Understanding Social Communication Disorder

By The Understood Team

 

If you suspect your child has social communication disorder (SCD) or if he was recently diagnosed with SCD, you probably have a lot of questions. That’s understandable. SCD is a recently defined condition, and it’s gone by different names in the past. You may have heard it called “pragmatic language impairment” or “semantic pragmatic disorder.”

Children with SCD have trouble using spoken language in socially appropriate ways. They tend to do OK with the mechanics of speaking—pronouncing words and constructing sentences. But they struggle to hold conversations. This can make it harder to make and keep friends and do well in school.

If your child has SCD, there’s a lot you can do to help him improve his communication skills. Here are some key facts about social communication disorder, along with suggestions for how you and professionals can help.

What is social communication disorder?

Children with SCD have difficulty with pragmatics—the unspoken, subtle rules of spoken language that allow people to connect. They don’t always understand the give-and-take of a conversation. Some of them monopolize conversations or interrupt a lot. Others hesitate to talk at all.

It’s not because these children are rude or their parents haven’t taught them manners. For reasons that aren’t yet clear, it’s difficult for children with SCD to learn how to use language in socially appropriate ways.

SCD was only recognized as a diagnosis in 2013, when the American Psychiatric Association (APA) added it to the Diagnostic and Statistic Manual of Mental Disorders(DSM). It was an attempt to clear up decades of debate[1] about whether this condition is a symptom of a language impairment, a sign of an  (such as) or a separate condition entirely.

One of the main signs of autism is weak social communication skills. That’s why many medical professionals would diagnose children with SCD with autism. New studies, however, show that at least some children with SCD symptoms don’t have the other signs of autism, such as narrow interests and repetitive behavior.[2] According to the American Psychiatric Association, these children should be diagnosed with SCD.

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How common is social communication disorder?

It’s not clear how many children have SCD. Pervasive development disorders occur in roughly 5 to 15 children per 10,000 births.[3] But how many of these children would now be diagnosed with SCD is not known. More research is needed to determine the prevalence of SCD.

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What causes social communication disorder?

Experts aren’t sure what causes SCD. It’s thought to be a neurodevelopmental (brain) disorder.[4] One theory is that social communication disorder may be due to a “glitch” in the brain’s right hemisphere[5] that makes it harder for kids to process verbal and visual information simultaneously. Another theory is that the disorder is somehow related to weak executive functioning skills.[6]

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What are the symptoms of social communication disorder?

Everyone struggles with social situations from time to time. But for a child with SCD, navigating social situations is a daily challenge. Your child may say inappropriate or unrelated things during conversations. Or he may interrupt a lot.

Most children intuitively grasp the nuances of conversation. Kids with SCD, however, may find it difficult to learn the basic rules of conversation: how to start one, listen, phrase a question, stay on topic and know when the chat is over.[7]

Signs of SCD show up in early childhood, but it may not be diagnosed until kids start school. The symptoms often include:

  • Delay in reaching language milestones
  • Little interest in social interactions
  • Going off-topic or monopolizing conversations
  • Not adapting language to different listeners (talks the same way to an adult as to a friend)
  • Not adapting language to different situations (speaks the same way in the classroom as on the playground)
  • Difficulty making inferences and understanding things that are implied, but not stated explicitly
  • Not giving background information when speaking to an unfamiliar person
  • Not understanding how to properly greet people, request information or gain attention
  • Tendency to be overly literal and not understand riddles and sarcasm
  • Trouble understanding nonverbal communication, such as facial expressions
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What skills are affected by social communication disorder?

Having social communication issues can affect your child’s experiences inside and outside the classroom.

  • Academic skills: Kids with SCD can have trouble making inferences and understanding social subtleties. This can cause them to lag behind in developing reading and writing stills. Children with SCD are often able to develop phonemic awareness—recognizing sounds of letters. But they tend to struggle with. As a result, their reading issues might not be noticed until early elementary school, when kids move from “learning to read” to “reading to learn.
  • Social skills: Making and keeping friends can be difficult for kids with SCD. They may inadvertently offend other kids. They may struggle more than others to handle typical conflicts.

Children with SCD also often have behavioral issues, such as hyperactivity.[8] A lack of social communication skills can lead kids to be frustrated and act out.[9]

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How is social communication disorder diagnosed?

Symptoms must be present in early childhood for kids to be diagnosed with SCD. But parents and doctors may not recognize the signs until years later.

