view, the challenge for a pragmatic theory is the determination of the normal developmental pattern within which different pragmatic phenomena may find a precise role. Such a framework of normal behavior would then permit the systematic study of abnormal pragmatic development.