Social (pragmatic) communication disorder | |
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Other names | SPCD |
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 difficulties in the social use of verbal and nonverbal communication. Individuals who are defined by the acronym "SPCD" struggle to effectively indulge in social interactions, interpret social cues, and may struggle to use words 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.
While 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.
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 affected by 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]
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Individuals with social communication disorder have particular trouble understanding the meaning of what others are saying. Children with the disorder often exhibit:[ This paragraph needs citation(s) ]
According to Bishop and Norbury (2002), children with semantic pragmatic disorder can have fluent, complex 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 are not as strong or obsessional as people with autism spectrum disorders. [4]
The current view 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). Individuals often assume a 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 meaning beyond a literal interpretation.[ This paragraph needs citation(s) ]
Because 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 that typically manifest in early childhood. The DSM-5 diagnostic criteria for social communication disorder are as follows:
- A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
- Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
- Impairment of the ability to change communication to match the 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 the use of overly formal language.
- 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.
- Difficulties understanding what is not explicitly stated (e.g., making inferences) and non-literal or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
- B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
- C. The onset of symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
- D. The symptoms are not attributable to another medical or neurological condition or low abilities in the domains of word structure and grammar and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder. [ citation needed ]
Common assessments used to identify SPCD are:
Although several tests can be done to try to identify SPCD, some tests are better suited to diagnose SPCD than others. Also, there is not a specific assessment or test that can diagnose SPCD, unlike other disorders such as ASD, DLD, and PLI.
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Treatments for SPCD are less established than for treatments for other disorders such as autism. [6] Similarities between SPCD and some aspects of autism lead some researchers to try some treatments for autism with people with SPCD. [7]
Speech therapy can help individuals who have communication disorders. Speech and language therapy treatment focuses on communication and social interaction. [8] Speech therapists can work with clients on communication in various settings. [9]
Hyperlexia is a similar but different disorder where the 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 a nonverbal learning disability to PLI. [10]
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. [11] 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.
Before 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. [12] Social communication disorder is distinguished from autism by the absence of any history (current or past) of restricted or repetitive patterns of interest or behavior in SPCD. [13]
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. [14] 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. [15] [16]
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. [4]
Before 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 disorder SPCD could have fallen into ASD, PLI, DLD, etc. The reason is that 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 seems to be no developmental cause. [19] In social environments, DLD seemed to have fewer 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 because 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 tend to be a lot of similarities between SCPD and PLI but SLI deals with Semantic-Pragmatic issues. [22] This means that several issues fall into Semantic-Pragmatic issues such as uncommon word choice, speaking to oneself out loud and interesting, unimpaired phonology, and syntax. [22]
Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, is a term formerly used to describe a neurodevelopmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted, repetitive patterns of behavior and interests. Asperger syndrome has been merged with other disorders into autism spectrum disorder (ASD) and is no longer considered a stand-alone diagnosis. It was considered milder than other diagnoses which were merged into ASD due to 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).
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 disorder (ASD) is a neurodevelopmental disorder that begins in early childhood, persists throughout adulthood, and affects two crucial areas of development: social communication and restricted, repetitive patterns of behavior. There are many conditions comorbid to autism spectrum disorder 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.
Asperger syndrome (AS) was formerly a separate diagnosis under autism spectrum disorder. Under the DSM-5 and ICD-11, patients formerly diagnosable with Asperger syndrome are diagnosable with Autism Spectrum Disorder. The term is considered offensive by some autistic individuals. It was named after Hans Asperger (1906–80), who was an Austrian psychiatrist and pediatrician. An English psychiatrist, Lorna Wing, popularized the term "Asperger's syndrome" in a 1981 publication; the first book in English on Asperger syndrome was written by Uta Frith in 1991 and the condition was subsequently recognized in formal diagnostic manuals later in the 1990s.
Pathological demand avoidance (PDA) or extreme demand avoidance (EDA) is a proposed disorder, and proposed sub-type of autism spectrum disorder, defined by characteristics such as a demand avoidance—which is a greater-than-typical refusal to comply with requests or expectations—and extreme efforts to avoid social demands. Any expectation, even routine activities, such as brushing teeth, or highly desired activities, such as getting ready to leave home to visit a playground, can trigger avoidant behavior. If the demand cannot be avoided, a panic attack or a meltdown may ensue.
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.
Autism, also called autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental disorder marked by deficits in reciprocal social communication and the presence of restricted and repetitive patterns of behavior. Other common signs include difficulty with social interaction, verbal and nonverbal communication, along with perseverative interests, stereotypic body movements, rigid routines, and hyper- or 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 nonspeaking, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.
The relationship between autism and memory, specifically memory functions in relation to Autism Spectrum Disorder (ASD), is 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.
Nonverbal autism, also called nonspeaking autism, is a subset of autism spectrum disorder 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.
Nicola Botting is a language and communication scientist whose work focuses on language and psychological outcomes of children with low birth weight, autism spectrum disorder, developmental language disorder, and other developmental disabilities. She is Professor of Developmental Disorders, Language & Communication Science at the City University of London. Botting is editor-in-chief of the journal Autism & Developmental Language Impairments.
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.
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