Social (Pragmatic) Communication Disorder & Autism: Explained

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Social (pragmatic) communication disorder (SCD) was first included as its own diagnosis in the most recent Diagnostic and Statistical Manual of Mental Disorders, DSM-5. Prior to this, children with SCD were often misdiagnosed with autism spectrum disorder (ASD).

SCD shares characteristics with autism in that both disorders involve difficulties with social communication.

Someone with social (pragmatic) communication disorder will struggle with both verbal and nonverbal communication, language processing, social cognition, and pragmatics. They will have a hard time matching their communication skills and language to the social situation or circumstances. Unlike with autism, they will not have issues with repetitive behaviors or limited and restricted interests.

Treatments for social (pragmatic) communication disorder include both behavior interventions, such as applied behavior analysis, and speed and language therapy. Treatment will evolve as a child ages, and treatment protocols differ between young children, school-aged children, adolescents, and adults.

Early intervention can help a child learn how to manage SCD and communicate more effectively.

What Is Social (Pragmatic) Communication Disorder?

SCD can make it difficult for a child to socialize and communicate well with others. The disorder can impact relationships and academic performance.

Signs and symptoms of SCD include:

  • Difficulties using communication in a social manner. This includes problems with engaging in back-and-forth communications, asking questions, making comments, responding to social conversation with relevant ideas, and using gestures, such as waving or finger pointing.
  • Inability to follow communication rules. This often involves trouble with storytelling, taking turns in a conversation, staying on topic, regulating interactions through verbal and nonverbal communication tools, and being able to rephrase something when misunderstood.
  • Issues changing conversation style and communication to fit the social situation. We all change our communication style somewhat depending on our audience. For example, we talk differently to a peer than a teacher, and we talk more quietly inside than outside. Someone with SCD may have trouble with these situations. They may also be unable to match tone, pitch, and language syntax to the circumstances.
  • Trouble making inferences and hearing what is not said. Difficulties understanding tone, metaphors, humor, idioms, and contextual conversation and language are common among those with SCD.

Social (pragmatic) communication disorder can make it difficult for a person to make and keep friends, and talk about feelings and emotions. The person struggles with both communicating and understanding language and social context. It can be hard for someone with SCD to follow along in a conversation or make appropriate small talk.

Ultimately, SCD is a communication disorder that can make social situations uncomfortable and overwhelming. It can often result in behavior problems and difficulties at school and at home.

Causes of Social (Pragmatic) Communication Disorder

There is no definitive cause of SCD, but there may be a genetic link. Theories speculate that difficulties with social communication and pragmatic language can be heritable, which means they can run in families. Research is ongoing to determine if there is a genetic or heritability link.

SCD is also thought to be a neurodevelopmental brain disorder involving the right hemisphere of the brain, which can make it hard to process both visual and verbal information simultaneously.

Other theories link SCD to poor executive functioning.

Links Between SCD & Autism

Social (pragmatic) communication disorder and autism share several traits. Both involve difficulties with language, speech, verbal and nonverbal communication skills, and social situations.

The main difference between the two is that autism also includes characteristic behaviors, such as an intense and near-obsessive focus on specific areas of interest or objects as well as repetitive behaviors.

SCD and autism cannot be diagnosed together. They have been recognized as two separate disorders since the DSM-5 was published in 2013.

Autism will often need to be ruled out first before SCD is diagnosed. If a child does not fit all of the behavioral characteristics of autism but struggles with social communication, they may then be evaluated for SCD.

The Benefits of Early Intervention With an SCD Diagnosis

SCD is typically diagnosed around age 4 or 5 when it is clear that a child is struggling with social communication skills. By this age, a child is usually able to interact socially and should have developed language skills. Children with SCD often struggle to hit language benchmarks on time and have little to no interest in social interactions.

Social (pragmatic) communication disorder can have similar characteristics to other developmental and language delays and disorders. Typically, issues like hearing loss and autism will need to be considered and dismissed first.

Parental input, observations, and evaluations (often in a variety of settings) are helpful tools in diagnosing SCD. Speech and language pathologists often conduct evaluations as part of the diagnostic process.

An early diagnosis can ensure that interventions and treatments start as soon as possible, which can offer the most benefit to the child. While SCD cannot be cured, children can learn effective social and communication skills to manage the disorder.

