Download SOCIAL COMMUNICATION DISORDER: A New

SOCIAL COMMUNICATION DISORDER: A New Diagnosis in the DSM-5
Blair Schanzmeyer, BS, Ashleigh O. Boyd, MHS, CCC-SLP
Department of Communication Science and Disorders, University of Missouri, Columbia, MO
Introduction
Rationale for SCD
The Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-5), released in May 2013, revised criteria for autism
spectrum disorder (ASD) and added a separate diagnosis of social
(pragmatic) communication disorder (SCD).
The diagnosis for SCD was added to the DSM-5 to more accurately
and consistently recognize individuals with significant deficits in
verbal and nonverbal communication, to provide diagnostic
coverage for children who exhibit deficits in social communication
but do not have restricted, repetitive behaviors or interests, and
to reduce variability between individuals who are diagnosed with
ASD.
SCD Diagnostic Criteria
 Deficits in the social use of verbal and nonverbal
communication as manifested by all of the following:
Area of Difficulty:
Examples:
Using communication
for social purposes
· Greeting and sharing information, in a way that
is appropriate for the social context
Changing
communication to
match context or the
needs of the listener
· Speaking differently in a classroom than on a
playground
· Talking differently to a child than to an adult
· Avoiding use of overly formal language
Following rules for
conversation and
storytelling
· Taking turns in conversation
· Rephrasing when misunderstood
· Using verbal and nonverbal signals to regulate
interaction
SCD or ASD?
In order for SCD to be diagnosed, restricted, repetitive behaviors
or interests which are included in diagnostic criteria for ASD must
be ruled out.
Understanding what is · Making inferences
not explicitly stated and · Understanding idioms, humor, metaphors
nonliteral or ambiguous · Interpreting multiple meanings that require
meaning of language
using context for understanding
 Deficits result in functional limitations in effective
communication, social participation, social relationships,
academic achievement, and/or occupational performance
 Symptoms present in early developmental period
 Symptoms are not better accounted for by another mental
disorder and are not due to a general 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, or global developmental delay
Does the child
demonstrate deficits in
social communication
and social interaction?
Yes
Behavior:
Examples:
Stereotyped or repetitive
motor movements, use of
objects, or speech
· Simple motor stereotypes
· Lining up toys or flipping objects
· Echolalia
· Idiosyncratic phrases
Insistence on sameness,
inflexible adherence to
routines or ritualized
patterns of verbal or
nonverbal behavior
· Extreme distress at small changes
· Difficulties with transitions
· Rigid thinking patterns
· Greeting rituals
Highly restricted, fixated
interests that are abnormal
in intensity or focus
· Strong attachment to or preoccupation with
unusual objects
· Excessively circumscribed or perseverative
interests
Hyper– or hyporeactivity to · Apparent indifference to pain/temperature
sensory input or unusual
· Adverse response to
interests in sensory aspects
specific sounds or textures
of the environment
· Excessive smelling or
touching of objects
· Visual fascination of lights or movement
Does the child display
at least 2 of 4
restricted, repetitive
behaviors?
consider
ASD
diagnosis
consider
SCD
diagnosis
The SLP’s Role in SCD
It is within the scope of practice of speech-language pathologists (SLPs) to
diagnose communication disorders. SLPs typically make diagnoses of SCD
and ASD as members of teams, however; SLPs can make a diagnosis of
SCD independently if they have the necessary knowledge and experience
in communication disorders. SLPs involved in the diagnosis of SCD should
be specifically educated and appropriately trained in this area.
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Assessment
A comprehensive assessment of language skills as well as social
communication skills is necessary to make an appropriate SCD diagnosis.
The following chart provides examples of types of assessments that can be
used to evaluate social communication skills :
Type of
Assessment
Description
Standardized Empirically developed evaluation
Assessment tool with established reliability and
validity
Test of Language
Competence (Wiig & Secord)
-ages 5:0-18:0
Naturalistic Observation of child in everyday
Observing the child in the
Observations social settings with other individuals classroom
Arranging the observation
room with toys/peers to
mimic real world events
SCD Intervention
The overall goal of SCD intervention is to improve social interactions, not
to teach specific behaviors or skills . Treatment should aim to improve
social communication skills by addressing individual needs identified
during assessment. The following chart provides examples of evidencebased interventions for improving social communication skills (it is not an
exhaustive list).
