Social (Pragmatic) Communication

Disorder and Autism Spectrum

Disorder
Areeba Farhad
 Contents
• Diagnostic Criteria
• Causes
• Prevalence
• Prognosis
• Differential Diagnosis
• Comorbidity
• Treatment
Social (Pragmatic)
Communication Disorder
 Diagnostic Criteria
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 social context.

2. Impairment in 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
meaning 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 conditions.
•
 Causes
1. Researchers do not yet fully understand what causes
SCD. Some evidence suggests that certain genes may
increase the risk of SCD or be more prevalent among
people with SCD. However, there is no evidence that
any specific gene or combination of genes inevitably
causes SCD.

2. Researchers have also identified some brain differences

in people with SCD.
Prior to the separate classification by DSM-5, SPCD was thought
to coexist with ADHD and other genetic or neurological
conditions.

However, the DSM-5 considers SPCD its own disorder. This

means that it’s not caused by ASD, ADHD, or any other
neurodevelopmental condition.

Children must have time to sufficiently develop their language

skills before SPCD can be detected. Therefore, a diagnosis of
SPCD shouldn’t be made until they are at least 4 to 5 years old.
 Prevalence
• The incidence and prevalence of social (pragmatic)
communication disorder is not well known, as it is a new
diagnosis in the DSM-5.

• It is estimated that some form of pragmatic language

impairment can affect up to 7.5% of children. Males are
typically affected more than females, by a ratio of 2:1.

• SCD is rare in children younger than age 4.

Risk and Prognostic factors
Genetic and Physiological:
SPCD may run in families. Other risk factors may include
underlying:

• ADHD
• intellectual or developmental disabilities
• other language disorders
• learning disabilities
• hearing loss
• traumatic brain injuries
• dementia
 Differential Diagnosis
• Autism spectrum disorder
The presence of restricted/repetitive patterns of behaviour,
interests, or activities should suggest a diagnosis of autism
spectrum disorder rather social communication disorder.

• Social anxiety disorder (social phobia)

In social communication disorder, the individual has never had
effective social communication. In social anxiety disorder, social
communication skills have developed appropriately but are not
used due to anxiety, fear, or distress about social interactions.
• Intellectual disability and global developmental delay
Social communication skills can already be deficient in
individuals with global developmental delay or intellectual
disability. Thus, a separate diagnosis is not given unless the
social communication deficits are in excess of what is expected
with the intellectual disability itself.
 Comorbidity
1. Attention-deficit/hyperactivity disorder.
2. language disorders.
3. specific learning disorders.
 Treatment
• Treatment focuses on helping a person develop social and
communication skills and providing accommodations that
make it easier for them to function.

• No specific medication can treat SCD.

• In most cases, a person will need the support of a speech-

language pathologist. They may also need mental health
support. Some treatment options include:
1- Assistive communication devices: These devices can help a
person communicate in settings where they might otherwise
find it too difficult.
2- Communication training and support: Interventions that
teach people communication skills may make communication
easier. For example, social scripts can help teach children
language strategies for social interaction, while social stories can
build an understanding of social situations through stories.

3- Social skills practice: Various interventions can help people

practice their social skills. For example, peers without SCD may
work with a child with SCD to practice social skills, or a person
might practice skills with a therapist.
4-Speech Therapy
speech therapy may take place in a classroom or small group, or
one-on-one, depending on the speech disorder. Speech therapy
exercises and activities vary depending on your child’s age and
needs. During speech therapy for children, the SLP may:

Interact through talking and playing, and using books, pictures

other objects as part of language intervention to help stimulate
language development.
Model correct sounds and syllables for a child during age-
appropriate play to teach the child how to make certain sounds.
Provide strategies and homework for the child and parent or
caregiver on how to do speech therapy at home.
Autism Spectrum Disorder
 Diagnostic Criteria
To meet diagnostic criteria for ASD according to DSM-5, a child
must have persistent deficits in each of three areas of social
communication and interaction plus at least two of four types of
restricted, repetitive behaviors.
A. Persistent deficits in social communication and social
interaction across multiple contexts, as manifested by the
following, currently or by history (examples are illustrative, not
exhaustive; see text):

1- Deficits in social-emotional reciprocity, ranging, for example,

from abnormal social approach and failure of normal back-and-
forth conversation; to reduced sharing of interests, emotions, or
affect; to failure to initiate or respond to social interactions.
2- Deficits in nonverbal communicative behaviors used for social
interaction, ranging, for example, from poorly integrated verbal
and nonverbal communication; to abnormalities in eye contact
and body language or deficits in understanding and use of
gestures; to a total lack of facial expressions and nonverbal
communication.

3- Deficits in developing, maintaining, and understanding

relationships.
B- Restricted, repetitive patterns of behavior, interests, or
activities, as manifested by at least two of the following,
currently or by

1- Stereotyped or repetitive motor movements, use of objects,

or speech (e.g., simple motor stereotypes, lining up toys or
flipping objects, echolalia).

2- Insistence on sameness, inflexible adherence to routines, or

ritualized patterns of verbal or nonverbal behavior (e.g.,
extreme distress at small changes, greeting rituals, need to take
same route or eat same food every day).
3- Highly restricted, fixated interests that are abnormal in
intensity or focus (e.g., strong attachment to or preoccupation
with unusual objects, excessively circumscribed or perseverative
interests).

