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The American Psychiatric Association published this new edition of its diagnostic manual in May 2013. It provides healthcare providers with new guidelines for diagnosing mental and behavioral conditions. SCD encompasses problems with social interaction, social understanding, and pragmatics. Pragmatics refers to using language in proper context. For example, it’s important for children to develop the ability to use language differently when playing with, say, a younger child versus a teacher. The addition of SCD to the DSM-5 accompanied a major revamping of the manual’s diagnostic criteria for autism spectrum disorder (ASD). Field tests of the new criteria indicated that some children who would have received a diagnosis of autism under DSM-IV (the previous edition) would instead receive the new diagnosis of SCD. But while SCD is new to the DSM manual, it’s not new to speech-language pathologists. We have the training and experience to help.

HOW IS SCD DIAGNOSED?

SCD is diagnosed based on difficulties with both verbal and non-verbal social communication skills. These skills include:

• responding to others
• using gestures (like waving or pointing)
• taking turns when talking or playing
• talking about emotions and feelings
• staying on topic
• adjusting speech to fit different people or situations – for instance, talking differently to a young child versus an adult or lowering one’s voice in a library.
• asking relevant questions or responding with related ideas during conversation
• using words for a variety of purposes such as greeting people, making comments, asking questions, making promises, etc.
• making and keeping friends

Like SCD, autism involves difficulty with social communication skills. But autism has the additional defining characteristic of restricted and/or repetitive behaviors. So an evaluation must rule out autism before reaching a diagnosis of SCD. This differential diagnosis can be difficult because many symptoms and behaviors overlap between ASD and SCD. In addition, SCD can occur alongside other developmental issues such as language impairment, learning disabilities, speech sound disorder and attention-deficit/hyperactivity disorder.

WHAT WILL THERAPY ENTAIL?

• Speech and language treatments are more successful with family engagement.
• It is especially important for a disorder that affects the social communication.
• It will be important for you to provide lots opportunities for your child to practice skills in real-life situations.
• We likewise recommend that you involve additional “communications partners” such as your child’s teachers, counselors and other special educators such as occupational or physical therapists.
• Therapy typically progresses from a one-on-one with the therapist to support groups that promote using new skills with other children.

STRATEGIES FOR FAMILIES

There are many activities you can do at home to encourage social communication skills in line with the goals you develop with your child’s therapist. For example:

• Take turn. Participate in simple turn-taking activities that mirror the flow of social interaction. Examples including rolling or throwing a ball back and forth. Or you can repeat words and other sounds that your child makes. Start simple with just a few turns between you and your child or your child and another person.
• Read and discuss. Read a book with your child, asking and encouraging open-ended questions such as “what do you think about what he did?”
• Talk about the feelings. Books and stories provide a great opportunity to talk about feelings. Suggest why you think a character in a story is behaving or feeling a particular way.

Try extending this to real-life situations, privately discussing what a friend or sibling might be feeling and why.