Social (Pragmatic) Communication Disorder Nosheen Qadeer - - PDF document

Social (Pragmatic) Communication Disorder

Nosheen Qadeer Introduction

Social (pragmatic) communication disorder is characterized by difficulty with the use of social language and communication skills (also called pragmatic communication by professionals). A child or teen with this disorder will have difficulty in following the ordinary social rules of communication (whether they are verbal or nonverbal), following the rules for storytelling or conversations (each person takes a turn), and changing language depending upon the situation or needs of the listener. This disorder is most commonly diagnosed by age 5, since most children should possess adequate speech and language abilities by that time. SCD is diagnosed based on difficulties with both verbal and non-verbal social communication skills. These skills include:

• responding to others
• Gesturing is an important form of nonverbal social communication.
• 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

Oftentimes, a pragmatic language disorder or social communication disorder exists alongside autism, while other times, this type of speech and language disorder can present independently.

Diagnostic Criteria

• 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 the social context.

• 2. Impairment of 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
• r ambiguous 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 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. (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 2013).

Differential Diagnosis:

Autism Spectrum disorder

ASD is the primary diagnostic consideration for individual presenting with social communication deficits. The two disorders can be differentiated by the presence in autism spectrum disorder of restricted/repetitive pattern of behavior, interest, or activities and their absence in social (pragmatic) communication disorder. Individual with autism spectrum disorder may only display the restricted/ repetitive pattern of behavior, interest, and activities during the early development period, so a comprehensive history should be obtained. Current absence of symptoms would not preclude a diagnosis of autism spectrum disorder, If the restricted interests and repetitive behaviors were present in the past. A diagnosis of social (pragmatic) communication disorder should be considered only if the development history falls to reveal any evidence of restricted/ repetitive patterns of behavior, interests, or activities.

Attention deficit/hyperactivity disorder

Primary deficits of ADHD may cause impairment in social communication and functional limitation of effective communication, social participation, or academic achievement.

Social Anxiety disorder (Social Phobia)

The symptoms of social communication disorder overlap with those of social anxiety

• disorder. The differentiating feature is the timing of the onset of symptoms. In social (pragmatic)

communication disorder, the individual has never had effective social communication; in social disorder, the social communication skills developed appropriately but are not utilized because of anxiety, fear, or distress about social interaction.

Intellectual disability (Intellectual development disorder) and global development delay

Social communication skills may be deficient among individual with global development delay or intellectual disability, but a separate diagnosis is not given unless the social communication deficits are clearly in excess of intellectual limitation.

ASSESSMENT Informal Assessment

Pragmatics represents the whole act of communication and is not simply a sum of the

• parts. One might, however, initially identify that an individual has a problem with pragmatics

(the whole) and particular situations that present problems by:

• Observing the person with ASD.
• Interviewing numerous people about what communication situations are challenging and

identification of particular difficulties.

• Completing inventories or checklists.
• Using informal situations to sample the person’s ability to deal with specific

communication challenges. For an elementary school age student, this might translate into an observation in the classroom during group instruction and small group sessions, at recess, and in the lunchroom. Parents, teachers, aides and peers might contribute useful information during an interview or through a checklist. The student him or herself also might be able to identify situations that represent a challenge by completing a checklist. Challenging situations could be embedded within the daily routine so that the student might demonstrate how he manages situations such as being overlooked as papers are passed out, someone teasing him, or needing to ask for assistance with a difficult task. Comprehensive Assessment is conducted to identify and describe the following:

• Impairments in body structure and function, including underlying strengths and

weaknesses in communication and communication-related areas.

• Co-morbid deficits or health conditions, such as spoken or written language disorders,

ADHD, or developmental disabilities.

• Limitations in activity and participation, including functional communication and

interpersonal interactions.

• Contextual (environmental and personal) factors that serve as barriers to or facilitators of

successful communication and life participation.

• The impact of communication impairments on the individual’s quality of life. (American

Speech-Language-Hearing Association, ASHA).