4- Hyper- or hyporeactivity to sensory input or unusual interest

in sensory aspects of the environment (e.g. apparent
indifference to pain/temperature, adverse response to specific
sounds or textures, excessive smelling or touching of objects,
visual fascination with lights or movement).
C- Symptoms must be present in the early developmental
period.

D- Symptoms cause clinically significant impairment in social,

occupational, or other important areas of current functioning.

E-These disturbances are not better explained by intellectual

disability (intellectual developmental disorder) or global
developmental delay.
 Causes
• Genetics
For some children, autism spectrum disorder can be associated
with a genetic disorder, such as Rett syndrome or fragile X
syndrome. For other children, genetic changes (mutations) may
increase the risk of autism spectrum disorder. Some genetic
mutations seem to be inherited, while others occur
spontaneously.

• Environmental factors
Researchers are currently exploring whether factors such as
viral infections, medications or complications during pregnancy,
or air pollutants play a role in triggering autism spectrum
disorder.
 Prevalence
• The approximate prevalence of autism spectrum disorder
(ASD) is 1% in both US and non-US populations.

• Autism spectrum disorder is diagnosed four times more often

in males than in females.

• The prevalence of autism spectrum disorder has increased in

the past few decades, rising up to prevalence rates of 1.7% (or
1 in 59 children).
Risk and prognosis Factors
• In young children with ASD, the lack of social and
communication abilities may affect learning .
• The inflexibility and insistence may interfere with routine
activities such as eating, bathing, and sleeping.
• In ASD, adaptive skills are typically below the individual's
measured IQ.
• During adulthood, some individuals may have difficulties
establishing independence because of rigidity.
 Differential Diagnosis
1. Rett syndrome
Disruption of social interaction can be seen during the regressive
phase of Rett syndrome (between 1-4 years of age). A significant
proportion of affected young girls may have a symptoms that
meet criteria for ASD. However, after this period, social
communication skills usually improve.
2. Selective mutism
In selective mutism the affected child usually exhibits
appropriate communication skills in certain contexts and
settings. Even in settings where the child is mute, social
reciprocity is not impaired, and restricted or repetitive patterns
of behaviour do not exist.

3. Language disorders
In some language disorders, there can be problems of
communication with social difficulties. However, specific
language disorder is not usually associated with abnormal
nonverbal communication, nor with the presence of restricted,
repetitive patterns of behaviour, interests, or activities.
4. Social (pragmatic) communication disorder (SCD)
When an individual shows impairment in social communication
and social interactions but does not show restricted and
repetitive behaviour or interests then social (pragmatic)
communication disorder (SCD) is the the more likely diagnosis.

5. Attention-deficit/hyperactivity disorder
Abnormalities of attention (being overly focused, easily
distracted, or hyperactivity) is common in ASD. A diagnosis of
ADHD should be considered when attentional difficulties or
hyperactivity exceeds that typically seen in individuals of
comparable mental age.
6. Stereotypic movement disorder
Motor stereotypies are one of the diagnostic characteristics of
autism spectrum disorder, so an additional diagnosis of
stereotypic movement disorder is not given.

7. Schizophrenia
Schizophrenia in childhood onset cause a state in which social
impairment and atypical interests and beliefs occur, which could
be confused with the social deficits seen in autism spectrum
disorder. Hallucinations and delusions, which are defining
features of schizophrenia, are not features of autism spectrum
disorder.
 Comorbidity
• Adolescents and adults with autism spectrum disorder are at
increased risk for anxiety and depression.

• Some individuals may develop catatonic-like motor behaviour

(slowing and “freezing” mid-action), but are not usually to the
severity of a true catatonic episode.

• Epilepsy is also more common, and is further associated with

greater intellectual disability and lower verbal ability.
 Treatment
1.Applied Behavior Analysis (ABA). ABA is often used in schools
and clinics to help your child learn positive behaviors and reduce
negative ones. This approach can be used to improve a wide
range of skills, and there are different types for different
situations, including:

• Discrete trial training (DTT) uses simple lessons and positive

reinforcement.
• Pivotal response training (PRT) helps develop motivation to
learn and communicate.
• Early intensive behavioral intervention (EIBI) is best for
children under age 5.
• Verbal behavior intervention (VBI) focuses on language skills.
2.Treatment and Education of Autistic and Related
Communication-handicapped Children (TEACCH).
This treatment uses visual cues such as picture cards to help
your child learn everyday skills like getting dressed. Information
is broken down into small steps so they can learn it more easily.

3.The Picture Exchange Communication System (PECS).

This is another visual-based treatment, but it uses symbols
instead of picture cards. Your child learns to ask questions and
communicate through special symbols.
4.Occupational Therapy.
This kind of treatment helps your child learn life skills like
feeding and dressing themselves, bathing, and understanding
how to relate to other people. The skills they learn are meant to
help them live as independently as they can.

5.Sensory Integration Therapy.

If your child is easily upset by things like bright lights, certain
sounds, or the feeling of being touched, this therapy can help
them learn to deal with that kind of sensory information.
THANK YOU