Social (pragmatic) communication disorder

Last updated
Social (pragmatic) communication disorder
Other namesSPCD
Specialty Speech–language pathology
Symptoms Impaired social relatedness, verbal and nonverbal communication skills, and semantic language skills

Social (pragmatic) communication disorder (SPCD), also known as pragmatic language impairment (PLI), is a neurodevelopmental disorder characterized by significant difficulties in the social use of verbal and nonverbal communication. Individuals with SPCD struggle to effectively engage in social interactions, interpret social cues, and use language appropriately in social contexts. This disorder can have a profound impact on an individual's ability to establish and maintain relationships, navigate social situations, and participate in academic and professional settings. Although SPCD shares similarities with other communication disorders, such as autism spectrum disorder (ASD), it is recognized as a distinct diagnostic category with its own set of diagnostic criteria and features.

Contents

It has only been since 2013 that SPCD has become its own category in the DSM-5. [1] In creating this new category it allowed individuals to be considered with a form of communication disorder distinct from PLI and Autism Spectrum Disorder (ASD). [2] SPCD lacks behaviors associated with restrictions and repetition which are seen in ASD. [3]

Overview

Symptoms

Individuals with social communication disorder have particular trouble understanding the meaning of what others are saying, and they are challenged in using language appropriately to get their needs met and interact with others. Children with the disorder often exhibit:

According to Bishop and Norbury (2002), children with semantic pragmatic disorder can have fluent, complex and clearly articulated expressive language but exhibit problems with the way their language is used. These children typically are verbose. However, they usually have problems understanding and producing connected discourse, instead giving conversational responses that are socially inappropriate, tangential and stereotyped. They often develop eccentric interests but not as strong or obsessional as people with autism spectrum disorders.

The current view, therefore, is that the disorder has more to do with communication and information processing than language. For example, children with semantic pragmatic disorder will often fail to grasp the central meaning or saliency of events. This then leads to an excessive preference for routine and "sameness" (seen in autism spectrum disorders), as children with SCD struggle to generalize and grasp the meaning of situations that are new; it also means that more difficulties occur in a stimulating environment than in a one-to-one setting.

A further problem caused by SCD is the assumption of literal communication. This would mean that obvious, concrete instructions are clearly understood and carried out, whereas simple but non-literal expressions such as jokes, sarcasm and general social chatting are difficult and can lead to misinterpretation. Lies are also a confusing concept to children with SCD as it involves knowing what the speaker is thinking, intending and truly meaning beyond a literal interpretation.

Diagnosis

Due to the fact that the SPCD has been categorized only since 2013, diagnosis is yet to be fully established. In the DSM-5, the child is diagnosed with SPCD if the child does not meet the criteria for other disorders such as ASD and PDD-NOS. [1]

The DSM-5 categorizes SPCD as a communication disorder within the domain of neurodevelopmental disorders, listed alongside other disorders of speech and language which typically manifest in early childhood. The DSM-5 diagnostic criteria for social communication disorder is as follows:

  1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
  2. Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
  3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
  4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).

Assessments and tests

Common assessments used to identify SPCD are:

  1. The developmental, dimensional and diagnostic interview (3Di) [4]
  2. The child communication checklist (CCC) [4]
  3. The strengths and difficulties questionnaire (SDQ) [4]
  4. Natural Observation
  5. Targeted Observation of Pragmatics in Children's Conversations (TOPICC) [4]
  6. Analysis of Language Impaired Children's Conversation (ALICC) [4]
  7. Structured Observation [4]
  8. Test of Language Competence [4]
  9. Assessment of Comprehension and Expression (ACE 6‐11) [4]
  10. Test of Pragmatic Language [4]
  11. Bus story [4]
  12. Expression, Reception and Recall of Narrative Instrument (ERRNI) [4]

Although there are several tests that can be done to try to identify SPCD, there are some tests that are better suited to diagnose SPCD than others. As well, there is not a specific assessment or test that is able to diagnose SPCD unlike other disorders such as ASD, DLD and PLI.

