Social (Pragmatic) Communication Disorder (SCD), a newer diagnosis in the mental health arena, affects thousands of individuals across the globe. SCD includes problems related to social communication, understanding of social situations, and the proper use of language (pragmatic language impairment). Today, likely because of SCDs recent growth in awareness and understanding, SCD sufferers can connect relatively easily with professionals who know how to walk with, encourage, and treat someone living inside of this struggle. So, what exactly is social communication disorder? And why has it so recently appeared in the healthcare scene? Let’s get straight to some answers.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Associations (APA), is the ruling reference manual for understanding the classification of all mental health disorders. The DSM has been rewritten many times; all information in new additions trumps prior editions.
To understand SCD and its definition today, one must turn to the DSM. SCD was first acknowledged as a mental health condition by the DSM in 2013, in DSM-5 (the 5th edition). In the past, the DSM and most physicians had classified SCD as another condition known as Asperger Syndrome. Up until 2013, Asperger’s, which is a milder form of autism, presented itself in unique ways and was deserving of its own name and medical classification. However, the 2013 version of the DSM made new clarifications for Asperger’s (which should now be classified as autism spectrum disorder (ASD)) and added in the new (and separate) diagnosis of social communication disorder, or SCD. SCD is often part of an ASD diagnosis, but they are not the same. Care providers need to rule out ASD before they diagnose one with SCD.
Symptoms of SCD
Because this condition is essentially an updated understanding of Asperger Syndrome, one will likely find many similarities between the two. Each is ultimately a form of mild ASD. There are a variety of ways SCD can present, but impairments or difficulties are centered around speech and language. Symptoms will also vary based on an individual’s age, their ‘expected’ level of development, and the context in which communication is occurring. Typically, symptoms of SCD affect both verbal and non-verbal behaviors.
- General or specific difficulties with regard to social interactions
- Difficulty in applying speech and common speech styles in communicating
- Misunderstanding or misuse of context or linguistic politeness
- General or specific cognitive difficulties
- Difficulty in the use of pragmatics, or symbols, eye contact, and body language in communication
- Difficulty in emotional response and interpretation in communication
You may find that one who suffers from SCD doesn’t know how to respond to others, struggles with the appropriate use of gestures while speaking, often veers off topic, has difficulty adjusting the level of their speech for different people and situations, struggles taking turns and playing with others, and asks irrelevant questions or has irrelevant responses.
Of note is the term pragmatic language impairment (PLI). You will hear this often in relationship to SCD. PLI speaks specifically to the language challenges of SCD: knowing what to say, how to say it, and when to say it. For the person with SCD, this manifests in the misunderstanding of the language others are using, using language appropriately to have needs met, and using language socially to make (or keep) friends. PLI can be a component of many different disorders, including SCD, autism, traumatic brain injury, and learning disabilities.
Treatment for SCD
Concepts and care plans in the treatment of SCD can be both numerous and complex (which is not unlike many mental health disorders). Most physicians and care providers defer largely to the resources of the American Speech-Language-Hearing Association (ASHA) when treating SCD. ASHA, when developing intervention strategies, is consistent with the World Health Organization (WHO) framework as well. Note that treatment is multifaceted. It is nearly impossible to exhaustively report all of its possibilities and nuances.
Treatment strategies are focused on increasing an individual’s active engagement and independence in their normal communication environments. Treatment typically occurs via three different modalities:
- Augmentative and Alternative Communication (AAC): This involves the supplementation of speech with symbols.
- Computer-Based Instruction: This involves the use of computers for teaching language skills.
- Video-Based Instruction: Also called video-modeling, this modality uses videos of target behaviors to instruct the learner.
The list of specific treatments that may be employed is long. The behavioral, peer-based, and social communication interventions and techniques used will differ based on the individual’s existing behaviors and the new behaviors desired. ASHA states that the different interventions are “based on principles of learning that include identifying desired behaviors, gradually shaping these behaviors through selective reinforcement, and fading reinforcement as behaviors are learned.” Some specific treatments include peer-mediated social play, comic strip conversations, social skills groups, and Social Stories, The Denver Model (play-based therapy), and milieu training (includes strategies for home treatment). Note again that this is not an exhaustive list.
When deciding on care modalities and treatment options, one must remember to consider a few other factors. This includes asking questions like: What is the individual’s social normal(s)? What cultural considerations must I make? What language is the one the individual is most comfortable with? Care providers must also take into account developmental stage (ASHA notes that adolescents can be particularly challenging to treat) as well as any hearing impairments.
SCD is a condition that has and does affect many people today. Though relatively new as an official diagnosis, SCD and its components, treatment modalities, and treatment options are not new to speech-language pathologists. They have been treating the parts of SCD for many years; it’s simply been happening under a different diagnosis. Rest comfortably in knowing that there is a huge variety of clinical treatments and strategies for home available to you or your loved one and qualified medical professionals ready to tailor a care plan to fit the needs of you and your family.
ABA Programs Guide Staff
Updated April 2020
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