Extra credit

Assessing Child and Adolescent Pragmatic Language Competencies: Toward Evidence-Based Assessments

Robert L. Russell Æ Kenneth L. Grizzle

Published online: 3 April 2008

� Springer Science+Business Media, LLC 2008

Abstract Using language appropriately and effectively in

social contexts requires pragmatic language competencies

(PLCs). Increasingly, deficits in PLCs are linked to child and

adolescent disorders, including autism spectrum, external-

izing, and internalizing disorders. As the role of PLCs

expands in diagnosis and treatment of developmental psy-

chopathology, psychologists and educators will need to

appraise and select clinical and research PLC instruments

for use in assessments and/or studies. To assist in this

appraisal, 24 PLC instruments, containing 1,082 items, are

assessed by addressing four questions: (1) Can PLC domains

targeted by assessment items be reliably identified?, (2)

What are the core PLC domains that emerge across the 24

instruments?, (3) Do PLC questionnaires and tests assess

similar PLC domains?, and (4) Do the instruments achieve

content, structural, diagnostic, and ecological validity?

Results indicate that test and questionnaire items can be

reliably categorized into PLC domains, that PLC domains

featured in questionnaires and tests significantly differ, and

that PLC instruments need empirical confirmation of their

dimensional structure, content validity across all develop-

mental age bands, and ecological validity. Progress in

building a better evidence base for PLC assessments should

be a priority in future research.

Keywords Pragmatic language competence � Assessment of language skills � Childhood disorders � Social communication skills � Childhood language disorders

Assessing Pragmatic Language Competencies: Toward

Evidence-Based Assessments

Until recently, even the most commonly used language

assessment instruments (e.g., CELF-3, TOLD, etc.) did not

include evaluations of each of the four most widely rec-

ognized language domains (syntax, semantics, phonology,

and pragmatics). In fact, pragmatic language competencies

(PLCs)—the ability to appropriately and effectively use

language in social contexts—were not examined by any of

the common language assessment instruments. Although

this is no longer the case, PLC assessments are still omitted

in many general measures of language competence. Even

when included, the assessment of PLCs is less circumspect

than the evaluation of syntax, vocabulary, and semantics.

Although the latter domains are crucial in children’s lan-

guage development, the success and appropriateness of an

utterance in context depends on far more than a sentence’s

grammaticality, vocabulary, and meaning (Ninio and Snow

1999). The way in which a child’s language is used in the

important contexts and encounters in their social environ-

ment (e.g., home, school, peer environments) may be more

relevant to adjustment and social success than their com-

petence in the more traditionally assessed language areas.

For example, strong empirical evidence has linked def-

icits in PLCs with many developmental, communication,

learning, and psychiatric disorders. It is well known that

PLC deficits are symptomatic of children with autism

spectrum disorders [PDD, NOS, Autism, and Asperger

Disorder; ASD] (Lord 1993; Mawhood et al. 2000; Rapin

1996; Tager-Flusberg 1993; Tager-Flusberg and Caronna

2007), even when these children demonstrate normal or

near normal development of other language competencies

such as in syntax (Barrett et al. 2004; Bishop 2000; Norbury

et al. 2004). But the linkage of PLC deficits with ASDs is

R. L. Russell (&) � K. L. Grizzle Department of Pediatrics, Medical College of Wisconsin,

8701 Watertown Plank Road, P.O. Box 26509, Milwaukee,

WI 53226-0509, USA

e-mail: [email protected]

123

Clin Child Fam Psychol Rev (2008) 11:59–73

DOI 10.1007/s10567-008-0032-1

not unique (Botting and Conti-Ramsden 1999). Children

with Attention-Deficit/Hyperactivity Disorder (ADHD)

have substantial PLC deficits. In fact, the severity, if not the

form, of PLC deficits in children with ADHD can approx-

imate those of children with ASD (Bishop and Baird 2001)

and children with language disorders (Russell et al. sub-

mitted). Not surprising, then, that children with ADHD are

found to differ reliably from typically developing controls

(Geurts et al. 2004) in the degree of their PLC deficits. In

addition, PLC deficits have also been identified in children

with Conduct Disorder (CD) and Oppositional Defiant

Disorder (Gilmour et al. 2004), with more than two-thirds

of the children with CD also exhibiting PLC deficits.

The extensiveness of PLC deficits across these disrup-

tive behavior disorders has suggested that the DSM-IV

criteria for ADHD, ODD, and possibly CD may contain

symptomatic descriptions that partially characterize

comorbid PLC impairments (Camarata and Gibson 1999;

Russell 2007; Tannock 2000; Westby and Cutler 1994). By

‘‘comorbid’’ it is meant that their deficits in PLCs are so

pervasive as to seriously impair the children’s functional

adaptation across a variety of contexts, not that children

with various psychiatric diagnoses simply have some

pragmatic language issues. It is well established that

structural language disorders and psychiatric difficulties

are commonly comorbid, in the first sense. Twenty-six

years ago, Baker and Cantwell (1982a, b) reported that

over half (53%) of language and speech disordered chil-

dren were found to have a diagnosable psychiatric disorder.

These substantial comorbidity rates have been corroborated

in subsequent studies (Cohen et al. 1993, 1998) and are

observed whether examining language-disordered children

for unsuspected psychiatric disorders or vice versa.

Comorbidity rates of 50% are twice as high as the esti-

mated 25% comorbidity rate between childhood

psychiatric disorders (Costello et al. 2003). In addition,

Beitchman et al. (2001) discovered that 40% of children

identified with early speech and/or language impairment

had some type of psychiatric diagnosis in adulthood, with

anxiety disorders being the most common. These and other

studies (e.g., Fujiki et al. 2002; Jerome et al. 2002) provide

strong evidence of the relationship between language

functioning, psychiatric status, and emotional adjustment.

However, these research studies were based on language

evaluations that did not formally assess children’s PLCs,

raising strong suspicion that comorbidity rates between

language disorders and psychiatric disorders would actu-

ally be higher, if PLCs had been assessed.

