A large part of parenting involves distinguishing between our imagined fears and the real issues our child may be facing. Sometimes it can be difficult to tell if a concern is valid — children go through a wide variety of developmental stages and have a range of personality traits, so it can be challenging to determine if something is a temporary quirk of childhood or a symptom of something more serious. Add some internet research, and the situation can quickly become even more confusing. Many disorders have symptoms that overlap but are diagnosed and treated differently, such as social pragmatic communication disorder and autism. 

Social pragmatic communication disorder is a newer diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that is characterized by difficulties understanding and following the mostly-unspoken rules of social communication, such as adapting your style of conversation based on the social context of a situation, taking turns to talk, or understanding facial expressions or non-literal meaning. 

Prior to the introduction of this diagnosis, people with similar language disorders often received a diagnosis of autism or Asperger syndrome, two diagnoses that are now included within the Autism Spectrum Disorder (ASD) diagnosis. But social pragmatic communication disorder is a unique diagnostic category with its own behaviors, diagnostic criteria, and treatment options.

Here’s what we’ll cover:


What similarities do SCD and ASD share?

Social pragmatic communication disorder (SCD) and autism spectrum disorder (ASD) do share similarities, however, they are not the same. SCD was added to the DSM-5 to more appropriately diagnose and treat people who experience social communication difficulties but do not exhibit the repetitive behaviors or restricted interests included in the diagnostic criteria of ASD. 

Both disorders involve functional impairments in social communication skills and difficulties in social interactions and relationships. 


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What behaviors distinguish SCD from ASD?

The primary difference that distinguishes SCD from ASD is that ASD involves restrictive and repetitive interests and behaviors. ASD behaviors may include: 

  • An extreme attachment to rituals and routines
  • Fixation on lining things up, or keeping them in a certain order or placement 
  • Repetition of certain sounds, words, or phrases 
  • Difficulty participating in pretend or imaginative play 
  • Sensitivities to sensory input, such as sound, lights, or physical sensations 
  • Obsession with specific objects, characters, or topics
  • Repetitive behaviors like jumping, rocking, hand-flapping, head banging, or twirling. 


SCD behaviors are more specific to communication, and include: 

  • Interrupting others 
  • Difficulty staying on topic in a conversation
  • Responding in a way that is not relevant or understandable 
  • A lack of non-verbal gestures, such as waving or pointing 
  • Speech delays or language impairment 
  • Difficulty making friends or maintaining relationships
  • Trouble understanding non-literal meaning, such as idioms, metaphor, or sarcasm 


How is social pragmatic communication disorder diagnosed?

Social pragmatic communication disorder is diagnosed through a series of screenings, such as a hearing test and evaluations from a speech pathologist, as well as collected information from parents, teachers, doctors, and caregivers. Interviews, questionnaires, personal observations, and family medical history all offer valuable clues that can lead to a diagnosis of SCD. 

When a child is being evaluated for SCD, it is important to tell the medical professionals conducting the evaluation if the child has a habit of repetitive behavior, extremely focused interests, and/or an unusual reaction to sensory input. 


Treatment differences between SCD and ASD

Despite their similarities, SCD and ASD often have different approaches to treatment. Language therapy with a speech pathologist helps people with SCD learn more about communication skills and conversational nuance. A speech-language therapist may work with people who have SCD, either one-on-one or in small groups, using role-play or visual tools, such as illustrations to help define facial expressions. 

ASD treatment includes a large range of options, including occupational therapy, cognitive behavioral therapy, behavioral management therapy, medication, and nutrition. People with an ASD diagnosis may also benefit from language therapy options. 

If you have concerns about your child’s speech, communication, or social interactions, do not hesitate to ask your pediatrician for a more thorough evaluation. Regardless of the diagnosis, early intervention can make a significant impact on a child’s future prospects.