Relevant Developmental Disorder: Social (Pragmatic) Communication Disorder [SCD]

DSM-5 (American Psychiatric Association [APA], 2013) diagnostic criteria for social (pragmatic) communication disorder:

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.

Five concepts to bear in mind when developing and treating a student with a diagnosis of SCD (per Brinton & Fujiki, 2018):

1. Conceptualize social communication.

2. Concentrate on the child, not the label.

3. Aim for authenticity.

4. Facilitate flexibility

5. Stay the course.

• Potential treatment option for improving conversational skills: social language-based intervention (as described by Brinton, Robinson, & Fujiki, 2004):
  • Procedure:
    • 1. Analysis of video clips in terms of characters' perspectives, predicting reactions to conversational contributions, and "reading" implications of spoken language and nonverbal cues (taking context into account.)
    • 2. Conversation game:
      • Make one comment on the topic, ask a question, and listen to the response.
      • Make two comments on the topic, ask a question, and listen to the response.
      • Make two comments on the topic, ask a question, listen to the response, and comment on that response.
      • Make two comments on the topic, ask a question, listen to the response, comment on that response, ask a related question, and listen to the response.
      • Make several comments on the topic, ask a question, listen to the response, make some comments on that response, ask a related question, and listen to the response.
    • 3. General strategies for conversation (introduced at advanced stage).
  • Does research support the use of this social-language based intervention?: Yes, but the Brinton et al. (2004) study is the only one that utilizes this specific intervention, and this study is narrow in scope (single case study).
  • In my clinical practice: I would potentially utilize this or another program to improve conversational abilities with a student, especially if they were motivated to interact with peers. Such a student would need to have adequate cognitive capabilities. Motivation to interact with peers and strong parental support would also prove beneficial. It should be noted that the particular approach outlined in Brinton et al. (2004) is very intensive. Improving conversational ability is an extremely worthwhile therapy goal, as it could potentially improve a student's overall quality of life across multiple settings (home, school, etc.).

• Framework for understanding and organizing the strengths and challenges of individuals with social learning issues and creating more efficient curricula: The ILAUGH model (Winner, 2000)
  • I: Initiation of Language
  • L: Listening with Eyes and Brain
  • A: Abstract and Inferential Language/Communication
  • U: Understanding Perspective
  • G: Gestalt Processing/Getting the Big Picture
  • H: Humor and Human Relatedness
• Other concepts defined by Winner (2000) :
  • Expected/Unexpected Behavior: For specific situations. Expected behavior promotes positive feelings, unexpected behavior creates uncomfortable feelings.
  • Smart Guess/Wacky Guess: A means of helping individuals to predict behavior in social situations.
  • Social Fake: A term used in helping students to distinguish between genuine interest vs. mere "tolerance" of a conversational partner in social situations.
  • "Think with your eyes": Used instead of telling someone to "maintain good eye contact" or "look at me."
• In my clinical practice: Useful concepts to bear in mind when addressing pragmatics with students. A framework that can potentially be applied in collaborating with teachers and other professionals in addressing students' pragmatic capabilities as well. A student would need to have sufficient cognitive capabilities to appropriately participate in the activities suggested by Winner (2000).

• Potential treatment option for improving social understanding: social stories
  • Per Gray (2010) as cited in Cosgrave (n.d.): "A Social Story describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format. The goal of a Social Story is to share accurate social information in a patient and reassuring manner that is easily understood by its audience."
    • Improving social understanding can potentially improve social functioning and behavior of children with ASD.
  • Does research support the use of social stories?: Most researchers think there is insufficient evidence to consider the use of social stories an evidence-based practice. A meta-analysis by Kokina & Kern (2010) on the use of social stories in 18 studies produced a PND score indicating that the treatment had a low/questionable effectiveness rating. The researchers found that individual participants' PND scores usually indicated that the treatment was either highly effective or highly ineffective.
  • In my clinical practice: I am unlikely to use social stories given the lack of concrete evidence supporting their use, especially as time spent addressing social stories in clinic sessions could instead be spent implementing intervention methods supported by stronger evidence.

References

American Psychiatric Association. (2013). Diagnostic and statistic manual of mental disorders (5th

ed.). Washington, DC: American Psychiatric Publishing.

Brinton, B., & Fujiki, M. (2018). Social communication disorder: This is our baby, SLPs! The

ASHA Leader, 23(4), 38-39.

Brinton, B., & Fujiki, M. (2004). Description of a program for social language intervention: If you

can have a conversation, you can have a relationship. Language, Speech, and Hearing Services

in Schools, 35(3), 283-290.

Cosgrave, G. (n.d.). Social stories. Retrieved from http://www.educateautism.com/social-

stories.html

Kokina, A., & Kern, L. (2010). Social Story™interventions for students with autism spectrum

disorder: A meta-analysis. Journal of autism and developmental disorders, 40(7), 812-826.

Winner, M. (2000). Inside out: What makes the person with social cognitive deficits tick? San Jose,

CA: Think Social Publishing, Inc.