SOCIAL COMMUNICATION DISORDER: A New …

1 Blair Schanzmeyer, BS, Ashleigh O. Boyd, MHS, CCC-SLP Department of COMMUNICATION Science and disorders , University of Missouri, Columbia, MO SOCIAL COMMUNICATION DISORDER: a new Diagnosis in the DSM-5 Daily Facebook Likes Posted by Fans Year 1 10/1/09 9/30/10 Area of Difficulty: Examples: Using COMMUNICATION for SOCIAL purposes Greeting and sharing information, in a way that is appropriate for the SOCIAL context Changing COMMUNICATION to match context or the needs of the listener Speaking differently in a classroom than on a playground Talking differently to a child than to an adult Avoiding use of overly formal language Following rules for conversation and storytelling Taking turns in conversation Rephrasing when misunderstood Using verbal and nonverbal signals to regulate interaction Understanding what is not explicitly stated and nonliteral or ambiguous meaning of language Making inferences Understanding idioms, humor, metaphors Interpreting multiple meanings that require using context for understanding Introduction The Diagnostic and Statistical Manual of Mental disorders .

2 Fifth Edition (DSM-5), released in May 2013, revised criteria for autism spectrum disorder (ASD) and added a separate diagnosis of SOCIAL (pragmatic) COMMUNICATION disorder (SCD). SCD Diagnostic Criteria Deficits in the SOCIAL use of verbal and nonverbal COMMUNICATION as manifested by all of the following: Behavior: Examples: Stereotyped or repetitive motor movements, use of objects, or speech Simple motor stereotypes Lining up toys or flipping objects Echolalia Idiosyncratic phrases Insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal or nonverbal behavior Extreme distress at small changes Difficulties with transitions Rigid thinking patterns Greeting rituals Highly restricted, fixated interests that are abnormal in intensity or focus Strong attachment to or preoccupation with unusual objects Excessively circumscribed or perseverative interests Hyper or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment Apparent indifference to pain/temperature Adverse response to specific sounds or textures Excessive smelling or touching of objects Visual fascination of lights or movement Deficits result in functional limitations in effective COMMUNICATION , SOCIAL participation, SOCIAL relationships, academic achievement, and/or occupational performance Symptoms present in early developmental period Symptoms are not better accounted for by another mental disorder and are not due to a general medical or neurological condition.

3 Or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability, or global developmental delay Type of Assessment Description Example Standardized Assessment Empirically developed evaluation tool with established reliability and validity Test of Language Competence (Wiig & Secord) -ages 5:0-18:0 Parent/Teacher Report Measure Rating scales and/or checklists to obtain a compressive profile of SOCIAL COMMUNICATION skills Children s COMMUNICATION Checklist-2 (Bishop) -ages 4:0-16:11 Naturalistic Observations Observation of child in everyday SOCIAL settings with other individuals Observing the child in the classroom Analog Task(s) Observation of child in simulated SOCIAL situations Arranging the observation room with toys/peers to mimic real world events SCD Intervention The overall goal of SCD intervention is to improve SOCIAL interactions, not to teach specific behaviors or skills.

4 Treatment should aim to improve SOCIAL COMMUNICATION skills by addressing individual needs identified during assessment. The following chart provides examples of evidence-based interventions for improving SOCIAL COMMUNICATION skills (it is not an exhaustive list). SCD or ASD? In order for SCD to be diagnosed, restricted, repetitive behaviors or interests which are included in diagnostic criteria for ASD must be ruled out. The SLP s Role in SCD It is within the scope of practice of speech-language pathologists (SLPs) to diagnose COMMUNICATION disorders . SLPs typically make diagnoses of SCD and ASD as members of teams, however; SLPs can make a diagnosis of SCD independently if they have the necessary knowledge and experience in COMMUNICATION disorders . SLPs involved in the diagnosis of SCD should be specifically educated and appropriately trained in this area.

