In addition to the changes related to individuals with Aspergers and HFA, the DSM-V introduced a new condition in the diagnostic category of communication disorders: Social (Pragmatic) Communication Disorder (SCD). SCD is marked by difficulties with pragmatics—aka practical everyday use—or the social use of language and communication. Therefore, SCD is concerned with an individual’s use of verbal and nonverbal social communication in everyday life.
The condition is of particular interest to individuals with Aspergers or HFA because, in the DSM-V, it specifically states that individuals who have marked deficits in social communication but whose symptoms do not otherwise meet the criteria for autism spectrum disorder (ASD) should be evaluated for social (pragmatic) communication disorder.
SCD is expressed as deficits in understanding and following social rules of verbal and nonverbal communication in real life, changing language according to the needs of the listener or situation, following rules for conversations and storytelling, and understanding what is not specifically and explicitly stated.
Some illustrative examples that individuals with SCD may struggle with:
- Greeting and/or sharing information that is appropriate for the social context
- Speaking differently in a classroom than the playground
- Talking differently to children and adults
- Taking turns in conversations
- Knowing how to use verbal and nonverbal signal to guide interaction
- Recognizing nonliteral or ambiguous meaning of language (e.g. idioms, humor, metaphors, etc)
Other requirements for a diagnosis of SCD include that these deficits result in limitations of effective communication, social participation, academic achievement, and/or occupational performance. Also, the symptoms must be related to the early developmental period of a child’s life and not related to other medical/neurological conditions or abilities.
Social (pragmatic) communication is based on the development of basic speech and language skills, therefore, SCD is rarely seen in children younger than four years due to lack of development of speech and language abilities needed to diagnose it. Milder forms of this disorder, however, may not be seen until early adolescence when language and social interactions grow in complexity.
ASD and SCD differ by the presence of restricted, repetitive patterns of behavior, interests, or activities in autism and their absence in SCD. For parents seeking answers for their child’s development, it is important to keep in mind that only if a developmental history fails to provide evidence of these past patterns, should a diagnosis of social (pragmatic) communication disorder be considered.
What do you think about this new diagnosis?
by ACN Executive Director Loree Primeau, PhD, OTR, FAOTA
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), (pp. 47-49), American Psychiatric Association, 2013.
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