Week 8: Study Guide Forum- Social Pragmatic Communication Disorder

Irene Piper

College of Nursing-PMHNP, Walden University

NRNP 6665: PMHNP Care Across the Lifespan I

Dr. Nataliya Ishkova

January 22, 2022

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Social Pragmatic Communication Disorder (SPCD)

SPCD is a new diagnosis in the DSM-5 characterized by problems with verbal and nonverbal

social communication that cannot be explained by low cognitive ability. (“APA_DSM-5-Social-

Comunication-Disorder.pdf, ” 2013).

Image retrieved from: https://www.smalltalkspeechtherapy.com.au/social-communication-what-does-it-mean/

Signs and Symptoms:

Individuals with SPCD may have difficulty in:

● using language for social purposes (e.g., greeting and sharing information)

● appropriately matching communication to the social context

● following rules of the communication context (e.g., back and forth of conversation)

● understanding nonliteral language (e.g., jokes, idioms, metaphors)

● integrating language with nonverbal communicative behaviors (Swineford, Thurm, Baird,

Wetherby & Swedo, 2014).

To diagnose SPCD, the deficits must result in impaired social, academic and occupational

functioning; the onset starts in the early developmental period and symptoms not attributable to

another medical or neurological condition, or low abilities in domains of word structure and are

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not better explained by autism spectrum disorder, intellectual ability or other mental disorder

(American Psychological Association [APA], 2013).

Differential Diagnoses:

● Autism spectrum disorder (ASD) – primary diagnostic consideration for individuals with

social communication deficits, but an assessment is needed to determine the presence of

restricted/repetitive patterns of behaviors (APA, 2013).

● ADHD- ADHD may cause impairments in social communication and functional

limitations of effective communication, social participation, or academic achievement

(APA, 2013).

● Social anxiety disorder (social phobia) – the symptoms of SPCD overlap with those of

social anxiety disorder (APA, 2013).

● Intellectual disability and global disability- social communication skills may be deficient

among individuals with intellectual and global disability (APA, 2013).

Incidence:

● Occurs in about 7.5% of children and affects more boys than girls by a ratio of 2.6:1.0 (as

cited in American Speech-Language-Hearing Association [ASHA], 2022).

● Higher prevalence rates (23%–33%) have been noted in individuals with language

disorders (as cited in ASHA, 2022).

Development and Course:

Diagnosis of SPCD is rare among children younger than four years. By age 4 or 5, most children

will have adequate speech and language abilities to reveal specific deficits in social

communication. Milder deficits may not be apparent until early adolescence when language and

social interactions become more complex (APA, 2013).

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Prognosis:

The outcome of SPCD varies. Some children improve over time, while others continue to have

deficits persisting into adulthood. Even among those who have significant improvements, the

early deficits in pragmatics may cause lasting impairments in social relationships and behavior

(APA, 2013).

Considerations Related to Culture, Gender, Age:

● Social norms may vary across and within cultures.

● Clinicians must acquire knowledge of their client’s cultural norms to determine what is

typical for that client.

● Determine the client’s rules of communication and variations in patterns. Diagnosis of

SPCD should not be made until children are 4–5 years of age.

● May occur more in boys than girls. (ASHA, 2022)

Pharmacological Treatments:

● Risperidone could be considered in the treatment of emotional and behavioral problems

manifesting from SPCD (Moreton & Imran, 2015).

● The Risperidone’s benefits may also have been achieved through improving symptoms of

the comorbid mixed disorder of emotions and conduct (Moreton & Imran, 2015).

Nonpharmacological Treatments:

● Behavioral Interventions/Techniques- to modify existing behaviors through selective

reinforcement, and fading reinforcement as behaviors are learned (ASHA, 2022).

● Peer-Mediated/Peer-Implemented- interventions are those in which typically developing

peers are taught strategies to facilitate play and social interactions (ASHA, 2022).

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● Social Communication Treatments- interventions designed specifically to increase social

communication skills such as Comic Strip Conversations, Sore Skills Strategy, Social

Communication Intervention Project (SCIP), Social Scripts, Groups, and Social Stories

(ASHA, 2022).

○ SCIP therapy- speech and language therapy focuses on social understanding and

social interpretation, pragmatics, and language processing. This manualized

intervention may offer general guidance on making an activity easier or more

challenging for the child depending on the child’s profile needs (Gail & Adams,

2018).

Diagnostics and Labs:

Screenings and Comprehensive assessment for individuals with communication deficits may aid

in accurate diagnosis and appropriate treatments.

