Social communication disorder, pragmatic language impairment

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For a long time, many people in my life, including my Aspie ex-boyfriend, have noticed many similarities I have to Aspies. Yet whenever I read books or blogs describing the condition from the inside, they always talk about lifelong sensory issues and routines and rituals, i.e., the rest of autism, which I never had, even according to the memories of my own family members who have thought I have some kind of Asperger's. "It's a spectrum," they say when I question them. But those who talk about autism from the inside say it's much more than just social and communication problems. And I've always ruled out nonverbal learning disorder too, because despite having had a much higher verbal than performance IQ as a kid (I think because the performance part was timed and I was afraid of timed tests) and having all those social issues, I never had the motor problems like dysgraphia or dyspraxia or the visual-spatial problems like invading people's personal space or being unable to think in pictures.

But there was one other possibility: this new DSM-5 condition Social Communication Disorder, which is associated with the relatively little-known Pragmatic Language Impairment or Semantic-Pragmatic Language Disorder.

http://crackingtheenigma.blogspot.com/2 ... r-new.html

This description of pragmatic language impairment mentions a LOT of stuff that could have fit my childhood, including ADD-like stuff and Aspie-like stuff:

http://speechtherapy.ygoy.com/2011/08/0 ... -symptoms/

I didn't talk late, but I had strange ways of understanding things, or of not understanding things. For instance, I initially thought the women's bathroom at my elementary school was only for adult women and thus off-limits, because there was a girls' bathroom in the classroom hall. When psychologists were interviewing me to try to find out if my parents were abusing me, I had no idea that their questions meant anything other than the most literal interpretation that came to mind, and I gave naive answers that almost got my parents in big trouble. I didn't undersand why it was bad to lie to your parents about anything, but good to lie to a casual acquaintance about why you weren't going to eat the food they offered. I didn't understand why bluntness got me in so much trouble; only as an adult did I really understand that it's basically considered a tactful form of aggression, an unspoken message that you don't respect the other person enough to follow standard tact protocols for negative opinions. I didn't understand why my family always wanted to hug me when I didn't ask for a hug, although by puberty I understood that people who were really sad usually wanted to be given a hug. I had a general hard time learning "common sense," which contrasted with my supposed intellectual cleverness and frustrated the adults around me. And fitting the "prefers facts to stories" PLI criterion, I always found fiction rather boring and only read it for school or by my parents' prompting as they tried to get me more cultured. When I finally started reading whole books by my own choice, it was nonfiction, mostly psychology, because I was trying to figure out myself and other people in an analytical, nerdy way.

And I had all of this without autism. The following links indicate that pragmatic language impairment, or semantic-pragmatic disorder, or social communication disorder, or whatever you call it, can exist in the absence of autism and NLD:

http://www.slideshare.net/RALLICampaign/what-is-pli
http://www.psychologytoday.com/blog/mak ... erland-asd

Some stuff I found mentions Asperger's and/or NLD symptoms in association with PLI, but these other sources indicate that that not all cases of PLI necessarily meet the Asperger's or NLD criteria. If this is true, it would explain a lot.

And it also indicates that social communication disorder in the DSM-5 might actually do some good for kids like I was. My mom had to fight to get me an IEP because there was no label that quite fit me (though they later labeled me ADD), yet I had serious non-academic problems in school. Hopefully people will use the new recognition of this condition responsibly, and instead of disqualifying autistic kids who are too mild in certain autistic traits for needed services, they'll make it easier for non-autistic, not-quite-NLD kids with social learning difficulties to get help that could make it a lot easier for them to "catch up" on important social and emotional skills.

Most people like to belong, even Aspies and PerhapsAspies like you and me. Good for you you found this new diagnosis in the DMS. I personally have doubts about this DMS system. Not that you haven't any authistic traits, no I mean that the DMS is compiled by psychaitrists who aim to put odd people and behaviours in pigeonholes in order to medicated them. Something you're born with is part of you and makes you unique.

Yeah, I know, labels are complicated, and so is the DSM-5 (and other versions of the DSM). I don't really agree with the idea of pathologizing everything under the Sun, and I've been reading about some problems with the DSM-5 where they're likely to pathologize things that they shouldn't. However, I do favor a more nuanced understanding of human mental and neurological diversity that can help people who were once just known as "weird" or "stupid" or something along those lines know what's going on and what they need in order to adapt to life. I don't think pragmatic language impairment or social communication disorder gives me any sense of "belonging" per se, because it doesn't have the same kind of place in the culture that autism does. I just find it useful for my personal understanding, to reconcile my NT-like sensory traits with my AS-like history of social problems and to make sense of how my own life turned out. And I decided I'd post about it because I thought it might be useful to other people in a similar situation.

