Social pragmatic communication disorder

[Anonymous]

Anonymous wrote:

Anonymous wrote:Your child is also really young. Many kids with very mild ASD don't get diagnosed until much older when the social deficits become clear.

So if you are treating the symptoms with social groups, speech, OT...how would the course of therapy differ with the diagnosis?

It really wouldn't.

[Anonymous]

Anonymous wrote:Your kid sounds like mine at that age, and this is basically the diagnosis he has now at age 9 from his speech therapist (I think they called it semantic pragmatic disorder). I told his psychologist I wasn't interested in an ADOS at this time because the distinction between autism and "social communication disorder" in the DSM is irrelevant (for DS, at this point) because it won't change any services we seek right now.

And the prejudice against autism rears it's ugly head. You weren't "interested" in the ADOS b/c you know your speech therapist can't diagnose autism and god forbid, you have a child with autism.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Your child is also really young. Many kids with very mild ASD don't get diagnosed until much older when the social deficits become clear.

So if you are treating the symptoms with social groups, speech, OT...how would the course of therapy differ with the diagnosis?

It really wouldn't.

A child like this could get an IEP with a "developmental delay" diagnosis--but that's really only good til age seven. Then your child will need a real diagnosis.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Your child is also really young. Many kids with very mild ASD don't get diagnosed until much older when the social deficits become clear.

So if you are treating the symptoms with social groups, speech, OT...how would the course of therapy differ with the diagnosis?

It really wouldn't.

A child like this could get an IEP with a "developmental delay" diagnosis--but that's really only good til age seven. Then your child will need a real diagnosis.

If you want supports or accommodations in a public school.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think its the new catch-all, which used to be PDD-NOS.

No it's not. If you don't have a kid with this diagnosis, best not to give ignorant opinions.

Actually, I think this is true. The removal of PDD-NOS from the DSM and the creation of social-communication disorder suggests that borderline ASD diagnoses will now be SCD instead of PDD-NOS. The problem with SCD is that it's not clear how it exists outside of the DSM -- eg there is not a big body of research on diagnostic tests and therapies. That's why it's probably better to look to ASD therapies on social skills for guidance. My kid sounds a lot like OPs and that is what we are doing.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think its the new catch-all, which used to be PDD-NOS.

No it's not. If you don't have a kid with this diagnosis, best not to give ignorant opinions.

Actually, I think this is true. The removal of PDD-NOS from the DSM and the creation of social-communication disorder suggests that borderline ASD diagnoses will now be SCD instead of PDD-NOS. The problem with SCD is that it's not clear how it exists outside of the DSM -- eg there is not a big body of research on diagnostic tests and therapies. That's why it's probably better to look to ASD therapies on social skills for guidance. My kid sounds a lot like OPs and that is what we are doing.

Social skill therapies are all based on some group or another, but it the rigor under which they were designed that makes Unstuck and On Target, The Kazdin Method, or Superflex generalizable to other kids with LDs or even NT kids.

However, Social Communication Pragmatics disorder is a stand alone diagnosis unto itself. There is a lot of similarity between ASD, so at 4 it's possible the OP's kid will actually receive an ASD diagnosis down the line. You "opinion" doesn't make something true and quite frankly is patronizing to parents who have been given this diagnosis since it was created with and who never received an autism diagnosis even with the ADOS. It's not just autism-lite.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Your kid sounds like mine at that age, and this is basically the diagnosis he has now at age 9 from his speech therapist (I think they called it semantic pragmatic disorder). I told his psychologist I wasn't interested in an ADOS at this time because the distinction between autism and "social communication disorder" in the DSM is irrelevant (for DS, at this point) because it won't change any services we seek right now.

And the prejudice against autism rears it's ugly head. You weren't "interested" in the ADOS b/c you know your speech therapist can't diagnose autism and god forbid, you have a child with autism.

