Pragmatic language disorders as predictors of psychopathological trajectories in childhood and adolescence: a systematic review

Introduction: Pragmatic language competence, defined as the ability to use language appropriately in social contexts, is fundamental to adaptive development. Although pragmatic deficits are recognized across multiple neurodevelopmental conditions, their predictive validity for later psychopathology remains underexplored. This systematic review examines whether early pragmatic language impairments predict subsequent psychopathological outcomes in children and adolescents, thereby providing indirect, dimensional evidence relevant to the ongoing nosological debate surrounding Social (Pragmatic) Communication Disorder (SPCD), although no included study diagnosed SPCD according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria. Methods: A systematic search was conducted for longitudinal studies published between 1980 and 2025 that assessed pragmatic language skills in children aged 4 to 14 years and measured psychopathological outcomes after a minimum six-month follow-up. Methodological quality was evaluated using the Newcastle-Ottawa Scale (NOS), and the review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Results: Sixteen studies met the inclusion criteria, with eight rated as high quality, seven as moderate quality, and one as low quality. Findings suggest that pragmatic deficits may predict internalizing symptoms (anxiety, depression, suicidality), externalizing problems (hyperactivity, conduct difficulties), and persistent peer relationship difficulties. These associations appeared robust after controlling for structural language abilities and general cognitive functioning. Evidence for psychotic outcomes was less consistent. Discussion: Given the heterogeneity and methodological limitations of the evidence base, these findings should be regarded as convergent and suggestive rather than definitive. The results indicate that early pragmatic language impairments may serve as a transdiagnostic marker of vulnerability for diverse psychopathological trajectories, supporting dimensional models of psychopathology such as the Hierarchical Taxonomy of Psychopathology (HiTOP) and the Research Domain Criteria (RDoC), an interpretation that the present evidence supports indirectly rather than confirms. Routine screening for pragmatic difficulties in early childhood may identify at-risk individuals and inform preventive interventions in child and adolescent mental health services. Future research should address cross-cultural generalizability, employ multimodal assessment approaches, and test bidirectional relationships between pragmatic development and psychopathology.