Unit 3: Semantics, pragmatics, and clinical and developmental contexts

The disciplines of clinical and developmental pragmatics emerged during the 1970s and 1980s. They were triggered, in part, by the kinds of concern over a purely semantic conception of language and meaning we usually associate with the ordinary language philosophers – in particular, Austin, Searle and Grice (see A3–A5). Clinical pragmaticians, such as Rapin and Allen (1983, 1988) and Bishop and Rosenbloom (1987), were particularly troubled by a focus on single words and sentences ‘as the only units of meaning’, within clinical practice, because it meant that:

disproportionate emphasis was placed on structural language skills, often at the expense of any consideration of how clients used their language skills in a range of communicative situations. Also, despite the fact that normal language skills do not produce utterances in a linguistic vacuum, assessment and treatment of language skills proceeded by and large on the basis of single word and single sentence productions. In attempting to eliminate these assumptions, or at least reduce their significance, clinicians and researchers embraced new methods of pragmatic assessment and treatment, redefined notions of treatment efficacy in pragmatic terms and even devised new nosological [i.e. disease-related] categories to reflect the clinical significance of impairments of pragmatic language skills. (Cummings 2009: 11)

We provide you with three studies below, so that you can become more familiar with these two important applied approaches.


  • Archer, D. (2011) ‘Theory and practice in pragmatics’. In: Archer and Grundy (eds.) The Pragmatics Reader. London and New York: Routledge, pp471–81
  • Archer, D. and P. Grundy (2011) The Pragmatics Reader. London and New York: Routledge (especially Section 8, Pragmatics and conversation – development and impairment)
  • Bishop, D.V.M. and L. Rosenbloom (1987) ‘Classification of childhood language disorders’ in W. Yule and M. Rutter (eds.) Language Development and Disorders, London: Mac Keith Press
  • Cummings, L. (2009) Clinical Pragmatics, Cambridge: Cambridge University Press
  • Rapin, I. and D.A. Allen (1983) ‘Developmental language disorders: nosological considerations’ in U. Kirk (ed.) Neuropyschology of Language, Reading and Spelling, New York: Academic Press, pp155–84
  • Rapin, I. and D.A. Allen (1988) ‘The semantic-pragmatic deficit disorder: classification issues’, International Journal of Language and Communication Disorders 33: 82–87

3.1 The semantic–pragmatic interface and the meaning of conjunctions

If you had to explain conjunctions to someone who was struggling with the notion that and can be used to join, or to differentiate between,and but to contrast two propositions, would you opt for a syntactic, semantic or pragmatic description?1

Paltiel-Gedalyovich (2002) argues for a clinical approach that is attuned to pragmatic principles. The reason? Children begin to use connectives, such as and and but, from the toddler period (Clark 1973; see also 3.3 on this site). However, the acquisition of their full semantic – and then pragmatic – meaning is thought to occur gradually through mid-childhood (Caplan 1996: 161); such that, by adulthood, competent speakers can readily manipulate pragmatic principles as a means of generating context-specific implicatures. Paltiel-Gedalyovich (2002: 204) provides the following example, in which Speaker B manipulates the Manner Maxim (Grice 1975), as a means of signalling that she believes the other Beatles contributed much less to the band’s success than Paul McCartney:

Speaker A:            Do you think that all the Beatles contributed equally to their success?
Speaker B:            Well, Paul wrote the songs and Paul played the songs and Paul sang the songs.

Paltiel-Gadalyovich (2002: 209) suggests that, when clinicians prioritize syntactic deficits, in a way that instructs children to recognize – so that they might remove – potentially deletable material such as the above, they are in danger of teaching them ‘to always delete this material’ (even though, as in this case, the repetitive use of and can serve important, pragmatic purposes in context). She also highlights the potential dangers of an approach that is too attuned to the semantics of a conjunction (such as or), such that ‘the emphasis in therapy’ is very much ‘on the possible meanings, rather than on the calculations made by speaker and listener in encoding and deriving meaning’ (ibid.: 209). Paltiel-Gadalyovich therefore promotes a pragmatic-based clinical approach, which attempts to teach the child to recognize the speaker’s intention in using and, or and but. This might involve teaching the child to distinguish those contexts where ‘it is more appropriate to delete (be brief)’ from ‘those contexts, where it is more appropriate not to delete’ (and, hence, intentionally flout the Manner Maxim).


The need to understand syntactic, semantic and also pragmatic meaning in order to use conjunctions felicitously has led researchers like Paltiel-Gadalyovich (ibid.: 205) to ascertain whether (children’s) tests relating to their use already assess pragmatic capabilities as opposed to testing merely syntactic and semantic knowledge (as they purport to). Paltiel-Gadalyovich provides the example of the Token Test for Children(TTFC) (DiSimoni 1978; see also the 1987 CELF-R test) which requires children to pick up only one of two visual items in response to a verbal instruction using the coordinator or:

  1. Visual stimulus: diagram
  2. Verbal stimulus:             Point to the small circle or the large square

The correct response, according to the test’s authors, requires pointing to only one shape – that is, the small circle only or the large square only. Yet, according to Paltiel-Gadalyovich, the truth conditions of or also allow for a third possibility: pointing to both the small circle and then the large square. This leads Paltiel-Gadalyovich to conclude that the ‘error’ of pointing to both the small circle andthe large square (as opposed to only one of the two) has to be pragmatically determined, via conversational implicature. Spell out that implicature below, by filling in the missing words:

  1. The ______ used or not ___.
  2. If the speaker had used ___, then s/he would have definitely wanted me to point to two items.
  3. Since the speaker chose or, choosing a coordinator which expects me to point to only ___ item, s/he must expect me to choose only ___. Otherwise the speaker, in observing the maxim of _________ would have chosen ___.

