Social (Pragmatic) Communication Disorder

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I recently attended a networking luncheon in South Florida where the attendees were asked to share something new they recently learned about themselves. A woman to my left, a marketing executive, said that she had just been diagnosed with social communication disorder, or SCD. The diagnosis, she said, changed her life for the better.

Initially, the room was silent, but this was quickly followed by clapping and questions. I was particularly intrigued as to what had prompted her to seek a diagnosis. She explained her nagging sense of always feeling different than others and a long history of experiencing challenges interacting with children and adults. The diagnosis allowed her to give a proper label to her sense of being different and to receive validation as well as tools, support and skills from a licensed speech and language pathologist. The diagnosis and treatment allowed her to be successful in both her personal and professional life.

As a speech and language pathologist and the founder of an online speech therapy company, I found the timeliness of her diagnosis to be fortuitous. Prior to 2013, the diagnosis of SCD did not exist, and this woaman would likely have been misdiagnosed with autism or autism spectrum disorder. It was only in 2013 that social communication disorder was added and defined in the DSM-5, the newest revision of the diagnostic manual for mental disorders. At that point, it was described as persistent difficulties in the social use of verbal and nonverbal communication. The label of autism or ASD would not have targeted her challenges. More importantly, the wrong diagnosis would not have given her the impetus to address her issues and receive the proper treatment.

While most professionals agree SCD overlaps with autism or ASD, it’s a diagnosis that reflects the social pragmatics and not the whole autistic profile. Generally, those diagnosed with SCD have autistic-like issues of social disengagement, difficulty understanding social cues and rules and limited expressive skills. They may have difficulties modulating the volume of their voices in the context of social situations (indoor vs. outdoor voices) or the age or position of someone to whom they are speaking, taking turns, making inferences or understanding humor or figurative speech. When someone makes an offhand statement about “raining cats and dogs,” an individual with SCD will seek the animals amid the raindrops.

However, there are two classic autism behaviors that are not present in those with social communication disorder: sensory restricted interests and repetitive self-stimulating behaviors, also known as stimming. Though the behaviors may vary, repetitive behaviors are generally a means of coping with everyday life. For some, rocking back and forth or repeatedly twirling a piece of string helps reduce anxiety or manage sensory discomfort. For others, constantly touching a particular texture or head banging helps gain the sensory input needed for daily functioning.

This classic differentiation is often the basis of diagnosis since there are limited formal assessment tools for SCD, and the diagnosis is often made using process of elimination. Generally, if a client has other language impairments or presents with repetitive disorders, there is a strong likelihood the diagnosis of SCD will be eliminated.

Although SCD is a recent addition to the DSM, speech therapists have years of experience diagnosing and treating social pragmatics disorder, which refers to the appropriate use of language in social situations — a key challenge for those diagnosed with SCD. As therapists, we have a wide range of assessment tools to evaluate pragmatic language skills and well-established protocols to improve it. And we have strategies to teach the interpretation of non-verbal communication, such as the role of facial expressions in the meaning of a sentence, the use of the pause and how inflection at the end of a sentence indicates a question.

Many researchers believe SCD should not be a separate diagnosis. They think the diagnosis is suspect to cultural bias and based on flimsy research. But I personally see the value.