What is Social (Pragmatic) Communication Disorder?
Social (Pragmatic) Communication Disorder (SCD) is a diagnosis characterized by impairment in communication for social purposes. This diagnosis is given when an individual has difficulty using verbal and/or nonverbal communication that is appropriate for the social context. Individuals with this disorder may present with difficulties across a number of areas of social communication including:
- Social greetings, such as saying hello or introducing oneself
- Sharing personal information and general knowledge
- Modifying communication based on characteristics of the listener; for example, understanding that one interacts differently with a young child versus an adult, and differently with a close friend versus an acquaintance
- Taking turns in conversation, which includes difficulty responding to others in conversation, staying on topic, or allowing the other person an opportunity to speak
- Changing communication to match the behavior of the listener or the context of the situation
- Using gestures in conversation, such as pointing or waving
- Understanding various forms of nonverbal communication
- Understanding aspects of verbal communication that are not explicitly stated; for example, difficulty understanding implied and indirect uses of language, such as metaphors and humor
These challenges lead to impairment across a number of areas. In addition to having challenges connecting and interacting with peers, these symptoms often cause challenges in educational and occupational functioning.
Why am I just hearing about Social Communication Disorder now?
Social Communication Disorder (SCD) was introduced to the Diagnostic and Statistical Manual of Mental Disorders (DSM) for the first time in the most recent update (DSM-5) in 2013. Prior to this time, individuals who demonstrated these symptoms may not have been accurately diagnosed or identified. Before the introduction of SCD into the DSM-5 some of the individuals who currently meet diagnostic criteria for this disorder may have been classified as having Pervasive Developmental Disorder – Not Otherwise Specified or Communication Disorder – Not Otherwise Specified.
How is Social Communication Disorder different from Autism?
Both Autism Spectrum Disorder (ASD) and Social Communication Disorder (SCD) are characterized by challenges in verbal and/or nonverbal communication for social purposes. However, there are a number of differences between these diagnoses. Individuals with ASD also demonstrate restricted, repetitive patterns of interests or behaviors. This can include highly fixated interests, stereotyped or repetitive motor movements, inflexible adherence to routines, and sensory sensitivities. If an individual is demonstrating these symptoms in addition to challenges with social communication, they would likely be diagnosed with ASD and not with SCD.
How do I know if my child has Social 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.
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.
What causes someone to have Social Communication Disorder?
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.
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.
American Psychiatric Association: www.apa.org
American Speech-Language-Hearing Association: www.asha.org
Social Thinking: https://www.socialthinking.com
Written by Cara Remmes, PhD