INT. J. LANG. COMM. DIS.

, JULYSEPTEMBER
VOL.

40,

NO.

2005,

3, 333347

Research Report

Elicited and spontaneous communicative

functions and stability of conversational
measures with children who have pragmatic
language impairments
Catherine Adams and Julian Lloyd
University of Manchester, UK
(Received 5 March 2004; accepted 2 December 2004)

Abstract
Background: The preliminary phase of a project aimed at establishing appropriate
outcome measures for intervention with children who have pragmatic language
impairments (PLI) is reported. Assessment methods for children with PLI are
considered in the context of developing outcome measures for intervention
studies. Communicative function assessments in elicitation and conversational
contexts are compared. The stability of measures derived from conversational
profiling is also considered.
Aims: To investigate the utility of an elicited communicative function assessment
in discriminating the pragmatic characteristics of children with PLI and to
compare this method to conversational profiling. An additional aim was to
estimate the degree of variation on conversational indices derived from
interactions with children with PLI.
Methods & Procedures: Fifteen children with PLI (mean age 9;5 years) and an agematched control group were assessed on two occasions on a new
communicative function elicitation task and on a conversation task. A checklist
of communicative functions was employed in analysing the elicitation and the
conversation tasks. An analysis of conversation was carried out to derive
conversational indices such as verbosity and meshing.
Outcomes & Results: The elicitation task failed to discriminate between the PLI
and control groups and showed a strong ceiling effect. Significant betweengroup differences were found for both communicative function in conversation
measures and on conversational indices. The variation in conversation indices is
relatively small compared with the baseline measures.

Address correspondence to: Catherine Adams, Human Communication and Deafness, School of
Psychological Sciences, University of Manchester, Manchester M13 9PL, UK; e-mail: catherine.
adams@manchester.ac.uk

International Journal of Language & Communication Disorders

ISSN 1368-2822 print/ISSN 1460-6984 online # 2005 Royal College of Speech & Language Therapists
http://www.tandf.co.uk/journals
DOI: 10.1080/13682820400027768

334

Catherine Adams and Julian Lloyd

Conclusions: A more representative picture of communicative function ability
arises from unstructured tasks rather than from structured elicitation tasks for
the age group of children with PLI. The elicitation procedure outlined in this
paper might be better suited to a younger age group. Differences between
communicative function performance on elicitation and conversation situations
suggest a strong effect of context on the pragmatic performance of children
with PLI. The conversational indices reported show sufficient stability to be
employed in an outcome measure provided the minor variations indicated are
factored into estimates of change.
Keywords: pragmatics, assessment conversation, child language, intervention.

Introduction
In the population of children with developmental language disorders, a subgroup
has been identified whose difficulties lie principally with the use of language in social
contexts. Bishop (2000) has termed this subgroup Pragmatic Language Impairment
(PLI) but it has also been discussed under its previous label of semanticpragmatic
language disorder. Children with PLI are typically verbose, have poor turn-taking
skills, a difficulty staying on topic and significant difficulty in developing
conversational skills. PLI is thought to be closely related to autism (Boucher
1998) and these children share many of the social and cognitive features of autistic
children, with the exception that their social withdrawal is less extreme.
Work on the characteristics and long-term outcomes of PLI has been reported
over the last decade or more (Leinonen and Letts 1997, Botting and Conti-Ramsden
1999, Bishop 2000). Speech and language practitioners have received limited support
from the research base in implementing communication interventions for these
children in school and clinic settings. There is little existing high-quality evidence
that pragmatic ability can be enhanced by facilitation or by direct intervention and
yet a significant proportion of services in educational speech and language therapy is
directed to the amelioration of pragmatic difficulties. Evidence regarding pragmatic
intervention exists in the form of quasi-experimental studies and expert opinion from
language-disordered populations (Conant et al. 1984, Bedrosian and Willis 1987,
Camarata and Nelson 1992, Richardson and Klecan Aker 2000) and in children with
autism (Gray 1998), in addition to some case studies of children with PLI (Letts and
Reid 1994, Willcox and Mogford-Bevan 1995, Adams 2001).
The intervention evidence base for PLI has suffered from the difficulty of
constructing pragmatic tasks or assessments that will function as reliable outcome
measures. These instruments need to be sensitive to the particular nature of the
problems of children with PLI and sensitive to change, while at the same time
demonstrating reliability and stability. Language pragmatics includes a number of
observable and covert behaviours interpretable in specific contexts and with
reference to a set of implicit rules of reference and inference. Controlling
experimental variables in such a complex system presents substantial challenges and
designing assessment tasks which have content validity is a further challenge.
Existing standardized tests tap aspects of language pragmatics such as inference
(the Test of Language Competence, Wiig and Secord 1989; the Assessment of
Comprehension and Expression (611), Adams et al. 2001) and ambiguity resolution
(Understanding Ambiguity; Rinaldi 1996). Less attention has been paid recently to

