Does Your Child Have Social Communication Disorder?

Your Child's Symptoms May Be Too Mild for Autism

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Social Communication Disorder is a "new" diagnosis, created when the DSM-5 (diagnostic manual) was republished in 2013. This disorder includes some but not all of the symptoms of Autism Spectrum Disorder, making it a sort of "lite" or "mild" version of autism.  

If you've been aware of autism for any period of time, the idea of a "milder" autism diagnosis may sound very familiar. In fact, Social Communication Disorder has an awful lot in common with two diagnoses that were removed from the Diagnostic Manual (DSM) in 2013.

These two now-defunct disorders were Asperger syndrome and PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified).

In short, when Asperger syndrome and PDD-NOS were removed from the Diagnostic Manual, Social Communication Disorder was created to take their place.

Diagnostic Criteria for Social Communication Disorder

The following criteria from the 2013 DSM-5 describe the symptoms of SCD:

A.Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:

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).

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 the 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 to 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.

How Is Social Communication Disorder (SCD) Like and Unlike Autism?

Here, according to the DSM-5, is how Social Communication Disorder differs from autism: "The two disorders can be differentiated by the presence in autism spectrum disorder of restricted/repetitive patterns of behavior, interests, or activities and their absence in social (pragmatic) communication disorder." 

In other words, children with autism have social communication challenges and repetitive behaviors, while children with social communication disorder have only social communication challenges.

According to an article in the Journal of Neurodevelopmental Disorders, most of those social communication challenges are related to difficulties in speech pragmatics (the appropriate use of social speech):

 SCD is defined by a primary deficit in the social use of nonverbal and verbal communication... Individuals with SCD may be characterized by difficulty in using language for social purposes, appropriately matching communication to the social context, following rules of the communication context (e.g., back and forth of conversation), understanding nonliteral language (e.g., jokes, idioms, metaphors), and integrating language with nonverbal communicative behaviors.

But of course it isn't possible to have problems with using social speech if you are either too young to use spoken language or are non verbal. Thus, people with SCD must be verbal and relatively high functioning, and must be diagnosed when they are old enough to use spoken language:

Sufficient language skills must be developed before these higher-order pragmatic deficits can be detected, so a diagnosis of SCD should not be made until children are 4–5 years of age. Social communication disorder can co-occur with other communication disorders in the DSM-5 (these include language disorder, speech sound disorder, childhood-onset fluency disorder, and unspecified communication disorder), but cannot be diagnosed in the presence of autism spectrum disorder (ASD).

Why Social Communication Is Hard to Separate from Autism

While it should, in theory, be simple enough to distinguish autism from SCD, it's actually very difficult. In part, that's because repetitive behaviors don't have to be present for an autism diagnosis to be given. In fact, if repetitive behaviors were ever present, even ten years ago, and have long since disappeared, you can still be diagnosed with autism. Here's how this rather odd caveat is explained in the DSM:

Individuals with autism spectrum disorder may only display the restricted/repetitive patterns of behavior, interests, and activities during the early developmental period, so a comprehensive history should be obtained. Current absence of symptoms would not preclude a diagnosis of autism spectrum disorder, if the restricted interests and repetitive behaviors were present in the past. A diagnosis of social (pragmatic) communication disorder should be considered only if the developmental history fails to reveal any evidence of restricted/repetitive patterns of behavior, interests, or activities.

So, at least in theory, any person who once had unusually repetitive behaviors and now has pragmatic speech challenges can be diagnosed as autistic. Thus it is (again in theory) impossible to progress from an autism diagnosis to an SCD diagnosis. What's more, an SCD diagnosis can only be given after the practitioner has explored the child's behavioral history in depth.

A Word from Verywell

Parents may feel frustrated if their child receives an autism diagnosis rather than the milder SCD diagnosis, especially if their child is doing well in areas other than social communication. They may even choose to avoid mentioning old autism-like behaviors that their child has "outgrown," in order to avoid an autism spectrum diagnosis. But it's quite possible that the autism diagnosis will help your child in more ways than you might expect. A person who has "only" Social Communication Disorder may not receive the same level of services as a person with the same symptoms and an Autism Spectrum diagnosis. So even if your child has outgrown or learned to manage autistic symptoms, it may be worth your while to describe past symptoms in order to help your child qualify for a diagnosis that offers more and better services and support

Sources:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.

Gibson, J., Adams, C., Lockton, E. and Green, J. (2013), Social communication disorder outside autism? A diagnostic classification approach to delineating pragmatic language impairment, high functioning autism and specific language impairment. J Child Psychol Psychiatr, 54: 1186–1197.

Swineford, Lauren et al. Social (pragmatic) communication disorder: a research review of this new DSM-5 diagnostic category.Journal of Neurodevelopmental Disorders 2014 6:41

 

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