I've learned from my recent experiences that I'm just as capable of learning "emotional intelligence" skills as anyone else in spite of having gotten off to a late start, and capable of changing my ways and overcoming old problems. I have no intention to let a label limit me, and don't think others should be limited by their labels either. It's all about things making sense.

I personally see it more like PDD-NOS if you fullfill some symptoms, but not all.
I also have PLI I would say.

I have those symptoms of PLI:

A child or a person suffering from it will exhibit difficulty in conversing properly. A BIT
The exchange of conversation – taking turns while interacting is poor. A BIT
They face problem when replying to indirect requests. For example, if someone indirectly asks them, ‘who wouldn’t like to go out in this nice weather?’ instead of asking directly ‘let us go out’, or any such other request, they find it hard to reply. YES
They have hard time starting a topic. A BIT
If these individuals do not understand what the other person is saying, then they find it hard to ask people to explain or repeat themselves. YES
These individuals find it difficult to make decisions and to choose from options. YES
They have trouble understanding body language and other non-verbal hints. A BIT
They find it problematic to explain events, stories, or points. SOMETIMES
Their organizational skills are not good. YES
Their language development is delayed. YES
They like facts than stories. NO
They have hard time understanding and distinguishing jokes, criticism, sarcasm, and ridicule. JUST SOMETIMES

PLI would propably even fit me better as a diagnosis than autism and also goes along with my sensory processing disorder and dyslexia as a child, but I see it more as a "develepmental spectrum" if you will, I'm dx with HFA though.

If you have sensory processing disorder, you're definitely closer to the autism spectrum than I ever was. My only possible sensory issues as a child were regarding the not liking hugs thing (though I think it was more of not understanding what a spontaneous hug meant), and my having been able to not make a big deal out of pain when I was little, most notably not seeking any kind of hugs or comfort for it. But I outgrew that kind of stuff, and after all I've read about the autism spectrum and related conditions, I feel my sensory experience is much more NT-like. That's part of why I always ended up scoring myself as very NT on the Aspie Quiz (like 160 NT, 40 AS). But there must have been something going on with me neurologically, if it's true that I really was weirder than a friend's autistic/PDD-NOS kid as a family member has claimed.

Possible.
I'm on the NT-AS-Quiz around 100 NT and 100 AS the last time I took it. Don't remember the exact score and on the AQ I got 26. When I was younger I scored 32 on the AQ.

The problem is that neurodiversity is a spectrum and most are "somewere" on the syndrome mix who have neuropsychiatric disorders and most are not 100% this or that. Some just might fit better one diagnosis or the other. There are also spectrums within those disorders.

As a child I was propably more ASD and as I grew older more PLI and now those aren't my mainproblems anymore, but my mood is, propably bipolar. And I got tics growing up, very late actually and just very rare, not even dx.
So I outgrew one thing mostly and got something else in exchange if you will.
Just when I'm under huge pressure like a shock or something, this can "make" me autistic again.

There is a book on the topic that I like: The Syndrome Mix (click)

Interesting. Based on both my own personal experience of eventually "catching up" on social skills and common sense, and various stories of I've heard of people with various neurological quirks, many people do tend to eventually learn some things they had trouble with as a kid and may not appear all that different as adults. The dyslexic mother of a college friend grew up able to read fine except when tired or stressed; my Aspie ex-boyfriend seems to have "outgrown" many of his sensory issues and has managed to hold a job all his adulthood (though he struggles with boredom, stress, and social discomfort); and even some people who present as Kanner autistics when young eventually learn how to write or even speak if they are not under too much stress.

"The Syndrome Mix" looks interesting. If I want to read another book about neurological quirks, I might go for it. It doesn't mention PLI specifically, but given that it tends to be an aspect of AS and NLD (kind of how NLD is often an aspect of AS from what I've read), they might have good descriptions of the types of problems PLI can cause.

Also interesting was this video I just saw talking about the differentiations of the autism spectrum:
http://www.youtube.com/watch?v=7Pcac-7c ... e=youtu.be

They talk about the speech problems in Kanner's and some cases of PDD-NOS vs. the pragmatic language problems of Asperger's. In the description of the pragmatic language problems, all of that stuff could have described the young me. My not having any of the other autistic traits such as sensory processing problems, motor problems, and a need for ritual and routine might have been what's allowed me to make so much progress in that area that I'm for all practical purposes just a quirky NT now.