Treatment

Treatments for SPCD are less established than for treatments for other disorders such as autism. [5] Similarities between SPCD and some aspects of autism leads some researchers to try some treatments for autism with people with SCD. [6]

Speech therapy can help individuals who have communication disorders. Speech and language therapy treatment focuses on communication and social interaction. [7]  Speech therapists can work with clients on communication in various settings. [8]

Prognosis

Hyperlexia is a similar but different disorder where main characteristics are an above-average ability to read with a below-average ability to understand spoken or written language. Joanne Volden wrote an article in 2002 comparing the linguistic weaknesses of children with nonverbal learning disability to PLI. [9]

Differences between SPCD and autism

Communication problems are also part of the autism spectrum disorder (autism); however, individuals with autism also show a restricted pattern of behavior, according to behavioral psychologists. The diagnosis of SPCD can only be given if autism has been ruled out. [10] It is assumed that those with autism have difficulty with the meaning of what is being said due to different ways of responding to social situations.

Prior to the release of the DSM-5 in 2013, SPCD was not differentiated from a diagnosis of autism. However, there were a large number of cases of children experiencing difficulties with pragmatics that did not meet the criteria for autism. The differential diagnosis of SPCD allows practitioners to account for social and communication difficulties which occur to a lesser degree than in children with autism. [11] Social communication disorder is distinguished from autism by the absence of any history (current or past) of restricted/repetitive patterns of interest or behavior in SPCD. [12]

History

In 1983, Rapin and Allen suggested the term "semantic pragmatic disorder" to describe the communicative behavior of children who presented traits such as pathological talkativeness, deficient access to vocabulary and discourse comprehension, atypical choice of terms and inappropriate conversational skills. [13] They referred to a group of children who presented with mild autistic features and specific semantic pragmatic language problems. In the late 1990s, the term "pragmatic language impairment" (PLI) was proposed. [14] [15]

Rapin and Allen's definition has been expanded and refined by therapists who include communication disorders that involve difficulty in understanding the meaning of words, grammar, syntax, prosody, eye gaze, body language, gestures, or social context. While autistic children exhibit pragmatic language impairment, this type of communication disorder can also be found in individuals with other types of disorders including auditory processing disorders, neuropathies, encephalopathies and certain genetic disorders. [16]

Prior to the release of the DSM-5, there was debate over the relationship between semantic pragmatic disorder and autistic disorder, as the clinical profile of semantic pragmatic disorder is often seen in children with high-functioning autism. [17] Before the DSM-5 specified SPCD as a separate diagnosis, people with SPCD symptoms were often diagnosed with pervasive developmental disorder not otherwise specified (PDD-NOS). [18]

As mentioned in the introduction, SPCD has only been around since 2013. Before it emerged as its own disorder SPCD could have fallen into ASD, PLI, DLD, etc. The reason being because several of these disorders include an issue with social communication. [19] In terms of developmental language disorder (DLD), individuals with this disorder have issues with language form and content and there seem to be any developmental cause. [19] In social environments DLD seemed to have less difficulties than SPCD. [19]

In regards to ASD, ASD behaviors normally involve repetitive behaviors [20] which are normally not present in SPCD. It does not mean that SPCD does not show such behaviors. [20]

PLI tends to be the disorder that is more common to SPCD than the other disorders due to the fact that both disorders are focused on the pragmatic difficulties individuals have in language with both disorders. [21] SPCD has an element of social communication that is lacking or undeveloped, unlike PLI. [22]

In terms of Specific language impairment, there tends to a lot of similarities to SCPD and PLI but SLI deals with Semantic-Pragmatic issues. [22] This means that there are several issues that fall into Semantic- Pragmatic issues such as uncommon word choice, speaking to oneself out loud and interesting, unimpaired phonology and syntax. [22]

See also

Related Research Articles

<span class="mw-page-title-main">Asperger syndrome</span> Neurodevelopmental diagnosis now categorized under ASD

Asperger syndrome (AS), also known as Asperger's syndrome, formerly described a neurodevelopmental disorder characterized by significant difficulties in social interaction and nonverbal communication combined with restricted and repetitive patterns of behavior and interests. The syndrome has been merged with other disorders into autism spectrum disorder (ASD) and is no longer considered a stand-alone diagnosis. It was considered to differ from other diagnoses that were merged into ASD by relatively unimpaired spoken language and intelligence.