SCERTS
Social communication (SC), emotional regulation (ER), and
transactional support (TS), is a model of service provision that focuses
on how to regulate emotions and communicate with others.
Social Skills
Groups
Specific instruction, role-playing, and feedback are used to teach ways
of interacting appropriately with typically developing peers.
Social
Scripts
Scripted prompts (visual and/or verbal) are used to teach ways to
appropriately use language during social interactions. These scripts are
gradually faded as children use social language more spontaneously.
Video
Modeling
It is estimated that one-third of children diagnosed with
ASD under DSM-IV criteria will not be diagnosed with ASD
under DSM-5 criteria; however, there are controversial
findings as to what percentage of these children will meet
criteria for a diagnosis of SCD. Retrospective studies have
examined proportion of subjects who no longer met
criteria
for Posted
ASD, butby
didFans
meet Year
criteria
“Likes”
1 for SCD according to
10/1/09criteria:
– 9/30/10
DSM-5
 4.2% (2/48) - Taheri & Perry, 2012
 28% (5/18) - Mayes, Black, & Tierney, 2013
 63% (12/19) - Wilson et al., 2013
Example
Parent/Teacher Rating scales and/or checklists to
Children’s Communication
Report
obtain a compressive profile of social Checklist-2 (Bishop)
Measure
communication skills
-ages 4:0-16:11
Analog Task(s) Observation of child in simulated
social situations
DSM-IV vs. DSM-5 Criteria
Video clips captured using a video camera are edited to show positive
target behavior. Videos can show target behavior being completed by
either typically developing peers or child (called video self-modeling).
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Future Directions
There is a need for prospective studies to examine the
prevalence of individuals diagnosed with SCD according to
DSM-5 diagnostic criteria. Additionally, valid assessment
tools should be established to improve the consistency of
diagnosis.
References
American Psychiatric Association. (2013). Social (pragmatic) communication disorder.
Available from www.dsm5.org/... Fact Sheet.pdf
American Speech-Language Hearing Association. (2014). Social communication disorders
in school-age children. Available from www.asha.org/Practice-Portal/ClinicalTopics/.
Autism Speaks. (2014). DSM-5 diagnostic criteria. Available from
www.autismspeaks.org/what-autism/diagnosis/dsm-5-diagnostic-criteria.
Autism Speaks. (2014). Social communication disorder: Parents seek guidance. Available
from www.autismspeaks.org/blog/2014/01/31/social-communication-disorderparents-seek-guidance
Delano, M. E. (2007). Video modeling interventions for individuals with autism.
Remedial and Special Education, 28, 33-42.
Kulage, K. M., Smaldone, A. M., and Cohn, E.G. (2014). How will DSM-5 affect autism
diagnosis? A systematic literature review and meta-analysis. Journal of Autism and
Developmental Disorders, 44, 1918-1932.
Mayes, S.D., Black, A., & Tierney, C.D. (2013). DSM-5 under-identifies PDDNOS:
Diagnostic agreement between the DSM-5, DSM-IV, and checklist for autism
spectrum disorder. Research in Autism Spectrum Disorders, 7, 298-306.
Norbury, C. F. (2014). Practitioner review: Social (pragmatic) communication disorder
conceptualization, evidence, and clinical implications. Journal of Child Psychology
and Psychiatry, 55 (3), 204-216.
Paul, D., & McCarty, J. (2014) Answers to your DSM-5 questions. The ASHA Leader, 19,
56-58.
Taheri, A., & Perry, A. (2012). Exploring the proposed DSM-5 criteria in a clinical sample.
Journal of Autism and Developmental Disorders, 42, 1810-1817.
Wilson, C. E., Gillan, N., Spain, D., Robertson, D., Roberts, G., Murphy, C. M., et al. (2013).
Comparison of ICD-10R, DSM-IV-TR and DSM-5 in an adult autism spectrum
disorder diagnostic clinic. Journal of Autism and Developmental Disorders, 43,
2515-2525.
This project is supported by the Health Resources and Services
Administration (HRSA) of the U.S. Department of Health and Human
Services (HHS) under grant #T73MC00022, Missouri LEND. This
information or content and conclusions are those of the author and
should not be construed as the official position or policy of, nor should
any endorsements be inferred by HRSA, HHS or the U.S. Government.