Autism Spectrum Disorder vs Social (Pragmatic) Communication Disorder: What are the similarities and treatment strategies?

Mother and father with young boy have a successful meeting with a Therapist
Written by Dr. John Carosso

What is this new diagnosis, Social (Pragmatic) Communication Disorder?

In my new book, Managing the 5 Most Challenging Childhood Behavioral Health Conditions of our Day, there is a chapter on autism explaining the nature of this condition and treatment strategies. However, since DSM-V, a new diagnosis has come into play, Social Pragmatic Communication Disorder (SPCD) that is increasingly being used and becoming recognized as a variant of the autism spectrum. In that respect, SPCD involves:

-Problems using communication (verbal and nonverbal) in social situations

-Challenges adapting communication style to fit the context or the style of people the person communicates with

-Problems following social rules like taking turns during conversations

-Difficulty understanding implied messages

So, clearly, one can see how SPCD has some overlap with ASD, particularly what we formerly called ‘Asperger’s Disorder’ (high functioning autism). In that respect, the primary element of Asperger’s is social awkwardness, obsessiveness, and usually some sensory issues. When we see children at our clinic with those signs of SPCD but who are not obsessive and nor do they demonstrate any overt self-stimulatory behavior (hand-flapping, pacing, lining-up objects, spinning…), then the diagnosis of SPCD is considered. In that respect, a child with SPCD typically meets many or most of the social criteria for ASD but lacks any self-stimulatory behaviors (SSB).

For those who remember…

You may recall, years ago, prior to DSM-5, the diagnosis of Pervasive Developmental Disorder NOS (PDDNOS) was commonly used in place of Autistic Disorder (AS). In those days, PDDNOS was considered on the autism spectrum, but a milder case of autism. PDDNOS was likely over-used in its day.

Is SPCD becoming over-used as well?

We’ll have to wait and see. The most important factor is whether a child meets the full diagnostic criteria for ASD. If they don’t, it’s often due to a lack of SSB. In such a situation, it is often legitimate to consider a diagnose of SPCD (given the criteria is met).

Treatment of SPCD

The primary deficit of SPCD is, as the name implies, ’social’ in terms of difficulty understanding verbal and nonverbal communication. Consequently, treatment entails practicing those skills in terms of rehearsing and role-playing social situations and conversations, maintaining appropriate boundaries, understanding nuances, and carrying out the finer points of social interactions. We also incorporate speech/language therapy to target language skills, namely pragmatic (conversational) speech.

I hope that helps to clarify the difference and nuances between ASD and SPCD. The two have some overlap, and in cases of very mild autism, sometimes making the differentiation can be a challenge. If you have any questions, feel free to email me at jcarosso@cpcwecare.com

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