• Users Online: 227
  • Home
  • Print this page
  • Email this page
Home Current issue Archives Ahead of print Search Subscribe Instructions Submit article About us Editorial board Contacts Login 

 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 42  |  Issue : 3  |  Page : 148-157

The effect of age on the degree of improvement of pragmatics in delayed language developed children


1 Department of Phoniatrics, Alexandria University, Alexandria, Egypt
2 Department of Psychiatry, Alexandria University, Alexandria, Egypt

Date of Submission11-Apr-2021
Date of Decision22-May-2021
Date of Acceptance09-Jun-2021
Date of Web Publication28-Sep-2021

Correspondence Address:
Heba E.A.El Wafa
Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, 00
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejpsy.ejpsy_14_21

Rights and Permissions
  Abstract 


Background The study of actual language use is called “pragmatics.” The literal meaning of an utterance is necessary, but not sufficient for the partner to reconstruct the meaning conveyed by the actor. The interventions of pragmatic impairments depend mainly on improving the four important aspects for any effective social communication contexts that are social interactions, social cognition, language processing, and pragmatic skills.
Aim The paper aims to study the effect of age on pragmatic intervention to decide what age is more appropriate to give the better response of pragmatic impaired children.
Patients and methods This study was conducted on 20 children with pragmatic impairments attending the Unit of Phoniatrics, in the outpatient clinic of Alexandria Main University Hospital. The children of the study were divided into two groups: group A: 10 children with pragmatic skill impairments aged (5–<6.5) years old and group B: 10 children with pragmatic skills impairments aged (6.5–8) years old. First, Initial assessment: (A) elementary diagnostic procedures: history taking, general examination. (B) Clinical diagnostic aids: psychometric evaluation, Arabic language test, and pragmatic language skills evaluation by using the Arabic version of Test of Pragmatic Language second edition, which is a subtest of Comprehensive Arabic language test. Second, Intervention: the program was applied to all children in groups of 2–3 children, one session per week, each session ranging from 45 to 60 min. Two types of interventions were applied which were: (a) direct intervention: typically delivered by speech-language pathologist and (b) indirect interventions: typically consisted of advices and instructions to the parents or to support the generalization of social communication skills in the child’s environment. “Say and Do Positive Pragmatic Fun Sheets” program helps children learn to use appropriate social communication skills in everyday situations. The fun sheets target a variety of social communication skills in the following areas: giving information, persuasion, requesting, problem solving, feelings, appropriate interaction, greetings/politeness, and topic maintenance. The duration of therapy was about 3–6 months. Third, Reevaluation: after a period of 3–6 months of therapy using the protocol of initial assessment.
Results A statistically highly significant increase in the scores of the cases of the school-age studied groups A and B was seen when comparing between pre- and posttherapy, and no statistically significant difference when comparing posttherapy scores between the two studied groups.
Conclusion There is no difference in improvement degree of pragmatics in the two age groups so starting therapy can be done at any age to improve the pragmatic skills of children.

Keywords: age, arabic, communication, fun sheets, pragmatics


How to cite this article:
Maghraby RE, Sayed WE, Wafa HE. The effect of age on the degree of improvement of pragmatics in delayed language developed children. Egypt J Psychiatr 2021;42:148-57

How to cite this URL:
Maghraby RE, Sayed WE, Wafa HE. The effect of age on the degree of improvement of pragmatics in delayed language developed children. Egypt J Psychiatr [serial online] 2021 [cited 2021 Dec 8];42:148-57. Available from: http://new.ejpsy.eg.net/text.asp?2021/42/3/148/326848




  Introduction Top


The pragmatic impairments are defined as inappropriate and ineffective use of language and gestures for social communication within the social contexts (Adams, 2005).

The long-term impact of pragmatic impairments is a risk factor for emotional and behavioral difficulties. Many children with pragmatic language impairments experience problematic peer relationship and have a negative impact on the social participation that may ultimately lead to a higher risk of mental health problems (Conti-Ramsden and Botting, 2004; Whitehouse et al., 2009; Ketelaars et al., 2010; Ellis Weismer 2013; Bishop, 2014).

There are two types of pragmatic impairments:
  1. Primary pragmatic impairments: it shows limitations of speech acts and inference arising directly from the limitations in social development irrespective of language status as in high functional autism (Denniset al., 2001).
  2. Secondary pragmatic impairments: due to the lack of language experience or very limited language repertoire as in specific language impairments and/or learning disabilities (Prutting and Kittchner, 1987).


