Written by Najwa Bashir

In the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a new condition called Social (Pragmatic) Communication condition (SPCD) was added. Individuals with this disorder have problems with their pragmatic communication skills (Amoretti et al., 2021). Individuals with this condition, which is a type of Communication Disorder (CD), have a major issue with their functional skills in a broad sense. Sometimes people with SPCD have trouble communicating with others, can’t change what they say depending on the situation, and have trouble following the rules of speech (American Psychiatric Association, 2013, p. 47).

Children who don’t meet the standards for an autism spectrum disorder may have social problems when they talk to others. This is referred to as social (pragmatic) communication disorder (Flax et al., 2019). In the past, before DSM-5, three types of behavior were needed to diagnose ASD: interacting with others, communicating, and restricted, repetitive, or stereotypical behaviors. Communication and social interaction have been combined into a single criterion called “Social Communication,” with structure language used as an additional descriptor. The RRB criteria have stayed mostly the same, with the addition of sensory problems and behaviors that were not in DSM-IV. The term “Social Pragmatic Communication Disorder” (SPCD) was created to include kids who didn’t meet the new criteria for ASD but might have met criteria for DSM-IV, and PDD-NOS in the past, such as having limited hobbies and doing the same things over and over again (Swineford et al., 2014). ASD 299.00 (F84.0) or Language Disorder 315.39 (F80.9) are not the only problems that kids with SPCD have when it comes to communicating with others. As Flax et al. (2019) say, SPCD is a developmental condition that causes problems with social, vocal, and nonverbal communication.

Prevalence

Not much is known about how common SPCD is in the general population using DSM-5 criteria right now. Also, there isn’t much known about what functional effects come from weaknesses in certain types of social-pragmatic communication (Adams et al., 2015). South Korean kids ages 7 to 12 who were evaluated for autism had SPCD in 0.5% of the cases (Kim et al., 2014). A clinical group of kids with autism was screened, and only 8% met the standards for SPCD. Most of these kids had major behavior problems (Mandy et al., 2017). The structure language skills, on the other hand, were not reviewed independently (Saul et al., 2023).

Functional Impairment

Many kids who have problems with social and pragmatics also have issues with their behavior and emotions (Mandy et al., 2017). Gemillion and Martel (2014) also say that kids who have behavior problems often have issues with speaking, social skills, and everyday life skills. Some people have said that social-pragmatic skills help connect structured language to behavior, especially in poor areas (Law et al., 2014). It has also been said that social and functional communication skills are important for getting ready for school (Pace et al., 2019). These skills play a big role in how well kids do in reading and math at a young age and in their ability to control their emotions (Ramshook et al., 2020). As expected, kids with SPCD have trouble with schoolwork, especially reading (Freed et al., 2015), because they need to use their social cognitive and inferencing skills to understand what they read. So far, research has shown that social-pragmatic deficits are linked to other developmental issues that raise the risk of bad outcomes. This shows how much SPCD might cost the public health system and how important it is to plan good health and education services for kids who have these problems (Saul et al., 2023).

Diagnostic Criteria for Social (Pragmatic) Communication Disorder

According to DSM 5 TR (APA, 2022), the following are the diagnostic criteria for social (pragmatic) communication disorder:    

A. People who have persistent problems with social verbal and unconscious interactions show it in the following ways:

1. Problems making friends and communicating in a way that fits the social situation, like saying hello and sharing information.
2. Being unable to change the way you talk depending on the setting or the person you are talking to includes not using too much serious language, talking differently in a classroom than on the field, and talking differently to a child than to an adult.
3. Problems following the rules for talking and sharing stories, such as being patient, asking questions when something isn’t clear, and knowing how to use spoken and silent hints to manage interactions.
4. Difficulty understanding subtext (like making conclusions) and unclear language (like puns, jokes, metaphors, and words that can mean more than one thing depending on the context).

B. The problems make it hard to communicate, meet new people, form relationships, do well in school, or do well at work, either on their own or together with other problems.
C. The signs start in the early stages of development, but the problems might not show up fully until they have to deal with social situations that are too hard for them to handle.
D. The symptoms aren’t caused by another neurological or medical condition or by not being good at grammar and word structure. They also don’t fit better with autism spectrum disorder, intellectual developmental disorder (ID), global developmental delay, or another mental disorder.

