The visual-gestural modality as a theoretical challenge for clinical pragmatics

This paper argues that the visual-gestural modality modality of sign languages poses a central theoretical challenge for clinical prag- matics. Traditional models, largely based on spoken languages, as- sume a linear and sequential organization of interaction. Italian Sign Language (LIS), by contrast, relies on simultaneity, spatial structuring, and the integration of manual and non-manual resources, thereby re- shaping the conditions of meaning construction. The paper shows that key domains such as reference, discourse coherence, and interactional alignment cannot be directly mapped onto spoken-language models, but must be reconceptualized in terms of spatial reference and multi- modal coordination. This has important implications for the identifica- tion and assessment of pragmatic deficits. Autism Spectrum Disorders (ASD) are examined as a testing ground. Evidence from signers with ASD suggests that pragmatic difficulties emerge primarily in the coor- dination of multiple channels rather than in modality-specific deficits, while sign languages make these difficulties more visible. The paper concludes that clinical pragmatics must adopt a modality-sensitive perspective, redefining pragmatic competence as the coordination of distributed semiotic resources.