Diagnostic criteria of Social Communication Disorder in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American Psychiatric Association, 2013; Swineford et al., 2014):
  1. Persistent difficulties in the social use of verbal and nonverbal communication as in the following symptoms:
    1. Impairments in the use of language for social communication purposes, such as greeting and asking for information.
    2. Impairments in the ability to change the communication style to match context or the needs of the listener, such as speaking differently in an education sitting than on physical education classes, talking differently to a baby than to an adult like a father.
    3. Impairments within the way of using conversation and storytelling rules, such as taking turns in conversation, rephrasing when misunderstood and breaking down, and impairments in knowing how to use verbal and nonverbal signals to manage the social communication and interactions.
    4. Difficulties in understanding and making inferences of nonliteral language, idioms, humor, metaphors, multiple meanings that depend on the context for interpretation.
  2. The results of pragmatic deficits lead to functional limitations in effective communication, social participation, social relationships and academic achievement, or occupational performance.
  3. The onset of symptoms is within the early developmental period (but deficits cannot become completely evident until demands for social communication exceed the limited capacities).
  4. The symptoms are not due to any other medical or psychological condition or poor morphological, semantic and grammatical skills, and do not seem to be better explained by autism spectrum disorder, intellectual disability, global developmental delay, or another disturbance.


The interventions for pragmatic language impairments and social communication problems focus mainly on improving the main four elements that are social interactions, social cognition, language processing, and pragmatic skills; all the previous elements are very important for any effective social communication contexts (Adams, 2005).

The speech-language pathologists (SLPs) combine a direct approach (fostering remediation of impairment within the child) with an indirect approach (adaptation of the context to match the needs of the child) and the implementation of these interventions is often based on the individual profile of pragmatic impairments (Adams et al., 2006).

The modified form of “Say and Do Positive Pragmatic Fun Sheets” program (Gill et al., 2003) is a rehabilitation program that targets social communication skills and includes activities targeting how to give information, persuasion skills, requesting, problem solving, feelings and emotions, recognition and correction of inappropriate behaviors, using appropriate greeting and various politeness forms, and taking conversational turns in a specific topic.


  Aim Top


This work aims to study the effect of age on pragmatic intervention to decide what age is more appropriate to give the better response of pragmatic impaired children.


  Patients and methods Top


Patients

This study was conducted on 20 children with pragmatic impairments attending the Unit of Phoniatrics, in the outpatient clinic of Alexandria Main University Hospital.

Inclusion criteria

Children complaining of pragmatic impairments and delayed language of both sexes, in the age ranging from 5 to 8 years who were identified either by the complaint of the parents or by the results of formal assessment.
  • Group A: 10 children with pragmatic skill impairments aged (5–<6.5) years old.
  • Group B: 10 children with pragmatic skills impairments aged (6.5–8) years old.


Exclusion criteria

  1. Children with intellectual disability.
  2. Children with brain damage.
  3. Children with hearing impairment or visual impairment.
  4. Psychiatric problems [e.g., autistic spectrum disorder (ASD)].


Sample size calculation: performed by medical research institute—Department of Medical Statistics, Alexandria University.

Z-test power analysis: CL.0.95 N20 K2 n10 precision 0.05, Effect size 30.00.

So a minimal hypothesized total sample size of 20 Egyptian school-aged children with language impairment, both sexes (10 each group), is needed to detect assumed average proportional improvement in the pragmatic composite score (30%) for the two groups independently after conducting a scheduled training program taking in consideration 5% sample error and 95% level of confidence using χ2 test.


  Methods Top


Initial assessment

The children of the study were evaluated by the following protocol of assessment:
  1. Elementary diagnostic procedures:
    1. History taking including personal data, complaint, analysis of symptoms, and detailed present, past, and family history.
  2. Clinical diagnostic aids:
    1. Psychometric evaluation:
      1. Stanford-Binet Scale 4th edition to assess mental age, verbal intelligence quotient, abstract intelligence quotient, and general intelligence quotient (كيرلس, 1998).
      2. Childhood Autism Rating Scale is conducted if needed to exclude autism spectrum disorder (Shopleret al., 1986).
    2. Arabic language test (Kotbyet al., 1995):
      1. To assess receptive language, expressive language, semantics, and total language. The child’s score was then compared with the mean of his age group to determine the child’s language age and language defects.
    3. Pragmatic skills evaluation:
      1. Arabic version of Test of Pragmatic Language second edition (TOPL2), which is a subtest of Comprehensive Arabic language test, is used to assess pragmatic language skills (Ras and El-maghraby, 2008).
      2. The test has four principal uses: identifying individuals with pragmatic language deficits, determining individual strengths and weaknesses, and documenting an individual’s progress.
    4. Audiological evaluation:
      1. It is conducted if needed for the exclusion of audiological problems.
    5. Ophthalmological evaluation:
      1. It is conducted if needed for the exclusion of visual problems.