Autism spectrum disorder (ASD) also has to be ruled out in order to make an SCD diagnosis. Physicians and psychologists rule out ASD when kids don’t show other telltale symptoms, such as obsessive interests and repetitive behaviors (like rocking back and forth).[10]

There’s more than one way to diagnose SCD. The American Speech-Language-Hearing Association (ASHA) recommends evaluating children in many different settings.[11] An evaluation by a , also referred to as a speech therapist, might include:

  • Observing your child in the classroom and at home
  • Interviewing your child’s teacher or caregiver or having her fill out a questionnaire
  • Performing formal one-on-one testing to assess your child’s language and communication skills

ASHA suggests a range of language and behavioral tests, including the Clinical Evaluation of Language Fundamentals, the Test of Language Competence, and Vineland Adaptive Behavior Scales. It also recommends the Children’s Communication Checklist and Pragmatic Rating Scale to assess children’s “spontaneous” conversational skills.

The goal of testing is to analyze your child’s verbal and nonverbal communication skills in different situations. This helps professionals figure out whether these skills are affecting your child’s ability to form relationships and learn. The therapist also may try out different strategies during the evaluation to see which works for your child. If your child is diagnosed with SCD, the therapist will work closely with you to develop a plan.

There are several ways to seek a speech-language evaluation:

  • Seek help privately. Speech-language evaluations may be available at low cost or for free at local universities that train speech-language pathologists.
  • Contact your state’s  system. If your child is under age 3, you can request an evaluation, free of charge and without a referral. The early intervention system is mandated by the federal  (IDEA). It provides services for infants and toddlers with disabilities and their families. If your child is found to have a delay or disability, the staff will work with you to develop anIndividualized Family Service Plan (IFSP). An IFSP includes services that may be provided on a sliding-fee basis.[12] Learn more about early intervention.
  • Contact your local school district. Whether your child attends public or, you can contact your local school district to request that your child be evaluated for SCD.
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What conditions are related to social communication disorder?

Kids with social communication disorder may have other conditions as well. Doctors refer to this as comorbidity. Here are some conditions that have been linked with SCD:

  • Autism spectrum disorder: Kids with ASD typically have an unusually intense interest in a few topics. They often perform repetitive movements and become extremely disturbed by changes in routines—as well as have difficulty with social skills.[14] Kids with ASD also can struggle with relationships and academics.
  • Reading issues: Reading issues are common among kids with SCD. For instance, they tend to have trouble interpreting the nuances of language. This can make reading comprehension difficult.[15]
  • : Research has shown kids with SCD are more likely to have ADHD, a condition often characterized by hyperactivity and inattention, as well as difficulties with social communication skills. Because many children have both ADHD and SCD, some researchers have theorized that the lack of “pragmatic competence”—the ability to use language in socially appropriate ways—might be an early sign of ADHD.[16]

It’s important to mention that some experts dispute the idea that SCD ever occurs by itself.[13] They suggest that difficulties with social communication are just symptoms of other conditions.

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How can professionals help with social communication disorder?

Treatments that are specific to social communication disorder have yet to be defined. Even so, there are many ways professionals can help your child gain social communication skills.

Therapy
A speech therapist can work one-on-one with your child, helping him practice turn-taking, introducing and ending topics and other conversational skills. The therapist may use role-playing games and visuals, such as comic strips, to help your child learn strategies to manage social situations. The therapist also can train you in how to reinforce these skills at home.

Your Child’s School
If your child has been diagnosed with SCD and qualifies for  services, you and a team of specialists at the school will develop an Individualized Education Program(). This might include , social skills training and in-class support, such as a teacher’s aide.

The school also may recommend—or you can request— a 504 plan for your child. This is a written plan that details how the school will accommodate your child’s needs. may include teaching your child strategies to boost reading comprehension and giving your child more time to process information.

Even without special services, there are things the school can do to help your child academically:

  • Informal accommodations can help kids without IEPs or 504 plans. Teachers might, for instance, provide story outlines or pictures to help your child retell a story in sequence.
  • Response to intervention (RTI) is an approach used by some public schools. It identifies students who are falling behind in certain skill areas and then provides small-group instruction at an appropriate level. Your child might get one-on-one instruction if group instruction isn’t effective.
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What can be done at home for social communication disorder?

It can be challenging to raise a child with social communication disorder. But there are ways you can work on your child’s skills at home. Here are a few ideas:

  • Make reading interactive. When you’re reading, ask your child to think about what’s happening in the story. Ask questions like, “I wonder what Alice will do now?” Or, “How do you think the mother feels?” By encouraging your child to reflect on what you’ve read, you can help him learn to make inferences that are essential for reading comprehension.
  • Model good communication behavior. When talking to your child, make eye contact. Also discuss the polite way to ask for things and why one way might be more effective than another. Give your child lots of opportunities to practice those skills with you at home, and praise him for his success.[17]

Explore more strategies that help kids with language disorders, including role-playing games that build social skills and the best sports for kids with social skill issues.

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What can make the journey easier?

This is a lot of information to absorb and act on. As you continue to learn, try to pace yourself. Trust your instincts and observations. Wherever you are in your journey, this site can help you find many ways to support your child with social communication disorder.