● Social Responsiveness Scale, 2nd edition (SRS-2) – a 65-item questionnaire of social

impairment that has been rigorously tested in both children and adults. The SRS-2

generates scores for five Treatment Subscales: Social Awareness, Social Cognition,

Social Communication, Social Motivation, and Restricted Interests and Repetitive

Behaviors (Flax et al., 2019).

● Comprehensive Assessment of Spoken Language- measures spoken language across four

structural categories: Lexical/Semantic, Syntactic, Supralinguistic, and Pragmatic

Language (Pearson, 2022).

● Autism Diagnostic Interview-Revised (ADI-R) – structured interview used for diagnosing

autism, planning treatment, and distinguishing autism from other developmental

disorders (Pearson, 2022).

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● The Wechsler Abbreviated Scale of Intelligence (WASI) and the Developmental Abilities

Scale (DAS)- the performance IQ scores of WASI and DAS are essential information

whether nonlinguistic cognitive abilities had any effect on associations related to social

impairment, higher-order Language impairment, and the presence of repetitive behaviors

(Flax et al., 2019).

Comorbidities:

ADHD, learning disorders, OCD, non-verbal language disorders, pragmatic language

impairment, and conduct disorder may be comorbid in individuals with problems in social

communication (Topal et al., 2018).

Legal and Ethical Considerations:

Providers, therapists, or clinicians shall:

● Provide clinical services and scientific activities competently.

● Obtain informed consent from the patient or family about the nature and possible risks

and effects of services provided.

● Counsel the patient and family and provide education to prevent further complications

related to a social communication disorder.

● Consult and collaborate with families, individuals with a social communication disorder,

other professionals, support personnel, peers, and other invested parties to identify

priorities and build consensus on an intervention plan focused on functional outcomes.

● Advocate for individuals with a social communication disorder and their families at the

local, state, and national levels.

● Protect the patients’ privacy and confidentiality and follow the facility’s policy.

● Adhere to the Telehealth law and HIPAA compliance.

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● Adhere to the professional standards of practice. (ASHA, 2022).

Pertinent Patient Education Considerations:

● Continue with therapy sessions as recommended to improve symptoms.

● Use of resources in the community for support.

● Monitor other comorbid symptoms that may put the patient at high risk for self-harm or

aggression to others, requiring hospitalization.

Other Considerations:

● Young people meeting the criteria for SPCD showed high levels of diverse

psychopathology and social impairment, suggesting they may have substantial needs that

should be taken seriously by clinical and educational services.

● Findings in SPCD appear to exist on the border between ASD and non-ASD, and this can

provide a diagnostic place for people who have marginally subthreshold autistic traits.

(Mandy, Wang, Lee, & Skuse, 2017)

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders.

fifth ed. Washington, DC.

American Speech-Language-Hearing Association [ASHA]. (2022). Social Communication

Disorder. Retrieved from: https://www.asha.org/practice-portal/clinical -topics/social-

Communication-disorder/#collapse_2

APA_DSM-5-Social-Communication-Disorder.pdf. (2013). Retrieved from:

https://www.psychiatry.org

Flax, J., Gwin, C., Wilson, S., Fradkin, Y., Buyske, S., & Brzustowicz, L. (2019). Social

(Pragmatic) Communication Disorder: Another Name for the Broad Autism Phenotype?

Autism: The International Journal of Research and Practice, 23(8), 1982–1992.

Gaile J, & Adams C. (2018). Metacognition in speech and language therapy for children with

social (pragmatic) communication disorders: implications for a theory of therapy. doi:

10.1111/1460-6984.12326.

Mandy, W., Wang, A., Lee, I., & Skuse, D. (2017). Evaluating social (pragmatic)

Communication disorder. Journal of Child Psychology and Psychiatry, 58(10), 1166–

1175. https://doi.org/10.1111/jcpp.12785

Moreton, A., & Imran, S. (2015). A role for risperidone in the treatment of communication

disorder and comorbid mental health problems. BMJ case reports, 2015,

bcr2015210951. https://doi.org/10.1136/bcr-2015-210951

Swineford, L. B., Thurm, A., Baird, G., Wetherby, A. M., & Swedo, S. (2014). Social

(pragmatic) communication disorder: a research review of this new DSM-5 diagnostic

category. Journal of neurodevelopmental disorders, 6(1), 41.

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https://doi.org/10.1186/1866-1955-6-41

Topal Z, Demir Samurcu N, Taskiran S, Tufan AE, & Semerci B. (2018). Social communication

disorder: a narrative review on current insights. Neuropsychiatric Disease and

Treatment, Volume 14, 2039–2046.

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