Formal Assessment

TOOLS:

• The Rosetti Infant-Toddler Language Scale

The Rossetti Infant-Toddler Language Scale (Rosetti, 2006) is a criterion referenced instrument designed to assess the communication skills of children from birth through 36 months

• f age. The scale assesses preverbal and verbal areas of communication and interaction,

including: Interaction-Attachment, Pragmatics, Gesture, Play, Language Comprehension, and Language Expression. The examiner may directly observe a behavior that occurs spontaneously, directly elicit a behavior from the child, or use the parent’s or caregiver’s report to credit the child’s performance. This well-respected test is a criterion-referenced not a normed-referenced

• instrument. Criterion-referenced tests compare the subject's mastery of the specified behaviors

to the specified behaviors.

• The Westby Play Scale

It is developed by Dr. Carol Westby (2000), is a scale for assessing children’s play. Westby linked pragmatic language use in children to the development of their symbolic play

• skills. She found that a child’s ability to use language coincides with the emergence of

predictable symbolic play schemes. The Westby Play Scale is organized according to developmental levels of play and language. They observe the child through natural play and can take as little or as long as they want. The purpose is to see where the child is in terms of play and

• language. Parents and educators would be able to use this assessment by checking off if the

individual is exhibiting the signs in each area. Assessment findings are used to create pragmatic language goals for the 18month to 6-year-old child.

• The Social-Emotional Evaluation (SEE)

It is developed by Elisabeth Wiig (2008) a criterion-referenced assessment designed to evaluate aspects of emotional and social awareness in children ages 6 through 12 years. The abilities probed by the SEE are part of the repertoire of skills that define social-emotional

• competence. The SEE contains four core subtests (Identifying Common Emotions, Identifying

Emotional Reactions, Understanding Social Gaffes, and Understanding Conflicting Messages),

• ne supplemental test (Recognizing Facial Expressions), and a Social Emotional Questionnaire

for parents/caregivers and educators. The standardization samples for the SEE included over 800 children across the United States and closely resembles U.S. Census Bureau Data for 2007. Test- retest and inter-rater reliability were all very high and over .88.

• The Pragmatic Language Skills Inventory (PLSI)

It is developed By James E. Gilliam, Lynda Miller a standardized, norm-referenced teacher-rating instrument that helps identify children ages 5 through 12 years’ old who have pragmatic language disabilities. The 45-item PLSI is an easy-to-use rating scale with three

• subscales. The PLSI incorporates the primary characteristics of pragmatic language into three

subscales: Classroom Interaction Skills (includes using figurative language, maintaining a topic during a conversation, explaining how things work, writing a good story, and using slang appropriately), Social Interaction Skills (which includes knowing when to talk and when to listen, understanding classroom rules, taking turns in conversation, and predicting consequences for one’s behavior, and Personal Interaction Skills (which includes initiating conversations, asking for help, participating in verbal games, and using appropriate nonverbal communicative

• gestures. The PLSI was standardized on 1,175 students (610 boys, 565 girls) between 5 and 12

years of age. The sample represents the U.S. population of school-age children with respect to geographic region, gender, race, ethnicity, and disability status. Reliability data are reported in the manual and indicate high levels of internal consistency, excellent interrater agreement, and good test-retest reliability.

Researches

EDUTEA: A DSM-5 teacher screening questionnaire for autism spectrum disorder and social pragmatic communication disorder Paula Morales-Hidalgo, Carmen Hernández-Martínez, Nuria Voltas, Josefa Canals Teacher's reports about child psychopathology are often useful because they make it possible to compare children's development within their normative peer group. The EDUTEA questionnaire aims to provide clinicians and researchers with a brief tool that can be used to screen autism spectrum disorders and social communication disorders in school settings. Method: It was designed according to DSM-5 criteria and validated in a sample of 2,660 Spanish

• schoolers. Results: The EDUTEA showed a two-factor structure with high internal reliability:

Social communication impairments (α=.95) and Restricted behavior patterns (α=.93). The ROC curve showed that the area under the curve was highly predictive (.90). We propose using a cut-