Because emerging research links childhood externaliz-

ing and internalizing disorders to PLC deficits (Im-Bolter

and Cohen 2007), it is both timely and important to

familiarize psychologists and educators with domains of

pragmatic competence and to evaluate the content and

other forms of validity associated with PLC assessment

instruments (Adams 2001; Adams et al. 2006; Farmer and

Oliver 2005; Hyter et al. 2001; Penn 1999; Richardson and

Klecan-Aker 2000; Weist et al. 1991a, b). Fortunately,

there is an extensive research and theoretical literature on

many domains comprising pragmatic competence dating

back to the 1970s (e.g., Freedle 1977; Halliday 1973;

Hymes 1974; Russell 1979a, b, c; Schiffrin 1987; Snow

and Ferguson 1977). Moreover, the assessment of chil-

dren’s PLCs has long been recognized as crucial among

speech language pathologists, even if historically such

assessments relied on structured participant observation

rather than on validated questionnaires or tests. The

importance afforded PLC assessments by speech language

pathologist, however, is plainly evident in Cantwell and

Baker’s (1987) diagnostic decision tree model. In that

model, PLCs are at the top node of their diagnostic deci-

sion tree, just below the evaluation of sensory (e.g.,

hearing) factors that may contribute to language

dysfunction.

The central role of PLCs in typical and atypical child-

hood development is also acknowledged by current efforts

to devise and evaluate PLC assessment instruments (e.g.,

Adams 2002). As new and updated editions of language

tests incorporate PLC subscales, psychologists and educa-

tors will need to grow familiar with and knowledgeable

about PLC deficits to carry out routine psychological and

educational assessments, in addition to knowing when to

refer their child patients for more specialized assessments

conducted by speech language pathologists. In this regard,

appraisals of the content, structural/dimensional, ecologi-

cal, and diagnostic validity of PLC instruments are needed.

To date, little has been written about what PLC domains

are, or should be, how they are assessed, in diagnostic tests,

behavioral checklists/questionnaires, and structured par-

ticipant observations and with what comparative intensity.

Basing analyses on a broad sample of PLC (sub)tests

and checklists/questionnaires (N = 24), the present review

provides a critical appraisal of the development and utility

of PLC assessment instruments in clinical use or in

research. The review also includes recommendations of

how some of the instruments can be employed to deepen

clinical/developmental and educational evaluations. Four

key questions, addressed using quantitative and qualitative

analyses, orient the review: (1) Can the PLC domains

targeted by individual assessment items be reliably iden-

tified?, (2) What are the core PLC domains that are most

commonly assessed by checklists/questionnaires and tests?,

(3) What is the relationship between the salience of PLC

domains in tests/tasks versus checklists/questionnaires?,

and (4) What degree of content, structural, diagnostic, and

ecological validity do the PLC assessment instruments

currently have?

60 Clin Child Fam Psychol Rev (2008) 11:59–73

123

In addressing these questions, neutrality has been

maintained with respect to whether authors of the tests and/

or checklists/questionnaires advocate that the development

of PLCs drive the development of important aspects of

structural language competencies and social cognition (i.e.,

a view ascribed to functionalists) or, alternatively, that

PLCs are simply another important feature of language

such as syntax (i.e., a view ascribed to structuralists;

Ninio and Snow 1999; see also Shirk and Russell 1996,

pp. 226–258, for a functionalist application of PLCs in

understanding change processes in child psychotherapy).

Instead, the focus has been on the language domains featured

in the specific items included in checklists/questionnaires

or tests described as focusing on pragmatics. Hopefully, the

current review will help to familiarize psychologists and

educators with the types of domains that PLC instruments

contain and will serve to focus research on developing tests/

tasks and questionnaires that provide strong, evidence-based

PLC evaluations and targets for treatment (Barlow 2005;

Hunsley and Mash 2005; Weist et al. 1991a, b).

Method

Measures and Instruments

Questionnaires (with rating scales), checklists (with pres-

ent/absent scoring), and tests that assess PLCs were

identified through common search engines (e.g., MED-

LINE, PSYCHINFO) with various combinations of search

terms (e.g., social, communication, assessment, pragmatic,

language, disorder, child), review of bibliographies in book

chapters or journal articles, and through instruments and

their bibliographies available from publishers. We included

questionnaires/checklists and tests ‘‘under development,’’

if they had been used and published, even if norms were

not available. We did not, however, include lists of PLCs

provided in some articles and chapters as suggested foci for

assessments, or instruments that include a few PLC items,

if the instruments were clearly constructed for other pur-

poses (e.g., Child Behavior Checklist; Achenbach 2001).

This search resulted in the identification of 11 question-

naires, 2 checklists, and 11 tests, containing 1082 items.

Figure 1 provides the names of the questionnaires/check-

lists and tests, date of publication, and what kinds of

reference distributions and age ranges are included for each

test (Academic Communication Associates 1989; Adams

and Bishop 1989; Adams et al. 2001; Bishop 2003, 2004;

Bishop and Adams 1989; Bloom et al. 1999; Bowers et al.

1994; Brice 1992; Carrow-Woolfolk 1999; Kleiman 1994;

Leonard et al. 2002; Penn 1988; Phelps-Terasaki and

Phelps-Gunn 1992; Prutting and Kirchner 1987; Rinaldi

1996, 2001; Rubin 1985; Semel et al. 2003; Seymour et al.

2003; Smith et al. 2000; Stott et al. 2002; Wiig 1990; Wiig

and Secord 1988).

Coding system development. Domains for the PLC

coding system were drawn from the theoretical and research

literatures on pragmatics (e.g., Bach and Harnish 1979;

Britton and Pellegrini 1990; Brown and Levinson 1978;

Grice 1967; Levinson 1983; Lyons 1977; Palmer 1986;

Schenkein 1978; Searle 1969; Sperber and Wilson 2002).

Thirteen PLC domains were identified and defined for

coding purposes using this literature: Requests; Speech Acts

(variety and appropriateness); Interlocutor Variety; Gricean

Principles; Negotiations, Directions, and/or Instructions;

Conversational Turn-taking; Topic Control and Mainte-

nance; Nonliteral Language, Use of Indirection, and

Presupposition; Rituals, Greetings, Goodbyes; Nonverbal

Communication; Speech Characteristics (such as prosody)

and Fluency; Theory of Mind and Emotion Language;

Discourse Attentiveness and Empathy, and Narrative. Pre-

liminary review of two clinical questionnaires (Bishop

2003; Semel et al. 2003) also suggested the need to include

a Vocabulary and an Other category. When assessing coder

agreement and consensual classification of all items, two

further domains were deemed necessary: Syntax/Grammar

and Comprehensibility of an utterance. See Table 1 for the

17 domains, definitions, and examples. In defining domains

and in coding items, the intent was to be inclusive rather

than to exclude domains or items in the instruments because

of the degree of inference that might be necessary to relate

them to PLCs. For example, if items probed the children’s

use of mental state verbs or emotion language the item was

coded as Theory of Mind and Emotion Language, not

because theories of mind are universally accepted as prag-

matic phenomena but because the items were included in

the pragmatic instrument. Similarly, most aspects of

vocabulary and grammar would not be considered as

pragmatic phenomena per se, though they may relate to the

latter in important ways. Finally, the degree of sophistica-

tion involved in the use of PLCs was not assessed. For this

reason, for example, simple and complex requests were

both coded as Requests (see Russell 2007).