Children with pragmatic language impairments

335

the clinical assessment of aspects of pragmatics to do with expressive discourse,

such as the speech act or communicative function. The speech act has been defined
as the peformative, or action accomplishing, aspects of language use and particularly
the (illocutionary) force associated with an utterance (Grundy 2000: 276). The Test
of Pragmatic Language (Phelps-Teraski and Phelps-Gunn 1992) assesses the use of
some speech acts in structured tasks. However, practitioners generally employ nonstandardized schemes to supplement any testing such as Rinaldis (2001) Social Use
of Language Programme. Speech acts observation schedules such as Feys (1986)
Responsive/Assertive classification scheme and the Social Interactive Coding
System of Rice et al. (1990) may be employed to profile speech acts.
Tests have limited potential as outcome measures for pragmatic skills due to
restrictions on re-testing and lack of local norms. Observation schemes generally
present analytical frameworks but are based on spontaneous outputs that render reassessment problematic and which are time-consuming to analyse. An elicitation
procedure married to an observation scheme, however, might hold promise as an
outcome measure as well as constraining transcription and analysis time. In this project,
a new elicitation procedure is outlined that prompts the child to use speech acts in a
structured context. From now on, this will be referred to as the communicative function
elicitation task. The term communicative function is preferred to that of speech act
since it more closely describes the functional role of the utterance in context.
It is known that children with specific language impairments (SLI) demonstrate
a comparable range of communicative functions to the child with typical language
development (Gallagher and Craig 1984, Meline and Brackin 1987, Prutting and
Kirchner 1987, Craig 1995) limited only by their capacity to encode these functions
in grammatically well-formed utterances. Less is known about the ability of children
with PLI to produce communicative functions in situated contexts. Bishop and
Adams (1989) and Bishop et al. (1994, 2000) showed that children with PLI could
make use of exchange structure for the purposes of conversation but dealt
principally with responsiveness and initiations in their analysis. Ziatas et al. (2003)
demonstrated a lower rate of explanations and descriptions in populations of
children with autism compared with children with SLI or Aspergers syndrome.
Single case studies (e.g. Willcox and Mogford-Bevan 1995) have also shown that
children with PLI have mastery over some forms of communicative function. There
are, however, no systematic group studies of either the communicative functions of
children with PLI or the potential of such an assessment to contribute toward
pragmatic profiling. The context of communicative function sampling might also
have an impact on the emerging pattern of behaviour, particularly for children with
PLI who are known to have difficulty as the amount of contextual information
increases. It is not known whether the child with PLI will produce a similar range of
communicative acts in conversation and in elicitation tasks.
Conversational profiling provides another option for monitoring change but, by
its relatively unstructured nature, poses difficulties of natural variation in
communication performance from one time to another (Bishop et al. 2000). To
use such measures (e.g. Bishop and Adams 1989) to evaluate changes in pragmatic
performance as a result of an intervention, it is necessary to have factored in the
allowable variation in the chosen conversation measures on different occasions. If
this is not done, there is a danger of showing significant changes that might have
arisen simply as a result of some typical variation in the unstructured assessment
procedures. Bishop et al. (1994) found reasonable stability in conversations with

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Catherine Adams and Julian Lloyd

children with PLI between differing conditions of stimuli and interlocutor. Using
similar methods, it should therefore be possible to estimate the natural perturbation
in these measures that need to be factored into outcome measures.
This study considered the potential of two assessment tools developed to assess
pragmatic behaviour in children with PLI: a speech act elicitation task and a
conversation task. Specific research questions were as follows:
the pragmatic problems of children with PLI manifested on a
N Are
communicative function elicitation task?
elicitation and conversation tasks have similar discriminatory potential in
N Do
differentiating the pragmatic skills children with PLI from their typically
developing peers?

is the degree of variation (expressed as a proportion of conversational

N What
indices) found in repeated measures of conversations in children with PLI?

Methods
Subjects
Fifteen children (10 boys and five girls, mean age 9;5 years, SD52;5, range 7;311;6)
identified as having PLI by their speech and language therapists were included in the
study. All subjects with PLI were recruited from three specialist language provisions
in the North West and West Midlands of England and Northern Ireland and were
attached to mainstream primary schools. All had received statements of special
educational needs. The speech and language therapists in charge of the specialist
units had considerable experience in diagnosis of pragmatic language impairments.
All children had marked impairments in pragmatics and this was the primary reason
they were receiving speech and language therapy. Clinician opinion was preferred in
respect of diagnosis since there is no current accepted valid method of differential
diagnosis of PLI and other types of language impairment. The instrument of usual
choice the Childrens Communication Checklist (CCC) (Bishop 1998), which has
been used in previous research is designed to indicate the presence of pragmatic
language impairment in individual children and provides a mean of confirming a
clinical opinion. Recent research (Norbury et al. 2004), however, indicates that even
the revised version of this checklist (CCC-2; Bishop 2003) cannot differentiate PLI
from other language disorders. CCC-2 provides a pragmatic composite score aimed
at partialling out PLI from SLI, but Norbury et al. were unable to validate this
differentiation. This recent evidence suggests that there is no advantage of using
CCC scores to discriminate children with PLI and SLI. Moreover in this study we
were not attempting to compare SLI and PLI children. No children in the PLI group
had a diagnosis of frank autism in clinical records.
An age-matched control group (mean age59;4 years, SD51;5, range57;111;0)
also took part in the study. Control subjects were recruited from the mainstream
primary schools attached to the language units provision. Subjects were matched
within 3 months to PLI children on age and by sex. Control children had no history
of speech and language delay or received any special attention for communication or
other learning disability. Using the British Picture Vocabulary Test (BPVS) (Dunn
et al. 1997) as a screen all control children functioned at above the 20th centile, with
the mean centile being 53.2 (range 2099).

