Social (Pragmatic) Communication Disorder Nosheen Qadeer - PDF document

Social (Pragmatic) Communication Disorder Nosheen Qadeer Introduction Social (pragmatic) communication disorder is characterized by difficulty with the use of social language and communication skills (also called pragmatic communication by professionals). A child or teen with this disorder will have difficulty in following the ordinary social rules of communication (whether they are verbal or nonverbal), following the rules for storytelling or conversations (each person takes a turn), and changing language depending upon the situation or needs of the listener. This disorder is most commonly diagnosed by age 5, since most children should possess adequate speech and language abilities by that time. SCD is diagnosed based on difficulties with both verbal and non-verbal social communication skills. These skills include:  responding to others  Gesturing is an important form of nonverbal social communication.  using gestures (like waving or pointing)  taking turns when talking or playing  talking about emotions and feelings  staying on topic  adjusting speech to fit different people or situations for instance, talking differently to a young child versus an adult or lowering one’s voice in a l ibrary  asking relevant questions or responding with related ideas during conversation

 using words for a variety of purposes such as greeting people, making comments, asking questions, making promises, etc.  making and keeping friends Oftentimes, a pragmatic language disorder or social communication disorder exists alongside autism, while other times, this type of speech and language disorder can present independently.

Diagnostic Criteria A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following: 1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context. 2. Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language. 3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction. 4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation). B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination. C. The onset of symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities). D. The symptoms are not attributable to another 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 (intellectual developmental disorder), global

developmental delay, or another mental disorder. (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 2013). Differential Diagnosis: Autism Spectrum disorder ASD is the primary diagnostic consideration for individual presenting with social communication deficits. The two disorders can be differentiated by the presence in autism spectrum disorder of restricted/repetitive pattern of behavior, interest, or activities and their absence in social (pragmatic) communication disorder. Individual with autism spectrum disorder may only display the restricted/ repetitive pattern of behavior, interest, and activities during the early development period, so a comprehensive history should be obtained. Current absence of symptoms would not preclude a diagnosis of autism spectrum disorder, If the restricted interests and repetitive behaviors were present in the past. A diagnosis of social (pragmatic) communication disorder should be considered only if the development history falls to reveal any evidence of restricted/ repetitive patterns of behavior, interests, or activities. Attention deficit/hyperactivity disorder Primary deficits of ADHD may cause impairment in social communication and functional limitation of effective communication, social participation, or academic achievement. Social Anxiety disorder (Social Phobia) The symptoms of social communication disorder overlap with those of social anxiety disorder. The differentiating feature is the timing of the onset of symptoms. In social (pragmatic) communication disorder, the individual has never had effective social communication; in social disorder, the social communication skills developed appropriately but are not utilized because of anxiety, fear, or distress about social interaction.

Intellectual disability (Intellectual development disorder) and global development delay Social communication skills may be deficient among individual with global development delay or intellectual disability, but a separate diagnosis is not given unless the social communication deficits are clearly in excess of intellectual limitation.

ASSESSMENT Informal Assessment Pragmatics represents the whole act of communication and is not simply a sum of the parts. One might, however, initially identify that an individual has a problem with pragmatics (the whole) and particular situations that present problems by:  Observing the person with ASD.  Interviewing numerous people about what communication situations are challenging and identification of particular difficulties.  Completing inventories or checklists.  Using informal situati ons to sample the person’s ability to deal with specific communication challenges. For an elementary school age student, this might translate into an observation in the classroom during group instruction and small group sessions, at recess, and in the lunchroom. Parents, teachers, aides and peers might contribute useful information during an interview or through a checklist. The student him or herself also might be able to identify situations that represent a challenge by completing a checklist. Challenging situations could be embedded within the daily routine so that the student might demonstrate how he manages situations such as being overlooked as papers are passed out, someone teasing him, or needing to ask for assistance with a difficult task. Comprehensive Assessment is conducted to identify and describe the following:  Impairments in body structure and function, including underlying strengths and weaknesses in communication and communication-related areas.

 Co-morbid deficits or health conditions, such as spoken or written language disorders, ADHD, or developmental disabilities.  Limitations in activity and participation, including functional communication and interpersonal interactions.  Contextual (environmental and personal) factors that serve as barriers to or facilitators of successful communication and life participation.  The impact of communication impairments on the individual’s quality of life. (American Speech-Language-Hearing Association, ASHA). Formal Assessment TOOLS:  The Rosetti Infant-Toddler Language Scale The Rossetti Infant-Toddler Language Scale (Rosetti, 2006) is a criterion referenced instrument designed to assess the communication skills of children from birth through 36 months of age. The scale assesses preverbal and verbal areas of communication and interaction, including: Interaction-Attachment, Pragmatics, Gesture, Play, Language Comprehension, and Language Expression. The examiner may directly observe a behavior that occurs spontaneously, directly elicit a behavior from the child, or use the parent’s or caregiver’s report to credit the child’s performance. This well-respected test is a criterion-referenced not a normed-referenced instrument. Criterion-referenced tests compare the subject's mastery of the specified behaviors to the specified behaviors.  The Westby Play Scale It is developed by Dr. Carol Westby (2000) , is a scale for assessing children’s play. Westby linked pragmatic language use in children to the development of their symbolic play