An index of the salience of PLC domains. To identify core

PLC domains empirically, two indices of each domain’s

salience were devised. The first index of salience was

determined by noting how many of the checklists/question-

naires or tests contained at least one item for each of the 17

PLC content domains. We reasoned that a domain’s cen-

trality would be reflected in the degree to which it was

included as a targeted area in the set of examined instruments.

Central PLCs would be assessed by most checklists/ques-

tionnaires and tests, whereas peripheral PLC domains would

be assessed by only a few checklists/questionnaires and tests.

The second index of salience was determined by noting

how many items were directed at each PLC content domain

Clin Child Fam Psychol Rev (2008) 11:59–73 61

123

across all the questionnaires or tests. We reasoned that a

domain’s centrality would be reflected in the number of

probes contained in this set of instruments. A PLC domain

collectively viewed as central would be probed by many

items, whereas a PLC domain collectively viewed as rel-

atively peripheral would be probed by fewer items.

To calculate the index of salience, each PLC content

domain received a ranking in terms of what proportion of

questionnaires/checklists or tests included probes relevant

to it and in terms of how many total probes it received

summing across the 24 assessment instruments. These

ranks were summed separately for questionnaires/check-

lists and tests to discover the relative salience of each of the

17 PLC domains by type of assessment methodology.

Results

Can PLC Domains Probed by Questionnaire/Checklist

and Test Items be Reliably Identified?

A random sample of 389 of the 1,082 items was selected

and coded independently by two raters using definitions

contained in Table 1. Each questionnaire/checklist and test

item was assigned to as many as three domains, with a

primary (A), secondary (B), and tertiary classification (C).

We assessed inter-rater agreement at three levels, namely:

(1) Percent of agreement of primary, (2) primary or sec-

ondary, and (3) primary or secondary or tertiary

classifications. For agreements restricted to primary clas-

sifications, the two raters agreed on 81% of their domain

classifications; for primary and/or secondary classifica-

tions, the two raters agreed on 88% of their classifications;

and for primary, secondary, or tertiary classifications, the

two raters agreed on 91% of their classifications. We fur-

ther assessed agreement using Cohen’s Kappa, an index of

agreement that adjusts for chance. An agreement was

recorded if the lead rater’s A code for a particular item was

matched by the reliability rater’s A or B code. If they did

not match, the disagreement was entered as the lead and

reliability raters’ A codes. Using this method Cohen’s

Kappa was .84, a score describing substantial strength of

agreement (Kundel and Polansky 2003; Landis and Koch

1977). This value was reproduced when using the reli-

ability rater’s A codes as the target and the lead rater’s A or

B codes for registering agreements. Most of the observed

0 5 10 15 20 25

Age in Years

ACE (2) TLC (2) UA (4)

ALICC (4) CRIL(1)

ERRNI (2) DELV (1,2)

CASL-NLL (2) CASL-PJ (2) TOPS-R (3)

TOPL (2) SULPR(4)

ORS (4) PP (1)

CCC (2) GLS (4)

TASCC (4) VPRS (4)

FCP (4) APSS (4) PCSP (4) PPR (3)

CCSR (4) PCA (4)

Fig. 1 Age appropriateness for pragmatic language questionnaires and tests. ˘ = adults. PCA = Profile of communicative appropriate- ness (1983), CCSR = Communication competence self report (1985),

PPR = Pragmatic protocol (1987), PCSP = Pragmatic communica-

tion skills protocol (1989), APSS = Adolescent pragmatics screening

scale (1992), FCP = Functional communication profile (1994),

VPRS = Verbal pragmatic rating scale (1999), TASCC = Teacher

assessment of student communicative competence (2000),

GLS = General language screen (2002), CCC = Children’s commu-

nication checklist-2 (2003), PP = Pragmatic profile (2003),

ORS = Observational rating scale (2003), SULPR = Social use of

language program-revised (2001), TOPL = Test of pragmatic

language (1992), TOPS-R = Test of problem solving-elementary,

revised (1994), CASL-PJ and NL = Comprehensive assessment of

spoken language subtests—pragmatic judgment and nonliteral lan-

guage (1999), DELV = Diagnostic evaluation of language

variation—pragmatic domain (2003), ERRNI = Expression, recep-

tion and recall of narrative instrument (2004), CRIL = Criterion

referenced inventory of language (1990), ALICC = Assessment of

language impaired children’s conversations (1989), UA = Under-

standing ambiguity (1996), TLC = Test of language competence

(1989), and ACE = Assessment of comprehension and expression

(2001). Reference distribution: 1 = criterion referenced, 2 = norm

referenced, 3 = local, 4 = none

62 Clin Child Fam Psychol Rev (2008) 11:59–73

123

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m st

a n

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ju st

/m o

d ifi

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n d

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o ti

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s, d

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a n

d in

st ru

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s

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b e s

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s a b

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n e g

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p ri

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d o

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f m

in d

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), q

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fo r)

,

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n (b

e re

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a n

t) ,

a n

d m

a n

n e r

(a v

o id

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sc u

ri ty

a n

d a m

b ig

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b e

b ri

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a n

d o

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e a c h

in a c c o

rd

w it

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e p

ri n

c ip

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f c o

-o p

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(m a k

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c o

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ib u

ti o

n fi

tt in

g to

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te d

p u

rp o

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c u

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lk )

T e ll

s p

e o

p le

th in

g s

th e y

a lr

e a d

y k

n o

w

Clin Child Fam Psychol Rev (2008) 11:59–73 63

123

disagreements occurred due to one rater utilizing the

‘‘Other’’ category as their A code without providing a B or

C code. With 17 domains, 453 of the 482 questionnaire/

checklist items (roughly 94%) and 597 of the 600 test items

(roughly 99%) could be classified consensually to their

primary PLC domain.