Also interesting is that bit at the end of the video about "once neurodifferent, always neurodifferent." I may function like other NTs and know the same important things they know, but I didn't learn it quite the same way, and I may not see it and understand it all in the same way they do. It's probably something like being a dyslexic who eventually ended up within the normal range of literacy.

SPLD (semantic-pragmatic language disorder) and also NVLD are both mentioned in the "autistic disorders" chapter and also in how far they differ from autism.

"SPLD can be differentiated from Asperger's as follows:

- SPLD kids tend to have more early speech delays than Asperger's.
- SPLD kids tend to have somewhat socialization skills than Asperger's.
- The appropriate label may change over time as the child matures."



My problem with the term autism is, that now my social understanding is "too good". I have no trouble finding friends now or to talk to strangers. But I tend to routines (very slightly), sensory processing disorder (SPD) and PLI. So, they didn't know what to do with me and still gave me the lable HFA in the end. I think PDD-NOS would be propably more correct or maybe PLI and SPD.
But interesting video though.



Yes, I mainly agree on this.
I noticed that on me, but also on other ppl I know.
But I also think that disorders how they are described are "just" cathegories we try to describe neuropsychiatric differences with.
They are not fixed and can change.
Also some disorders are highly overlapping.

Thanks for the info. I just downloaded The Syndrome Mix, and I'll be interested to read the parts about autism spectrum and communication disorders. I didn't have any speech delays, but that's the only major thing so far that doesn't seem to fit about PLI, vs. the 4 or 5 things that don't fit about Asperger's or other ASDs. And if all Asperger's cases basically involve a PLI without a speech delay as part of the symptoms, then a speech delay may not be a necessary condition.

And yeah, the brain is very complicated, and we're a long way from ever being able to pinpoint any specific issue in any specific part of the brain or nervous system. We can only get vague, general differences, such that brains in many people with ASD tend to be bigger and more complicated/less orderly looking or something like that. (I have a relatively small head and a thus a small brain for what it's worth, which is more circumstantial evidence that I don't have an ASD.)

You're not alone. The reason they decided to add Social Communication Disorder is because research showed the most common reason for a PDD NOS diagnosis was significant social-communication impairment without meeting restricted/repetitive behavior criteria.

(I guess I'm odd, because I'm PDD NOS because my social impairment was too mild, and I do have prominent restricted/repetitive behavior - I'm very stimmy and have intense interests and sensory issues. To make it even wierder, I meet DSM-5 social criteria but not DSM-4, because of how they reworded it.)

Ettina - Yeah, I did see that bit about PDD-NOS when I was looking up stuff on PLI/SCD. They said a large portion of PDD-NOS cases had only social symptoms. Maybe some of them are people like me who just happened to get checked out for it some 10 years later, when autistic spectrum conditions became a popular diagnosis. When I was a kid, no popular diagnosis even remotely fit me until ADD became popular during my pubescent years.

Raziel - I downloaded the "Kids in the Spectrum Mix" book and read about the various autistic spectrum disorders, which they use to include NLD and other things that aren't in the "official" autistic spectrum. The SPLD stuff didn't fit entirely, particularly the speaking late and the semantic problems, but I heard the term "pragmatic language impairment" started to became popular because sometimes only the pragmatic problems are seen. I don't think I had socialization or theory of mind problems as badly as people with ASDs do, but now that I think back to the problems I had when I was younger, some of it had to do with not being able to properly assess the relative importance of, say, one person's feelings vs. another's. For instance, I was a tattle tale. I did this to make my parents happy and make them accept me for being an honest, straightforward person. When I turned my sisters in for making trouble, or turned my divorced parents in to one another for saying mean things behind each other's backs, I didn't think that maybe the feelings of the person I was tattling on were more important, or just as important, and so it didn't occur to me to compromise by just saying nothing. I distinctly remember my dad trying to teach me this compromise when I was roughly pre-teen or early teen age. I think I started to get better at it by my late teens and early 20s, but by then people could guess the information I was trying to hide. Now, thankfully, I'm rarely asked to try to hide stuff anymore that other people might be trying to find out from me. I just have no occasion to blab. By the time it could possibly come up, I've forgotten I was ever told anything in the first place.

In any case, there was definitely something missing when it came to my ability to develop common sense and good social skills and to speak and understand things in context. Pragmatic language impairment, without the semantic problems historically associated with it, is the best term I've been able to find to describe something like this. The upcoming Social Communication Disorder also pretty much seems to fit, as it mentions specifically having pragmatic language problems and social skills problems without any of the other traits of an autism spectrum disorder.