Children with pragmatic language impairments

337

Procedure
All children participated in the elicitation task. A subset of ten children from the PLI
group (six boys and four girls) with a mean age of 9;10 years (SD59;10,
range57;1111;6), and ten children from the control group with a mean age of 9;8
years (SD51;3, range57;311;0) also took part in the conversation study.
Assessment on elicitation and conversation tasks took place in a quiet room with
only the child and tester present. The sessions were videoed and a protocol was
developed to score the recordings for the elicitation task. Conversational coding was
completed from the video using the procedure described below. To permit an
assessment of variation in pragmatic performance, each child was assessed on a
second occasion. A 2-week interval between Times 1 (T1) and 2 (T2) was
considered the optimum interval, but due to school access problems, the period
between testing ranged from 2 to 16 weeks.
Communicative function elicitation task procedure
A scripted procedure for eliciting pragmatic behaviours was developed based on the
communicative-demand strategy (Creaghead 1984) for eliciting and assessing
pragmatic behaviours (Paul 1995). (This was originally known as the Peanut Butter
Protocol.) This approach involves setting up situations that tempt the child to
exhibit typical communicative functions using a series of tasks and props. Nineteen
communicative functions were targeted in the procedure. The communicative
functions elicitors were contained within a prepared written script available only to
the tester. The aim of the script was to provide a repeatable but naturalistic and
interesting task for the age group of children chosen. Tasks and props used included
a map task to elicit clarification requests and responses to clarification requests
(Lloyd 2003); toy telephones to elicit greetings, closings, questions and answers; a
magic trick to elicit hypothesizing, explaining and predictions; fake biscuits to elicit
choices and comments; and locked boxes to elicit requests for an object. The
communicative functions elicited and examples from the script are set out in the
appendix.
Each child in both groups took part in the elicitation script task on two
occasions. Three assessors completed the assessments between the groups with the
same child being seen twice by the same assessor. Assessors were trained in advance
in the administration of the elicitation script and pre-test checks were made to
ensure accuracy of delivery.
Each communicative function was coded according to the following:
the behaviour was elicited.
N Yes:
the behaviour was not elicited.
N No:
i.e. not observable: the behaviour could not be observed due to
N n/o,
contextual factors (e.g. the child became fidgety, or one of the prompts did
not work properly).

Conversation task
The subjects were assessed through a conversation task that was based on the
Analysis of Language Impaired Childrens Conversation (ALICC), developed by

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Catherine Adams and Julian Lloyd

Bishop, Adams and colleagues (Adams and Bishop 1989, Bishop and Adams 1989,
Bishop et al. 2000, Adams et al. 2002). Conversations were gathered using the semistructured method devised by Adams and Bishop (1989). This method uses blackand-white photographs as prompts to initiate particular topics:
A visit by the doctor; a birthday party; a car breaking down.
N T1:
T2:
N Building a bonfire; a family day trip; taking a pram from a rubbish tip.
The aim was to use the photograph to initiate conversation with the child but then
to move on to discuss the childs own similar experiences. The recordings were
transcribed; turns and utterances were identified and numbered using the guidelines
presented by Bishop et al. (2000). A particular focus of attention was adult
solicitations: utterances by the adult that solicit either information or acknowledgement
from the child. Solicitations for information include wh-questions (Where did you
go on holiday?), yesno questions (Do you like chocolate?), and clarification
requests (C: I went with Paul; A: Whos Paul?). In later analysis, the ability of the
child to respond to adult solicitations is used in constructing conversational indices.
Communicative function analysis of conversation samples
To provide a measure of the types of communicative functions used in conversation,
every transcribed conversation was coded using utterance as the unit of analysis. The
acts chosen reflect the major categories used in previous studies of PLI childrens
conversations such as Bishop and Adams (1989) and Bishop et al. (2000). In
conversations, the range of communicative functions is likely to be limited by the
constraints of the context. A reduced number of communicative functions were
therefore selected for analysis. These are as follows:
correspond to Request for information and Asking questions in
N Questions:
the elicited communicative functions task.
incorporates Explanation, Predicting, Hypothesizing/giving reaN Answers:
sons, Making choices, Answering.
incorporates Comment on object, Volunteering to communicate.
N Statements:
for clarification by children in the conversational data were also
N Requests
recorded. These were mostly non-specific requests (e.g. What?), whereas