Diagnostic Features of Social (Pragmatic) Communication Disorder

Drawing on DSM 5 TR (APA, 2022), here are the signs  that someone has  childhood fluency disorder:

• Finding it hard to understand pragmatics, which is the social use of words and conversation. This shows up as problems understanding and following the rules of both spoken and unspoken communication in real-life situations, as well as changing their language to fit the listener’s needs or the situation, and following the rules for conversations and telling stories.
• Due to problems with social communication, people can’t communicate effectively, participate in social activities, make friends, do well in school, or do their jobs successfully. There is no better way to understand the problems than by having low skills in structural language, cognitive ability, or autism spectrum disease.

Associated Features

Below-mentioned are some associated features of social (pragmatic) communication disorder:

• Language impairment, which means falling behind in language stages and having structured language problems in the past or present, is the most common social (pragmatic) communication disorder trait.
• People who have trouble communicating with others may avoid social situations.
• People who are affected are also more likely to have attention-deficit/hyperactivity disorder (ADHD), mental and behavioral problems, and certain learning issues.

Looking at the prevalence scores of this disorder, it appears that the condition is not diagnosed much and there have not been enough studies on it. However, the aforementioned diagnostic criteria and features can help spot individuals with SPCD so professional treatment can be sought in time.

References

• Adams, C., Gaile, J., Lockton, E., & Freed, J. (2015). Integrating language, pragmatics, and social intervention in a single-subject case study of a child with a developmental social communication disorder. Language, Speech, and Hearing Services in Schools, 46(4), 294-311. https://doi.org/10.1044/2015_LSHSS-14-0084
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
• American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (2022). Washington, DC, American Psychiatric Association.
• Amoretti, M. C., Lalumera, E., & Serpico, D. (2021). The DSM-5 introduction of the Social (Pragmatic) Communication Disorder as a new mental disorder: a philosophical review. History and Philosophy of the Life Sciences, 43(4), 108. https://doi.org/10.1007/s40656-021-00460-0
• 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, 23(8), 1982-1992. https://doi.org/10.1177/1362361318822503
• Freed, J., Adams, C., & Lockton, E. (2015). Predictors of reading comprehension ability in primary school-aged children who have pragmatic language impairment. Research in developmental disabilities, 41, 13-21. https://doi.org/10.1016/j.ridd.2015.03.003
• Gremillion, M. L., & Martel, M. M. (2014). Merely misunderstood? Receptive, expressive, and pragmatic language in young children with disruptive behavior disorders. Journal of Clinical Child & Adolescent Psychology, 43(5), 765-776. https://doi.org/10.1080/15374416.2013.822306
• Kim, Y. S., Fombonne, E., Koh, Y. J., Kim, S. J., Cheon, K. A., & Leventhal, B. L. (2014). A comparison of DSM-IV pervasive developmental disorder and DSM-5 autism spectrum disorder prevalence in an epidemiologic sample. Journal of the American Academy of Child & Adolescent Psychiatry, 53(5), 500-508. https://doi.org/10.1016/j.jaac.2013.12.021
• Law, J., Rush, R., & McBean, K. (2014). The relative roles played by structural and pragmatic language skills in relation to behaviour in a population of primary school children from socially disadvantaged backgrounds. Emotional and Behavioural Difficulties, 19(1), 28-40. https://doi.org/10.1080/13632752.2013.854960
• 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
• Pace, A., Alper, R., Burchinal, M. R., Golinkoff, R. M., & Hirsh-Pasek, K. (2019). Measuring success: Within and cross-domain predictors of academic and social trajectories in elementary school. Early Childhood Research Quarterly, 46, 112-125. https://doi.org/10.1016/j.ecresq.2018.04.001
• Ramsook, K. A., Welsh, J. A., & Bierman, K. L. (2020). What you say, and how you say it: Preschoolers’ growth in vocabulary and communication skills differentially predict kindergarten academic achievement and self‐regulation. Social Development, 29(3), 783-800. https://doi.org/10.1111/sode.12425
• Saul, J., Griffiths, S., & Norbury, C. F. (2023). Prevalence and functional impact of social (pragmatic) communication disorders. Journal of Child Psychology and Psychiatry, 64(3), 376-387. https://doi.org/10.1111/jcpp.13705
• 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, 1-8. https://doi.org/10.1186/1866-1955-6-41