Social (Pragmatic) Communication Disorder

Social communication disorders may include problems with social interaction, social cognition, and pragmatics. A social communication disorder may be a distinct diagnosis or may occur within the context of other conditions, such as autism spectrum disorder (ASD), specific language impairment (SLI), learning disabilities (LD), language learning disabilities (LLD), intellectual disabilities (ID), developmental disabilities (DD), attention deficit hyperactivity disorder (ADHD), and traumatic brain injury (TBI). Other conditions (e.g., psychological/emotional disorders and hearing loss) may also impact social communication skills. In the case of ASD, social communication problems are a defining feature along with restricted, repetitive patterns of behavior.

Signs and symptoms of social communication disorders include problems with social interaction (e.g., speech style and context, rules for linguistic politeness), social cognition (e.g., emotional competence, understanding emotions of self and others), and pragmatics (e.g., communicative intentions, body language, eye contact).

An individual may say words clearly and use long, complex sentences with correct grammar, but still have a communication problem – if he or she has not mastered the rules for social language known as pragmatics.

Pragmatics involve three major communication skills:

• Using language for different purposes, such as
  • greeting (e.g., hello, goodbye)
  • informing (e.g., I’m going to get a cookie)
  • demanding (e.g., Give me a cookie)
  • promising (e.g., I’m going to get you a cookie)
  • requesting (e.g., I would like a cookie, please)
• Changing language according to the needs of a listener or situation, such as
  • talking differently to a baby than to an adult
  • giving background information to an unfamiliar listener
  • speaking differently in a classroom than on a playground
• Following rules for conversations and storytelling, such as
  • taking turns in conversation
  • introducing topics of conversation
  • staying on topic
  • rephrasing when misunderstood
  • how to use verbal and nonverbal signals
  • how close to stand to someone when speaking
  • how to use facial expressions and eye contact

An individual with pragmatic problems may

• say inappropriate or unrelated things during conversations
• tell stories in a disorganized way
• have little variety in language use

It is not unusual for children to have pragmatic problems in only a few situations. However, if problems in social language use occur often and seem inappropriate considering the child’s age, a pragmatic disorder may exist. Pragmatic disorders often coexist with other language problems such as vocabulary development or grammar. Pragmatic problems can lower social acceptance. Peers may avoid having conversations with an individual with a pragmatic disorder.

Source: American Speech-Language-Hearing Association

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, defines diagnostic criteria for Social Communication Disorder as:

A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:

1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for social context.
2. Impairment in the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meaning of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation.)

B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.

C. The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).

D. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.

Source: American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.