What are the Core PLC Domains Sampled in

Questionnaires/Checklists and Tests?

For questionnaires/checklists alone. Each of the 17

domains received a rank in terms of how many of the

questionnaires/checklists included at least one domain-

relevant item and in terms of the number of domain-rele-

vant items that were included across the 13 questionnaires/

checklists (see Table 2). Summing these two rank orders

provided a basis to estimate the relative salience of PLC

domains, and presumably their importance. The six most

salient domains were, in descending order: Requests;

Speech Characteristics and Fluency; Nonverbal

Communication; Topic Control and Maintenance; Con-

versational Turn-taking; and Negotiations, Directions, and/

or Instructions. The six least salient areas were, in

ascending order: Comprehensibility; Rituals, Greetings, or

Goodbyes; Nonliteral Language, Use of Indirection or

Presupposition; Syntax/Grammar; Speech Acts; and Nar-

rative. In addition, the second to the last row in Table 2

provides the total number of the 17 PLC domains that each

questionnaire/checklist probed. As is evident, no ques-

tionnaire/checklist had items that assess all PLC domains.

However, two probe 15 of the 17 domains. On the other

hand, six questionnaires/checklists probe less than 10 of the

PLC domains. Finally, only four questionnaires/checklists

probe all six of the most salient areas: the ORS, TASCC,

PP, and APSS.

For tests alone. Each of the 17 domains received a rank

in terms of how many tests included at least one item

relevant to its PLC domain and in terms of the number of

domain-relevant items that were included across the 11

tests (see Table 3). As with the questionnaires/checklists,

Table 2 Domains of pragmatic skill probed by thirteen questionnaires: salience and content validity

CCC ORS TASCC PP APSS PCPS PCA SULPR CCSR PPR FCP GLS VPRS RQ,RT a R Ranks

(final rank Q)

Req 1 5 3 12 8 9 5 8 2 4 2 1,1 2 (1)

SpFl 7 1 7 2 1 12 4 3 5 3 3,3 6 (2)

NoVer 5 2 10 10 7 2 6 6 7 2,4 6 (2)

TopCon 1 1 2 3 3 5 5 5 4 1 6,2 8 (3)

ConTurn 2 1 3 2 2 1 2 8 8 3 5,3 8 (3)

NDI 1 2 2 7 3 9 7 1 1 4,4 8 (3)

LocVar 3 1 8 4 1 1 1 3 2 8,4 12 (4)

ToMEL 7 1 2 1 12 2 1 7,6 13 (5)

Gric 6 2 1 2 1 2 1 1 4 10,4 14 (6)

Voc 10 3 1 1 2 1 2 1 9,5 14 (6)

DisAtt 4 1 3 3 4 1 4 1 9,5 14 (6)

Nar 3 2 2 1 11 1 1 9,6 15 (7)

SpActs 1 1 4 9 2 7 8,7 15 (7)

SynG 3 2 4 4 1 11,8 19 (8)

NLit 3 2 3 2 2 12,8 20 (9)

Rit 1 4 2 1 1 1 13,7 20 (10)

Compre 4 2 14,9 23 (11)

Total Coded 60 26 49 51 38 58 41 48 19 30 16 11 6

Total

#Domains

15 15 14 13 12 11 10 9 8 7 7 7 3

Unable to code 10 2 1 1 10 29 3 1 1

CCC = Children’s communication checklist-2, ORS = Observational rating scale, TASC = Teacher assessment of student communicative

competence, PP = Pragmatics profile, APSS = Adolescent pragmatics screening scale, PCSP = Pragmatic communication skills protocol,

PCA = Profile of communicative appropriateness, SULPR = Social use of language program-revised, CCSR = Communication competence

self report, PPR = Pragmatic protocol, FCP = Functional communication profile, GLS = General language screen, VPRS = Verbal pragmatic

rating scale, SULP = Social use of language program a

RQ, RT gives the rank of the pragmatic domain in terms of how many questions target it across all of the questionnaires and in terms of how

many of the 13 questionnaires target it at least once

64 Clin Child Fam Psychol Rev (2008) 11:59–73

123

summing these two rank orders provided a basis to estimate

the relative salience of PLC domains, and presumably their

importance. The six most salient areas are, in descending

order: Requests; Narrative; Nonliteral Language, Use of

Indirection, or Presupposition; Nonverbal Communication;

Theory of Mind and Emotion Language; and Rituals,

Greetings, or Goodbyes. The six least salient areas are, in

ascending order: Discourse Attentiveness and Empathy;

Interlocutor Variety; Comprehensibility; Gricean Princi-

ples; Topic Control and Maintenance; and Speech Acts.

The second to the last row in Table 3 provides information

about the total number of the 17 domains that each test

probed. As is evident, no test probes more than 10 of the 17

domains. Finally, only one test probes all six of the most

salient PLC domains: the TOPS-R.

For tests and questionnaires/checklists together. Table 3

also contains the results for tests and questionnaires/

checklists combined in its last column. The six most salient

PLC domains across tests and questionnaires are, in

descending order: Requests; Nonverbal Communication;

Negotiations, Directions, or Instructions; Speech Charac-

teristics and Fluency; Theory of Mind and Emotion

Language; and Narrative. The six least salient PLC

domains across tests and questionnaires are, in ascending

order: Comprehensibility; Discourse Attentiveness and

Empathy; Interlocutor Variety; Gricean Principles; Speech

Acts; and Syntax/Grammar.

What is the Relationship Between the Salience of PLC

Domains Across Tests/Tasks and Questionnaires/

Checklists?

Comparing Tables 2 and 3 reveals several descriptive dif-

ferences between the tests and questionnaires/checklists.

For example, six of the 13 questionnaires/checklists probe

more PLC domains ([10) than the broadest test. Con- versely, there are more (sub)tests than questionnaires/

checklists that focus intensively on one or two PLC

domains. The rank orders of PLC domains in the pool of

tests versus the pool of questionnaires/checklists were

correlated. Spearman’s q was .14, p = .60, indicating that there was not a significant degree of correspondence

between the salience of featured PLC domains across tests

and questionnaires/checklists. The correlation remained

insignificant even when the comparison was restricted to

instruments that contained items probing six or more PLC

domains (q = .22, p \ .4), thus eliminating narrow band tests focusing on one or two PLC domains.

