Has your child been diagnosed with autism spectrum disorder (ASD), or does he or she exhibit symptoms of autism? Before seeking autism-specific assistance, make sure the diagnosis is correct.
You may learn that your child has Social (Pragmatic) Communication Disorder (SCD). Recently added to the most current, fifth-edition of the DSM (Diagnosis and Statistical Manual of Mental Disorders), the signs and symptoms of ASD are very similar – and even overlap – with those of social pragmatic communication disorder, even though the two conditions are different.
Since the newest edition of the DSM-5, field tests show that some children who were diagnosed with ASD via the parameters of the older-edition of DSM-4 would now be diagnosed with SCD as a result of the new criteria.
If your child does not have a diagnosis yet or was diagnosed with ASD based on the 4th-edition of the DSM, it may be worthwhile to schedule a consultation with a licensed speech-language pathologist who is trained to identify the difference.
Speech-language pathologists are available at most medical centers or your physician can refer you to a reputable center or clinic for an accurate diagnosis.
What is the Difference Between Social Pragmatic Communication Disorder and Autism?
One of the main differences between ASD and SCD – and a red-flag for parents who suspect their child was misdiagnosed with ASD – is that children with autism have difficulties with social communication AND they exhibit repetitive and/or disruptive behaviors.
Repetitive or disruptive behaviors include things like:
- Repeated body movements, such as rocking, flapping, jumping, twirling
- Obsessive fixation on routines and rituals
- Putting things in order and in order again and/or a preoccupation with things being in a very specific order or placement
- Excessive repeating of sounds, syllables, words and/or phrases
- Intense and obsessive preoccupation with specific objects or subjects
- Extreme sensory sensitivity, particularly to sound and/or chaos
Any disruption to routine, order and their schedule or an affront to their sensitivities can result in loud, sometimes violent, outbursts with aggression being self-inflicted or inflicted upon others (or objects) in their immediate environment.
If your child was diagnosed with autism but doesn’t tend to display the restrictive, repetitive or disruptive behaviors associated with autism spectrum disorder, he or she should be reassessed for an accurate diagnosis. You may find out the real issue is social pragmatic communication disorder.
What is Social Pragmatic Communication Disorder?
Social (Pragmatic) Communication Disorder (SCD) encompasses problems related to your child’s communication. She may pronounce words properly and speak in full sentences but struggle to hold a two-way conversation, frequently misunderstand what others are communicating or not recognize pragmatics, the use of language in its proper context.
For a child to receive an SCD diagnosis, the following four key criteria must be present.
1. Persistent difficulties using verbal and nonverbal communication cues across several contexts
- Social purposes, including greeting others and sharing information in a way that’s appropriate for the situation
- Matching the listener’s needs, such as using an indoor versus outdoor voice, implementing every day rather than formal language and talking in different ways and with different language when addressing kids and adults
- Following conversation and storytelling rules, including taking turns during a conversation, rephrasing information when the listener misunderstands him and recognizing and using verbal and nonverbal signals to regulate what’s happening during interactions
- Understanding information that’s not explicitly stated or is nonliteral, ambiguous or open to interpretation, such as making inferences and recognizing idioms, metaphors, humor, and words or phrases with multiple meanings depending on the context
2. Communication difficulties
The inability to effectively communicate with family, friends and their community in a home, school or other setting.
3. Delayed milestones at an early age
The difficulties emerge in the early years, even if they aren’t diagnosed until later childhood or the teen years. Examples include delays in reaching speech or language milestones and disinterest in talking.
4. Challenges unrelated to other medical or language difficulty
Communication issues are not linked to another general or neurological medical or specific language difficulty, such as intellectual disability, global developmental delay or autism spectrum disorder.
Children who are screened for social pragmatic communication disorder are evaluated on their ability to do the following:
- Respond to others
- Talk about their feelings and emotions
- Take turns speaking and responding to others
- Stay on topic
- Use gestures and hand movements to express themselves (waving hello/goodbye, pointing, expressive gesturing, etc.)
- Adjust their speech according to the situation or environment (speaking quietly in a library or learning to speak differently to toddlers as opposed to adults)
- Ask questions or make comments that relate to the conversation topic
- Make and keep friends
- Use words for a variety of purposes, from greetings and requests to conversations and expressing emotions
If you have a young child, under 5-years of age, you may be thinking right now, “My child doesn’t do any of those things. He must have SCD.”
Do not automatically assume anything. Different children develop social communication skills at various stages, and your child may simply be less communicative right now.
Alternatively, you may feel that your teen could not have SCD. Maybe you think, “Sure, sometimes he can’t hold a conversation, but that’s because of normal teenage moodiness.”
Actually, your child could have SCD. Sometimes, it’s not diagnosed until adolescence when social interactions become more complicated, uncertain and challenging.
Social Pragmatic Communication Disorder vs Autism: How to Obtain an Accurate Diagnosis
Due to the differences in ASD and SCD, professional assessment is critical.
