By now, most folks who have any interest in or connection to autism know that autism was redefined by the American Psychiatric Association in their most recent diagnostic manual, published in 2013. Before the diagnostic revision, social communication disorder did not exist as a separate disorder; instead, social communication difficulties were addressed within the autism diagnosis because one of the main characteristics of autism is poor social communication.
For a long time, there was disagreement in the medical field about where social language belonged diagnostically. But now, apparently after much debate, Social Communication Disorder (SCD) is a stand-alone diagnosis. Children who may have been diagnosed on the autism spectrum with Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS) previously are now most likely to fall under the SCD umbrella.
The good news is that even though SCD is a new diagnosis, social communication is not new to the field of speech-language pathology! Speech therapists have long known about and worked with pragmatic language disorder, so knowledgeable and experienced help is available.
So, What Is SCD?
Social Communication Disorder is primarily an impairment in pragmatics. Pragmatics, or pragmatic language, is social language; it is being able to understand and use language in social situations. It includes understanding and using verbal language, as well as understanding and using appropriate nonverbal language, such as gestures and facial expressions.
Children with pragmatic language disorders may have adequate vocabulary and grammar skills, but, despite these skills, they have difficulty using language in social contexts. Pragmatic language is something that most of us learn incidentally; we learn these skills just by observing them in our environment. But some children don’t “absorb” the social skills modeled by others. It has nothing to do with parents not teaching good manners; these children just don’t connect with the language that connects people.
Using our language sounds simple, but for some children, it is very challenging, and struggling to learn social language can have serious consequences. If you suspect your child may have social communication problems, you may have noticed:
• Delayed language milestones, such as limited vocabulary or development of phrases and sentences.
• Frequent disinterest in initiating social interaction and engaging in social interaction; may be socially isolated because it’s difficult to interact.
• Difficulty participating in conversations; difficulty starting a conversation, staying on topic, and/or ending a conversation appropriately.
• Difficulty adapting to communication partner; e.g., talks the same way to the school principal as he does to his friends.
• Difficulty adapting to communication situations; e.g., talks the same way in the classroom as he does on the playground.
• Doesn’t seem to understand the meaning of gestures, such as a shoulder shrug, or facial expressions, such as a frown.
• Responding to others in very unusual ways, making him seem rude or abrupt or even “weird.”
• A tendency to be very literal; difficulty understanding figurative language, such as idioms, or gleaning meaning from context.
As always, this list of symptoms is meant to highlight some characteristics of SCD. If you suspect the disorder, you are encouraged to seek professional help and an official assessment and diagnosis.
How Are SCD and ASD Different? How Is SCD Diagnosed?
The thing that distinguishes SCD from ASD is that children with autism spectrum disorder may have social communication problems, but they also have other symptoms that are specific to ASD. In addition to social difficulties, individuals with autism may also have very intense interest in certain topics and may perform repetitive movements, such as rocking back and forth or hand flapping. But, because of the disorders’ similarities, a diagnosis of autism spectrum disorder must be ruled out before a diagnosis of SCD can be made. A psychologist is the professional who would probably evaluate and make a decision about the presence or absence of autism. If autism spectrum disorder is diagnosed, autism is the source of the social communication problems, not SCD.
A speech-language pathologist conducts a comprehensive evaluation of social communication skills by administering specific tests and by observing and/or interviewing a child in a variety of environments. Children may not have social difficulty in every situation, so it’s important to evaluate skills in more than one setting, including home and school. Typically, family members, teachers, and caregivers are important members of the diagnostic team, in addition to the speech-language pathologist and psychologist.
Autism and SCD are not the only disorders associated with social language problems. Individuals with other disorders or disabilities, such as speech and/or language disorders, learning disabilities, and ADHD, may experience social difficulties. Symptoms shared between multiple disorders can make diagnosing difficult because multiple assessments may be necessary to rule out other conditions.
Then What?
Social Communication Disorder can impact your child’s academic and social development. For example, children with SCD often have difficulty comprehending what they read; they can say the words, but don't understand the meaning of the text. They also often have difficulty making or keeping friends in the neighborhood or at school, or may be the target of bullying. If testing determines that your child has a social communication impairment that affects learning and/or social development, treatment options are available, usually privately or through the school district. A treatment plan or Individualized Education Program may be developed to teach new social skills and to foster the integration of those skills into your child’s environments. With help, your child can learn to participate in conversations and discussions; learn to understand and use body language and expressions; learn to understand and use nonliteral language, such as idioms and inference; and learn to do many things that will enable him or her to communicate with others more effectively.
Postscript
In each blog, I try to stress the importance of an accurate diagnosis. If the diagnosis isn’t correct, the treatment probably won’t be either. As I indicated earlier, speech-language pathologists have a long history of diagnosing and working with children and adolescents with social language problems. The creation of Social Communication Disorder as a bona fide diagnosis emphasizes the important role speech therapists have in diagnosing and treating social communication deficits. If your child is struggling, answers and help are available.