Pragmatic Language Deficits

[Anonymous]

DC is in middle school. She has ADHD, social anxiety, and pragmatic language deficits. The pragmatic language deficits were confirmed through a speech language evaluation about four years ago. It's very difficult to communicate with DD. If you try to explain something to her, especially about rules or some social aspect, the response goes something like "Stop mom, I know all all that. I don't want to talk about it." When she has struggles at school with a friend or with a teacher, it's close to impossible to find out what happened or why she is stressed out about a particular situation. If she's having a difficult time with a particular subject, it's difficult to figure out the details. Counseling has been difficult. She refuses to get out of the car. When we manage to get into the counselor's office, she won't say anything. We've tried three different counselors and all of them indicated it's difficult to engage with her in a conversation. Yesterday, she was with me when we picked up her sister and her sister's friend. As soon as they entered the car, she told her sister's friend, I heard you did X,Y, and Z. Something that's embarrassing and that you keep private. Her sister was furious and friend looked upset. When we got home, I explained that saying something like that to her sister's friend is hurtful and the friend will feel that she cannot trust her sister. DD expression towards me was just flat/blank, absolutely no response or reaction. I have no idea if she understood what I was trying to explain. DD makes friends but then cannot keep friends because of these issues.

Did speech therapy help your child with pragmatic language deficits? What types of skills or tips do they teach in speech therapy for this situation? If there a speech language therapist in Northern VA that you can recommend?

[Anonymous]

Honey your child is autistic. This behavior is not a simple problem with pragmatic speech. My DD has all the diagnoses that you mention, and they kept overlooking ASD because it looks so different in high functioning girls. See someone like Dr. Stixgrud and get this girl some real help.

[Anonymous]

She's on the spectrum. ABA

[Anonymous]

ABA or social skills classes. My dd is younger and just does ABA but some of her older ABA classmates go to a social skills center in Alexandria. I don’t know the name but search ASD social skills groups. They all seem to make progress there

[Anonymous]

ABA, with a focus on verbal behavior. I’d start by determining what language skills are actually missing that is making this difficult. Typically pragmatic language requires “lower-level” / prerequisite language skills that are often overlooked. I’d get a full receptive and expressive language evaluation to start with and focus on missing skills before trying to address pragmatics as a whole.

[Anonymous]

Anonymous wrote:She's on the spectrum. ABA

ABA is not a panacea.

[Anonymous]

Anonymous wrote:

Anonymous wrote:She's on the spectrum. ABA

ABA is not a panacea.

Nope, it isn’t. It certainly can help with language skills though, among other things. I’ve probably helped at least 500 kids and families using ABA. You definitely need to choose a good provider with experience and educational experience to match your child and family needs, as you would with any professional.

[Anonymous]

Anonymous wrote:

Anonymous wrote:She's on the spectrum. ABA

ABA is not a panacea.

I know. I have one HFA.

[Anonymous]

Anonymous wrote:ABA, with a focus on verbal behavior. I’d start by determining what language skills are actually missing that is making this difficult. Typically pragmatic language requires “lower-level” / prerequisite language skills that are often overlooked. I’d get a full receptive and expressive language evaluation to start with and focus on missing skills before trying to address pragmatics as a whole.

I would also get a full speech evaluation as that is expressive speech and if language is a struggle talk therapy will be too. Aba will not help.

[Anonymous]

Anonymous wrote:

Anonymous wrote:ABA, with a focus on verbal behavior. I’d start by determining what language skills are actually missing that is making this difficult. Typically pragmatic language requires “lower-level” / prerequisite language skills that are often overlooked. I’d get a full receptive and expressive language evaluation to start with and focus on missing skills before trying to address pragmatics as a whole.

I would also get a full speech evaluation as that is expressive speech and if language is a struggle talk therapy will be too. Aba will not help.

I don’t disagree with getting a speech eval too but if you think ABA is useless then you clearly haven’t met an experienced ABA provider specializing in verbal behavior.

Speech and ABA can work together, actually very good to do it that way.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:ABA, with a focus on verbal behavior. I’d start by determining what language skills are actually missing that is making this difficult. Typically pragmatic language requires “lower-level” / prerequisite language skills that are often overlooked. I’d get a full receptive and expressive language evaluation to start with and focus on missing skills before trying to address pragmatics as a whole.

I would also get a full speech evaluation as that is expressive speech and if language is a struggle talk therapy will be too. Aba will not help.

I don’t disagree with getting a speech eval too but if you think ABA is useless then you clearly haven’t met an experienced ABA provider specializing in verbal behavior.

Speech and ABA can work together, actually very good to do it that way.

NP. Can you explain a little bit about what ABA might look like for a tween with pragmatic language deficits? My tween has a relatively new ASD diagnosis and the neuropsych report mentioned pragmatic speech therapy as being helpful. How many hours a week would ABA be? I thought it was usually a lot of hours. Or maybe that’s just for younger kids? It’s so hard to find information on ABA for kids who are diagnosed later and fall into that space between anxiety/ADHD/ASD without meeting the classic presentation of any of them.

[Anonymous]

OP, try to find a child psychologist who has experience with kids on the spectrum. It sounds like a tricky combination of possible ASD (and other things) as well as adolescence...

The one thing I'd mention that PPs haven't is that a lot of psychologists don't really know how to deal well with kids on the spectrum. Finding someone with experience is key.

ABA can be a crapshoot. A lot of ABA therapy is directed toward much younger children who have been recently diagnosed.

You also could try a speech pathologist with experience developing kids' pragmatic speech skills.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:ABA, with a focus on verbal behavior. I’d start by determining what language skills are actually missing that is making this difficult. Typically pragmatic language requires “lower-level” / prerequisite language skills that are often overlooked. I’d get a full receptive and expressive language evaluation to start with and focus on missing skills before trying to address pragmatics as a whole.

I would also get a full speech evaluation as that is expressive speech and if language is a struggle talk therapy will be too. Aba will not help.

I don’t disagree with getting a speech eval too but if you think ABA is useless then you clearly haven’t met an experienced ABA provider specializing in verbal behavior.

Speech and ABA can work together, actually very good to do it that way.

NP. Can you explain a little bit about what ABA might look like for a tween with pragmatic language deficits? My tween has a relatively new ASD diagnosis and the neuropsych report mentioned pragmatic speech therapy as being helpful. How many hours a week would ABA be? I thought it was usually a lot of hours. Or maybe that’s just for younger kids? It’s so hard to find information on ABA for kids who are diagnosed later and fall into that space between anxiety/ADHD/ASD without meeting the classic presentation of any of them.

ABA is more for behavior, not speech. For speech you need a good SLP.

[Anonymous]

Could also be anxiety on top of ASD and speech.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:ABA, with a focus on verbal behavior. I’d start by determining what language skills are actually missing that is making this difficult. Typically pragmatic language requires “lower-level” / prerequisite language skills that are often overlooked. I’d get a full receptive and expressive language evaluation to start with and focus on missing skills before trying to address pragmatics as a whole.

I would also get a full speech evaluation as that is expressive speech and if language is a struggle talk therapy will be too. Aba will not help.

I don’t disagree with getting a speech eval too but if you think ABA is useless then you clearly haven’t met an experienced ABA provider specializing in verbal behavior.

Speech and ABA can work together, actually very good to do it that way.

Where does one find this for a middle schooler or older?