N
N
N
N

most requests for clarification by children in the scripted procedure would be

potential requests for elaboration (What colour door?) in response to an
ambiguous instruction (Go to the church).
Clarifications: corresponds to item 19 on the communicative function task:
Clarifying.
Denial/correction: these utterances are unsolicited, and would correspond to
item 8 on the communicative function task: Denial/correction.
Recapitulations are utterances that restate or summarize information which
has already been stated in the conversation. These are important
conversational devices but were not elicited from the children in the
communicative function task.
Conversational mechanics: do not correspond to any of the communicative
functions and have no topical content. These are utterances that are used to
establish mutual engagement and turn management. These include requests
for acknowledgements and acknowledgements, utterances used to reinforce

Children with pragmatic language impairments

339

either ones own or ones partners contribution, affective expressions, and

utterances that are used to retain a speaking turn.

Conversational indices
The same data were then subject to further analysis as follows. Using methods from
Adams et al. (2002) and Bishop et al. (2000), the following indices of conversational
behaviour were employed:
participation.
N Discourse
Conversational
N Assertiveness. dominance.
N Verbosity.
N Responsiveness.
N Meshing.
N
Discourse participation is the ratio of child utterances to tester utterances. It can be
used to evaluate each partners contribution to the conversational floor time. A ratio
of 1.0 suggests that both partners have contributed equally to the conversation. A
ratio less than 1.0 suggests the tester has dominated the conversation. A ratio greater
than 1.0 suggests the child has dominated the conversation (Lloyd et al. 2001).
Conversational dominance is an index that can be used to estimate the degree to
which the child dominates the conversation by repeatedly requesting information or
by providing unsolicited information. The following formula was derived:
Conversationaldominance~child first partszstatements
=adult
zchildfirst partszstatements

Assertiveness is an index that indicates the childs tendency to initiate
conversational exchanges. The following formula was derived:
Assertiveness~Child first parts=Total child utterances
An index of verbosity was used to identify a tendency to verbosity in the form of
extended unsolicited talk in a single turn. It was defined as the number of child turns
that included four or more statements in sequence as a proportion of the total turns
for that conversation:
Verbosity~number of child turns which contain four or more statements in
sequence=total number of turns in conversation
Responsiveness5proportion of child responses to tester utterances ending in a
soliciting or neutral intonation. In this analysis, nods and shakes of the head were
treated as yes/no answers.
Meshing was defined as the quality of fit between adult solicitations and child
responses. Four categories of meshing have been defined (for a more detailed
description of these categories, see Bishop et al. 1998):
the response is judged to be a good fit with the first soliciting part
N Adequate:
(A: Where are you going on Saturday?; C: To the zoo).
the child produces a less than optimal response because of some
N Inadequate:
linguistic limitation, comprehension failure, or lack of general knowledge.

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Catherine Adams and Julian Lloyd

When using this code no allowance is made for age (e.g. A: Wheres Tenby?;
C: Long way away).
Pragmatically inappropriate: the response does not fit the social and/or
communicative context of the soliciting part. This may be because the child
has failed to take into account previously given information, ignores an adult
solicitation, produces a tangential response, an over-literal response that does
not appreciate the speakers intention, or uses dont know uncooperatively
(e.g. A: Have you ever been to the doctor?; C: I had an apple a day; A Where
did your dad take you last Saturday?; C: Can you please not ask that question).
No response: the child is given an opportunity to respond but does not do so.

An index of problematic responses was derived using the following formula:

Response problems~child (inadequate responseszpragmatically inappropriate
responseszno responses)=total child responses
An index of pragmatically inappropriate responses was calculated as follows:
Pragmatic problems~pragmatically inappropriate responses=total child responses

Results
Communicative function elicitation task
The elicitation procedure did not distinguish between the PLI and control groups
on the number of communicative functions elicited. Both groups were performing
at or close to ceiling level for most of the items. Similarly, little variation was found
between T1 and T2 for either the PLI or the control group. Though the results did
suggest that knowledge gained in the task during T1 could affect the performance of
some children in T2 (for example, in T2, the child already knows that a pen is
hidden in the locked box and therefore does not have to ask about the location of
the pen), similar results were found for both the PLI and control groups. Figure 1
shows a pattern of responses for one item on the elicitation task (Requesting an
Object) which is representative of all other items. The majority of responses are
correct with little variation between the groups and little change over time and a
pronounced ceiling effect. Children with PLI tended to show a little more variability
in their responses when the data is displayed graphically but this is not significant for
any communicative function items.
Conversation task
In the following analyses, a 262 mixed factorial ANOVA design was employed.
Conversational measures described in the last section were the dependent variables.
The independent variables were time of testing (two levels: T1 and T2) and group
(two levels: PLI and control). Time was manipulated within subjects, while group
was manipulated between subjects.
Table 1 shows the total and mean number of turns and utterances for the PLI
tester and controls tester conversations. No significant main effect of time or group,
and no significant interaction between time and group, was found for any of these
measures of turns and utterances. These findings suggest no significant differences

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Children with pragmatic language impairments

Figure 1. Distribution of elicitation codes for communicative function item 26, Requesting an Object,
from Times 1 and 2.
Table 1.