A second way to assess the salience of PLC domains in

tests versus questionnaires/checklists is to parse the PLC

domains in terms of their relative appearance develop-

mentally, as depicted in Table 1. As Adams (2002) has

indicated ‘‘assessment of language pragmatics is currently

restrained by limitations in normative methodologies.

Knowledge of developmental ‘norms’ is limited so that

only very approximate age of emergence can be provided’’

(pp. 974–975) and, we would add, age of relative mastery

and the form of the progression from emergence to mas-

tery. Therefore, the groupings should be considered

heuristic, even if based on the temporal order of develop-

ment as suggested by preliminary empirical investigations

and partly on logical considerations (Kaplan 1966; Russell

2007).

The first set of PLC domains we have labeled Precur-

sors/Enablers and include the basic emerging competencies

that are required to participate in pragmatic language

interaction. These include: ability to decode and encode

nonverbal communications; the developing sensitivity to

vocalizations and spoken language (Discourse Attentive-

ness and Empathy), development of vocalizations,

articulation, and prosodics (Speech Characteristics and

Fluency); ritual greetings/goodbyes (Rituals, Greetings,

Goodbyes), comprehensibility and the emergence of

vocabulary. The second set of PLC domains we have

labeled Basic Exchanges/Rounds. These involve those PLC

domains that facilitate discourse exchanges and rounds

across two or three turns at talk as in question/answer

sequences. These include fitting one’s conversational

contributions into the flow of interactive speech (Conver-

sational Turn-taking), the ability to seize and maintain

topics of conversations (Topic Control and Maintenance),

requests (e.g., question/answer sequences), use of a dif-

ferentiated set of speech acts (Speech Acts), the use of

syntax/grammar and ease in communicating to a variety of

listeners (Interlocutor Variety). The third set of PLC

domains we have labeled Extended Literal and Nonliteral

Discourse. These include those PLC domains that facilitate

participation in the extended discourses that build a sense

of identity and social belonging, namely, ability to partic-

ipate in the give and take of discourse (Negotiations,

Directions, or Instructions), the development and use of

theory of mind and internal emotion language (e.g., as

evidenced by use of internal state language; Theory of

Mind and Emotion Language), the ability to form and

comprehend extended narratives (Narrative), the ability to

use language in a metaphorical or nonliteral way (Nonlit-

eral Language, Use of Indirection, or Presupposition), and

the conscious orientation to being relevant, succinct, and

informing (Gricean Principles).

The number of items that fell into each of the three

developmental levels across tests and questionnaires/

checklists were tabulated. Tests had 75, 165, and 357,

while questionnaires/checklists had 158, 183, and 112

items focused on Precursors/Enablers, Basic Exchanges/

Rounds, and Extended Literal and Nonliteral Discourse,

respectively. A chi-square analysis of the number of items

Clin Child Fam Psychol Rev (2008) 11:59–73 65

123

T a

b le

3 D

o m

a in

s o

f p

ra g

m a ti

c sk

il l

p ro

b e d

b y

e le

v e n

(s u

b )t

e st

s: sa

li e n

c e

a n

d c o

n te

n t

v a li

d it

y

A L

IC C

C A

S L

-P J

T O

P S

-R T

O P

L C

R IL

D E

L V

-P D

U A

A C

E E

R R

N I

T L

C C

A S

L -N

L R

Q ,R

T a

R R

a n

k s

(fi n

a l

ra n

k Q

)

R a n

k st

o ta

l

(Q +

T )

R e q

7 2

2 3

1 3

7 6

1 1

2 ,

2 4

(1 )

1

N a r

1 0

3 2

5 1

6 8

1 ,3

4 (1

) 5

N L

it 4

1 2

2 1

0 1

1 1

4 1

5 1

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0 3

,1 4

(1 )

6

N o

V e r

1 1

4 9

5 ,2

7 (2

) 2

T o

M E

L 1

1 1

8 7

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(2 )

4

R it

1 0

2 1

2 6

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0 (3

) 8

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I 4

1 4

6 1

7 ,3

1 0

(3 )

3

S p

F l

1 2

6 1

9 9

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3 (4

) 3

V o

c 1

5 8

,6 1

4 (5

) 7

S y

n G

4 6

1 0

,5 1

5 (6

) 9

C o

n T

u rn

7 1

1 1

,5 1

6 (7

) 6

S p

A c ts

5 3

1 1

,5 1

6 (7

) 9

T o

p C

o n

6 1

1 2

,5 1

7 (8

) 7

G ri

c 4

2 1

3 ,5

1 8

(9 )

1 0

C o

m p

re 2

1 4

,6 2

0 (1

0 )

1 2

L o

c V

a r

1 5

,7 2

2 (1

1 )

1 0

D is

A tt

1 5

,7 2

2 (1

1 )

