Social (pragmatic) communication disorder (SPCD), also known as semantic-pragmatic communication disorder, or pragmatic language impairment (PLI), is a neurodevelopmental disorder characterized by difficulties in the social use of verbal and nonverbal communication. Individuals with SPCD struggle to effectively participate in social interactions and interpret social cues, and may struggle to use words appropriately in social contexts. This disorder can have a profound impact on an individual's ability to establish and maintain relationships, navigate social situations, and participate in academic and professional settings. While SPCD shares similarities with other communication disorders, such as autism spectrum disorder (ASD), it is recognized as a distinct diagnostic category with its own set of diagnostic criteria and features. SPCD was granted its own category in the DSM-5 in 2013. The creation of this new category allowed individuals to be considered affected by a form of communication disorder distinct from autism spectrum disorder (ASD). SPCD lacks behaviors associated with restrictions and repetition which are seen in ASD.
Signs and symptoms
Individuals with social communication disorder have particular trouble understanding the meaning of what others are saying. Children with the disorder often exhibit:
Delayed language development Language disorders (similar to the acquired disorder of aphasia) such as word search pauses, jargoning, word order errors, word category errors, and verb tense errors Stuttering or cluttering speech Repeating words or phrases Tendency to be concrete or prefer facts to stories Difficulties with: Pronouns or pronoun reversal Understanding questions Understanding choices and making decisions Following conversations or stories (conversations are "off-topic" or "one-sided") Extracting the key points from a conversation or story; they tend to get lost in the details Verb tenses Explaining or describing an event Understanding satire or jokes and contextual cues Reading comprehension Reading body language Making and maintaining friendships and relationships because of delayed language development Distinguishing offensive remarks According to Bishop and Norbury (2002), children with semantic pragmatic disorder can have fluent, complex articulated expressive language but exhibit problems with the way their language is used. These children typically are verbose. However, they usually have problems understanding and producing connected discourse, instead giving conversational responses that are socially inappropriate, tangential, and stereotyped. They often develop eccentric interests but are not as strong or obsessional as people with autism. The current view is that the disorder has more to do with communication and information processing than language. For example, children with semantic-pragmatic disorder will often fail to grasp the central meaning or saliency of events. This then leads to an excessive preference for routine and "sameness" (seen in autism spectrum disorder). Individuals often assume a literal communication. This would mean that obvious, concrete instructions are clearly understood and carried out, whereas simple but non-literal expressions such as jokes, sarcasm, and general social chatting are difficult and can lead to misinterpretation. Lies are also a confusing concept to children with SCD as it involves knowing meaning beyond a literal interpretation.
Diagnosis Because SPCD has been categorized only since 2013, diagnosis is yet to be fully established. In the DSM-5, the child is diagnosed with SPCD if the child does not meet the criteria for other disorders such as ASD. The DSM-5 categorizes SPCD as a communication disorder within the domain of neurodevelopmental disorders, listed alongside other disorders of speech and language that typically manifest in early childhood.
Assessments and tests Common assessments used to identify SPCD are:
The developmental, dimensional, and diagnostic interview (3Di) The child communication checklist (CCC) The strengths and difficulties questionnaire (SDQ) Natural Observation Targeted Observation of Pragmatics in Children's Conversations (TOPICC) Analysis of Language Impaired Children's Conversation (ALICC) Structured Observation Test of Language Competence Assessment of Comprehension and Expression (ACE 6‐11) Test of Pragmatic Language Bus story Expression, Reception, and Recall of Narrative Instrument (ERRNI) Although several tests can be done to try to identify SPCD, some tests are better suited to diagnose SPCD than others. Also, there is not a specific assessment or test that can diagnose SPCD, unlike other disorders such as ASD, DLD, and PLI.
Treatment
Treatments for SPCD are less established than for treatments for other disorders such as autism. Similarities between SPCD and some aspects of autism lead some researchers to try some treatments for autism with people with SPCD. Speech therapy can help individuals who have communication disorders. Speech and language therapy treatment focuses on communication and social interaction. Speech therapists can work with clients on communication in various settings.
Similar or related disorders Hyperlexia is a similar but different disorder where the main characteristics are an above-average ability to read with a below-average ability to understand spoken or written language. Joanne Volden wrote an article in 2002 comparing the linguistic weaknesses of children with a nonverbal learning disability to PLI.
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