Do you agree with Paltiel-Gadalyovich that our understanding – and use – of or and and has as much (if not more) to do with pragmatics as semantics and/or grammar, and hence is best explained to children via conversational implicature rather than by semantic or syntactic theory only? What might be lost if clinicians fail to consider pragmatic competence?


  • Caplan, R. (1996) ‘Discourse deficits in childhood schizophrena’ in J.H Beitchman, N.J. Cohen, M.M. Konstantarea and R. Tannock (eds.)  Language, Learning, and Behavior Disorders, Cambridge: Cambridge University Press, pp156-177
  • Clark, E.V. (1973) ‘How children describe time and order’ in C.A. Ferguson and D.I. Slobin (eds.) Studies of Child Language, New York: Holt, Rinehart and Winston, pp586-606
  • DiSimoni, F. (1978) The Token Test for Children, Hingham, Mass: Teaching Resources Corp
  • Grice, H.P. (1975) ‘Logic and conversation’, in P. Cole and J. Morgan (eds) Syntax and semantics 3: speech acts, pp. 41–58. New York: Academic Press. Reprinted in Grice 1989: 22–57
  • Paltiel-Gedalyovich, L.R. (2002) ‘Testing linguistic concepts: Are we testing semantics, syntax or pragmatics?’ In: Fava (ed.) Clinical Linguistics: theory and applications in speech pathology and therapy, pp197–212. Amsterdam and Philadelphia: John Benjamins
  • Rapin, I. and D.A. Allen (1988) ‘The semantic–pragmatic deficit disorder: Classification issues’, International Journal of Language and Communication Disorders 33: 82–7
1You might remember that the coordinating conjunction and formed part of our discussion of – the potential difference between – conversational implicature and pragmatic enrichment (A3.5). We also asked you to determine how the ‘consequence sense’ of and is derived in propositions such as ‘Tom dropped the vase and it broke’ as part of the B3.2.1 Task.

3.2. Clinical Pragmatics and Conversation Analysis

Clinical pragmatics is one of the areas where pragmatic theory and conversation analysis regularly overlap (see A6). In his 1999 article ‘Discourse, pragmatics, conversation, analysis’, for example, Schegloff uses a conversation analytic approach to demonstrate how Alvin (a commissurotomy 1 patient) was able ‘to parse and to grasp the talk’ of a Principal Investigator (Ezra) and Testing Assistant (Dan) and also ‘respond effectively in interaction’ to them prior to the start of a test – albeit using gestures and physical actions as opposed to verbal turns-at-talk. This was surprising, at the time of publication, as Alvin’s medical condition was believed to lead to problems in respect to ‘turn-taking, the doing of ... commands and requests’, and the appropriate use ‘of conventional norms we ordinarily term “etiquette” or “politeness”’ (ibid.: 418). Moreover, formal testing procedures undertaken on Alvin seemed to confirm he did, indeed, experience problems – especially when it came to understanding indirect requests. Yet, Schegloff found Alvin was able to respond to an address by name (by looking directly at the Speaker), to move his chair when asked ‘Can you come a bit closer to the table?’, and even interpret the initial ‘absence of approval’ for his new physical position as an indication of perhaps not having moved enough, at which point he moved a little more without being prompted to do so. Schegloff argues that this constitutes ‘a kind of sensitive micro-tuning and adjustment of conduct to interactional contingencies in a request/compliance sequence’ (ibid.: 423), and also that, as:

The form ‘can you come a bit closer ...’ ... literally asks a question about ability or capacity [this] ‘request for action’ has to be analyzed out of this utterance as the indirect speech act being enacted. This is ... just the sort of non-literal usage which – in the common view – persons with a discourse/pragmatic deficit would be expected to have trouble with. (ibid.: 421)

Schegloff also queries whether Alvin’s cough (with his hand covering his mouth) is indicative of him having chosen the most opportune moment to clear his throat (as none of the participants were engaged in ‘active interaction’ at this point). If it was, Schegloff believes that we can interpret this as ‘etiquette’, that is, ‘another of the components of pragmatics and interactive discourse organization’ (ibid.: 424). Schegloff goes on to conclude that:

in order to understand the physical movements which constitute the whole of Alvin’s participation in this episode – indeed to come to ‘see’ them at all, in an analytic sense – we need to appreciate ... their status as social actions [i.e. c]ompliance, responsive attention deployment, approval solicitation, and the like ... (ibid.: 424)


As Schegloff (1999) ably demonstrates, there is much to be gained from observing the minutiae of people’s actions as they engage in normal conversation – in both a clinical context and, also, to better understand the human communicative process more generally. This might involve the use of speech or the use of physical actions and gestures. Spend some time observing this minutiae of communicative behaviour in others (in terms of their use of speech and also their use of physical actions and gestures). You might also consider videoing yourself communicating with family and friends (having secured their permission first!). In this way, you will be able to review the recordings over time – as a means of improving your observational and analytical skills.