A communication disorder is any disorder that affects an individual's ability to comprehend, detect, or apply language and speech to engage in dialogue effectively with others. This also encompasses deficiencies in verbal and non-verbal communication styles. The delays and disorders can range from simple sound substitution to the inability to understand or use one's native language. This article covers subjects such as diagnosis, the DSM-IV, the DSM-V, and examples like sensory impairments, aphasia, learning disabilities, and speech disorders.

The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), was a group of disorders characterized by delays in the development of multiple basic functions including socialization and communication. It was defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the International Classification of Diseases (ICD).

Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, motor disorders, and autism spectrum disorders. In broader definitions ADHD is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.

Pervasive developmental disorder not otherwise specified (PDD-NOS) is a historic psychiatric diagnosis first defined in 1980 that has since been incorporated into autism spectrum disorder in the DSM-5 (2013).

Mixed receptive-expressive language disorder is a communication disorder in which both the receptive and expressive areas of communication may be affected in any degree, from mild to severe. Children with this disorder have difficulty understanding words and sentences. This impairment is classified by deficiencies in expressive and receptive language development that is not attributed to sensory deficits, nonverbal intellectual deficits, a neurological condition, environmental deprivation or psychiatric impairments. Research illustrates that 2% to 4% of five year olds have mixed receptive-expressive language disorder. This distinction is made when children have issues in expressive language skills, the production of language, and when children also have issues in receptive language skills, the understanding of language. Those with mixed receptive-language disorder have a normal left-right anatomical asymmetry of the planum temporale and parietale. This is attributed to a reduced left hemisphere functional specialization for language. Taken from a measure of cerebral blood flow (SPECT) in phonemic discrimination tasks, children with mixed receptive-expressive language disorder do not exhibit the expected predominant left hemisphere activation. Mixed receptive-expressive language disorder is also known as receptive-expressive language impairment (RELI) or receptive language disorder.

Autism spectrum disorders (ASD) are neurodevelopmental disorders that begin in early childhood, persist throughout adulthood, and affect three crucial areas of development: communication, social interaction and restricted patterns of behavior. There are many conditions comorbid to autism spectrum disorders such as attention-deficit hyperactivity disorder and epilepsy.

Specific language impairment (SLI) is diagnosed when a child's language does not develop normally and the difficulties cannot be accounted for by generally slow development, physical abnormality of the speech apparatus, autism spectrum disorder, apraxia, acquired brain damage or hearing loss. Twin studies have shown that it is under genetic influence. Although language impairment can result from a single-gene mutation, this is unusual. More commonly SLI results from the combined influence of multiple genetic variants, each of which is found in the general population, as well as environmental influences.

The Autism Diagnostic Observation Schedule (ADOS) is a standardized diagnostic test for assessing autism spectrum disorder. The protocol consists of a series of structured and semi-structured tasks that involve social interaction between the examiner and the person under assessment. The examiner observes and identifies aspects of the subject's behavior, assigns these to predetermined categories, and combines these categorized observations to produce quantitative scores for analysis. Research-determined cut-offs identify the potential diagnosis of autism spectrum disorder, allowing a standardized assessment of autistic symptoms.

The epidemiology of autism is the study of the incidence and distribution of autism spectrum disorders (ASD). A 2022 systematic review of global prevalence of autism spectrum disorders found a median prevalence of 1% in children in studies published from 2012 to 2021, with a trend of increasing prevalence over time. However, the study's 1% figure may reflect an underestimate of prevalence in low- and middle-income countries.

Pathological demand avoidance (PDA) or extreme demand avoidance (EDA) is a proposed disorder and sub-type of autism spectrum disorder, defined by characteristics such as a greater-than-typical refusal to comply with requests or expectations and extreme efforts to avoid the social demand. Any expectation, even familiar, routine activities for highly desired activities, such as getting ready to leave home to visit a playground, can trigger avoidant behavior, and if the demand cannot be avoided, a panic attack or a meltdown may ensue.

<span class="mw-page-title-main">Classic autism</span> Neurodevelopmental condition

Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism,Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.