Total and mean number of turns and utterances for the PLI tester and control tester
conversations at Times 1 and 2
Time 1

PLI conversations
Turns
Adult utterances
Child utterances
Discourse participationa
Control conversations
Turns
Adult utterances
Child utterances
Discourse participationa

Time 2

Total

Mean

SD

Total

Mean

SD

1498
1371
1212

149.80
137.10
121.20
0.87

(54.37)
(46.66)
(40.16)
(0.29)

1452
1331
1172

145.20
133.10
117.20
0.80

(51.24)
(36.99)
(64.73)
(0.27)

1589
1406
1407

158.90
140.60
140.70
0.92

(59.01)
(31.08)
(81.50)
(0.36)

1648
1503
1468

164.80
150.30
146.80
0.89

(81.54)
(46.69)
(93.56)
(0.33)

Un-codeable utterances were excluded from the calculation of discourse participation ratios.

between the PLI tester and control tester conversations concerning the amount of
talk that took place between the participants. Both groups of children therefore were
offered balanced opportunities to participate in the discourse.
Communicative functions in conversation
Table 2 shows the mean proportions of the communicative function types for the
PLI and control groups at T1 and T2. No significant main effect of time, and no
significant interaction between time and group, was found for any of the
communicative function types. A significant main effect of group was found for
questions (F(1, 18)55.62, p50.029), clarification requests (F(1, 18)54.83, p50.041),
clarifying (F(1, 18)56.29, p50.022) and recapitulation (F(1, 18)55.31, p50.033).
The PLI group used higher proportions of questions, clarification requests,
clarifying responses and recapitulations than the control children.

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Catherine Adams and Julian Lloyd

Table 2. Mean proportions of the communicative function types in conversation for the PLI
and control groups at Times 1 and 2
PLI

Control

T1
Communicative acts

Mean

Questions
2.08
Answers
45.31
Statements
18.99
Clarification requestsa
0.42
Clarifyinga
4.87
Denial/correction
0.33
Recapitulationa
1.24
Evaluation
0.07
Conversational mechanics 16.27
Other
0.97
Un-codeable
9.46
a

T2

T1

T2

SD

Mean

SD

Mean

SD

Mean

SD

(1.98)
(8.67)
(9.13)
(0.75)
(2.67)
(0.56)
(1.97)
(0.22)
(10.08)
(0.84)
(4.22)

3.40
46.14
19.10
0.60
4.05
0.35
1.65
0.35
16.05
0.57
7.59

(3.47)
(21.49)
(16.80)
(1.36)
(6.37)
(0.77)
(1.04)
(0.77)
(8.59)
(0.66)
(6.58)

0.78
50.72
24.36
0
1.17
0
0.12
0.03
14.40
0.12
8.00

(1.45)
(19.52)
(18.51)
(0)
(1.37)
(0)
(0.28)
(0.98)
(6.52)
(0.38)
(3.48)

1.18
46.51
27.40
0
1.58
0
0.64
0.24
14.97
0.52
6.96

(1.48)
(17.76)
(18.77)
(0)
(1.26)
(0)
(0.81)
(0.49)
(5.92)
(1.42)
(4.40)

PLI.control, p,0.05.

Conversational indices
Table 3 shows the mean conversational behaviour indices for the PLI and control
groups at T1 and T2. A significant main effect of group was found for response
problems (F(1, 18)513.954, p50.002) and pragmatic problems (F(1, 18)56.29,
p50.000), with the PLI group displaying more problematic responses than the
controls in both categories.
Variation in conversational indices over time
Table 4 shows the differences between conversational indices derived for both
groups at T1 and T2. There is no significant difference between-groups on any of
the indices in the degree to which T1 and T2 performance differed from each other.

Table 3.

Mean conversational behaviour indices scores for the PLI and control groups at
Times 1 and 2
PLI

Control

T1

T2

T1

T2

Communicative indices

Mean

SD

Mean

SD

Mean

SD

Mean

SD

Conversational dominance
Assertiveness
Verbosity
Responsiveness
Response problemsa
Pragmatic problemsa

0.28
0.03
0.02
0.95
0.27
0.20

0.15
0.02
0.02
0.04
0.13
0.11

0.25
0.04
0.01
0.93
0.33
0.22

0.20
0.03
0.02
0.05
0.13
0.12

0.30
0.01
0.03
0.95
0.08
0.01

0.24
0.02
0.02
0.28
0.09
0.01

0.31
0.01
0.02
0.93
0.12
0.02

0.24
0.01
0.02
0.08
0.16
0.02

PLI.control, p,0.01.