  • Schegloff, E.A. (1999) ‘Discourse, pragmatics, conversation, analysis’, Discourse Studies 1(4): 405–35

1 ‘Commissurotomy’ is the name given to a procedure whereby the corpus callusom is surgically severed, with the result that the right and left hemispheres of the brain can no longer communicate.

3.3 Developmental Pragmatics and the Turn-Taking Capacity of Infants

As the name suggests, developmental pragmaticians investigate the way(s) in which language-intact children develop their pragmatic skills and/or competence. Prominent among the earliest researchers was Elizabeth Bates (1974, 1976), who not only pioneered the modern study of child language development, but was one of the first researchers to emphasize the pragmatic dimensions of language acquisition. Bates was particularly interested in how the brain processes language. However, in contrast to Chomsky’s ‘standard’ and ‘extended standard theories’ (1965, 1971), which promoted the idea of a language acquisition device, Bates believed that linguistic knowledge is distributed throughout the brain and hence that the acquisition of language rests on a foundation of general mental abilities. Bates and her colleagues were particularly keen to document preverbal infants’ proto-imperative and proto-declarative competencies: that is, the use of a combination of intentional vocalizations and gestures by 8–10 month old infants as a means of eliciting help or obtaining desired objects (Bates et al. 1975), as Bates believed these vocal and gestural activities served as building blocks for toddlers’ later verbal communications.

By about the same age – 8–10 months – infants developing normally can also engage in meaningful turn-taking sequences with ‘sensitive’ adult interlocutors (e.g. their caregivers). ‘The crucial role’ of the sensitive adult is demonstrated by the fact that the same pattern of turn alternations is not evident in peer–peer interaction until around the age of 3.

As Ninio and Snow (1996: 91) explain:

Once children have learned to take their turns reliably they are faced with the problem of maintaining the turn—holding the floor. This may be a more serious problem for children than for adults, since children speak relatively slowly and dysfluently; [and] pauses and dysfluencies represent opportunities for the interlocutor to seize a turn. Adults [therefore] tend to protect children’s turns, but in peer-interaction situations children must learn to hold the floor long enough to finish their own turns, a challenge that becomes greater as one’s playmates become more skilled in exploiting opportunities to seize the floor.

By the age of 4, however, most normally developing children have learned how to signal that their turn is not yet complete, by using devices like sentence-initial and or repetitive et puis (‘and then’).


Donahue et al. (1980) suggested that a useful way of investigating children’s interactional (and, in particular, topic-initiating and maintaining) strategies is to get them to role-play, as though they were an interview host of – or interviewee on – a talk show. Schley and Snow (1992) have since adapted this approach slightly so that the children are asked to ‘interview’ an adult interviewee for a period of some four minutes. Importantly, the adult interviewee is usually instructed to be ‘politely responsive but not helpful in keeping the conversation going’ (Ninio and Snow 1996: 159). What age of children do you think would be able to cope with such role-play? Can you see any potential weaknesses with this approach, be they age specific or applicable to all age groups? What are they? What kinds of linguistic evidence would you use to gauge whether a child’s conversational skills were good or poor?


  • Bates, E. (1974) ‘The acquisition of pragmatic competence’. Journal of Child Language 1(2): 277–82
  • Bates, E. (1976) Language and Context: Studies in the Acquisition of Pragmatics, New York: Academic Press
  • Bates, E., L. Camaioni, and V. Volterra (1975) ‘The acquisition of performatives prior to speech’ Merill-Palmer Quarterly 21: 205–26
  • Chomsky, N. (1965) Aspects of Theory of Syntax, Cambridge, MA: MIT Press
  • Chomsky, N. (1971) ‘Deep structure, surface structure, and semantic interpretation’ in D.D. Steinberg and L.A. Jakobovitz (eds.) Semantics: An Interdisciplinary Reader in Philosophy¸ Linguistics and Psychology, Cambridge: Cambridge University Press, pp182-216
  • Donahue, M., R. Pearl and T. Bryan (1980) ‘Conversational competence in learning disabled children: responses to inadequate messages’, Applied Psycholinguistics 1: 387–403
  • Ninio, A. and C.E. Snow (1996) Pragmatic Developments: Essays in developmental science. Boulder, CO: Westview Press (Chapters 3–6 provide a comprehensive picture of ‘normal’ pragmatic development from infancy to approximately 3 years; Chapters 7 and 8 focus on the development of conversational ability and connected discourse)
  • Schley, S. and C.E. Snow (1992) ‘The conversational skills of school-aged children’, Social Development 1: 18–35