I'm sorry you feel this way PP but your reaction really says more about you than me. Having the autism evaluation done would have been at least an additional $1,200, more likely closer to $1,500 because she probably would have had to incorporate a school visit since our greatest concerns were related to peers. Our out of pocket expenses for therapies run us about $10,000/year. We are not interested in enrolling him in a public school, and we are already doing every therapy the psychologist would have recommended even with an autism dx. Maybe you have an extra $1,500 to burn, but I didn't see the point.

Also, he's had an ADOS, completed by the public schools when he was 4 1/2. The results of that said no autism, but I'm not so sure. I'm happy to spend the money to re-evaluate when the answer will be useful.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think its the new catch-all, which used to be PDD-NOS.

No it's not. If you don't have a kid with this diagnosis, best not to give ignorant opinions.

Actually, I think this is true. The removal of PDD-NOS from the DSM and the creation of social-communication disorder suggests that borderline ASD diagnoses will now be SCD instead of PDD-NOS. The problem with SCD is that it's not clear how it exists outside of the DSM -- eg there is not a big body of research on diagnostic tests and therapies. That's why it's probably better to look to ASD therapies on social skills for guidance. My kid sounds a lot like OPs and that is what we are doing.

Social skill therapies are all based on some group or another, but it the rigor under which they were designed that makes Unstuck and On Target, The Kazdin Method, or Superflex generalizable to other kids with LDs or even NT kids.

However, Social Communication Pragmatics disorder is a stand alone diagnosis unto itself. There is a lot of similarity between ASD, so at 4 it's possible the OP's kid will actually receive an ASD diagnosis down the line. You "opinion" doesn't make something true and quite frankly is patronizing to parents who have been given this diagnosis since it was created with and who never received an autism diagnosis even with the ADOS. It's not just autism-lite.

It's a diagnosis that was created on paper, not out of research. It's not a new disorder that suddenly came into being because the DSM drafters discovered it as a new disease. The DSM is to a certain extent a line-drawing exercise, and kids who are on the ASD line will fall into SCD now. Not sure why you find that insulting? I have a kid who likely (not sure yet) will be give an SCD diagnosis and I have no problem with this.

"Some children who previously would have received a diagnosis of PDD-NOS may now receive a diagnosis of Social Communication Disorder."

https://www.autismspeaks.org/dsm-5/faq

":The inclusion of SCD was partially driven by the transition from DSM-IV PDD to DSM-5 ASD and the subsequent loss of DSM-IV PDD-NOS. PDD-NOS was a broad diagnostic category that included all conditions in which “there is severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behaviors, interests, and activities"

https://jneurodevdisorders.biomedcentral.com/articles/10.1186/1866-1955-6-41

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think its the new catch-all, which used to be PDD-NOS.

No it's not. If you don't have a kid with this diagnosis, best not to give ignorant opinions.

Actually, I think this is true. The removal of PDD-NOS from the DSM and the creation of social-communication disorder suggests that borderline ASD diagnoses will now be SCD instead of PDD-NOS. The problem with SCD is that it's not clear how it exists outside of the DSM -- eg there is not a big body of research on diagnostic tests and therapies. That's why it's probably better to look to ASD therapies on social skills for guidance. My kid sounds a lot like OPs and that is what we are doing.

Social skill therapies are all based on some group or another, but it the rigor under which they were designed that makes Unstuck and On Target, The Kazdin Method, or Superflex generalizable to other kids with LDs or even NT kids.

However, Social Communication Pragmatics disorder is a stand alone diagnosis unto itself. There is a lot of similarity between ASD, so at 4 it's possible the OP's kid will actually receive an ASD diagnosis down the line. You "opinion" doesn't make something true and quite frankly is patronizing to parents who have been given this diagnosis since it was created with and who never received an autism diagnosis even with the ADOS. It's not just autism-lite.

It's a diagnosis that was created on paper, not out of research. It's not a new disorder that suddenly came into being because the DSM drafters discovered it as a new disease. The DSM is to a certain extent a line-drawing exercise, and kids who are on the ASD line will fall into SCD now. Not sure why you find that insulting? I have a kid who likely (not sure yet) will be give an SCD diagnosis and I have no problem with this.