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Children with pragmatic language impairments

Table 4.

Differences between the mean conversational behaviour indices scores for the PLI
and control groups for Times 1 and 2

Conversational dominance
Assertiveness
Verbosity
Responsiveness
Response problems
Pragmatic problems

PLI

Control

20.03
0.01
20.01
20.02
0.06
0.02

0.01
0
20.01
20.02
0.04
0.01

Discussion
Examining pragmatic behaviours through communicative function elicitation
procedures with a yes/no approach either was not sufficient to discriminate the
pragmatic problems of the PLI group or was not taxing enough to have potential to
show change over time. Although children engaged with the procedure satisfactorily
as an assessment technique, clearly the production of communicative functions is
not problematic by this age for children with PLI. This is not an entirely unexpected
result. Practitioners have noted that the addition of structure into assessment task
favours the support of pragmatics for these children (Leinonen et al. 2000). Bishop
and Adams (1991) found similar results in their appraisal of referential
communication in these children in which a formal barrier task failed to elicit the
known problematic reference behaviours of children with PLI. Similar ceiling effects
have been found on tasks of inference where the task, although challenging, simply
fails to tap into the complex nature of the cognitive and linguistic processes involved
(Botting and Adams 2005), whereas when the task is made more abstract, distinct
group differences emerge (Adams in preparation).
The findings illustrate the difficulty of selecting appropriate assessment
procedures for clinical pragmatics. Tasks employed in the assessment of pragmatic
language performance for children with PLI, including checklists and elicitation
tasks, can be useful in identifying aspects of behaviour in individuals who might be
targeted in intervention. Tasks that attempt to discriminate children with PLI from
other groups, however, must be employed with reference to the childs age and
linguistic ability and must take the availability of supportive context into account. In
this case, the elicitation task is well within the PLI childrens capacity. It may be that
a more taxing elicitation procedure might be developed that would pick up
difficulties with sophisticated communicative function production in more realistic
contexts. It would also be interesting to investigate the natural history of
communicative function development in children with PLI in a longitudinal study.
In the meantime, the present assessment procedure might have more clinical
potential with younger children who are still in the process of developing
communicative functions.
The conversation analyses used in this study did identify differences in pragmatic
behaviour between groups. In particular, the framework called meshing, which
examines the goodness-of-fit between adult solicitations and child responses, helped
to distinguish between the PLI and control groups, and gave some indication about
where PLI childrens problems with conversational interaction might lie. This
replicates the findings of Bishop and Adams (1989) and Bishop et al. (2000).

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Catherine Adams and Julian Lloyd

Although the PLI and control groups both generally displayed fairly high
degrees of responsiveness to adult solicitations, the PLI group was more likely to
give pragmatically inappropriate, inadequate and no responses than were the
controls.
An examination of communicative act types observed in conversation revealed
differences between the PLI and control groups. Compared with the controls, the
PLI group used higher proportions of questions, clarification requests, clarifications
and recapitulations. This pattern of results might be predicted based on the findings
of previous work on PLI children (Adams and Bishop 1989). The contrast between
the ceiling effects in the elicitation task and the discriminative power of the
conversation task suggests there is a strong effect of context for processing
pragmatic language for the PLI group. Capturing the additional load involved in
moving from pragmatics as a formal or abstract level of linguistics and the
conversation task that taps into situated pragmatics (Duchan 2000) is the key to
accessing communicative functions and conversational behaviours which will form
the basis of intervention.
One of the aims of this study was to consider which assessments have the
potential to function as outcome measures. The measures will be dependent, of
course, on the age and nature of the children receiving the intervention. For the
age group of children under consideration here, communicative function elicitation
tasks are an inadequate means of measuring change since they cannot tap into the
childs difficulties with the complexities of verbal interaction. Conversational
measures both communicative functions within conversations and conversational
indices have more discriminatory power and therefore more potential to show
change.
The third research question addressed was concerned with the estimation
of variation in pragmatic performance on these two assessment procedures. There
is obviously no need to consider the elicited communicative function task since
this lacked variation in the ceiling T1 scores. There was a small variation in
pragmatic performance between T1 and T2 on conversational indices. An estimate
of the (admittedly small) degree of variation in performance on the conversation
coding is now available to factor in to the outcome measures in the intervention
stage of the study. Change in pragmatic performance which claims to be causally
related to the presence of the intervention would need to be significantly greater
than this.
Conversation coding therefore holds promise for outcome measurement, but
it is time consuming and requires more work to ensure its clinical applicability.
The conversation coding system employed here requires further refinement to
produce a time-limited procedure that can be used in intervention studies (Adams
et al. submitted). The resulting data might help us to determine whether the
conversational, linguistic and/or social behaviour of children with PLI can change as
a result of intervention.
There is a danger in any outcome study that even well-designed and evaluated
measures will not tell us what we can see happening before our eyes. To ward off
such failures with this population, it will be necessary to develop outcome measures
that are detailed enough to show changes in subtle complex and high-level pragmatic
abilities (such as time-limited conversation analysis), but which are sufficiently broad
such to detect generalization of gains expected to pervade family life and school
performance. In addition to the measures of communicative function outlined in