Intervention

The program was applied to all children in both studied groups A and B, in groups of 2–3 children according to age, general IQ, and total language score, one session per week, each session ranging from 45 to 60 min. The training sessions were administered by SLP in the Unit of Phoniatrics, Faculty of Medicine, Alexandria Main University Hospitals. The duration of therapy was about 3–6 months.

An informed consent was orally taken from parents and/or legally caring surrogate in addition to the child’s assent of all children participating in the study.

Two types of interventions were applied that were:
  1. Direct intervention: it was typically delivered by SLP.
  2. Indirect interventions: typically consisted of advices and instructions to the parents or primary caregivers to support the generalization of social communication skills in the child’s environment.


Parents were invited to attend the therapeutic sessions to observe and learn the therapeutic techniques to promote more effective communication with their children in the child’s environment.

The following steps were applied during each therapeutic session for pragmatic impairments:
  1. At the beginning of each session:
    1. Talking about the target, the concept, and the intent of the targeted social communication skill.
    2. Giving several examples about the targeted skill of the session before asking the child to take a turn.
  2. Then:
    1. Reading the instructions on the top of each funny sheet and explaining the instructions to the children to know how to play.
    2. Practicing the targeted social communication skill in the fun sheets of the chapter by asking each child to take one turn before beginning the second round in the game.
    3. Using different therapeutic techniques according to the nature of the targeted skill, for example, modeling, group work, role-play, and practicing the targeted pragmatic skill during conversations.
    4. Immediately after each child’s turn, using praise in case of a correct answer but in case of an inappropriate answer, giving corrective feedback and asking the child to repeat the utterance to use the correct target form.
    5. Not finishing the activity sheet until each child used the targeted skill form correctly more often than not.
  3. At the end of the session: modeling the targeted social communication skill between the children or between children and their attended parents to stimulate the real conversation and generalization.
  4. Terminal criterion for any targeted social communication skill from one of the following (Paul, 1992):
    1. According to Paul (1992) in the “pragmatic activities for language intervention” program: the termination criterion is at the discretion of the clinician, in addition to the opinion and recommendation of the attended parents or primary caregiver.


The “Say and Do Positive Pragmatic Fun Sheets” program (Gill et al., 2003)

“Say and Do Positive Pragmatic Fun Sheets” program helps children learn to use appropriate social communication skills in everyday situations by completing the fun sheets. The activities of fun sheets include a variety of engaging things to do including fill-ins, role-playing, stories, matching, and more. The fun sheets target a variety of social communication skills in the following areas:
  1. Giving information
  2. Requesting
  3. Persuasion
  4. Problem solving
  5. Greetings/politeness
  6. Appropriate interaction
  7. Feelings
  8. Topic maintenance


“Say and Do Positive Pragmatic Fun Sheets” is a fun program for students, aged from 5 to 13 years old who have social communication impairments. Some fun sheets can be done at home. All sheets need minimal preparation and do not consume the time of the sessions. Each targeted skill is introduced to the child by different activities; the used activities make the sessions more fun and the child more interested.

Each chapter targets one of the social communication skills and contains from 11 to 13 exercises. The exercises in each chapter are arranged in order from easier to more difficult level as in the appendix of this recent study.

Reassessment

The children of the studied groups were evaluated by the same protocol of assessment after a period of 6 months of therapy.

Statistical methodology

Data were fed to the computer and analyzed using IBM SPSS software package version 20.0 (SPSS I, 2011).

Qualitative data were described using number and percent.

The Kolmogorov-Smirnov test was used to verify the normality of distribution (Lilliefors, 1967).

Quantitative data were described using range (minimum and maximum), mean, SD, median, and interquartile range.

The significance of the obtained results was judged at the 5% level.

The tests used in this study are:
  1. χ2 test:
    • For categorical variables, to compare between different groups.
  2. Fisher’s exact or Monte Carlo correction:
    • Correction for χ2 when more than 20% of the cells have expected count less than 5.
  3. Student’s t test:
    • For normally distributed quantitative variables, to compare between two studied groups.
  4. Paired t test:
    • For normally distributed quantitative variables, to compare between two periods.
  5. Pearson coefficient:
    • To correlate between two normally distributed quantitative variables.
  6. Mann-Whitney test:
    • For abnormally distributed quantitative variables, to compare between two studied groups.
  7. -Wilcoxon signed ranks test:


For abnormally distributed quantitative variables, to compare between two periods.


