Elsevier

Brain and Language

Volume 85, Issue 3, June 2003, Pages 451-466
Brain and Language

Weak coherence, no theory of mind, or executive dysfunction? Solving the puzzle of pragmatic language disorders

https://doi.org/10.1016/S0093-934X(03)00070-1Get rights and content

Abstract

Deficits in pragmatic language ability are common to a number of clinical populations, for example, right-hemisphere damage (RHD), Autism and traumatic brain injury (TBI). In these individuals the basic structural components of language may be intact, but the ability to use language to engage socially is impaired. Despite the nature of these difficulties being well documented, exactly what causes these difficulties is less clear. Furthermore, the current status of causal explanations for pragmatic difficulties across these populations is divergent and sometimes contradictory. This paper explores the empirical validity of three theories that attempt to explain pragmatic language impairment. It is recommended that a new, more convergent approach to investigating the causes of pragmatic language disability be adopted.

Introduction

The traditional components of language, phonetics, semantics, and syntax, adequately characterise the structure of language, but are insufficient to explain the richness of meanings that arise whenever language is used to communicate. These broader, inferred meanings, comprise the pragmatic dimension of language and are a product of the particular linguistic units chosen and the context in which they occur, including the social context. Thus, the ability to communicate relies not only upon an intact language system, but also upon knowledge of the specific communicative context, knowledge about the co-conversant(s), as well as general knowledge of the world. It relies upon ‘higher order’ abilities whereby numerous cognitive systems interact in order that knowledge of context and language can combine to generate novel inferences specific to each communicative act. So, whilst semantics refers to language meaning in its literal, context-independent usage, pragmatics is arguably a more complex concept, necessary to explain how meaning is derived from the social context.

Just as aphasic conditions have provided unparalleled opportunities to examine semantic processing, a variety of clinical populations with pragmatic difficulties have been identified and provide the means to examine and hopefully elucidate pragmatic processes. For example, in people with frontal lobe damage, right-hemisphere damage, Schizophrenia and Autism the structure of language is usually intact, but the ability to use language to engage socially is compromised, suggesting impairment at the pragmatic level of language functioning. Because pragmatic language draws upon many different knowledge bases and interacting cognitive systems it is considered the most complex aspect of linguistic functioning. It is possible, therefore, that similar pragmatic deficits may result from different points of dysfunction in the “pragmatic system”. For example, a failure to understand that the remark “it’s hot in here” is a request to open the window, may reflect a failure to understand the words themselves, a failure to recognise that a non-literal reading of the remark is required, a failure to infer the intentions of the speaker, a failure to identify oneself as the potential perpetrator of the required action, and so on. Eales (1993) has argued that similar pragmatic deficits are, therefore, likely to reflect a heterogenous range of underlying functional deficits or abnormalities, as reflected by the large number of disorders which are characterised by pragmatic disturbance.

This fact may explain the wide variety of theoretical positions that have emerged to explain pragmatic deficits. However, whilst a number of interesting and potentially important conceptual advances are being made in the area, there has been a general lack of cross-reference between parallel streams of research conducted in different clinical populations. This seriously limits the extent to which each model can claim explanatory power or generalisability. The aim of this paper is to examine and compare three different theoretical positions: The Social Inference Theory, the Weak Central Coherence Hypothesis, and the Executive Dysfunction theory in order to critically evaluate their validity.

Right-hemisphere damage, Autism and traumatic brain injury represent three clinical groups that have been the focus of a great deal of pragmatic language research. While other groups (e.g., Alzheimer’s Disease, Schizophrenia) are also known to suffer pragmatic deficits, it is the deficits in these former populations that have primarily motivated explanatory models of pragmatic function. As demonstrated by Table 1, similar communication deficits are reported in each.

