Pragmatic Disorders in the Twenty-First Century

In 40 years, pragmatics has moved from a position of relative obscurity in the study of language disorder to become an area of central interest to clinicians and researchers in speech-language pathology. Several factors have contributed to the growing prominence of pragmatics in a clinical context. They include the recognition of pragmatics as a branch of linguistics on an equal footing to disciplines like syntax and semantics, the realisation that many clients have intact structural language skills but still communicate inadequately, and the development of better techniques for the assessment and treatment of individuals with pragmatic language impairments. The emergence of clinical pragmatics has resulted in many achievements, not least for the management of children and adults with pragmatic disorders. But we would do well not to assume that these achievements will simply continue in the years to come. For the substantial present-day gains of clinical pragmatics to be extended into the future, new directions for research need to be explored. In this chapter, I reflect on the form that these directions might take, and consider the clinical populations and issues that might concern speech-language pathologists in the years ahead. In thinking about new priorities in clinical pragmatics, the chapter considers how disciplines such as neuropsychology and psychiatry will have an increased role to play in our understanding of pragmatic disorders. The chapter will also address a growing diagnostic role for pragmatic language impairments in the management of clients with psychiatric disorders and conditions such as dementia. If these new directions prove to be correct, the first 40 years of clinical pragmatics will have prepared the ground for many more years of fruitful intellectual and clinical inquiry in pragmatics.