  Results Top


Characteristics of the studied groups ([Table 1] and [Table 2])
Table 1 Descriptive analysis of the studied groups according to Stanford-Binet intelligence scale (n=20)

Click here to view
Table 2 Distribution of the studied children in both groups A and B according to pretest Arabic language test scores

Click here to view


According to the Stanford-Binet intelligence scale ([Table 1]){Table 1}

[Table 1] shows no significant difference between the studied groups A and B regarding verbal IQ, abstract IQ, and general IQ.

According to pretest Arabic language test scores ([Table 2]){Table 2}

In group A, the mean of receptive language was 79.40 with SD ±11.83, the mean of expressive language was 79.0 with SD ±10.35, the mean of semantics was 134.2 with SD ±6.53, and the mean of total language was 301.1 with SD ±26.36.

In group B, the mean of receptive language was 82.30 with SD ±10.77, the mean of expressive language was 84.20 with SD ±11.85, the mean of semantics was 140.1 with SD ±5.30, and the mean of total language was 315.6 with SD ±26.09.

No significant differences were detected between the studied groups A and B regarding receptive, expressive, and total language scores, whereas there was a highly significant difference between the two studied groups regarding the semantics of the language.

Comparison between the studied groups before and after therapy as regard to formal testing

Pragmatic skill evaluation by using the Arabic version of Test of Pragmatic Language second edition ([Figure 1],[Figure 2],[Figure 3])
Figure 1 Comparison between pre- and posttherapy of studied children in group A.

Click here to view
Figure 2 Comparison between pre- and posttherapy of studied children in group B.

Click here to view
Figure 3 Comparison between pre- and posttherapy of both studied groups A and B according to Test of Pragmatic Language second edition.

Click here to view


In group A, there was a statistically significant increase in regulating, informing, and expressing scores and a statistically highly significant increase in requesting, organizing devices, and total pragmatic scores.

In group B, there was a statistically significant increase in expressing scores and a statistically highly significant increase in requesting, informing, organizing devices, and total pragmatic scores.

However, no significant differences were detected between the studied groups A and B regarding regulating, informing, expressing, requesting, organizing devices, and total pragmatic scores in posttherapy results.

Arabic language evaluation by using Arabic language test ([Figure 4])
Figure 4 Comparison between pre- and posttherapy of both studied groups according to Arabic language test.

Click here to view


In group B, there was a statistically significant increase in semantics scores and statistically highly significant increase in receptive, expressive, and total Arabic language scores.

However, no significant differences were detected between the studied groups A and B regarding receptive, expressive, semantics, and total Arabic language scores in posttherapy results.

Comparison between both studied groups according to the improvement in pretest total pragmatic scores of TOPL2 ([Table 3], [Figure 5])
Table 3 Comparison between both studied groups according to the improvement in pretest total pragmatic scores of TOPL2

Click here to view
Figure 5 Comparison between both studied groups A and B according to the improvement in pretest total pragmatic scores of Test of Pragmatic Language second edition.

Click here to view


There was no statistically significant difference in the improvement in pretest total pragmatic scores of TOPL2 of both studied groups A and B.,

In group A, the mean of increase in pretest total pragmatic scores was 17.20±2.44, whereas the mean of increase in pretest total pragmatic scores of group B was 19.10±4.07.


  Discussion Top


Language assessment

Standardized tests of language proved to be essential as outcome measures for pragmatic language intervention because most children showed strong signals of change in language skills (Adams et al., 2006).

The current study showed a consistent pattern of improvement in all items of the Arabic language test in both studied groups A and B. This improvement could be explained in the study of Adams et al. (2006) in which the study was conducted on six children aged between 5 and 9 years with pragmatic language impairments who received 8 weeks of intensive pragmatic intervention. The six children were assessed before and after therapy by Assessment of Comprehension and Expression (Adams, 2011) and Clinical Evaluations of Language Fundamentals Test (CELF) (Semel et al., 2000). These changes could be explained as a generalized effect of treatment due to the changes that were made in the children’s social environments by the teachers and parents of six children. Another contributory factor may be increases in confidence and motivation toward language as a result of the intervention (Adams et al., 2006).