Several factors complicate the diagnosis of Asperger syndrome (AS), an autism spectrum disorder (ASD). Like other ASD forms, Asperger syndrome is characterized by impairment in social interaction accompanied by restricted and repetitive interests and behavior; it differs from the other ASDs by having no general delay in language or cognitive development. Problems in diagnosis include disagreement among diagnostic criteria, the controversy over the distinction between AS and other ASD forms or even whether AS exists as a separate syndrome, and over- and under-diagnosis for non-technical reasons. As with other ASD forms, early diagnosis is important, and differential diagnosis must consider several other conditions.

<span class="mw-page-title-main">Autism spectrum</span> Neurodevelopmental disorder

Autism, formally called autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental disorder characterized by deficits in social communication and social interaction, and repetitive or restricted patterns of behaviors, interests, or activities, which can include hyper- and hyporeactivity to sensory input. Autism is clinically regarded as a spectrum disorder, meaning that it can manifest very differently in each person. For example, some are nonverbal, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.

This relationship between autism and memory, specifically memory functions in relation to Autism Spectrum Disorder (ASD), has been an ongoing topic of research. ASD is a neurodevelopmental disorder characterised by social communication and interaction impairments, along with restricted and repetitive patterns of behavior. In this article, the word autism is used to refer to the whole range of conditions on the autism spectrum, which are not uncommon.

The history of autism spans over a century, autism has been subject to varying treatments, being pathologized or being viewed as a beneficial part of human neurodiversity. The understanding of autism has been shaped by cultural, scientific, and societal factors, and its perception and treatment change over time as scientific understanding of autism develops.

Developmental Language Disorder (DLD) is identified when a child has problems with language development that continue into school age and beyond. The language problems have a significant impact on everyday social interactions or educational progress, and occur in the absence of autism spectrum disorder, intellectual disability or a known biomedical condition. The most obvious problems are difficulties in using words and sentences to express meanings, but for many children, understanding of language is also a challenge. This may not be evident unless the child is given a formal assessment.

Autism is characterized by the early onset of impairments in reciprocal social interaction and communication and restricted repetitive behaviors or interests. One of the many hypotheses explaining the psychopathology of autism, the deficit in joint attention hypothesis is prominent in explaining the disorder's social and communicative deficits. Nonverbal autism is a subset of autism spectrum where the person does not learn how to speak. One study has shown that 64% of autistic children who are nonverbal at age 5, are still nonverbal 10 years later.

John N. Constantino is a child psychiatrist and expert on neurodevelopmental disorders, especially autism spectrum disorders (ASD). Constantino is the Blanche F. Ittleson Professor of Psychiatry and Pediatrics at Washington University School of Medicine.

The diagnosis of autism is based on a person's reported and directly observed behavior. There are no known biomarkers for autism spectrum conditions that allow for a conclusive diagnosis.