"Some children who previously would have received a diagnosis of PDD-NOS may now receive a diagnosis of Social Communication Disorder."

https://www.autismspeaks.org/dsm-5/faq

":The inclusion of SCD was partially driven by the transition from DSM-IV PDD to DSM-5 ASD and the subsequent loss of DSM-IV PDD-NOS. PDD-NOS was a broad diagnostic category that included all conditions in which “there is severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behaviors, interests, and activities"

https://jneurodevdisorders.biomedcentral.com/articles/10.1186/1866-1955-6-41

Dearie, the DSM is based on research. Nothing is really new. They eliminated PDD-NOS b/c it was way to broad and non-specific. Social Communication Pragmatics Disorder has a set of very specific characteristics. And yes, there will definitely be overlap in how you would treat autism, just not in the reimbursement from the insurance company. So keep your unhelpful comments to yourself, since it's obvious that you don't have a child with either diagnosis and are just trolling here to provoke an argument and address the OP's original question.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think its the new catch-all, which used to be PDD-NOS.

No it's not. If you don't have a kid with this diagnosis, best not to give ignorant opinions.

Actually, I think this is true. The removal of PDD-NOS from the DSM and the creation of social-communication disorder suggests that borderline ASD diagnoses will now be SCD instead of PDD-NOS. The problem with SCD is that it's not clear how it exists outside of the DSM -- eg there is not a big body of research on diagnostic tests and therapies. That's why it's probably better to look to ASD therapies on social skills for guidance. My kid sounds a lot like OPs and that is what we are doing.

Social skill therapies are all based on some group or another, but it the rigor under which they were designed that makes Unstuck and On Target, The Kazdin Method, or Superflex generalizable to other kids with LDs or even NT kids.

However, Social Communication Pragmatics disorder is a stand alone diagnosis unto itself. There is a lot of similarity between ASD, so at 4 it's possible the OP's kid will actually receive an ASD diagnosis down the line. You "opinion" doesn't make something true and quite frankly is patronizing to parents who have been given this diagnosis since it was created with and who never received an autism diagnosis even with the ADOS. It's not just autism-lite.

It's a diagnosis that was created on paper, not out of research. It's not a new disorder that suddenly came into being because the DSM drafters discovered it as a new disease. The DSM is to a certain extent a line-drawing exercise, and kids who are on the ASD line will fall into SCD now. Not sure why you find that insulting? I have a kid who likely (not sure yet) will be give an SCD diagnosis and I have no problem with this.

"Some children who previously would have received a diagnosis of PDD-NOS may now receive a diagnosis of Social Communication Disorder."

https://www.autismspeaks.org/dsm-5/faq

":The inclusion of SCD was partially driven by the transition from DSM-IV PDD to DSM-5 ASD and the subsequent loss of DSM-IV PDD-NOS. PDD-NOS was a broad diagnostic category that included all conditions in which “there is severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behaviors, interests, and activities"

https://jneurodevdisorders.biomedcentral.com/articles/10.1186/1866-1955-6-41

Dearie, the DSM is based on research. Nothing is really new. They eliminated PDD-NOS b/c it was way to broad and non-specific. Social Communication Pragmatics Disorder has a set of very specific characteristics. And yes, there will definitely be overlap in how you would treat autism, just not in the reimbursement from the insurance company. So keep your unhelpful comments to yourself, since it's obvious that you don't have a child with either diagnosis and are just trolling here to provoke an argument and address the OP's original question.

Read the second article I linked. There is still a TON of research to do to tease out the research-based differences between SCD and ASD. The "characteristics" of SCD listed in the DSM are diagnostic (ie in large part theoretical line-drawing), and not entirely clinical/research based. I'm not sure why you think this is offensive, unless you have some kind of investment in saying that your SCD kid is so very different from kids with ASD? There's still a whole lot unknown about SCD, but what is known is that the social communication deficits overlap with those in ASD, and that some kids who would have gotten a PDD-NOS diagnosis will now get SCD.

