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Understanding Social (Pragmatic) Communication Disorder: A Quick Review

By Jennifer Powell-Lunder, Psy.D

As a parent it can be difficult to keep up with what is going on in the clinical world. It can be particularly confusing when you have a child who is assigned a diagnosis that has been redefined or suddenly ceases to exist. With the publication of the most recent edition of Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM 5), the book clinicians use to determine diagnose, came many major changes affecting the diagnosis of childhood disorders. 

Traditionally the publication of an updated version of the DSM brings with it concerns, regrets, and of course some controversy. In 2013 one major change resulted in redefining the criteria for Autism. This redefinition was particularly confusing for parents whose children were already carrying a diagnosis of autism, Asperger’s, or pervasive developmental disorder.

What the changes entailed

The diagnosis of autistic disorder, Asperger’s disorder and pervasive developmental disorder where folded into one diagnosis, Autism Spectrum Disorder (ASD). The reasoning behind this was the acknowledgement that instead of these conditions representing separate and distinct disorders, they actually represented a cluster of symptoms on a continuum from mild to severe. At the same time this diagnosis replaced and redefined criteria for autism, the introduction of a new diagnosis, Social (Pragmatic) Communication Disorder, SCD, seemed to offer hope to some concerned that the redefinition would result in exclusion for many children. This group, including children who did not meet criteria for an ASD diagnosis however, seemed to exhibit symptoms warranting similar services.

What is SCD?

A diagnosis of SCD is assigned when the primary symptoms being exhibited are related to an individual’s inability to appropriately use or understand verbal and nonverbal social communication. Those diagnosed typically have trouble interacting socially because they do not understand the rules of social communication and fail to pick up on or misread social cues. They tend to interpret language in a concrete manner and fail to grasp such nuances as switching tone and presentation when addressing different groups of individuals (for example talking the same way whether addressing an adult or a same aged peer).

Does research offer support for the existence of SCD?

Many have expressed concerns that SCD is not really a distinct diagnosis in it’s own right, but instead simply a ‘milder’ form of autism that did not rise to the level of meeting ASD criteria. 

A couple of recent research studies however, seem to offer evidence that SCD is a distinct diagnosis. The most difficult supposition to sort out in relation to the SCD diagnosis is where it fails in relation to being characterized as a language disorder versus an autism spectrum disorder. This becomes an important distinction when formulating appropriate protocols for treatment. One thing however seems clear, children assigned a diagnosis of SCD can benefit form early identification and intervention.

Advice to unsure parents

If you have concerns that your child may meet criteria for SCD or, if your child is among those kids affected by the reclassification of autism, Asperger’s, or pervasive developmental disorder, your best approach is to seek assistance from a clinical professional.

In reality, clinical care isn’t about labels or redefinition, it is about appropriate prevention, intervention, and of course treatment.

For the future, a continued evaluation of intervention services and protocols will be necessary to determine how to best serve individuals assigned an SCD diagnosis. In the meantime the diagnosis will help to prevent the concerns that children exhibiting the symptoms but who do not meet criteria for ASD do not get lost in the shuffle.

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