You certainly don’t want to project anything onto your child that isn’t there or spend precious time and resources treating something that doesn’t exist.
However, if your child has a need, a diagnosis allows you to get her the help to learn important communication skills to succeed in school, at home, and in life.
To obtain an accurate diagnosis so you can get the proper treatment, therapy and help for your child, here are a few tips.
- Rule out ASD with an assessment performed by your child’s doctor and other professionals.
- Gain a referral to a speech pathologist who understands how to diagnose and treat social pragmatic communication disorder.
- Ensure the speech therapist observes and evaluates your child in numerous settings, including home, the classroom and community interactions.
- Remind your child’s teacher and caregivers to complete any questionnaires the therapist provides.
- Schedule formal one-on-one testing when the therapist assesses your child’s specific communication and language capabilities, skills, and challenges.
- Remember that an accurate diagnosis is complicated further if a child also has a speech disorder, ADD/ADHD, other behavioral disorders or a learning disability, so ensure the therapist addresses these concerns, too.
After you receive a formal diagnosis, you can begin beneficial therapy. It could change your child’s life.
Finding a Therapist Who Specializes in Social Pragmatic Communication Disorder or Autism
Regardless of whether or not your child has ASD or SCD, it’s important that he or she works with professionals who specialize in the specific condition.
For example, if your child has SCD, a speech-language pathologist who specializes in SCD may be available via your child’s school. If not, speak with your healthcare provider or reach out to ASD resources who may be able to offer referrals.
Speech-language pathologists are trained to work with individuals who have non-verbal communications as well as social interactions.
In addition to providing individuals and their families with practice and training, they also offer interactive visual tools – such as picture boards or tablets – which can help to bridge the gap as the individual makes progress through therapy.
How to Treat Social Pragmatic Communication Disorder
Treatment for social pragmatic communication disorder typically includes several stages which can be guided by a professional. These stages require the involvement of your entire family along with other adults in your child’s life. They most importantly necessitate the need for practice and patience.
Professional, one-on-one or small-group therapy with a licensed speech-language pathologist specializing in SCD works wonders for your child. This therapy can occur in a center, in your home or at your child’s school.
Family support & involvement
Your family is your child’s microcosm of society. Since communication doesn’t happen in a vacuum, the therapist will train the whole family in techniques, strategies, games, tools, etc., to help you communicate with your child. This practice will pay off in your child’s interactions with other social groups and communities, too.
Education & tools for teachers, coaches, and other elders
Just as your family will need to practice, the child will gain more support if teachers, coaches, and other close friends and family members possess the information and tools with which to engage your child more fully.
Practice, practice, practice
Your child needs practice in real-life scenarios. You can make this easy by providing communication partners for your child, including family members, other therapists, teachers, and peers.
Practice can occur naturally in a number of ways, including:
- conversations and gentle reminders
- using stories as a chance to discuss facial expression and ask/answer questions about characters’ interactions
- talking and asking about feelings and body language in particular situations
How to Support a Child with Social Pragmatic Communication Disorder at Home
After you have a diagnosis and treatment plan, help your child succeed by remaining an active participant in his therapy.
In addition to providing transportation to therapy appointments, work closely with the therapist. You can reinforce skills learned during sessions when you’re at home or in the community, and you can learn beneficial skills that help you support your child at home.
You can also practice several therapeutic activities with your child, including:
- Use visual supports for your child’s daily schedule, expectations, chore chart, etc., which is a benefit for kids with SCD who process information visually.
- Take turns and imitate the flow that’s typical of social interactions. Together, you can roll a ball back and forth, repeat words your child says or mimic a pet.
- Talk about the feelings. Use stories, books, and puppets to explore a character’s feelings and emotions. You can also review real-life scenarios that may occur with family members or peers.
- Read and discuss a book, and ask open-ended questions like, “What was your favorite part of the story?” Or “What did you think about what the boy did in chapter two?”
- Predict the next action in a story. Explore clues that lead you to the conclusion or work backward to discover clues.
- Introduce your child to developmentally appropriate pop culture so that she can relate to peers and have something to discuss.
- Plan structured play dates. Begin with one friend, and limit the time until your child’s skills develop enough to support more friends or a longer play time.
Finally, bridge the gap between home and school. Contact the special education department and ask for an Individualized Education Program (IEP) that includes speech therapy, social skills training, and other supports, including possibly a teacher’s aide.
An alternative to the IEP is a 504 plan. It also provides accommodations that help your child, including extra time to process information or reading support.
Handling an Autism or Social Pragmatic Communication Disorder Diagnosis
Parenting a child with SCD or ASD can be a challenge, and unanswered questions and concerns simply breed more unnecessary worry. Trust your instincts and seek the professional, qualified assistance needed to screen your child and obtain an accurate diagnosis.
The sooner you have a concrete diagnosis, the better able you and the experts will be at providing the essential tools and support your child needs to be successful.
To learn more about social pragmatic communication disorder and autism, contact Sarah Dooley Center online or at 804-521-5571.