1 1

T o

ta l

C o

d e d

3 6

5 9

7 2

4 4

1 3

0 1

7 3

2 6

6 7

4 1

7 5

0

T o

ta l

#

D o

m a in

s

1 0

1 0

8 7

6 5

3 2

2 1

1

U n

a b

le to

c o

d e

2 1

A L

IC C

= A

ss e ss

m e n

t o

f la

n g

u a g

e im

p a ir

e d

c h

il d

re n

’s c o

n v

e rs

a ti

o n

s, C

A S

L -P

J =

C o

m p

re h

e n

si v

e a ss

e ss

m e n

t o

f sp

o k

e n

la n

g u

a g

e p

ra g

m a ti

c ju

d g

m e n

t su

b te

st ,

T O

P S

-R =

T e st

o f

p ro

b le

m

so lv

in g

-e le

m e n

ta ry

re v

is e d

, T

O P

L =

T e st

o f

p ra

g m

a ti

c la

n g

u a g

e ,

C R

IL =

C ri

te ri

o n

re fe

re n

c e d

in v

e n

to ry

o f

la n

g u

a g

e ,

D E

L V

-P D

= D

ia g

n o

st ic

e v

a lu

a ti

o n

o f

la n

g u

a g

e v

a ri

a ti

o n

p ra

g m

a ti

c

d o

m a in

su b

te st

, U

A =

U n

d e rs

ta n

d in

g a m

b ig

u it

y ,

A C

E =

A ss

e ss

m e n

t o

f c o

m p

re h

e n

si o

n a n

d e x

p re

ss io

n ,

E R

R N

I =

E x

p re

ss io

n ,

re c e p

ti o

n a n

d re

c a ll

o f

n a rr

a ti

v e

in st

ru m

e n

t, T

L C

= T

e st

o f

la n

g u

a g

e c o

m p

e te

n c e ,

C A

S L

-N L

= C

o m

p re

h e n

si v

e a ss

e ss

m e n

t o

f sp

o k

e n

la n

g u

a g

e n

o n

li te

ra l

la n

g u

a g

e su

b te

st a

R Q

, R

T g

iv e s

th e

ra n

k o

f th

e p

ra g

m a ti

c d

o m

a in

in te

rm s

o f

h o

w m

a n

y q

u e st

io n

s ta

rg e t

it a c ro

ss a ll

th e

te st

s a n

d in

te rm

s o

f h

o w

m a n

y o

f th

e 1

1 te

st s

ta rg

e t

it a t

le a st

o n

c e

66 Clin Child Fam Psychol Rev (2008) 11:59–73

123

in each developmental level across tests and question-

naires/checklists revealed substantial and statistically

significant differences, v2(df = 2) = 141.39, p \ .0001. Questionnaires/checklists placed more emphasis on Pre-

cursors/Enablers than tests and, conversely, tests placed

more emphasis on Extended Literal and Nonliteral Dis-

course than questionnaires/checklists. This pattern

remained even when restricting analyses to instruments

that probed at least six PLC domains, which effectively

excluded narrow band subtests that focused only on one or

two domains. In this analysis, tests had 56, 148, and 137,

while questionnaires/checklists had 157, 182, and 108

items focused on Precursors/Enablers, Basic Exchanges/

Rounds, and Extended Literal and Nonliteral Discourse,

respectively, with v2(df = 2) = 41.32, p \ .0001. As in the previous analysis, questionnaires/checklists placed

more emphasis on early developing PLCs (Precursors/E-

nablers and Basic Exchanges/Rounds) and tests placed

more emphasis on later developing skills (Extended Literal

and Nonliteral Discourse).

What is the Degree of Structural, Ecological, and

Diagnostic Validity of PLC Instruments?

The relevance of test and questionnaire/checklist items to

multiple rather than to a single PLC domain(s) could

adversely affect an instrument’s dimensional or factorial

validity. However, about half of the instruments organize

the PLC domains they sample as if they are indicators of a

unidimensional construct of pragmatic competence. The

presumed unidimensionality of these instruments has not

been examined and confirmed empirically through factor

analytic studies. In fact, only internal consistency statistics

are reported. Conversely, the other half of the instruments

present a priori subscale composites or groupings, sug-

gesting that either pragmatic competence is conceived as

multidimensional and componential or that the subscales

can be combined into a single construct (Tomblin and

Zhang 2006). An enumeration of a subset of composite

scales contained in the tests and tasks reveals many dif-

ferent and possibly conflicting emphases and

conceptualizations: Voice, Fluency, Audience, Stylistic

Variations, Kinesics and Proxemics, Appropriateness of

Communication, Rituals and Conversational Skills, and so

on. The presumed multidimensionality has not been con-

firmed empirically in any of the tests or questionnaires that

provide subscale composite scores and only one instrument

provides norms for the subscales and composites (i.e., the

CCC).

Two instruments, the General Language Screen (GLS,

Stott et al. 2002) and the Verbal Pragmatic Rating Scales

(VPRS, Bloom et al. 1999), report exploratory factor

analyses employed to discover their dimensionality. For the

former, a two-factor solution accounting for only 44% of

the total variance was deemed best, with factor 1 appearing

to be a general language skills factor (articulation,

expressive, receptive, and pragmatic) and factor 2 appear-

ing to be a receptive language skills factor (Follows two-

step instructions, understands ‘‘Where’’ questions, places

objects when asked, and enjoys listening to stories). For the

VPRS, which focuses six questions on aspects of Gricean

relevancy theory, a three-factor solution was deemed best,

with factors dubbed ‘‘Discourse Content’’ (items were

Lexical selection, Quantity, and Specificity), ‘‘Parsimony’’

(Conciseness), and ‘‘Conceptual Unity’’ (Relevancy and

Topic Maintenance). It should be noted that none of the

exploratory factor analyses have been followed by confir-

matory procedures and neither study reported factor

reliabilities.

With content validity substantially varying across tests

and questionnaires/checklists, and with structural/dimen-

sional validity almost invariably left unexamined, it may

also be instructive to characterize the diagnostic and eco-

logical validity of these PLS instruments. If we parse

ecological validity into two aspects, one focusing on

verisimilitude (i.e., the degree to which test demands

mirror those faced in one’s everyday environment) and one

focusing on veridicality (i.e., the degree to which a test

shares variance with measures of everyday functioning;

Chaytor and Schmitter-Edgecombe 2003), it is clear that

the tests and questionnaires/checklists differ substantially.

Questionnaires/checklists and observational ratings appear

to have greater verisimilitude than the tests reviewed, with

the latter appearing to assess aspects of meta-pragmatic

awareness or judgment, rather than the degree to which a

child actually uses his/her PLCs appropriately in their

everyday contexts of interaction. Knowing what one should

or might say as a response to a verbally or pictorially

depicted social situation (meta-pragmatic awareness)

appears quite different from actually saying what is

acceptable when confronted in everyday life with a real

situation (pragmatic skill), as numerous studies in moral

development and ethics have shown (e.g., McColgan et al.

1983; Thoma et al. 1991). On the other hand, many of the

tests and questionnaires/checklists report empirical findings

demonstrating that scores on the pragmatic test or ques-

tionnaire/checklist share variance with measures of real-

world functioning (such as symptom rating scales), and

thus both appear to be amassing evidence for their

veridicality.

Veridicality and verisimilitude aside, it would appear

that none of the tests or questionnaires/checklists has

demonstrated its diagnostic validity, if we mean by diag-

nostic validity the provision of replicable evidence of the

pragmatic test’s or questionnaire’s acceptable level of

sensitivity and specificity across the age levels it purports

Clin Child Fam Psychol Rev (2008) 11:59–73 67

123

to assess. Since a ‘‘Pragmatic Communication Disorder’’ is

not recognized in the current DSM or ICD nosologies, a

lack of diagnostic validity can be viewed as not very sur-

prising and/or even as a moot point. However, as

descriptors of PLC problems change from ‘‘deficits’’ to

‘‘impairments,’’ and perhaps to a more widely recognized

developmental communication disorder (i.e., not just rec-

ognized by speech language pathologists), the attainment

of diagnostic validity will be crucial.

