Social (Pragmatic) Communication Disorder…not quite Asperger’s

600817_10200479396001791_905419060_nIn Part Five of our blog series…Dissecting the DSM-5…What it Means for Kids and Families we’ll look at the diagnostic criteria for Social (Pragmatic) Communication Disorder (SCD).

One of our greatest challenges in psychiatry has been describing how a person can have a little bit of something. Symptoms lacking in severity to meet the criteria for a specific disorder, but functional impairment of sufficient significance that the person clearly needs some type of clinical intervention.

This issue is a challenge with kids who are socially awkward, but don’t have symptoms of a severity to be characterized as an autism spectrum disorder, experienced some delay in language development (disqualifying them for a diagnosis of Asperger’s Disorder in the DSM-IV), or lacked the characteristic restricted, repetitive patterns of behavior, interest or activities characteristic of kids on the autism spectrum. Some clinicians historically used the term nonverbal learning disability to refer to this subgroup of patients.

The committee responsible for the DSM-5 felt the need to establish a diagnostic category to help facilitate the ability of persons struggling with social communication to access treatment. From the APA…

SCD is characterized by a persistent difficulty with verbal and nonverbal communication that cannot be explained by low cognitive ability. Symptoms include difficulty in the acquisition and use of spoken and written language as well as problems with inappropriate responses in conversation. The disorder limits effective communication, social relationships, academic achievement, or occupational performance. Symptoms must be present in early childhood even if they are not recognized until later when speech, language, or communication demands exceed abilities.

SCD has become the diagnostic category for kids who look like those with Asperger’s Disorder, but don’t meet full criteria for an autism spectrum disorder.

Updated July 11, 2014

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KM Logo UpdatedKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

 

About Dr. G

Dr. Stephen Grcevich serves as President and Founder of Key Ministry, a non-profit organization providing free training, consultation, resources and support to help churches serve families of children with disabilities. Dr. Grcevich is a graduate of Northeastern Ohio Medical University (NEOMED), trained in General Psychiatry at the Cleveland Clinic Foundation and in Child and Adolescent Psychiatry at University Hospitals of Cleveland/Case Western Reserve University. He is a faculty member in Child and Adolescent Psychiatry at two medical schools, leads a group practice in suburban Cleveland (Family Center by the Falls), and continues to be involved in research evaluating the safety and effectiveness of medications prescribed to children for ADHD, anxiety and depression. He is a past recipient of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness (NAMI). Dr. Grcevich was recently recognized by Sharecare as one of the top ten online influencers in children’s mental health. His blog for Key Ministry, www.church4everychild.org was ranked fourth among the top 100 children's ministry blogs in 2015 by Ministry to Children.
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8 Responses to Social (Pragmatic) Communication Disorder…not quite Asperger’s

  1. Sensory overload contributes to the individual’s reaction by withdrawing from social interaction to remain functional. In turn, they are labeled as higher in severity. This is inaccurate as sensory issues were completely eliminated from the diagnostic criteria.

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  2. drgrcevich says:

    Henny,

    Thanks for the comment! You raised a very good point. Here’s my guess…while lots of kids with SPCD likely have sensory processing issues, the presence of sensory processing issues aren’t necessary to diagnose the condition. One would need to rule out a primary sensory processing disorder (SPD) in making the diagnosis (recognizing that SPD isn’t yet “officially” recognized in the ICD-10) or consider SPD as a “comorbid” condition with the potential to complicate SPCD.

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    • That is precisely the reason why this severity level is not an accurate assessment of how the issue manifests itself. Every single parent can tell you how the sensory issues dominate their child’s life, yet it is overlooked as the cause of the many behaviors, including perseveration, stimming, and social withdrawal. What is pathetic is that clinician must yield to such a system to qualify for insurance reimbursement.

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  3. Cathy says:

    My daughter was just diagnosed with Social Pragmatic Communication Disorder; PDD-NOS; and ADD. I have 2 sons with Asperger’s, I have been dx’d with Asperger’s and my other daughter has ADHD. We have the alphabet soup of diagnoses in our house. All have Sensory issues. My daughter that was just diagnosed has major meltdowns daily and has no awareness of having to use the bathroom…there is no reaction, no awareness. She is very rigid as well. She has eye contact though which stumps the Drs. for some reason (I have eye contact) I am so confused about all this as I have done my research and the DSM V is doing away or rolling the PDD NOS dx into the ASD (Autism Spectrum Disorder) category.
    My husband and I just want to help our daughter. Our house is set up more like a therapy center than a house and we work with our beautiful kids daily.
    Could you help me with understanding why my daughter would get a PDD-NOS ex when it won’t exist very soon?
    Will PDD-NOS be rolled into the ASD umbrella and considered a part of autism?
    Any help would be greatly appreciated. As a “high functioning” Aspie I do a ton of research on this issue and really feel my daughter fits this criteria.
    Thanks!

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  4. noclaut says:

    NVLD and SCD means milder (at least usually) types of pervasive developmental disorders and other than “classical” types of “autism”. The terms NVLD or SCD have to be abolish for people who have developmental disorders with symptoms similar to more typical “species” of autism, but not so marked or not so severe. I would consider most people with NVLD and probably all with SCD as “autistic”. Children, who are “weird” have to be classified as ASD and PDD. The best symptom of it is problematic (or profound) developmental dyssemia (which has also PDD abbreviation) which means significant impairment in nonvrbal communication (such as lack of eye contact or inadequate facial expression).

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  5. Cathy says:

    My daughter has been dx’d with both the Social Communication Disorder and PDD (autism) I just want her to get the help she needs regardless of the expert labels. The only way I get that help is with the labels! She is so anxious in public settings and shuts down. She doesn’t want to be around people she doesn’t know or in crowds at all. She is also 9 years old and still hasn’t overcome toileting issues.
    I feel like the labels are a ball and chain rather than an avenue to help her. I only say that because it costs so much time money and energy just to get people to understand my daughter for who she really is and then get the help she needs.
    I can read the manuals and criteria, but what about looking objectively at my child and figuring out where she struggles and what best way would help her in each of these areas? ( just posing the question.)

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  6. noclaut says:

    I am from Poland and feel that American labels such as SCD and NVLD are just harmful understatements. I looks that it is just “soft” autism and pervasive developmental disorder of milder type. It of course means serious problem. These labels appear to describe only group of symptoms, not entire condition (a PDD). They sould be abolised IMHO.

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    • Cathy says:

      I love my daughter as she is. She is a beautiful bright amazing girl. But some of her challenges are too much for me to handle alone. And I shouldn’t have to. In America, the labels are necessary to get services that help our kids. As a parent, I don’t look at the label when I address my daughter. I see her for the wonderful creation that God gave me. I just want to be able to help her function to HER best so she can function in society as I won’t always be here to help her. So no matter the country or the label, the bottom line is getting the support we need for our dear children.

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