"In the DSM-5, ASD is a new diagnostic category in the Neurodevelopmental Disorders section, characterized by impairments in social communication and social reciprocity and by the presence of restricted interests and repetitive behaviors. DSM-5 ASD replaces the disorders that comprised the DSM-IV pervasive developmental disorders (PDD) category, including autistic disorder, Asperger’s disorder, and pervasive developmental disorder, not otherwise specified (PDD-NOS).

The inclusion of SCD was partially driven by the transition from DSM-IV PDD to DSM-5 ASD and the subsequent loss of DSM-IV PDD-NOS. PDD-NOS was a broad diagnostic category that included all conditions in which “there is severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behaviors, interests, and activities” [6]. Because DSM-5 ASD criteria require the presence of repetitive behaviors, some have raised the concern that some individuals who met the DSM-IV PDD-NOS criteria no longer have a diagnostic home and will therefore be ineligible for the treatment services appropriate for their impairments. Thus, SCD and ASD are common in the requirement of deficits in social communication skills, but individuals with SCD cannot evidence restricted interests, repetitive behaviors, insistence on sameness, or sensory abnormalities. It is essential to rule out a diagnosis of ASD by verifying the lack of these additional symptoms, currently or by history, before assigning a diagnosis of SCD. Thus, the criteria for SCD are qualitatively different from ASD and are not equivalent to “mild ASD.” However, whether children display the specific pattern of the SCD diagnostic criteria is still an empirical question, as the criteria have just been added to the DSM and children with severe social communication difficulties and without significant repetitive behaviors are often overlooked in the literature [7].

Although SCD may serve as a diagnostic home for individuals who would have previously met the criteria for DSM-IV PDD-NOS, the goal of new DSM diagnostic categories is not to prevent the loss of previously diagnosed disorders, but instead to represent natural phenomena as accurately as possible. Therefore, the rationale for the addition of SCD to DSM-5 communication disorders was rooted in literature suggesting that the impairment in pragmatics that is observed in individuals with significant social communication deficits can be differentiated from the structural and formulation difficulties that characterize language disorder. However, a long-standing debate exists regarding the nature of the overlap between social communication/pragmatic impairments and other communication and neurodevelopmental disorders. The introduction of the SCD diagnosis does not settle this debate, but instead gives researchers a tool with which to develop empirical evidence to answer the question.

Thus, in addition to the question of the overlap between SCD and other language disorders, important questions exist surrounding the practice of ruling out DSM-5 ASD when SCD is diagnosed [8]. Since the publication of the DSM-5, there has been a focus on how these particular issues may affect clinical practice [8]. While such discussions are important, the current review focuses on previous research relating to the new DSM-5 category and outlines research to be conducted to investigate the validity of the new diagnostic category. As described below, SCD aligns conceptually and practically with pragmatic language impairment, although SCD was purposefully expanded to incorporate difficulties with nonverbal communication. From the existing literature, we summarize what is known about differential diagnosis, familial aggregation, developmental course, and prognosis. We also discuss the possible impact of changes in the DSM-5 ASD criteria. We emphasize here and throughout that given the variable definitions used for pragmatic language impairment in the past and the broader definition of SCD in the DSM-5, it is not yet known if and how the extant literature on pragmatic language impairment will relate to findings for SCD."

[Anonymous]

Anonymous wrote:Any experience with this diagnosis?

We brought DS to a psychologist, who at almost age 4, has about a 6 month speech delay. He is painfully shy, introverted, and prefers parallel play. He never showed signs of ASD (initiates play, though struggles in groups) but has always been quirky. He initiated and played with the two aides she had observing, though was easily distracted when she wanted to read, and then again sit to sing together. He focused mainly on playing with her collection of cars. He is in school where he follows directions and is cooperative, though doesn't love the noise and rowdiness of being in a class with 22 kids. Noting his anxious temperament, we brought him for an evaluation to see what we could do to help.