The earlier the interventions begin, the more tools and social skills a child can acquire during crucial developmental stages.

Applied Behavior Analysis & Other Behavioral Interventions

Applied behavior analysis (ABA) is a behavioral intervention and the primary treatment for autism. While SCD differs from autism in key ways, many of the social and communication difficulties are similar. As a result, ABA can benefit both disorders.

ABA can improve communication and language skills by using positive reinforcement to encourage wanted behaviors while helping to decrease and phase out undesired behaviors. ABA is highly adaptable and can be tailored to fit the needs of each person specifically. It can also be used in a variety of settings, such as in an office or clinic, in the client’s home, or in school.

The most recommended treatments for SCD capitalize on a child’s strengths while addressing their weaknesses. ABA works within this framework.

ABA can:

  • Address specific barriers that make communication difficult.
  • Teach skills and tools for more effective communication and socialization.
  • Encourage and increase independence.
  • Establish individual goals and a plan to meet them.
  • Enhance communication, social skills, academic abilities, and self-reliance.

Additional behavioral interventions can also be helpful in treating SCD. For example, cognitive behavioral therapy (CBT) focuses on the connections between emotions, thoughts, and behaviors. CBT can help to reduce problematic social or communicative behaviors and replace those with more positive habits.

Speech & Language Therapy

Speech and language therapy can improve both verbal and nonverbal communication abilities. The therapy can also augment social understanding and build skills for social situations.

There are several tools that can be beneficial during speech and language therapy sessions, such as:

  • Augmentative and alternative communication (AAC). AAC uses pictures, gestures, and alternative methods to supplement speech.
  • Comic strip conversations. Conversations between two or more people are illustrated and depicted in a comic strip. This can then be used to explain what a person might be thinking or feeling. Comic strips also break up the social interaction into smaller sections that are easier to understand and follow.
  • Video-based instruction. Therapists can use videos to model social behaviors and computer technology to teach skills, including language, social skills, problem-solving, and social understanding.
  • Stories, scripts, pictures, and social strategies. Techniques that use visual and verbal aids can teach children how to improve social and communication skills.
  • Role-playing exercises. These games can help a child see both sides of a social interaction. It’s a straightforward way to learn what to expect from others and what is expected of them.

Speech and language therapists often start out working with a child with SCD on an individual basis. Later, they may add in small group sessions to augment the treatment plan. Small group settings can help children learn how to interact with peers in a safe, controlled, and highly structured environment.

Families play a big role in therapy. They help the child to use what they have learned during the sessions in everyday life and build upon these skills.

Age-Specific Treatment Plans

Social (pragmatic) communication disorder can impact people of all ages. Treatment plans will differ based on the developmental stage of the child.

Young children will need help with different social interactions than adolescents and those transitioning into adulthood. Children often have issues with making and keeping close friends, while adults with SCD often struggle with romantic relationships. 

  • Young children: Behavioral interventions, and speech and language therapies, can focus on teaching children how to initiate and respond to social situations. This includes how to understand and communicate through both verbal and nonverbal methods.
  • School-aged children: Therapies are often offered through schools. They can include social support, specialized services such as an aide, social skills training, and speech therapy. Therapies may focus on reading comprehension, academic skills, and social interactions as well as communication abilities.
  • Adolescents and teens transitioning into adulthood: Resources for teenagers with SCD include social skills groups and interventions that can support these individuals as they transition out of school and into society as adults. Typically, a range of providers, such as speech and language pathologists, vocational counselors, psychologists, and school counselors, can all offer resources for adolescents to facilitate the transition to adulthood.
  • Adults: Adults with SCD can benefit from life skills workshops and peer support groups that focus on navigating social situations, improving skills in conversation, and accomplishing daily life tasks.

Treatment for social (pragmatic) communication disorder should be based on detailed evaluations and observations of each individual. The treatment plan should be reevaluated as a person ages and changes. Parents, doctors, therapists, teachers, and mental and medical health providers will all work together to come up with a comprehensive treatment plan that can offer the most help managing SCD and improving social communication.

With proper therapy, a person with social (pragmatic) communication disorder can see great improvements, allowing them to engage in healthy, satisfying relationships.