ality of life. There will also be a qualitative process evaluation.
The findings of this study will inform the decision as to whether to progress to a full-scale definitive randomised controlled trial to test the effectiveness of E-PLAYS when delivered by speech and language therapists and teaching assistants within schools. The use of technology in game form is a novel approach in an area where there are currently few available interventions.
ISRCTN 14818949 (retrospectively registered).
Children with social communication impairments experience difficulties with using linguistic context to understand speakers’ meanings and, more broadly, with applying conventional norms and expectations from the wider society to relate to others . To illustrate, children with social communication impairments are likely to find it difficult to take turns during conversation, maintain a topic of conversation appropriately, recount coherent narratives, respond contingently, make inferences, understand non-literal language such as jokes, irony or sarcasm, repair communication breakdowns and generally follow conversational conventions. Pragmatic language skill may be defined as selection of the appropriate message or interpretation in relation to the communicative context . The terms ‘social communication’ and ‘pragmatic language’ are commonly used to refer to similar skills.
Recent systematic reviews of interventions for ‘social communication impairments’ or ‘pragmatic language impairments’ [3, 4] have adopted broad definitions for these terms encompassing both verbal and nonverbal aspects of communication to include abilities such as facial expression recognition and production . Whilst the terms ‘social communication’ and ‘pragmatic skill’ have often been used interchangeably in the research literature , for the current proposal, we follow the suggestion by Matthew et al.  and define ‘pragmatics’ more specifically as the linguistic component (excluding facial communication and other non-verbal communication) of social communication.
Children with social communication impairments are a heterogeneous group and encompass both clinical and non-clinical groups. Clinical groups include the categories of ‘Language Impairment’ (also commonly known as ‘Specific Language Impairment’ and, more recently, ‘Developmental Language Disorder’), ‘Social (Pragmatic) Communication Disorder’ and ‘Autism Spectrum Disorders’ as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V; ). ICD 10  as well as listing a number of pervasive developmental disorders (autism, Asperger’s and other pervasive developmental disorders) also describes a number of developmental disorders of language. Children experiencing difficulties with social communication are not limited to those covered by these DSM-V and ICD 10 diagnoses, however. Social communication and pragmatic language difficulties have also been shown to be associated with other clinical populations, notably those with ADHD  or conduct disorder [10, 11] and non-clinical groups such as shy children [12, 13]. There are also indications that social communication disorders are severely under-diagnosed, particularly in children of low socio-economic status [10, 14].
Research concerning children identified as having pragmatic language difficulties demonstrates that effects are far-reaching. Recent studies have shown associations between pragmatic language difficulties and behavioural problems , especially of the disruptive, externalising kind. Healthcare costs (excluding education costs) have been shown to be 36% higher for 4-year-old children with language disorders than for typically developing children . A number of studies have shown long-term negative effects: children with social communication impairments experience problematic peer relationships  and are commonly rejected and victimised by peers at school [18, 19]. Individuals diagnosed with pragmatic language impairments as children were found to experience continuing problems with establishing social relationships (such as friendships) later