Improving Pragmatic and Social Cognitive Abilities of Children with Psychiatric Disturbances

“You have to come and observe him! I know the report we got from his previous school district said his language skills were average, but something is really off.” These were the words I heard from one of the classroom teachers, at my work, which just happens to be an out-of-district school program within a psychiatric day treatment facility. In our transitional program we work with children who, due to their complex diagnoses (e.g., personality, mood, anxiety, and attachment disorders), frequently cannot be accommodated within their local school district until their behaviors can be managed more effectively.

So, I set up a series of observation times for the child in question, a bright seven year-old boy named J.R. Before I did that, I carefully reviewed his records, particularly a speech and language report. A solid language test was administered, scores were explained appropriately, child did not qualify for speech-language services, end of story – but is it? After barely a 10 minute observation of JR in the recreation room, I certainly saw what the teacher meant. Despite possessing average language skills and intelligence, JR didn’t know the first thing about playing and interacting with his peers. He attempted to join games at the most inappropriate times, he tried to dominate every single conversation, and when his peers finally let him join in, he threw a tantrum when he lost a board game. Even when his peers initiated conversations with him, his responses were frequently tangential and his interests were too immature for his age, so other children quickly lost interest in further interacting with him.

To many of us in the field these are all clear signs of social pragmatic language deficits. Formal and informal testing in this area confirmed my initial impressions. The above behaviors interfere significantly with JR’s academic success in the classroom and with his social interactions in school setting, yet somehow in his language assessment report, the social pragmatic language component was not addressed.

JR’s case is not unique. Many of us routinely assess and treat social pragmatic deficits of children on the autistic spectrum. Yet, quite often, I receive speech and language evaluations on a child, diagnosed with emotional, behavioral, and psychiatric disturbances (classified as Emotionally Disturbed or Other Health Impaired in the IEP), which do not include pragmatic language assessments nor make any requests with respect to future assessment or remediation of difficulties in this area. Yet, it’s clearly evident that the child strongly needs these skills for both social and academic success.

It is very important to understand that children with psychiatric diagnoses need more than just medicine and behavior management to make them better. They need to gain the appropriate vocabulary and language abilities to talk about emotions (own and others), understand verbal and nonverbal social cues, as well as routinely engage in perspective taking, all of which, we speech-language pathologists can teach them. More awareness and advocacy is needed among speech-language professionals to understand that given appropriate goal design, we can effectively address social cognitive abilities and positively improve these children’s functioning in both school and social settings.


Tatyana Elleseff, MA CCC-SLP, is a bilingual speech-language pathologist. Presently she works for the University of Medicine and Dentistry of New Jersey and has a private practice in Somerset, NJ. She is a New York University Master’s Level graduate with Bilingual Certification from Columbia University. She is licensed by the state of New Jersey and holds a Certificate of Clinical Competence from ASHA. She specializes in working with bilingual, multicultural as well as internationally adopted children with complex medical, developmental, neurogenic, psychogenic, and acquired communication disorders.