Social (pragmatic) communication disorder

Social (pragmatic) communication disorder is a condition where children find it difficult to talk to others in a social context. There is a persistent difficulty in the use of verbal and non verbal communication skills for social purposes.

Social communication disorder has been an official diagnosis since 2013. Prior to that, the condition was referred to as pragmatic language impairment or semantic pragmatic disorder. This is seen as those with the disorder have problems with pragmatics - how meaning is created and interpreted in particular contexts.

Children with social communication disorder have trouble following communication rules like taking turns to speak, greeting others and changing communication to match the context or needs of the listener. They are also unable to understand information that isn’t explicitly stated, such as sarcasm and metaphors.

However, they don’t have issues with speech or the mechanics of language, such as vocabulary and grammar. Pronunciation and stringing together sentences are usually not a problem for them.

Social communication disorder isn’t connected to intelligence too - those with the disorder as just as smart as others. It’s the unspoken, subtle rules of spoken language that are hard for them to grasp.

Social communication disorder may be a distinct diagnosis or may co-occur with other conditions, such as intellectual disability, developmental disabilities, learning disabilities, ADHD or traumatic brain injury. Children with social communication disorder cannot be diagnosed in conjunction with autism spectrum disorder (ASD). In the case of ASD, social communication problems are a defining feature, along with restricted, repetitive patterns of behavior.
Children are also at a higher risk for social communication disorder if there is a family history of communication or learning disorders.

Typical symptoms of social communication disorder include:

• Trouble understanding sarcasm, metaphors and being overly literal
• Unable to provide background information when talking to unfamiliar people
• Trouble understanding things that are implied rather than explicitly stated
• Trouble picking up on social cues like facial expressions and body language
• Failing to use appropriate greetings
• Unable to alter language and communication style based on a specific setting or partner
• Difficulties engaging in conversation, such as initiating or entering a conversation, maintaining a topic or taking turns to speak
• Unable to repair communication breakdowns. E.g. rephrasing things when misunderstood
• Difficulty making and keeping close friendships

Children with social communication disorder typically encounter difficulties connecting with peers, as well as challenges achieving school success and performing successfully in a job.

Because of their poorly developed conversational skills and inability to follow social rules, interaction with others becomes challenging. For example, they might not know how to greet others properly, take turns to speak or perceive when others are upset because of something they have said. As such, they would have difficulties making friends and forming close relationships with others.

Seeing as how social-communication skills are essential for achieving cognitive competences, their learning in school would be affected as well. With their inability to understand the meaning behind words, as well as how tone and context make words mean different things, receiving instruction from teachers becomes particularly challenging.

Such students are also likely to have low self-confidence and less motivation to learn because of their communication problems.

Our speech therapist will assess your child in the following areas:

• Using verbal and nonverbal means of communication, including natural gestures, speech and pictures
• Understanding and interpreting the verbal and nonverbal communication of others, including gestures and intonation
• Initiating spontaneous communication
• Initiate and maintaining conversation
• Manipulating conversational topics and repairing communication breakdowns
• Taking turns in functional activities across communication partners and settings
• Comprehending verbal and nonverbal discourse in social, academic, vocational, and community settings
• Understanding figurative and ambiguous language and making inferences when information is not explicitly stated
• Attributing mental and emotional states (e.g. thoughts, beliefs, and feelings) to oneself and others (Theory of Mind)
• Communicating for a range of social functions that are reciprocal and that promote the development of friendships and social relationships

An assessment is usually the first step in identifying a social communication disorder. Subsequently, your speech therapist will help design an intervention plan for your child. 

Early intervention is recommended by most experts for remediating of a social communication disorder. Becoming a more effective communicator helps your child advance developmentally, and prevents other issues such as behavioral and emotional problems.

Your therapist will work closely with you and your child to improve their communication skills and functioning.  Intervention may involve finding the best teaching strategies to help your child cope, or modifying their home/school environment to support them in fulfilling their learning potential.