  • Know your child’s issues. Knowing what specific issues your child has is the first step toward getting the best possible help. Talk to your child’s doctor about what’s happening. And learn more about how difficulty with conversation can play out in your child’s daily life.
  • Learn about special services. Explore more information on IEPs and 504 plans.
  • Get behavior advice. Parenting Coach provides simple strategies from experts to help you work through your child’s problem behaviors.
  • Connect with other parents. Remember that you’re not alone. Visit our communityto find other parents who are dealing with the same challenges you are.
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Key Takeaways

  • SCD can cause social, emotional and learning difficulties.
  • There are resources available to get free or low-cost therapy for your child.
  • You and qualified professionals can work together to help your child build social communication skills.

Sources

[1] "Exploring the Borderlands of Autistic Disorder and Specific Language Impairment," Dorothy V.M. Bishop and Courtney Frazier Norbury, University of Oxford, UK, Journal of Child Psychology and Psychiatry, 43:7 (2002), pp 917–929, retrieved fromhttp://www.theactgroup.com.au/documents/1469-7610.00114.pdf

[2] "The Nature of Pragmatic Language Impairment," Mieke Pauline Ketelaars, 2010, retrieved from http://miekeketelaars.net/files/Proefschrift%20M.%20Ketelaars.pdf

[3] "Pervasive Development Disorders (PPDs)." MedicineNet. WebMD. Web.http://www.medicinenet.com/pervasive_development_disorders/article.htm

[4] "Neurodevelopmental Disorders." Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. PsychiatryOnline. Web.http://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596

[5] McDonald, Skye. "Exploring the Cognitive Basis of Right-Hemisphere Pragmatic Language Disorders." Brain and Language 75.1 (2000): 82–107. NCBI. Web.http://www.ncbi.nlm.nih.gov/pubmed/11023640

[6] "What Is Executive Function?" National Center for Learning Disabilities. NCLD. Web.http://www.ncld.org/types-learning-disabilities/executive-function-disorders/what-is-executive-function

[7] "Social Communication Disorder." ChildMind.org. Child Mind Institute. Web.http://www.childmind.org/en/health/disorder-guide/social-communication-disorder

[8] Benner, Gregory. "Language Skills of Elementary-Aged Children with Emotional and Behavioral Disorders." Great Plains Research 15 (2005): 251–65. Digital Commons: University of Nebraska. Web. http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1792&context=greatplainsresearch

[9] Cummings, Louise. "Pragmatic Disorders." 2010. In: JH Stone, M Blouin, editors.International Encyclopedia of Rehabilitation.http://cirrie.buffalo.edu/encyclopedia/en/article/363/

[10] "Learn the Signs of Autism." Autism Speaks. Web.http://www.autismspeaks.org/what-autism/learn-signs

[11] "Guidelines for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders Across the Life Span [Guidelines]." American Speech-Language-Hearing Association. 2006. http://www.asha.org/policy/gl2006-00049/#sec1.9.4

[12] "Speech and Language Impairments." National Dissemination Center for Children with Disabilities. Jan. 2011. Web. http://nichcy.org/disability/specific/speechlanguage#ref11

13] Tager-Flusberg, Helen. "Evidence Weak for Social Communication Disorder." Simons Foundation Autism Research Initiative. SFARI, 30 May 2013. Web. http://sfari.org/news-and-opinion/specials/2013/dsm-5-special-report/
evidence-weak-for-social-communication-disorder

[14] "Diseases and Conditions: Autism." Mayo Clinic. Mayo Foundation for Medical Education and Research, 06 Oct. 2012. Web.http://www.mayoclinic.com/health/autism/DS00348/DSECTION%3Dtests-and-diagnosis

[15] "Children with Pragmatic Language Impairment." Communicating Phonics. London: Communication Trust, 2012. Web. http://www.thecommunicationtrust.org.uk/media/18922/
communicating_phonics_pragmatic_language_impairment.pdf

[16] Ketelaars, Mieke P., Juliane Cuperus, Kino Jansonius, and Ludo Verhoeven. "Pragmatic Language Impairment and Associated Behavioural Problems." International Journal of Language & Communication Disorders 45.2 (2010): 204–14. NCBI. Web.http://www.ncbi.nlm.nih.gov/pubmed/22748032

[17] "Helping Children Make Friends." Ontario Association for Families of Children with Communication Disorders. OAFCCD, 2009. Web.http://specialedpart1.weebly.com/uploads/3/8/2/9/38299941/friends.pdf

About the Author

Understood Team Graphic

The Understood Team is composed of writers, editors and community moderators, many of whom have children with learning and attention issues.

Reviewed by

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Laura Tagliareni, Ph.D., is a pediatric neuropsychologist in New York City and a clinical instructor at NYU Langone Medical Center.