What is Social (Pragmatic) Communication Disorder?
In 2013 a new disorder was defined called Social (Pragmatic) Communication Disorder (SCD). SCD is characterized by a persistent difficulty with verbal and nonverbal communication for social purposes that cannot be explained by low cognitive ability, Autism Spectrum Disorder, another medical or neurological condition, or low abilities in word structure and grammar.1,2 Children with SCD have trouble holding conversations and using spoken language in socially appropriate ways, but are usually good with the mechanics of speaking (pronouncing words and constructing sentences). Everyone struggles with social situations from time to time, but for a child with SCD, navigating social situations is a daily challenge.3
Symptoms of Social (Pragmatic) Communication Disorder
While symptoms of Social Communication Disorder (SCD) must be present in early childhood for a diagnosis to be made, it may not be fully clear that a child is demonstrating symptoms until later in development. With age, communication demands increase and expressive language abilities develop and so the symptoms of SCD may appear subtle at first.
Children with SCD may present with or without delays in reaching general language milestones. Concerns about SCD are generally found when a child consistently responds minimally to social initiatives from others, demonstrates difficulties in interactions with peers, and experiences challenges responding to various social interactions with others.
For an official diagnosis to be made, other diagnoses, including a diagnosis of Autism Spectrum Disorder needs to be ruled out. Both clinical psychologists and speech and language therapists can complete an evaluation to determine if an individual meets criteria for SCD.
Children with SCD have trouble learning how to start a conversation, listening, phrasing a question, staying on topic, and knowing when the chat is over. A child with SCD can lag behind in developing reading and writing skills, including reading comprehension. These children show an impaired ability to effectively communicate, participate socially, maintain social relationships, and perform academically or occupationally.
Children with SCD have trouble learning how to start a conversation, listening, phrasing a question, staying on topic, and knowing when the chat is over. A child with SCD can lag behind in developing reading and writing skills, including reading comprehension.3 These children show an impaired ability to effectively communicate, participate socially, maintain social relationships, and perform academically or occupationally.1
During conversation a child with SCD may show:3,4
- Inappropriate or unrelated responses
- Difficulty understanding the “give-and-take” of conversation, may monopolize conversation or interrupt often, or not respond at all.
- Difficulty adapting language to different listeners (using formal manners with an adult versus casual language with a peer)
- Poor adjustment of volume and tone of speech to fit the social environment
- Difficulty making inferences and understanding implied information that isn’t explicitly stated
- Lack of background information offered when speaking to an unfamiliar person
- Trouble understanding facial expressions and gesturing
- Trouble understanding riddles, sarcasm, and metaphors
- Getting too close to people when they speak
Symptoms are present in early childhood but can be noticed as a child ages and communication becomes more complex.1 Research shows children with SCD are more likely to have ADHD.3 A diagnosis of SCD should not be made until your child is at least 4-5 years old so that testing can detect these communication deficiencies.5
What causes Social Communication Disorder?
Researchers aren’t sure what causes SCD but it’s thought to be a neuro developmental (brain) disorder.3 The presence of a psychological/emotional disorder or hearing loss can impact a child’s social communication skills, and should be assessed.6 More research is needed before prevalence can be determined for this new diagnosis, previously children with these difficulties may have been diagnosed with Pervasive Developmental Disorder-Not Otherwise Specified.3,5
Similar to other psychological and communication disorders, the exact cause of Social Communication Disorder (SCD) is not well understood. Genetic factors appear to play a major role and individuals who have a family history of Autism Spectrum Disorder, Communication Disorders, or Specific Learning Disorders are more likely to have a SCD diagnosis.
What can be done to treat Social Communication Disorder?
SCD as a new disorder is somewhat debated, and treatment protocols and effectiveness will need to be researched in the coming years. Some argue that SCD never occurs by itself, that SCD is just a symptom of other conditions such as ADHD, Autism Spectrum Disorder, language disorder, other communication disorders.3,7 A speech pathologist can determine if your child has a social communication disorder; pediatricians, medical professionals, psychologists, and teachers may also be on your child’s care team.8
Treatment should include opportunities for generalization of social communication skills in various settings with various communication partners.8 A therapist may use Applied Behavioral Analysis, social skills groups, and cognitive behavioral therapy in the treatment of SCD.9 A professional may work with your child to practice turn-taking, introduce and end topics, and other conversational skills. Role playing games and visuals can also aid children in learning strategies to manage social situations.3
How common is Social Communication Disorder?
The incidence and prevalence rates of this disorder are not yet well understood, given that this diagnosis was just recently added to the DSM. However, preliminary research indicates that approximately 7.5% of children experience difficulties with social pragmatic communication, with higher rates of difficulties in males than females.
How can I help my child with Social Communication Disorder?
Children with Social Communication Disorder (SCD) can be explicitly taught the skills needed to engage in expected ways with others in their environments. Like other skills, these strategies need to be first taught and then reinforced through practice. Our social worlds are filled with nuanced and context dependent expectations. For example, the expectations for social greetings vary greatly based on a number of changing factors. These factors include the environment one is in, the nature of the relationship between the individuals, the length of time since the individuals last saw each other, and the apparent affect and behavior of the other individual.
Therefore, a “one size fits all” scripted approach to teaching social greetings and other skills is rarely successful. Social skills are best introduced first through building social awareness and teaching the concept that social rules shift based on the situation. Social Thinking (Winner, 1999) is an example of a curriculum that addresses these lagging skills by focusing on these concepts.
Both speech and language therapists and mental health professionals who have been trained in addressing social pragmatic communication concerns are able to work with youth to teach and guide their practice of these skills. Didactic teaching of these skills can be done either individually or in small groups.
These skills then need to be practiced with other peers. This practice can be done in small social skills groups, at school or in other environments with peers and adults. In addition to small group teaching and practice, these skills need to be reinforced in the environment in which the child engages for generalization to fully occur.
For this reason, and also due to the effects of symptoms on educational functioning, children with SCD are eligible and often receive treatment services through their schools. Individuals can also receive outpatient individual and group treatment services that promote social communication skills.
1 American Psychiatric Association
2 American Speech-Language-Hearing Association
4 American Academy of Child & Adolescent Psychiatry
5 Journal of Neurodevelopmental Disorders
6 American Speech-Language-Hearing Association
7 The Journal of Child Psychology and Psychiatry
8 University of Rochester
9 Montana Autism Education Project