What is Social (Pragmatic) Communication Disorder?

From the Guidelines

Social Pragmatic Communication Disorder (SPCD) should be managed with a comprehensive approach that includes speech-language therapy, social skills training, and cognitive behavioral therapy to improve pragmatic language skills and address social anxiety. This condition is characterized by persistent difficulties with verbal and nonverbal social communication, including understanding and following social rules in conversation, adapting communication to different contexts, and maintaining appropriate back-and-forth conversation 1. Unlike autism spectrum disorder, SPCD does not involve restricted interests or repetitive behaviors.

Key Components of Management

• Speech-language therapy focused on improving pragmatic language skills
• Social skills training to enhance social interactions and relationships
• Cognitive behavioral therapy to address social anxiety and related issues
• No specific medications are approved for SPCD, but associated conditions like anxiety or ADHD may be treated with appropriate medications if present

Importance of Early Intervention

Early intervention is crucial for better outcomes in individuals with SPCD. Treatment is typically long-term and involves regular sessions with speech-language pathologists who create individualized therapy plans targeting specific communication challenges. Parents and teachers play important roles by reinforcing skills in everyday settings and providing consistent practice opportunities.

Role of Speech and Language Professionals

Speech and language professionals have a key role in the management of people with communication and related symptoms, including those with SPCD. They should address illness beliefs, self-directed attention, and abnormal movement patterns through a process of education, symptomatic treatment, and cognitive behavioral therapy within a supportive therapeutic environment 1.

From the Research

Definition and Characteristics of Social Pragmatic Communication Disorder

• Social (pragmatic) communication disorder (SPCD) is a new diagnosis introduced by DSM-5, characterized by problems with verbal and nonverbal social communication 2.
• SPCD is distinct from autism spectrum disorder (ASD) in that it does not involve restricted and repetitive interests and behaviors 2, 3.
• The core symptoms of SPCD include difficulties with verbal and nonverbal communication, such as initiating or maintaining conversations, understanding tone of voice and sarcasm, and developing and maintaining relationships 2, 3.

Diagnosis and Assessment of SPCD

• The diagnosis of SPCD is currently challenging due to the lack of well-validated and reliable assessment measures 3.
• Proposed criteria for SPCD include persistent difficulties using verbal and nonverbal communication for social purposes, in the absence of restricted and repetitive interests and behaviors 3.
• Assessment of SPCD may involve the use of standardized parent-report measures, such as the Developmental, Dimensional and Diagnostic Interview (3Di) and the Child Communication Checklist (CCC) 2.

Relationship between SPCD and Other Neurodevelopmental Disorders

• SPCD may be related to other neurodevelopmental disorders, such as ASD, attention deficit hyperactivity disorder (ADHD), and conduct disorder 3.
• High rates of comorbidity between SPCD and other disorders raise questions about the utility of this diagnostic category 3.
• SPCD may be best conceptualized as a dimensional symptom profile that may be present across a range of neurodevelopmental disorders 3.

Interventions for SPCD

• Social pragmatic interventions, such as peer mentoring, social skills groups, and video modeling, may be effective in improving social communication skills in individuals with SPCD 4.
• Metacognition, or the ability to reflect on and monitor one's own thinking and behavior, may be an important component of interventions for SPCD 5.
• Individualized treatment programs that incorporate multiple modalities, such as video and visual learning, may be effective in improving social communication skills in individuals with SPCD 4, 5.