Children with pragmatic language impairments

345

this paper, assessment protocols must extend to other aspects of language behaviour
(narrative and inferential comprehension), to social attribution and participation, to
the childs ability to interact verbally at home and in school, and the impact of
intervention on educational performance.
Acknowledgements
Thanks to the assessors Esther Gilman and Yvonne McGoldrick, and to the North
West, West Midlands and Northern Ireland language units and therapists. Thanks
also to Dorothy Bishop for continued support and the use of ALICC. The project
was supported by an ESRC Realising Our Potential Award to the first author. An
earlier version of the paper was presented at the joint RCLST/CPLOL Conference,
Edinburgh, UK, 2003.
References
ADAMS, C., 2001, Clinical diagnostic studies of children with semanticpragmatic language disorder.
International Journal of Language and Communication Disorders, 36, 289306.
ADAMS, C., Inferential comprehension in children with pragmatic language impairments (in preparation).
ADAMS, C. and BISHOP, D. V. M., 1989, Conversational characteristics of children with semantic
pragmatic language disorder. I: Exchange structure, turn taking, repairs and cohesion. British
Journal of Disorders of Communication, 24, 211239.
ADAMS, C., COOKE, R., CRUTCHLEY, A., HESKETH, A. and REEVES, D., 2001, Assessment of Comprehension and
Expression 611 (ACE 611) (Windsor: NFER-Nelson).
ADAMS, C., GREEN, J., GILCHRIST, A. and COX, A., 2002, Conversational behaviour of children with
Asperger syndrome and conduct disorder. Journal of Child Psychology and Psychiatry, 43, 679690.
ADAMS, C., LLOYD, J., ALDRED, C. and BAXENDALE, J. (Submitted) Exploring the effects of communication
intervention for developmental pragmatic language impairments: a signal-generation study.
BEDROSIAN, J. L. and WILLIS, T. L., 1987, Effects of treatment on the topic performance of a school age
child. Language, Speech and Hearing Services in Schools, 18, 158167.
BISHOP, D. V. M., 1998, Development of the Childrens Communication Checklist (CCC): a method of
assessing qualitative aspects of communication impairment in children. Journal of Child Psychology
and Psychiatry, 39, 879891.
BISHOP, D. V. M., 2000, Pragmatic Language Impairment: a correlate of SLI, a distinct subgroup, or part
of the autistic continuum? In D. V. M. Bishop and L. Leonard (eds), Speech and Language
Impairments in Children: Causes, Characteristics, Intervention and Outcome (Hove: Psychology Press),
pp. 99114.
BISHOP, D. V. M., 2003, The Childrens Communication Checklist 2 (London: Psychological Corporation).
BISHOP, D. V. M. and ADAMS, C., 1989, Conversational characteristics of children with semantic
pragmatic disorder. II: What features lead to a judgement of inappropriacy? British Journal of
Disorders of Communication, 24, 241263.
BISHOP, D. V. M. and ADAMS, C., 1991, What do referential communication tasks measure? Some
evidence from language-impaired children. Applied Psycholinguistics, 12, 199216.
BISHOP, D. V. M., CHAN, J., ADAMS, C., HARTLEY, J. and WEIR, F., 2000, Conversational responsiveness in
specific language impairment: Evidence of disproportionate pragmatic difficulties in a subset of
children. Development and Psychopathology, 12, 177199.
BISHOP, D. V. M., HARTLEY, J. and WEIR, F., 1994, Why and when do some language-impaired children
seem talkative? A study of initiation in conversations of children with semanticpragmatic
disorder. Journal of Autism and Developmental Disorder, 24, 177197.
BOTTING, N. and CONTI-RAMSDEN, G., 1999, Pragmatic language impairment without autism. Autism, 3,
371396.
BOTTING, N. and ADAMS, C., 2005, Semantic and inferencing abilities in children with communication
disorders. International Journal of Language and Communication Disorders, 40, 4966.

