Social Communication Disorder-DSM Diagnosis

Do you struggle with diagnostic labels related to social communication disorder?

There is a new diagnostic label that has been added to the DSM-5!  “Social (Pragmatic) Communication Disorder”, (SCD) was recently added to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).  SCD describes people with significant difficulties using verbal and nonverbal communication for social purposes, leading to impairments in their ability to effectively communicate, participate socially, keep up social relationships, or otherwise perform academically or occupationally.  Ok, social or pragmatic disorders, nothing new here, right? Actually, this is new!  Having this diagnosis means a pragmatics disorder may be a distinct (stand alone)  diagnosis or may be associated with other conditions (e.g., ASD, SLI, etc.).  We have options!

Now, those individuals that have social difficulties but don’t show the restrictive or repetitive patterns of behavior, movement or activities (seen in ASD) have an accurate diagnostic label that reflects their treatment needs! For years, I’ve had students with pragmatic delays but without the classic signs of autism.  I’ve never been sure of where these student’s “fit” from a diagnostic standpoint.  This new label will recognize individuals who have significant problems using verbal and nonverbal communication for social purposes.  Previous editions of  DSM did not offer an appropriate diagnostic label for these individuals.

Assessing for Social Communication Disorder:

When assessing for  Social Communication Disorder, ASHA recommends that SLPs do a comprehensive assessment, which includes:

• standardized assessment(s),
• parent/teacher child report measures (rating scales),
• ethnographic interviewing, (an interview technique using open-ended questions, restatement and summarizing for clarification),
• analog task(s), (observation of the child in simulated social situations), and
• observation in a naturalistic social setting with other people.

Social communication norms may vary significantly across individuals and cultures.  Are you unsure of what pragmatic benchmarks are expected at different ages?  Check out ASHA’s Social Communication Benchmarks by Age for a summary of age-specific pragmatic skills.  SLPs determine a child’s norms within the context of their environment.  If you are evaluating an ELL student, be sure to familiarize yourself with social expectations in the student’s culture.  Cultural norms may influence social skills in many ways, including (but not limited to) eye contact, comfort with silence, turn-taking and interruptions.  Looking for ideas on doing social communication therapy in the preschool classroom?  Click here!

Keep these thoughts in mind when considering a diagnosis of Social Communication Disorder:

SLPs need to document signs of social communication delays starting in the early intervention setting.  Symptoms of SCD must be present in early childhood even if they are not recognized until later in the child’s life when communication demands exceed abilities.  Autism Spectrum Disorder (ASD) must be ruled out to consider a diagnosis of social communication disorder.

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