• ff score of 10, which gives high values of sensitivity (87%), specificity (91.2%) and positive

predictive value (.87). Moderate correlations were found with the severity score of the Autism Diagnostic Observation Schedule (ADOS-2) and the child pragmatic competence. Conclusions: The EDUTEA could be useful in ASD screening protocols in schools. Clinical Assessment of Pragmatics (CAPs): A Validation Study of a Video-Based Test of Pragmatic Language in Adolescent Students Adriana Lavi, Karen J Mainess, Noha Daher The purpose of this study was to examine the validity and reliability of a novel new video-based approach to assessing pragmatic language, namely the Clinical Assessment of Pragmatics (CAPs). This study included students with Language Impairment (LI), High- Functioning Autism (ASD) and non-disabled students. Thirty participants, ages 14 to 16 years

• ld, were administered 3 pragmatic judgment and 3 pragmatic performance subtests comprised
• f 10 items each for a total of 60 test items. Expert opinion was solicited for the purpose of
• btaining content validity. Study results revealed that this instrument provides a valid and

reliable comprehensive measure of pragmatic language skills. Both test-retest and interrater reliability were found to be strong. Experts rated the CAPs highly for both content and clarity. Concurrent validity was obtained on three of the CAPs subtests and was found to correlate to three existing pragmatic language instruments and measures (the Clinical Assessment of Spoken Language – Pragmatic Judgment subtest, the Test of Pragmatic Language and the Social Language Development Test, adolescent). CAPs is a tool which is both valid and reliable and can be used as a means of determining whether school-aged students present with deficits in pragmatic language skills, specifically, high-functioning autism or specific language impairment.

Management

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 turns. 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.

• Plan structured play dates. Begin with just one friend at a time and have a planned

activity with a time limit – say, 60 to 90 minutes to start.

• Visual support such as a picture of a child talking or an open mouth to cue your child

when it’s his turn to talk. This can help him learn to reduce inappropriate interruptions as well as learn when he’s expected to respond or comment.

Other Techniques:

• Role play: Engage in role play activities with adults and other children to simulate social

situations (e.g. going shopping, going to the park, visiting grandparents).

• Turn-taking games: Engage in turn taking games, such as board games to teach the

child that it is ‘okay to lose’.

• Facial expressions: Look at facial expressions and discuss the feelings associated with

the facial expressions.

• Miming: Practice through miming making faces that show different feelings.
• Describing activities: Look at pictures together to encourage descriptive language about

a topic or thing, with the adult prompting to keep the child on topic.

• Puppets: Take part in role play or puppet shows after watching a modeled situation.
• Comic strips: Use appropriate comic strips that illustrate social situations (do’s or

don’ts) and talk explicitly about what is happening.

• Social skills groups: Work with the school to set up small structured groups where social

skills can be practiced (e.g. turn taking, waiting, responding, staying on topic, questioning).

• Social stories: Develop social stories that depict how to behave and respond in certain

social situations.

• Greetings: Encourage your child to say ‘hello’ and ‘goodbye’ in social interactions.

If there are multiple areas of concern (i.e. beyond just social communication) both Occupational Therapy and Speech Therapy may well be recommended to address the functional areas of concern.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. What is Social Communication Disorder. Retrieved on March 28,2018 from https://www.autismspeaks.org. Morales-Hidalgo, P., Hernández-Martínez, C., Voltas, N., & Canals, J. (2017). EDUTEA: A DSM-5 teacher screening questionnaire for autism spectrum disorder and social pragmatic communication disorder. International Journal of Clinical and Health Psychology, 17(3), 269-281. Social (Pragmatic) Communication Disorder. (2017, August 24). Retrieved March 31, 2018, from https://psychcentral.com/disorders/social-pragmatic-communication- disorder. Grohol, J. (2017). Social (Pragmatic) Communication Disorder. Psych Central. Retrieved

• n March 28, 2018, from https://psychcentral.com.

Lavi, A. (2016). Clinical Assessment of Pragmatics (CAPs): A Validation Study of a Video-Based Test of Pragmatic Language in Adolescent Students. Autism-Open Access, 06(02). Gallagher, T. (1991). (Ed.). Pragmatics of language: Clinical practice issues. San Diego, CA: Singular Publishing Group.

Phelps-Terasaki, D. & Phelps-Gunn, T. (1992). Test of Pragmatic Language. Austin: Pro- ED Social (Pragmatic) Communication Disorders (SCD). (n.d.). Retrieved March 31, 2018, from http://www.suburbanspeechcenter.com/our-approach/social-pragmatic-language- disorders/