Discussion

A growing body of research suggests that PLC deficits may

have a level of comorbidity with psychiatric disorders in

children on par with the elevated levels found for structural

language disorders. These PLC deficits are not confined to

children falling along the autism spectrum, where such

difficulties comprise one of three major classes of symp-

toms in autism and a major class of symptoms for the child

with Asperger’s disorder. Instead, PLC deficits and

impairments have been shown to be strongly associated

with ADHD, ODD, and CD and are associated with

internalizing disorders as well (e.g., Baker and Cantwell

1982a, b; Beitchman et al. 1986, 1996; Cantwell et al.

1981; Cohen et al. 1998; Ginsburg et al. 1998; Tse and

Bond 2004). The most conservative interpretation of the

relationship between PLC deficits and childhood psychi-

atric disorders would suggest that PLC deficits place a

child at substantial risk for having or developing a psy-

chiatric disorder and vice versa. The least conservative

interpretation of the relationship would suggest that there is

a heretofore widely unrecognized communication disorder,

Pragmatic Communication Disorder, distinct from

Expressive and Expressive/Receptive Communication

Disorders, and symptoms of Pragmatic Communication

Disorder have been included in and conflated with the

diagnostic criteria of other DSM-recognized disorders. One

needs only to accept the most conservative interpretation,

however, to recognize that the development and improve-

ment of PLC evidence based assessments and instruments

are crucial to better understand the causes of comorbidity

between each domain of language functioning, including

PLC and psychiatric illness. With this understanding

treatment interventions could focus on validated treatment

targets.

The PLC domains probed by the various tests and

questionnaires/checklists included in this review could be

coded with substantial inter-rater agreement. Devising two

indices of the salience of the pragmatic domains across the

tests and tasks revealed a set of core PLC domains. The

6 highest ranked core areas collapsing over tests and

questionnaires/checklists were: Requests; Nonverbal

Communication; Negotiations, Directions, or Instructions;

Speech Characteristics and Fluency; Theory of Mind and

Emotion Language; and Narrative. This represents two

early developing domains (nonverbal communication and

speech fluency), and three relatively late developing

domains (Narrative, Theory of Mind and Emotion Lan-

guage, and Negotiations, Directions, and Instructions).

Requests were the only PLC domain from the middle

developmental phase where speakers learn how to engage

in simple discourse exchanges and rounds. If restricted to

the broader band instruments which probe at least 6 PLC

domains, the top five PLC domains are the same.

Rationales for the inclusion of even these core areas in

questionnaires/checklists and in tests, however, were not

often explicitly developed. For example, the top ranked

PLC was Requests—it had the most probes directed at it

(N = 191) and was a target in the greatest number of

instruments (N = 17). There are numerous reasons why

this place of distinction makes good sense, including, (1)

The study of requests is one of, if not the most, prolific

area(s) of research in developmental pragmatics, extending

from the preverbal (proto)requests of infants to those made

with subtle degrees of indirection and politeness by teen-

agers and adults (e.g., Brown and Levinson 1978; Ervin-

Tripp 1976; Garvey 1975; Goody 1978), (2) Requests are

quintessentially social, always involving two roles, the

requester and requestee, (3) According to an influential

theory of speech acts, the Request To Be Heard is repre-

sented in the highest node of the semantic representation of

each and every utterance, and thus Requests are implicated

in all acts of speech (Labov and Fanshel 1977; Ross 1970;

Sadock 1974), and (4) Requests can vary systematically in

linguistic form, degrees of directness, and prosodic fea-

tures, making their repertoire incredibly diverse and

flexible with nearly unlimited social utility. Deficits or

impairments in the ability to make requests can thus be

seen to have ramifications across all aspects of language

communication and social adaptation, and justifies their

central place in any assessment of PLC (Russell and Koch

1991). The more difficult question is: What is the smallest

set of items trained on precisely what aspects of requests

that must be included in an assessment instrument in order

to optimize content, ecological, and diagnostic validity?

The complexity of this question grows as one appreciates

the range of sophistication (e.g., in cognitive, emotional,

and interpersonal spheres, not to mention in language per

se) that spans use of the simplest (Milk, Mommy) to the

most complex indirect requests. Obviously, the same

question needs to be addressed for each pragmatic domain.

For example, extensive rationales for a similarly central

place in PLC assessment can be made for the ability to use

and understand internal state language, intentionality,

perspective-taking, and other aspects of Theory of Mind

68 Clin Child Fam Psychol Rev (2008) 11:59–73

123

and Emotion Language. In fact, according to one theory,

the full range and appropriate selection of polite, direct and

indirect, requests presupposes advanced Theory of Mind

and Emotion Language abilities for use in assessing the

relative solidarity and status/power of the requester/re-

questee and the cost (social, monetary, time, etc.) to the

requestee if the request should be granted (Brown and

Levinson 1987). Recent research and theory also suggest

that PLC and Theory of Mind and Emotion Language are

intricately interwoven, and require intact frontal lobe and

executive function development, and thus there is consid-

erable evidence that Theory of Mind and Emotion

Language abilities should be probed by PLC assessment

instruments as well (Abu-Akel 2003; Bishop and Norbury

2005; Carlson et al. 2004; Frith and Frith 2003; Kuperberg

et al. 2000; Martin and McDonald 2003; Sperber and

Wilson 2002; Stuss et al. 2001). But how many and which

Theory of Mind and Emotion Language processes or

markers must be included in a PLC assessment instrument?

Is the use of internal state language and emotion terms a

sufficient marker or must others be included as well?

The question of which domains must be included in a

test or questionnaire/checklist and at what age bands to

achieve a valid estimate of child’s PLC level is far from

being answered. For example, narratologists and folklorists

tell us there are a delimited number of story plots available

to speakers, but nowhere in the tests and questionnaires

was extent of plot repertoires queried (Russell and Bryant

2003; Russell and van den Broek 1988; Russell and

Wandrei 1996). Similarly, items probing joint attention

were conspicuously lacking. Conversely, one can also

question why Speech Fluency was such a central domain

across these tests and tasks, especially when most of the

items probing Speech Fluency did not concern prosody, a

recognized indicator of speaker emotion and an impaired

area of speech in children along the autism spectrum.

