Social communication disorder: causes, signs and treatment

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People with social communication disorder (SCD) have difficulty with verbal and nonverbal communication, but the symptoms are not due to intellectual disability or autism.

People with SCD understand language but may have difficulty processing or responding to it, either with speech or non-speech. They also have difficulty understanding social cues and social norms and may struggle to form and maintain relationships.

Although autism also causes difficulty in social situations, it produces other symptoms in addition. Therefore, people with SCD do not meet the criteria for an autism diagnosis. However, doctors must rule out autism before diagnosing SCD.

SCD is a relatively new diagnosis that the Diagnostic and Statistical Manual of Mental Disorders introduced only in its fifth edition, the DSM-5.

Read on to learn more about social communication disorder, including causes and symptoms and how to manage it.

SCD, which doctors may also call pragmatic communication disordercauses difficulties with language, social communication, and understanding social norms in intellectually typical people.

It can mimic some of the symptoms of autism, but, unlike autism, it does not cause restricted interests, repetitive behaviors, anxiety, or sensory differences.

People with SCD understand language but may not respond to it. Symptoms usually appear early in childhood. Parents or guardians may notice that their child shows little interest in engaging with others. They can show some early signs of autismsuch as delayed language development, lack of interest in pretend play, and failure to initiate social interactions with others.

The DSM-5 replaced conditions such as Asperger’s Syndrome and Pervasive Developmental Disorders with the broader diagnosis of autism spectrum disorder.

SCD does not fall under this umbrella. However, as doctors only recognized relatively recently, some people whose initial diagnosis was autism may find that SCD better explains their symptoms. This is likely the case if they only show social symptoms rather than a wider range of autism characteristics.

Researchers don’t yet fully understand what causes SCD. Some evidence suggests that there is a genetic overlap between autism and SCD. Certain genes may increase the risk of SCD or be more prevalent in people with SCD. However, there is no evidence that a specific gene or combination of genes inevitably causes sickle cell disease.

The researchers also identified some brain differences in people with SCD. The challenge is that these findings are often isolated, meaning that one study finds one structural change associated with sickle cell disease, while another study identifies another.

Scientists don’t know if these brain differences cause SCD or if some other factor – such as environmental effects – drives the brain differences.

SCD affects verbal and nonverbal communication, as well as social skills. People who show other symptoms, such as repetitive behaviors, restricted interests, or problems with sensory processing, may have a different condition, such as autism.

The DSM-5 lists the diagnostic criteria for SCD, noting that a person must have all of the following symptoms:

  • Difficulties in social contexts with verbal and non-verbal communication: These difficulties include:
    • difficulty matching communication to context
    • difficulty understanding the rules of conversation
    • difficulty understanding communication that is not literal and explicit
  • Communication limits: A person’s communication and social skills challenges significantly affect their life, for example by undermining communication, social relationships, or academic achievement.
  • Symptoms must appear early in development: However, they may not become evident until the child reaches an age where the expected level of social communication exceeds their abilities.
  • No other diagnosis: Another diagnosis, such as autism or intellectual disability, does not better explain the symptoms.

A person will also only be diagnosed with SCD if they have the ability to speak and understand language. Children who never do either may need a different diagnosis. Therefore, most children are diagnosed around the age of 4 or 5 years rather than as an infant or toddler.

Doctors diagnose SCD based on symptoms. In some cases, they may try to rule out another problem, such as a speech delay or a physical health problem that interferes with speech and communication.

They will only diagnose SCD if a person has symptoms that affect language, social skills, and nonverbal communication. Symptoms should:

  • appear in childhood
  • interfere with relationships or daily functioning
  • not be due to another health condition

Treatment aims to help a person develop social and communication skills and provide accommodations that help them function.

In most cases, a person will need the support of a speech therapist. They may also need mental health support.

Some treatment options include:

  • Communication aids: These devices can help a person communicate in environments where they might otherwise find it too difficult.
  • Communication training and support: Interventions that teach people communication skills can facilitate communication. For instance, social scenarios can help teach children language strategies for social interaction, while social stories can build an understanding of social situations through stories.
  • Practice of social skills: Various interventions can help people practice their social skills. For example, peers without SCD may work with a child with SCD to practice social skills, or a person may practice skills with a therapist.
  • Culturally specific training: Communication norms vary from culture to culture, and expectations in one culture may be unusual in another. For this reason, it is important for people to get support from culturally competent providers.
  • Behavioral interventions: Behavioral treatments reward behavior that a healthcare professional wants to see, such as making eye contact or communicating with peers. However, behavioral strategies are controversial in the neurodiversity community due to concerns about abuse and the stigmatization of neurodivergence. Behavioral interventions are not the only treatment option.

No specific medication can treat SCD. However, a person may take medication to manage unrelated symptoms or to deal with certain complications of sickle cell disease, such as anxiety in social settings.

There is no cure for SCD. As this is a relatively new diagnosis, research into how it develops and changes throughout a person’s lifetime is ongoing.

With the right treatment and support structures in place, people with sickle cell disease can lead happy and fulfilling lives. It is important to note that a person with SCD may not crave the same social interactions or communication that neurotypical people often desire. Adapting to this difference in cognition is important to ensure the well-being of someone with SCD.

People with SCD may also need accommodations at work or school to reach their full potential.

Social communication disorder is distinct from autism, but the two conditions share some common traits. This means that some people who were diagnosed with autism some time ago might actually have SCD instead. Getting the right diagnosis is important in identifying the support needed.

As with other forms of neurodivergence, it is important to focus on the treatment needs and goals of the person with SCD rather than trying to force them to conform to the norms of the larger culture. A compassionate treatment team, the right accommodations and a collaborative approach can help.

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