She recommended a social skills group, more speech therapy, and OT (thought his core looked week, and asked how he ran, which is a bit slow and awkward).

I sound like a broken record... But contact the Little Turtles Shyness study at University of Maryland and see if your son qualifies for their shyness study. His language delay might be a confounding factor, but being "painfully" shy is what they specialize in.

[Anonymous]

Anecdotally I have a child with social pragmatic disorder (can't get the name straight) and a close family member on the spectrum. Here are some differences that I notice (sample size obviously quite small, so it's personal experience):

1. ASD seems to have significantly more and severe sensory integration issues
2. Anxiety and rigid thinking is higher with ASD
3. This is a big one - social communication (DC) seems to be able to reflect on social situations in hindsight. He can see what went wrong, even if he needs a lot of practice changing behavior. ASD, not as able to be reflective because of metacognitive issues.

I can see that this might upset folks- it's not intended to generalize- it's just the unusual experience of one person being able to observe these two conditions side by side.

[Anonymous]

Anonymous wrote:Your kid sounds like mine at that age, and this is basically the diagnosis he has now at age 9 from his speech therapist (I think they called it semantic pragmatic disorder). I told his psychologist I wasn't interested in an ADOS at this time because the distinction between autism and "social communication disorder" in the DSM is irrelevant (for DS, at this point) because it won't change any services we seek right now.

My son's biggest challenges have been his difficulties with pragmatic language, overall slow language processing, social anxiety, and, frankly, his low average IQ. The IQ matters because we ended up putting him in a small private which has been fantastic for supporting his social and emotional growth, but most of the kids are really smart with these zippy little brains, and my kid is not like that. But we're making it work with the support of the school. Having the continuity of the same kids in his small class each year has been great, and this year for the first time he has a true best friend and a consistent pack of buddies at recess and lunch. He is also a lot more confident and less anxious.

The most useful other things we have done include 1) holding him back a year for K, 2) long term OT group focused on "Social Thinking" 3) a private speech therapist twice a week for years who also uses the "Social Thinking" stuff and sees him in his classroom. But I am not from DC area so I don't know if private speech pathologists travel to classrooms there.

We also did years of private OT and I think it was kind of a waste except when she was working on very specific skills, like handwriting or tying his shoes. Having her input on play activities we could do at home was helpful when he was young, too.

DS has grownup so much. I don't know what is due to therapy and what is just due to natural development. This week is our spring break and I took him to a children's play museum. He played with unfamiliar kids for hours! He was still immature and quirky for a 9 year old, but a couple years ago he would have just walked away from any play area when another kid came along. A couple years before that we would have just left the museum altogether because he would have hated the crowds and noise. He's really come a long way.

Ridiculous to try and get a disorder labeled onto your kid because he's simply average.

[Anonymous]

Anonymous wrote:Anecdotally I have a child with social pragmatic disorder (can't get the name straight) and a close family member on the spectrum. Here are some differences that I notice (sample size obviously quite small, so it's personal experience):

1. ASD seems to have significantly more and severe sensory integration issues
2. Anxiety and rigid thinking is higher with ASD
3. This is a big one - social communication (DC) seems to be able to reflect on social situations in hindsight. He can see what went wrong, even if he needs a lot of practice changing behavior. ASD, not as able to be reflective because of metacognitive issues.

I can see that this might upset folks- it's not intended to generalize- it's just the unusual experience of one person being able to observe these two conditions side by side.

I have a DS, 9, with ASD/ Asperger's and ADHD and I don't find your points 1, 2 and 3 to be true at all. People who meet DS in real life don't think he has any diagnosis even when they have known him for several yrs unless I tell them and when I tell people they are always surprised (most people have a stereotypical view of ASD like you.)

DS does not have severe sensory issues and never has. No clinical level of anxiety according to his neuropsych eval. His rigid thinking is not particularly noticible and he has no problems reflecting on his actions at all.

[Anonymous]

^the only clinical difference between ASD and SPD is that SPD does not have restricted interests and/or repetitive behaviors. That's it.