Signs of Social Communication Disorder

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

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

What Is Social Communication Disorder?

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.

Symptoms of Social Communication Disorder

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.

Diagnosing Social Communication Disorder

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 after age 4 to 5 years old when the child is old enough to use spoken language.

Some methods of diagnosing SCD include:

• Diagnostic testing by a speech-language pathologist (sometimes called a speech-language therapist), including taking a medical and behavioral history
• Talking with teachers and parents
• 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
• Using questionnaires that measure aspects of language proficiency

Other medical and neurological conditions that can affect speech must be ruled out, such as ASD, intellectual developmental disorder, global developmental delay, or other disorders.

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 autistic people also exhibit repetitive behaviors or intensely fixed interests, or they have done so in the past.

Autistic people might demonstrate the following traits that those with social communication disorder do not:

• Lining up toys rather than using them in ways that neurotypical children do
• Becoming unusually upset with transitions and interruptions in routines
• Showing extremely focused interest on a specific topic
• Tending 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. Social communication disorder cannot be diagnosed in conjunction with ASD and vice versa.

When to Call a Healthcare Provider

Parents and teachers can recognize signs that speech may not be developing in a typical way. Often, pediatricians are an excellent first line of defense. If you notice your child is displaying symptoms of social communication disorder, schedule a visit with your child's pediatrician. Make some notes beforehand to gather all your thoughts and concerns.

Depending on their thoughts, your child's pediatrician may refer them to specialist services, such as neuropsychiatric testing or speech-language pathologists. If your child is school-age, the school might also be able to help connect you to speech-language services.

Treating Social Communication Disorder

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 include:

• 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. Some examples include:

• Model social speech: Let your child see you join a conversation with phrases like, "Mind if I join you?"
• Point out social speech situations: If you're at a gathering or even watching a show together, point out social interactions your child struggles with. For example, if someone in a show seems busy or closed off, point out that they might not be open to a conversation.
• Role play: Practice areas that are difficult for your child. For example, you might role-play and pretend you are introducing yourself to each other at a party.

Summary

Since SCD is a relatively new diagnosis, more research needs to be done to determine how effective therapies are over the long term. SCD is distinct from autism, but both can present in similar ways. 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.