Test of Pragmatic Language-2nd edition (TOPL2)

The current study showed a consistent pattern of improvement in all items of the Arabic version of TOPL2 in both studied groups A and B. The average range of TOPL2 in group A was 9–22 in pretherapy assessment and increased to the average range of 24–40 in posttherapy assessment and the average improvement range between pretest and posttest scores was 18.0 (15.0–18.0). The average range of TOPL2 in group B was 15–21 in pretherapy assessment and increased to the average range of 36–39 in posttherapy assessment and the average improvement range between pretest and posttest scores was 19.0 (16.0–22.0).

Data were consistent with the recent results demonstrated in the study of Hyter et al. (2001) in which six participants were assessed before and after therapy for pragmatic language abilities by the TOPL. The intervention sessions occurred over an 8-week period and were scheduled twice weekly and the duration of each session was 30 min. Pretesting on the TOPL indicated that all participants were in the below-average range (80–89) and the posttest scores indicate that three participants’ scores increased to the average range (90–110) and the other three participants improved to the above-average range (111–120) and the results of the statistical analysis were that the t tests yielded statistically significant differences at the 0.01 level between pre- and posttest scores on the TOPL. Most participants’ TOPL scores changed after the intensive pragmatic intervention that had a positive effect on pragmatic skills especially describing information, giving directions (step by step), stating personal opinions about inappropriate behavior (judgments), and negotiating for desired outcomes (Hyter et al., 2001).

The results of the current study could also be explained by the study of Adams et al. (2012).

In that study, a single-blind randomized controlled trial (RCT) design was used to detect and evaluate the effectiveness of Social Communication Intervention Project (SCIP) for the students who have pragmatic impairments with or without features of ASD. The experimental treatment was an intensive manualized social communication intervention that aimed to improve the impairments in semantics and high-level language skills, pragmatic difficulties, and social interaction. The 88 children with pragmatic and social communication impairments, aged 5 year and 11 months, 10 year and 8 months were randomly distributed in a 2 : 1 ratio to SCIP or treatment-as-usual (TAU). Every student in the SCIP condition received up to 20 sessions of direct intervention. The results of two interventions (SCIP or TAU) were assessed before therapy, immediately after therapy, and at 6-month follow-up by CELF Fourth Edition (Semel et al., 2006) and Core Language Standard Score (CLSS) for language skills and parent-reported pragmatic functioning and social communication, teacher-reported ratings of classroom learning skills, and blind-rated perceptions of conversational competence for social communication skills.

The result of the SCIP intervention compared with TAU on standardized language assessment was no significant intervention effect on the structural language measures (CELF-4 and CLSS), and these results were not consistent with the results of the current study and the explanations of this contradiction between the two studies were that over one-third of participants were performing well within the normal range on CELF-4 and CLSS at pretherapy assessments. The standardized language assessments lacked the sensitivity to the impairments of a high-level language and big changes in raw scores were required to show the shifts in the standard scores of language assessments. There were significant remediation effects of the SCIP intervention when compared with TAU on the social communication skills after the comparison between pre- and posttherapy by the all previously mentioned tests and reports (Adams et al., 2012).

In the recent study, no significant differences were detected between the two studied groups A and B regarding posttherapy Arabic language test and Arabic version of TOPL2 scores. These results might be because no significant differences were detected in pretherapy TOPL 2, Arabic language test, Stanford-Binet test scores that indicate matching of both groups. According to demographic data, 70% of group A were above 5 years and 6 months of age, whereas 60% of group B were around the age of 6 years and 6 months that indicates a lack of low extreme ages of group A and a lack of high extreme ages of group B so the studied samples of both groups A and B were not suitable to study the effect of the training program on different age groups.


  Conclusion Top


There is no difference in improvement degree of pragmatic skills in the two age groups so starting therapy can be done at any age to improve the pragmatic skills of children.

