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Does Your Child Have Social Communication Disorder?

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Updated August 19, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

When the DSM-5 (diagnostic manual) was republished in 2013, it included a brand new diagnostic category: Social Communication Disorder. This disorder includes some but not all of the symptoms of Autism Spectrum Disorder -- making it very similar indeed to the now-defunct diagnosis called PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified).

How Is Social Communication Disorder Different from Autism?

Here, according to the DSM-5, is how Social Communication Disorder differs from autism: "The two disorders can be differentiated by the presence in autism spectrum disorder of restricted/repetitive patterns of behavior, interests, or activities and their absence in social (pragmatic) communication disorder."

Sounds simple, doesn't it? But if you read further, you discover that these repetitive behaviors really don't need to be present for an autism diagnosis to be given. If they were EVER present, even ten years ago, you can still be diagnosed with autism, and not Social Communication Disorder.

Here's how this rather odd caveat is explained: "Individuals with autism spectrum disorder may only display the restricted/repetitive patterns of behavior, interests, and activities during the early developmental period, so a comprehensive history should be obtained. Current absence of symptoms would not preclude a diagnosis of autism spectrum disorder, if the restricted interests and repetitive behaviors were present in the past. A diagnosis of social (pragmatic) communication disorder should be considered only if the developmental history fails to reveal any evidence of restricted/repetitive patterns of behavior, interests, or activities."

If this sounds clear as mud, it is. As you probably know, virtually EVERY toddler enjoys repetition -- the same bedtime stories, chase games, videos, foods. And most grow out of that preference. So the fact that your child grew out of the need for repetition (or learned, through therapy, how to comfortably manage change) doesn't mean he's no longer autistic -- even if his present symptoms seem to be more consistent with Social Communication Disorder.

This is not necessarily a bad thing. At this point, Social Communication Disorder has no standing in the medical or service community. That means there is a good likelihood that a person who has "only" Social Communication Disorder may not receive the same level of services as a person with the SAME symptoms and an Autism Spectrum diagnosis. So even if your child has outgrown or learned to manage autistic symptoms, it may be worth your while to describe past symptoms in order to help your child qualify for a diagnosis that offers more and better services and support.

Diagnostic Criteria for Social Communication Disorder:

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 the social context.
2.Impairment of 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 meanings 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 condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.

Diagnostic Features

Social (pragmatic) communication disorder is characterized by a primary difficulty with pragmatics, or the social use of language and communication, as manifested by deficits in understanding and following social rules of verbal and nonverbal communication in naturalistic contexts, changing language according to the needs of the listener or situation, and following rules for conversations and storytelling. The deficits in social communication result in functional limitations in effective communication, social participation, development of social relationships, academic achievement, or occupational performance. The deficits are not better explained by low abilities in the domains of structural language or cognitive ability.

Sources:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.

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