The types of pragmatic language difficulties experienced by patients who have sustained right-hemisphere damage (RHD) following stroke are multiple and varied (Ozonoff, 1996). The speech of RHD patients may be tangential and socially inappropriate (Joanette et al., 1990a). In addition, patients tend to misinterpret, or ignore, the intentions of others conveyed in discourse. Indeed, patients with RHD are less able to use the information provided about the mood of an individual (angry versus happy) to interpret whether a conversational remark has a sarcastic or joking intent (Brownell, Carroll, Rehak, & Wingfield, 1992; Kaplan et al., 1990). Furthermore, RHD patients have been observed to have trouble understanding the main point of conversations and stories (Hough, 1990) and have difficulty using the theme of a story to aid comprehension (Schneiderman, Murasugi, & Saddy, 1992). RHD patients are also often concrete and literal in their use and comprehension of language (McDonald & Wales, 1986) and are often reluctant to revise their initial interpretation of language even in the light of new contradictory information (Brownell, Potter, Bihrle, & Gardner, 1986) Consequently, they have particular difficulty with the comprehension of language tasks that require a flexible interpretation, such as metaphor and irony, narrative humour or short story jokes (Bihrle et al., 1986; Brownell et al., 1983) and demonstrate deficits in inference-making ability (Beeman, 1993; Brownell et al., 1986; McDonald & Wales, 1986). These problems are accentuated by accompanying paralinguistic deficits, such as impairments in speech prosody (Cohen, Prather, Town, & Hynd, 1990; Lalande et al., 1992; Weylman et al., 1989) as well as difficulty reading emotion in facial expression (Borod, 1993; Borod et al., 1986; Cohen et al., 1990; Lalande et al., 1992; Weylman et al., 1989), which serve to limit their already impaired capacity to communicate (Brownell & Martino, 1998). Indeed, compared to individuals with LHD, RHD patients are less able to identify whether the tone of voice in a message contradicts the verbal content of the message (Tompkins & Mateer, 1985). Thus, individuals with RHD have difficulty reading social-emotional cues, and using these cues to aid communication.

Ozonoff and Miller (1996) have noted a marked similarity in the language difficulties following right-hemisphere damage and high functioning individuals with Autism or Asperger Syndrome. High functioning autistic people may often display fluent and articulate speech. Nevertheless, they fail to engage in interactional conversation, are overly literal, tangential, and may talk at great length on socially inappropriate, or obscure, topics (Ozonoff & Miller, 1996). The tendency to take things literally is also demonstrated in pedantic, over-exact, comprehension and production (Happe & Frith, 1996). Autistic children have been shown to be significantly poorer than normal children at distinguishing between inappropriate and appropriate utterances (i.e., utterances that avoid redundancy, are informative, truthful, relevant and polite), suggesting that they have a poor knowledge about the social constraints of appropriate communication, and the function of language as it is used to convey information in a communicative sense (Surian, Baron-Cohen, & Van der Lely, 1996).

Pragmatic deficits are also often a consequence of traumatic brain injury (TBI). TBI is a heterogenous disorder, although frequently characterised by a concentration of damage to the frontal lobes and their connections. Subsets of TBI patients have been observed to display a range of communication impairments that fall into several broad categories. Patients may be over-talkative, showing little direction or organization in their communication and making tangential comments, drifting from topic to topic. In contrast, other patients exhibit impoverished language, in both quality and quantity, relying upon a small set of responses to meet their communication needs. Finally, patients may demonstrate confused, inaccurate and confabulatory verbal behaviour (Hartley & Jenson, 1992). TBI patients with mainly frontal damage have also been found to be impaired in various aspects of their pragmatic language, such as the ability to ignore the literal meaning of an utterance in order to comprehend conversational implicatures such as sarcasm (McDonald, 1992; McDonald & Pearce, 1996), humour (Docking et al., 1999; Docking et al., 2000), and ambiguous advertising slogans (Pearce et al., 1998).

This difficulty comprehending the indirect, more subtle language devices, is also reflected in language production. As such, TBI patients often have difficulty making indirect inferential requests in the form of a hint (McDonald & van Sommers, 1993). TBI patients also often have difficulty providing detailed and organised instructions (McDonald, 1993), perhaps due to a failure to consider the viewpoint or knowledge-state of their conversation partner. Certainly, in spontaneous social interactions, independent observers found that TBI patients displayed poor partner directed behaviour, a lack of interest in the other person (egocentricity), and a failure to follow up the other person’s remarks (partner-involvement) (Flanagan, McDonald, & Togher, 1995).

Section snippets

Theories of mechanisms underlying pragmatic function

The three theories that have emerged to explain the pragmatic deficits seen in these populations predict the same types of deficits in pragmatic language, but differ in relation to the mechanisms purported to cause these deficits.

General conclusions

This paper has attempted to address some of the more pertinent issues in the pragmatic literature to date. Most problematic is the fact that there is relatively little cross-reference to other theoretical stances, and indeed clinical populations. A general failure to concurrently consider different clinical populations suffering from similar deficits has lead to disparate theoretical accounts of pragmatic deficits. Indeed, failure to consider research across different populations has resulted

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