What Is Social Communication Disorder?

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Social communication disorder (SCD) is characterized by difficulties in using language to communicate effectively with other people. Because the symptoms of SCD are also common in people with autism spectrum disorder (ASD), it can be difficult to get an accurate diagnosis. Autism spectrum disorder must be ruled out before SCD can be diagnosed.

A child with SCD will typically have no problems understanding the meaning of individual words, developing a vocabulary, and comprehending grammar. They will, however, struggle with "pragmatic" language—the use of language to communicate appropriately in social situations. Someone with SCD, for example, may not understand how to greet someone properly, how to take turns in a conversation, or how to know when a situation requires a formal versus a familiar tone.

A speech-language pathologist can use a variety of social-skills training methods to help children with SCD be more socially communicative.

History

Social communication disorder became an official diagnosis in 2013, when the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published. Prior to that, children with these symptoms were diagnosed with pervasive developmental disorder not otherwise specified (PDD-NOS), a now-defunct "catchall" diagnosis used for those whose symptoms did not clearly point to another related disorder.

Symptoms

Symptoms of SCD include difficulties with:

  • Using communication for social purposes, such as initiating conversations, greeting people, and engaging in back-and-forth conversation
  • Knowing how to change tone and communication styles to suit a particular situation—for example, how to speak in a classroom as opposed to on the playground, or how to speak to a child versus an adult
  • Following accepted rules for conversation, such as taking turns, explaining things clearly, and using verbal and nonverbal signals and "cues" to convey feelings and interpret those of others
  • Telling and understanding stories or recounting events
  • Understanding non-literal uses of language, such as sarcasm, idioms, humor, or making inferences
  • Making poor or no eye contact
  • Having a hard time expressing feelings or emotions, or not understanding the feelings of others

Social communication disorder can impact many areas of a person's life and get in the way of participating in social situations, developing friendships, achieving academic success, and succeeding at jobs.

Causes of SCD

There is no known cause of social communication disorder. However, a child is at higher risk if there is a family history of autism, other types of communication disorders, or specific learning disability. Social communication disorder can also be present along with other disorders, such as speech delay, ADHD, and intellectual development disorder.

Diagnosis

Obviously, it isn't possible to diagnose SCD in a child who is either too young to use spoken language or who is nonverbal; the child must be verbal and relatively high-functioning. A diagnosis of SCD is usually made around age 4 to 5 years old, when the child is old enough to use spoken language.

Diagnostic testing for SCD is done by a speech-language pathologist (sometimes called a speech-language therapist) and involves taking a medical and behavioral history, talking with teachers and parents, as well as performing one or more of an assortment of available diagnostic tests. Interacting with a child in specific ways (such as having a 15-minute conversation), observing a child in a setting with others, or using questionnaires that measure aspects of language proficiency can help a clinician determine if a diagnosis of SCD is appropriate.

Finally, other medical and neurological conditions that can affect speech must be ruled out, such as autism spectrum disorder, intellectual developmental disorder, global developmental delay, or another disorder.

Social communication disorder can also co-occur with other communication disorders, including:

  • Language disorder
  • Speech sound disorder
  • Childhood-onset fluency disorder
  • Unspecified communication disorder

How Social Communication Disorder Differs From Autism

Like SCD, autism involves difficulty with social communication skills. The key difference is that people with autism also exhibit restricted interests and/or repetitive behaviors or have done so in the past.

These patterns include, for example, lining up toys rather than using them in ways that other children do, becoming severely upset with transitions and interruptions in routines, and showing extremely focused interest on a specific topic. Children with ASD also tend to be hyper- or hypo-sensitive to textures, sounds, and touch.

On the other hand, children with SCD have only social communication challenges. So, in order to arrive at a diagnosis of SCD, autism must be ruled out. In other words, social communication disorder cannot be diagnosed in conjunction with ASD and vice versa.

You may feel frustrated if your child receives an autism diagnosis rather than a milder SCD diagnosis, especially if they are doing well in areas other than social communication. You might even consider avoiding mentioning repetitive/restrictive behaviors that your child seems to have "outgrown" to avoid a diagnosis of ASD.

But an accurate autism diagnosis will make your child eligible for more services and support than are available to someone with SCD, so it's best to report any symptoms, even if they only occurred in the past.

Treatment

The main treatment for social communication disorder is speech-language therapy. Speech-language therapists use a variety of treatment modalities and methods, and can work with kids on conversation skills either one-on-one or in small groups. It's also critical for teachers and parents to reinforce these skills with opportunities to use them in school and at home.

The key skills for children with SCD to learn are:

  • Speech pragmatics: Speech pragmatics training can help a child understand the meaning of idioms, as well as teach them how and when to use appropriate greetings.
  • Conversation skills: Kids with SCD often struggle with back-and-forth exchanges, such as asking and answering questions during a conversation. A speech-language therapist can engage in role play to help a child develop these skills.
  • Non-verbal communication: Learning how to use language is one component of the skill set necessary to communicate effectively. The other is interpreting and using non-verbal cues to assess someone's mood, or knowing when someone is signaling discomfort or boredom, say, by looking at their watch.

Parents and teachers can supplement speech-language therapies by facilitating "real-life" conversations and interactions between the child and their peers.

A Word From Verywell

Since SCD is a relatively new diagnosis, more research needs to be done to determine how effective therapies are over the long term. If you suspect your child may have symptoms of social communication disorder, ask your pediatrician to refer you to a speech-language pathologist for an evaluation. Getting an accurate diagnosis, whether it's SCD or autism, will help your child get the appropriate services they need to improve their social interactions.

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Article Sources
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