5 Assessment A comprehensive assessment of language skills as well as SOCIAL COMMUNICATION skills is necessary to make an appropriate SCD diagnosis. The following chart provides examples of types of assessments that can be used to evaluate SOCIAL COMMUNICATION skills : SCERTS SOCIAL COMMUNICATION (SC), emotional regulation (ER), and transactional support (TS), is a model of service provision that focuses on how to regulate emotions and communicate with others. SOCIAL Skills Groups Specific instruction, role-playing, and feedback are used to teach ways of interacting appropriately with typically developing peers. SOCIAL Scripts Scripted prompts (visual and/or verbal) are used to teach ways to appropriately use language during SOCIAL interactions. These scripts are gradually faded as children use SOCIAL language more spontaneously. Video Modeling Video clips captured using a video camera are edited to show positive target behavior.

6 Videos can show target behavior being completed by either typically developing peers or child (called video self-modeling). This project is supported by the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS) under grant #T73MC00022, Missouri LEND. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the Government. References American Psychiatric Association. (2013). SOCIAL (pragmatic) COMMUNICATION disorder. Available from Fact American Speech-Language Hearing Association. (2014). SOCIAL COMMUNICATION disorders in school-age children. Available from To p i c s/. Autism Speaks. (2014). DSM-5 diagnostic criteria.

7 Available from Autism Speaks. (2014). SOCIAL COMMUNICATION disorder: Parents seek guidance. Available from parents-seek-guidance Delano, M. E. (2007). Video modeling interventions for individuals with autism. Remedial and Special Education, 28, 33-42. Kulage, K. M., Smaldone, A. M., and Cohn, (2014). How will DSM-5 affect autism diagnosis? A systematic literature review and meta-analysis. Journal of Autism and Developmental disorders , 44, 1918-1932. Mayes, , Black, A., & Tierney, (2013). DSM-5 under-identifies PDDNOS: Diagnostic agreement between the DSM-5, DSM-IV, and checklist for autism spectrum disorder. Research in Autism Spectrum disorders , 7, 298-306. Norbury, C. F. (2014). Practitioner review: SOCIAL (pragmatic) COMMUNICATION disorder conceptualization, evidence, and clinical implications.

8 Journal of Child Psychology and Psychiatry, 55 (3), 204-216. Paul, D., & McCarty, J. (2014) Answers to your DSM-5 questions. The ASHA Leader, 19, 56-58. Taheri, A., & Perry, A. (2012). Exploring the proposed DSM-5 criteria in a clinical sample. Journal of Autism and Developmental disorders , 42, 1810-1817. Wilson, C. E., Gillan, N., Spain, D., Robertson, D., Roberts, G., Murphy, C. M., et al. (2013). Comparison of ICD-10R, DSM-IV-TR and DSM-5 in an adult autism spectrum disorder diagnostic clinic. Journal of Autism and Developmental disorders , 43, 2515-2525. Does the child demonstrate deficits in SOCIAL COMMUNICATION and SOCIAL interaction? Ye s Does the child display at least 2 of 4 restricted, repetitive behaviors? consider ASD diagnosis consider SCD diagnosis DSM-IV vs.

9 DSM-5 Criteria It is estimated that one-third of children diagnosed with ASD under DSM-IV criteria will not be diagnosed with ASD under DSM-5 criteria; however, there are controversial findings as to what percentage of these children will meet criteria for a diagnosis of SCD. Retrospective studies have examined proportion of subjects who no longer met criteria for ASD, but did meet criteria for SCD according to DSM-5 criteria: (2/48) - Taheri & Perry, 2012 28% (5/18) - Mayes, Black, & Tierney, 2013 63% (12/19) - Wilson et al., 2013 Future Directions There is a need for prospective studies to examine the prevalence of individuals diagnosed with SCD according to DSM-5 diagnostic criteria. Additionally, valid assessment tools should be established to improve the consistency of diagnosis. Rationale for SCD The diagnosis for SCD was added to the DSM-5 to more accurately and consistently recognize individuals with significant deficits in verbal and nonverbal COMMUNICATION , to provide diagnostic coverage for children who exhibit deficits in SOCIAL COMMUNICATION but do not have restricted, repetitive behaviors or interests, and to reduce variability between individuals who are diagnosed with ASD.

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