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Today\u2019s \u201cGot Questions?\u201d response is by speech-language pathologists Diane Paul and Donna Murray. Dr. Paul is the director of clinical issues in speech-language pathology for the American Speech-Language Hearing Association. Dr. Murray serves as the senior director of the\u00a0<\/em>Autism Speaks Autism Treatment Network (ATN)<\/em><\/a>.<\/em><\/p>\n Thank you for your question. You\u2019re not alone in being confused about this diagnosis.\u00a0Social (Pragmatic) Communication Disorder (SCD)<\/a>\u00a0is, indeed, a new addition to the Diagnosis and Statistical Manual of Mental Disorders 5th edition (DSM-5). The American Psychiatric Association published this new edition of its diagnostic manual in May 2013. It provides healthcare providers with new guidelines for diagnosing mental and behavioral conditions.<\/p>\n SCD encompasses problems with social interaction, social understanding and pragmatics. Pragmatics refers to using language in proper context. For example, it\u2019s important for children to develop the ability to use language differently when playing with, say, a younger child versus a teacher.<\/p>\n The addition of SCD to the DSM-5 accompanied a major revamping of the manual\u2019s diagnostic criteria for autism spectrum disorder (ASD).<\/p>\n Field tests of the new criteria indicated that some children who would have received a diagnosis of autism under DSM-IV (the previous edition) would instead receive the new diagnosis of SCD.<\/p>\n But while SCD is new to the DSM manual, it\u2019s not new to speech-language pathologists. We have the training and experience to help.<\/p>\n How is SCD diagnosed?<\/strong><\/p>\n SCD is diagnosed based on difficulties with both verbal and non-verbal social communication skills. These skills include:<\/p>\n * responding to others<\/p>\n * taking turns when talking or playing<\/p>\n * talking about emotions and feelings<\/p>\n * staying on topic<\/p>\n * adjusting speech to fit different people or situations \u2013 for instance, talking differently to a young child versus an adult or lowering one\u2019s voice in a library.<\/p>\n * asking relevant questions or responding with related ideas during conversation<\/p>\n * using words for a variety of purposes such as greeting people, making comments, asking questions, making promises, etc.<\/p>\n * making and keeping friends<\/p>\n Like SCD, autism involves difficulty with social communication skills. But autism has the additional defining characteristic of restricted and\/or repetitive behaviors. So an evaluation must rule out autism before reaching a diagnosis of SCD.<\/p>\n This differential diagnosis can be difficult because many symptoms and behaviors overlap between ASD and SCD. In addition, SCD can occur alongside other developmental issues such as language impairment, learning disabilities, speech sound disorder and attention-deficit\/hyperactivity disorder.<\/p>\n The good news is that most medical centers have speech-language pathologists \u2013 professionals trained to assess and provide treatment for social-communication problems. Speech-language pathologists collaborate with teachers and parents to help develop children\u2019s social communication skills in the classroom and at home.<\/p>\n We recommend that you work with your son\u2019s doctor or school to find a speech-language pathologist with experience in assessing and treating SCD.<\/p>\n In many schools, speech-language pathologists meet with individual students as well as groups. Photo courtesy the American Speech-Language-Hearing Association.<\/span><\/span>Speech-language pathologists also work with individuals who have problems with the non-verbal aspects of communication and social interaction. For example, some children don\u2019t use gestures like waving to say \u201cgoodbye\u201d or extending arms to be picked up. Or, they may shake their head \u201cno\u201d when they mean \u201cyes.\u201d<\/p>\n Additionally we can develop visual supports and other forms of augmentative and alternative communication for individuals who are non-verbal or minimally verbal. This can be as simple as pointing to pictures on a picture board or as high-tech as a speech-generating computer or electronic tablet.<\/p>\n Your son can receive therapy for SCD in a variety of settings. Schools and school districts employ speech-language pathologists to provide such services as part of early intervention and special education programs. Many clinics and children\u2019s hospitals likewise offer social communication services. These include all the centers in the Autism Speaks Autism Treatment Network.<\/p>\n The therapist will work directly with your child and provide you with strategies for improving your son\u2019s social communication skills at home and in other settings.<\/p>\n What will therapy entail?<\/strong> We likewise recommend that you involve additional \u201ccommunications partners\u201d such as your child\u2019s teachers, counselors and other special educators such as occupational or physical therapists.<\/p>\n Therapy typically progresses from one-on-one with the therapist to support groups that promote using new skills with other children.<\/p>\n Strategies for families<\/strong> Take turns.<\/strong>\u00a0Participate in simple turn-taking activities that mirror the flow of social interaction. Examples including rolling or throwing a ball back and forth. Or you can repeat words and other sounds that your child makes. Start simple with just a few turns between you and your child or your child and another person.<\/p>\n Read and discuss.<\/strong>\u00a0Read a book with your child, asking and encouraging open-ended questions such as \u201cwhat do you think about what he did?\u201d<\/p>\n Talk about the feelings.<\/strong>\u00a0Books and stories provide a great opportunity to talk about feelings. Suggest why you think a character in a story is behaving or feeling a particular way. Try extending this to real-life situations, privately discussing what a friend or sibling might be feeling and why.<\/p>\n What\u2019s next?<\/strong>\u00a0Have your child try to predict what will happen next in a story. Help him locate the clues. Or work backward. Once an event happens, go back and figure out the clues leading up to the event. Take, for example, a picture of spilled milk and food on the floor; ask what might have happened.<\/p>\n Clue into pop culture.<\/strong>\u00a0Introduce your child to popular, developmentally appropriate shows and public figures so he can join related conversations with friends and classmates.<\/p>\n Plan structured play dates<\/strong>. Begin with just one friend at a time and have a planned activity with a time limit \u2013 say, 60 to 90 minutes to start.<\/p>\n Use visual supports.<\/strong>\u00a0Many children with SCD \u2013 like many children affected by autism \u2013 process information visually. Visual supports can be particularly useful in helping your child understand expectations and schedules.<\/p>\n For instance, you can use a visual support such as a picture of a child talking or an open mouth to cue\u00a0your child when it\u2019s his turn to talk. (See image at right.) This can help him learn to reduce inappropriate interruptions as well as learn when he\u2019s expected to respond or comment.<\/p>","protected":false},"excerpt":{"rendered":"\nEditor\u2019s note: see all our DSM-5 news coverage and perspective\u00a0here<\/a>.<\/em><\/strong><\/h4>\n
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Gesturing is an important form of nonverbal social communication.<\/span><\/span>* using gestures (like waving or pointing)<\/p>\n![\"\"](\"http:\/\/www.serrendipforautism.com\/demo1\/wp-content\/uploads\/2018\/03\/slp_in_school-300x240.jpg\")
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<\/p>\n\nFind the ATN center nearest you\u00a0here<\/a><\/em><\/strong>.<\/em><\/strong><\/h4>\n
\nSpeech and language treatments are more successful with family engagement. This is especially important for a disorder that affects the social communication. It will be important for you to provide lots opportunities for your child to practice skills in real-life situations.<\/p>\n
\nThere are many activities you can do at home to encourage social communication skills in line with the goals you develop with your child\u2019s therapist. For example:<\/p>\n![\"\"](\"http:\/\/www.serrendipforautism.com\/demo1\/wp-content\/uploads\/2018\/03\/visual_supports_tool_kit_250_5.jpg\")
<\/p>\nDownload a free copy of Autism Speaks Visual Supports Tool Kit\u00a0<\/em><\/strong>here<\/strong><\/a><\/em>.<\/em><\/strong><\/h4>\n
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