346

Catherine Adams and Julian Lloyd

BOUCHER, J., 1998, SPD as a distinct diagnostic entity: logical considerations and directions for future
research. International Journal of Language and Communication Disorders, 33, 71108.
CAMARATA, S. M. and NELSON, K. E., 1992, Treatment efficiency as a function of target selection in the
remediation of child language disorders. Clinical Linguistics and Phonetics, 6, 167178.
CONANT, S., BUDOFF, M., HECHT, B. and MORSE, R., 1984, Language intervention: a pragmatic approach.
Journal of Autism and Developmental Disorders, 14, 301317.
CRAIG, H., 1995, Pragmatic impairments. In P. Fletcher and B. MacWhinney (eds), The Handbook of Child
Language (Cambridge, MA: Blackwell), pp. 623640.
CREAGHEAD, N., 1984, Strategies for evaluating and targeting pragmatic behaviours in young children.
Seminars in Speech and Language, 5, 241252.
DUCHAN, J., 2000, Preface: Assessing childrens language: present, past and future. Topics in Language
Disorders, 21, 189192.
DUNN, L. M., DUNN, L. M. and WHETTON, C. W., 1997, The British Picture Vocabulary Scale, 2nd edn
(Windsor: NFER-Nelson).
FEY, M. E., 1986, Language Intervention with Young Children (Boston: College Hill).
GALLAGHER, T. and CRAIG, H., 1984, Pragmatic assessment: analysis of highly frequent repeated
utterances. Journal of Speech and Hearing Disorders, 49, 368377.
GRAY C, A., 1998, Social stories and comic strip conversations with students with Asperger Syndrome
and High-Functioning Autism. In E. Schopler and G. Mesibov (eds), Asperger Syndrome or HighFunctioning Autism? (New York: Plenum), pp. 167198.
GRUNDY, P., 2000, Doing Pragmatics (London: Arnold).
LEINONEN, E. and LETTS, C., 1997, Why pragmatic impairment? A case study in the comprehension of
inferential meaning. European Journal of Disorders of Communication, 32, 3552.
LEINONEN, E., LETTS, C. and SMITH, R., 2000, Childrens Pragmatic Communication Difficulties (London:
Whurr).
LETTS, C. A. and REID, J., 1994, Using conversational data in the treatment of pragmatic disorder in
children. Child Language Teaching and Therapy, 10, 122.
LLOYD, J., 2003, Spoken communication between deaf and hearing pupils. In C. Gallaway and A. Young
(eds), Deafness and Education in the UK: Research Perspectives (London: Whurr), pp. 5374.
LLOYD, J., LIEVEN, E. and ARNOLD, P., 2001, Oral conversations between hearing-impaired children and
their normally hearing peers and teachers. First Language, 21, 83107.
MELINE, T. and BRACKIN, S., 1987, Language impaired childrens awareness of inadequate messages.
Journal of Speech and Hearing Disorders, 52, 263270.
NORBURY, C. F., NASH, M., BAIRD, G. and BISHOP, D. V. M., 2004, Using a parental checklist to identify
diagnostic groups in children with communication impairment: a validation of the Childrens
Communication Checklist 2. International Journal of Language and Communication Disorders, 39,
345364.
PAUL, R., 1995, Language Disorders from Infancy Through Adolescence: Assessment and Intervention (St Louis:
Mosby).
PHELPS-TERASKI, D. and PHELPS-GUNN, T., 1992, Test of Pragmatic Language (Hove: Psychological
Corporation).
PRUTTING, C. A. and KIRCHNER, D. M., 1987, A clinical appraisal of the pragmatic aspects of language.
Journal of Speech and Hearing Disorders, 52, 105109.
RICE, M., SELL, M. and HADLEY, P., 1990, The Social Interactive Coding System: An on-line, clinically
relevant descriptive tool. Language, Speech and Hearing Services in Schools, 21, 214.
RICHARDSON, K. and KLECAN AKER, J., 2000, Teaching pragmatics to language-learning disabled children: a
treatment outcome study. Child Language Teaching and Therapy, 16, 123.
RINALDI, W., 1996, Understanding Ambiguity: An Assessment of Pragmatic Meaning Comprehension (Windsor:
NFER-Nelson).
RINALDI, W., 2001, Social Use of Language Programme (SULP) Revised (Windsor: NFER-Nelson).
WIIG, E. and SECORD, W., 1989, Test of Language Competence Expanded Edition (Hove: Psychological
Corporation).
WILLCOX, A. H. E. and MOGFORD-BEVAN, K., 1995, Conversational disability: assessment and remediation.
In M. Perkins and S. Howard (eds), Case Studies in Clinical Linguistics (London: Whurr),
pp. 146180.
ZIATAS, K., DURKIN, K. and PRATT, C., 2003, Differences in assertive speech acts produced by children
with autism, Asperger Syndrome, specific language impairment and normal development.
Development and Psychopathology, 15, 7394.

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Appendix: Pragmatic behaviours assessed via the elicitation
procedure

Communicative functions
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Greeting
Request for an object
Request for information
Comment on an object
Demonstration/explanation
Predicting
Hypothesizing/giving a reason
Denial/correction
Making choices
Giving reasons
Closing

Conversational devices
12.
13.
14.
15.
16.
17.
18.
19.

Answering
Volunteering to communicate
Attending to the speaker
Taking turns
Maintaining a topic
Asking questions
Requesting clarification
Clarifying

Extract from an elicitation script.

Communicative function: explaining.
Context from the elicitation script: the tester takes out a gift box. The tester says, I know what we can
do next. My friend has gone on holiday and hes asked me to give this to his mum. Its her birthday.
Should I take a peek inside to see what hes bought her? They open the box together: it contains an
unfamiliar object. The tester says, Ive never seen one of those before. How does it work?