Obviously no test can contain multiple items sampling each

and every type of nuance within and across PLC domains

and remain practicable. But, clearly, the content validity of

most of the tests and tasks reviewed appear insufficient or

lacking in empirical warrant in the sense of being based on

an explicit derivational or empirical procedures. The fact

that PLCs have a rather dramatic course of development at

least through adolescence adds a further level of compli-

cation for achieving content validity, especially as there

seems to be disparate rates of development of PLCs across

these years.

The lack of correlation between the salience of PLC

domains in tests and questionnaires/checklists is worri-

some, as both purport to be assessing aspects of the same

underlying construct(s) and there is a dearth of research

showing that outcomes of evaluations using PLC tests and

questionnaires/checklists correlate significantly with each

other at large effect size magnitudes. Further, it was

demonstrated that the instruments differ in their develop-

mental focus, with questionnaires/checklists focusing more

on the precursors and enablers (PE) and less on the more

advanced discourse skills (Extended Literal and Nonliteral

Discourse) than tests. In addition, in describing the eco-

logical validity of the tests versus the questionnaires/

checklists it appeared that they may in fact be assessing

different constructs—pragmatic skill versus meta-prag-

matic awareness. Although it is possible that measures of

meta-pragmatic awareness and pragmatic skill are so

highly correlated that their distinction is practically and

diagnostically unnecessary, in the moral development

domain, awareness turns out to be a less robust predictor of

actual behavior than was hoped (Kurtines and Greif 1974;

McColgan et al. 1983; Thoma et al. 1991). This analogy

would seem to have more than passing relevance, when it

is recalled that assessment of PLCs is focused not simply

on the acquisition of this or that decontextualized skill, but

on pragmatic skills that can be used appropriately in social

contexts of interaction. The stipulation that the skill must

be used appropriately has ineradicable moral connotations.

Clearly, the development of PLC instruments for clini-

cal use is improving, even if no test or questionnaire has

established and confirmed its dimensionality and diagnos-

tic validity. In addition, a growing set of developmental

psychopathologists involved in educational or neurocog-

nitive assessment have joined speech language pathologists

in recognizing the need for a new diagnostic category,

Pragmatic Communication Disorder. Such a diagnostic

category is needed to aptly characterize the PLC impair-

ments that beset children with and without a variety of

concomitant psychiatric disorders. Especially relevant for

these researchers/clinicians are corroborated studies of

PLC questionnaires/checklists or tests that provide esti-

mates of their satisfactory sensitivity and specificity (see

Bishop 2003, 2006 for exemplary advances in this direc-

tion; Russell et al. submitted). Here it will be necessary to

show how the symptoms of Pragmatic Communication

Disorder differ from those that characterize the other

already recognized childhood communication disorders,

namely, expressive and expressive/receptive communica-

tion disorder. There is much research to be accomplished

before Pragmatic Communication Disorder is widely rec-

ognized and incorporated into standard psychiatric

nosologies. Moreover, better characterizations of deficits in

PLCs will hopefully better elucidate the extent and patterns

of their comorbidities with psychiatric disorders. Sugges-

tions as to how PLC impairments congeal into recognizable

interaction styles and how these styles relate to psycho-

pathology have already begun (Russell 2007).

Until then, however, the many children with PLC

impairments must still be assessed and targets must be

Clin Child Fam Psychol Rev (2008) 11:59–73 69

123

identified for intervention. How should the practicing cli-

nician proceed? Our review suggests several reasonable

answers. As a broad screening of PLC functioning, several

questionnaires and an observation instrument currently

have the best content validity. These are the CCC, the

ORS, the TASCC, and the PP. Although it is unclear if

their a priori dimensional structures will be supported by

exploratory and confirmatory factor analytic studies, the

composite groupings of subscales not only make concep-

tual sense, but can also guide the characterization of a

child’s strengths and weaknesses across subdomains.

However, in this set of questionnaires and an observational

instrument, only two (CCC and PP) provide norms. As a

consequence, it would seem reasonable to use the CCC,

which has both UK and USA norms, and/or the PP as a

minimal screen for PLC deficits, in addition to structured

observations. It should be noted that these instruments can

be completed by multiple informants to achieve a more

circumspect multisource view of a patient’s PLCs in dif-

ferent contexts. To supplement their use, several

instruments can provide intense examination of a single or

a few PLC domains. For example, if a child appeared to

have difficulty with understanding and/or using nonliteral

language, on the basis of observation and questionnaire

item analysis, it would appear reasonable to select a more

narrowly targeted assessment instrument, such as the

CASL’s Nonliteral Language subtest. Those PLC domains

whose scores departed most from normative levels, on both

the broad screenings, and narrowly targeted assessments,

would be reasonable targets on which interventions could

be focused. Clearly, qualitative impressions of a child’s

PLCs are useful in the assessment process. However,

psychologists and educational personal will need to

become more adept in recognizing pragmatic deficits in the

children they evaluate and more abreast of the research

detailing their consequences for the children’s adjustment

(see Russell 2007 for several vignettes illustrating prag-

matic lapses). But there is currently little justification for

basing an assessment of a child’s PLCs on these impres-

sions alone, whether in the context of a speech/language,

educational, or psychological evaluation.

Even if the mental health and educational workforce

were collectively adept at differentiating and recognizing

PLC impairments in the children that they evaluate, there is

currently a dearth of empirically supported protocols for

use in their treatment. Clearly, developments in diagnostic

instrumentation must be matched with an intensive effort to

devise and evaluate treatment protocols for empirically

identified PLC targets. Such protocols might be fashioned

to piggyback on evidence-based treatments for the disor-

ders with which PLC impairments most often occur, first in

efficacy and then in effectiveness trials. In a word, much

needs to be done.

Our review has attempted to both characterize progress

in PLC assessment and to illustrate abiding shortcomings.

The field has been rapidly developing and there are new

instruments under development and cross-national forms

and norms of existing tests. These developments are

overwhelmingly positive and need to be sustained. How-

ever, our review suggests that the prospects for the

development of evidence-based PLC assessment instru-

ments will largely rest on the degree to which the

questionnaire/checklist and test innovators redress the type

of shortcomings we have described and illustrated.

Although these assessment instruments cannot supplant

diagnostic acumen and clinical experience, their potential

to augment them and produce more sensitive and specific

pragmatic language evaluations is obvious.

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