References

  1. 1 2 Mandy, William (2017-10-01). "Evaluating social communication disorder". Journal of Child Psychology and Psychiatry. 58 (10): 1166–1175. doi:10.1111/jcpp.12785. hdl: 1983/7cc49c4c-6e32-4231-929e-b2efc8705b05 . PMID   28741680. S2CID   33830045.
  2. ↑ Baird, & Norbury, G., & C.F (2015). "Social (pragmatic) communication disorders and autism spectrum disorder". Archives of Disease in Childhood. 101 (8): 745–751. doi:10.1136/archdischild-2014-306944. PMID   26699538. S2CID   10329682.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ↑ Norbury, Courtenay F. (2014). "Practitioner Review: Social (pragmatic) communication disorder conceptualization, evidence and clinical implications". Journal of Child Psychology and Psychiatry. 55 (3): 204–216. doi: 10.1111/jcpp.12154 . PMID   24117874.
  4. 1 2 3 4 5 6 7 8 9 10 11 Norbury, Courtenay (2013-10-09). "Practitioner Review: Social (pragmatic) communication disorder conceptualization, evidence and clinical implications". Journal of Child Psychology and Psychiatry. 55 (3): 204–16. doi: 10.1111/jcpp.12154 . PMID   24117874.
  5. ↑ Evidence- based practice and Autism in schools (2nd ed.). Randdolph, Massachusetts: National Autism Center. 2015. ISBN   978-0-9836494-5-8.
  6. ↑ Evidence- based practice and Autism in schools (2nd ed.). Randdolph,, Massachusetts: National Autism Center. 2015. ISBN   978-0-9836494-5-8.
  7. ↑ "Social Communication Disorder & how it's treated". Autism Speaks. Retrieved 2019-11-05.
  8. ↑ "Social Communication Disorder & how it's treated". Autism Speaks. Retrieved 2019-11-05.
  9. ↑ Volden, Joanne (October 22, 2002). "Nonverbal learning disability: What the SLP needs to know". The ASHA Leader. American Speech-Language-Hearing Association. Retrieved February 14, 2013.
  10. ↑ "Social (Pragmatic) Communication Disorder" (PDF). Retrieved September 28, 2013.
  11. ↑ Mash, Eric. (2016). Abnormal Child Psychology, 6e, 6th Edition. [VitalSource Bookshelf Online]. Retrieved fromhttps://cengagebrain.vitalsource.com/#/books/9781305445765/
  12. ↑ American Psychiatric Association, ed. (2013). "Social (Pragmatic) Communication Disorder, 315.39 (F80.89)". Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Publishing. pp. 47–49.
  13. ↑ Rapin I., and D. Allen (1983). "Developmental language disorders: Nosologic considerations", in U. Kirk (ed.), Neuropsychology of language, reading, and, spelling (pp. 155–184). Academic Press.
  14. ↑ Conti-Ramsden G.; N. Botting (1999). "Classification of children with specific language impairment: longitudinal considerations". J. Speech Lang. Hear. Res. 42 (5): 1195–204. doi:10.1044/jslhr.4205.1195. PMID   10515515.
  15. ↑ Bishop, D. V. M. (2000), "Pragmatic language impairment: A correlate of SLI, a distinct subgroup, or part of the autistic continuum?" In D. V. M. Bishop and L. B. Leonard (eds.), Speech and Language Impairments in Children: Causes, characteristics, intervention and outcome (pp. 99–113). Hove, UK: Psychology Press.
  16. ↑ Bishop, D. V., and C. F. Norbury (Oct 2002). "Exploring the borderlands of autistic disorder and specific language impairment: a study using standardised diagnostic instruments". Journal of Child Psychology and Psychiatry, and Allied Disciplines. 43 (7): 917–29. doi: 10.1111/1469-7610.00114 . ISSN   0021-9630. PMID   12405479. S2CID   21279403.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. ↑ Bishop, D. V.M. and Norbury, C. F. (2002). "Exploring the borderlands of autistic disorder and specific language impairment: a study using standardised diagnostic instruments" Journal of Child Psychiatry, 43: 917–929. doi: 10.1111/1469-7610.00114. [Wiley Online Library]. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/1469-7610.00114/full
  18. ↑ "Pervasive Developmental Disorder not Otherwise Specified (PDD NOS)", Encyclopedia of Autism Spectrum Disorders, New York, NY: Springer New York, 2013, p. 2209, doi:10.1007/978-1-4419-1698-3_101030, ISBN   978-1-4419-1697-6 , retrieved 2021-10-27
  19. 1 2 Mandy, William (2017-10-01). "Evaluating social (pragmatic) communication disorder". Journal of Child Psychology and Psychiatry. 58 (10): 1166–1175. doi:10.1111/jcpp.12785. hdl: 1983/7cc49c4c-6e32-4231-929e-b2efc8705b05 . PMID   28741680. S2CID   33830045.
  20. ↑ Swineford, Lauren B; Thurm, Audrey; Baird, Gillian; Wetherby, Amy M; Swedo, Susan (2014). "Social (pragmatic) communication disorder: a research review of this new DSM-5 diagnostic category". Journal of Neurodevelopmental Disorders. 6 (1): 41. doi: 10.1186/1866-1955-6-41 . PMC   4258293 . PMID   25484991.
  21. 1 2 3 Norbury, Courtenay F (2014-03-01). "Practitioner Review: Social communication disorder conceptualization, evidence and clinical implications". Journal of Child Psychology and Psychiatry. 55 (3): 204–216. doi: 10.1111/jcpp.12154 . PMID   24117874.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.