Recommendations

The study should be applied on wider age groups to decide the better age of application of the intervention program to obtain better and faster results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





[23]

 
  References Top

1.
Adams C (2005). Social communication intervention for school-age children: rationale and description. In: Seminars in speech and language. New York, NY: Thieme Medical Publishers, Inc. 181–188. Vol. 26  Back to cited text no. 1
    
2.
Adams C, Lloyd J, Aldred C, Baxendale J (2006). Exploring the effects of communication intervention for developmental pragmatic language impairments: a signal‐generation study. Int J Lang Commun Disord 41:41–65.  Back to cited text no. 2
    
3.
Adams C (2011). Clinical diagnostic studies of children with semantic–pragmatic language disorder. Int J Lang Commun Disord 36:289–306.  Back to cited text no. 3
    
4.
Adams C, Lockton E, Freed J, Gaile J, Earl G, McBean K et al. (2012). The Social Communication Intervention Project: a randomized controlled trial of the effectiveness of speech and language therapy for school‐age children who have pragmatic and social communication problems with or without autism spectrum disorder. Int J Lang Commun Disord 47:233–244.  Back to cited text no. 4
    
5.
Association AP (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). 5th ed. Arlington, VA: American Psychiatric Association.  Back to cited text no. 5
    
6.
Bishop DV (2014). Pragmatic language impairment: a correlate of SLI, a distinct subgroup, or part of the autistic continuum? In: Bishop DV, Leonard LB editors. Speech and language impairments in children: Ch 6. London, New York: Psychology Press 113–128.  Back to cited text no. 6
    
7.
Conti-Ramsden G, Botting N (2004). Social difficulties and victimization in children with SLI at 11 years of age. J Speech Lang Hear Res 47:145–161.  Back to cited text no. 7
    
8.
Dennis M, Lazenby AL, Lockyer L (2001). Inferential language in high-function children with autism. J Autism Dev Disord 31:47–54.  Back to cited text no. 8
    
9.
Ellis Weismer S (2013). Developmental language disorders: challenges and implications of cross-group comparisons. Folia Phoniatr Logop 65:68–77.  Back to cited text no. 9
    
10.
Gill K, De Ninno J, Callough M, Ink B (2003). Say and do positive pragmatic game boards fun sheets. Greenville, SC: Super Duper Publications.  Back to cited text no. 10
    
11.
Hyter YD, Rogers-Adkinson DL, Self TL, Simmons BF, Jantz J (2001). Pragmatic language intervention for children with language and emotional/behavioral disorders. Commun Disord Q 23:4–16.  Back to cited text no. 11
    
12.
Ketelaars MP, Cuperus J, Jansonius K, Verhoeven L (2010). Pragmatic language impairment and associated behavioural problems. Int J Lang Commun Disord 45:204–214.  Back to cited text no. 12
    
13.
Kotby MN, Khairy A, Barakah M, Rifaie N, El-Shobary A (1995). Language testing of Arabic speaking children. In: Proceedings of the XXIII World Congress of the International Association of Logopedics and Phoniatrics. pp. 236–266  Back to cited text no. 13
    
14.
Lilliefors HW (1967). On the Kolmogorov-Smirnov test for normality with mean and variance unknown. J Am Stat Assoc 62:399–402.  Back to cited text no. 14
    
15.
Paul R (1992). Pragmatic Activities for Language Intervention (PALI): semantics, syntax, and emerging literacy: Pro-Ed  Back to cited text no. 15
    
16.
Prutting CA, Kittchner DM (1987). A clinical appraisal of the pragmatic aspects of language. J Speech Hear Disord; 52:105–119.  Back to cited text no. 16
    
17.
Ras YA, El-maghraby RM (2008). Comprehensive Arabic language test as a tool for assessing delayed language impaired Egyptian children. PhD thesis: Alexandria University 35–49.  Back to cited text no. 17
    
18.
Semel E, Wiig E, Secord W (2000). Clinical Evaluation of Language Fundamentals — Third Edition (UK) (Hove: Psychological Corporation).  Back to cited text no. 18
    
19.
Semel E, Wiig EH, Secord W (2006). Clinical evaluation of language fundamentals - fourth edition UK Hove: Harcourt assessment.  Back to cited text no. 19
    
20.
Shopler E, Reichler R, Renner B (1986). The Childhood Autism Rating Scale (CARS) for diagnostic screening and classification in autism. New York, NY: Irvington.  Back to cited text no. 20
    
21.
SPSS I (2011). IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.  Back to cited text no. 21
    
22.
Swineford LB, Thurm A, Baird G, Wetherby AM, Swedo S (2014). Social (pragmatic) communication disorder: a research review of this new DSM-5 diagnostic category. J Neurodev Disord 6:1–8.  Back to cited text no. 22
    
23.
Whitehouse AJ, Line E, Watt HJ, Bishop DV (2009). Qualitative aspects of developmental language impairment relate to language and literacy outcome in adulthood. Int J Lang Commun Disord 44:489–510.  Back to cited text no. 23
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Aim
Patients and methods
Methods
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed112    
    Printed0    
    Emailed0    
    PDF Downloaded12    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]