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Social Communication Disorder

Social Communication Disorder (SCD) is a relatively new diagnosis, first defined in 2013. Before this time, children may have been diagnosed with Autism Spectrum Disorder (ASD) because one of the primary features of ASD is social communication difficulties. However, there is evidence that there is a group of children who have significant difficulties with social communication who do not present with the other features of ASD, such as a restricted range of interests and repetitive behaviours. It is these children who can now be diagnosed with SCD.

Children with SCD have trouble using spoken language and non-verbal communication skills in a socially appropriate way. They can construct sentences appropriately but struggle with the ‘pragmatics’ or ‘unspoken rules’ of conversation and social interactions. At present there are no known causes of SCD.

For a diagnosis of SCD, difficulties should be present from early childhood, however the signs of SCD are often not recognised until after the child starts school. Children are not diagnosed with SCD until after they reach 5 years old. ASD must be ruled out before considering a diagnosis of SCD, so it’s important that assessment is made by a multidisciplinary team which includes a SaLT who is able to thoroughly assess the child’s profile of language and social communication skills, using formal assessment tools and observations in a range of contexts. The child should only be given a diagnosis of SCD if their difficulties cannot be explained by a significant language impairment, e.g. Developmental Language Disorder (DLD) or intellectual impairment, e.g. Learning Disability. Social communication skills should be the primary area of difficulty.

In practice, you may see many children described as having ‘social communication difficulties’, ‘pragmatic language impairment’ or ‘semantic-pragmatic difficulties’ without a diagnosis of SCD. Many children who have other SLCN diagnoses will also have social communication difficulties in addition to their other speech and language needs.

There is evidence that children with SCD are at a higher risk for experiencing social, emotional and behavioural difficulties and it has been suggested that a high proportion of children who access Child and Adolescent Mental Health Services (CAMHS) may have SCD which has previously been undiagnosed.

SCD is a lifelong diagnosis and the prognosis is highly variable. Some children make considerable progress and their functional difficulties are minimised with support, while for others the difficulties persist into adulthood. In all cases there is a risk that, without appropriate support, the difficulties experienced in childhood can have lasting implications for developing social relationships and behaviour skills, as well as impacting on the development of core life skills such as literacy.

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Provide lots of opportunities for children to practise social skills in real life, functional scenarios.

Prevalence
The prevalence of SCD is not yet clear, although some estimates of prevalence in children have been as high as 7.5%. Social communication difficulties are also a common feature of a number of developmental disorders including Developmental Language Disorder (DLD) and Attention Deficit Hyperactivity Disorder (ADHD) – estimates of social communication difficulties occurring in children who have a diagnosis of DLD range from 23-33%.

What to look for
Some, but not all, children who have SCD demonstrate a limited interest in social interactions and prefer to spend time alone. SCD can impact on academic attainment in the longer term as these children can have difficulty learning to read and write – they often experience difficulties with reading comprehension in particular. This can lead children to lose interest in their learning and disengage from education if they do not receive appropriate support. Children can demonstrate behavioural difficulties due to limited understanding of the expectations for appropriate behaviour. Social communication difficulties can lead to negative behaviour arising from frustration. Children with SCD can also have significant difficulty managing peer relationships and may easily, and unintentionally, upset other children because of their impaired social interaction skills. They might also misinterpret the behaviour of others and can find it difficult to understand the impact of their own actions in conflict situations with peers.

Difficulties
During conversation, frequently going off topic or dominating the conversation.
Difficulty adapting language to different listeners (e.g. talking the same way to the headteacher as they would to a friend), or different situations (e.g. talking the same way in the classroom as they do on the playground).
Not giving background information when they talk to someone new, showing limited understanding of their listener’s prior knowledge.
Poor understanding of how to appropriately greet people, make requests, or gain attention. These difficulties can make the child appear rude.
Limited understanding of how to start a conversation and how to recognise or signal that a conversation has finished.
A tendency to interpret things very literally, which can cause difficulties understanding jokes (especially sarcasm), metaphors and idioms.
Difficulty making inferences and understanding information which is implied but not explicitly stated.
Myth Busting

Are all children able to understand more than they can say?
Children with SCD will not usually have significant difficulties with constructing sentences, and when talking about topics which are of special interest to them, can appear to have very good language skills. However, the difficulties associated with SCD impact on some skills related to understanding language, such as understanding non-literal language, inferencing and understanding intonation (consider the difference in meaning between “I didn’t say James took my apple” vs. “I didn’t say James took my apple”), and they commonly present with slow processing of language. This can mean that their understanding of language may, in practice, be worse than it appears.

Are children with SCD just naughty?
SCD is a neurodevelopmental disorder which makes it difficult for children to learn socially appropriate ways of communicating. Children are not being intentionally rude and SCD is not caused by poor parenting. It should be noted that there is thought to be a strong genetic component to neurodevelopmental conditions and therefore siblings and other family members may display similar difficulties.

Can SCD impact on a child’s academic attainment? Doesn’t it only affect their social skills?
SCD can have a significant impact on academic skills as well as social skills, and there can be a particular impact on development of literacy skills, especially reading comprehension. Children with SCD typically develop good decoding skills, but due to difficulty with skills such as inferencing, they often struggle to understand what they are reading. This often becomes apparent when children begin to transition from ‘learning to read’ to ‘reading to learn’.

Strategies

There are very few interventions which have been specifically developed for children with SCD as this is such a new diagnosis, however many interventions intended for children with ASD will be appropriate if they target the child’s individual social communication needs. Take a look at the strategies for children with ASD, as many of these will apply for SCD too!
Social skills interventions, particularly those addressing misunderstandings, e.g. comic strip stories (Carol Gray, 1994) can be useful to unpick problematic interactions and teach specific interaction skills.
It’s important to remember that pragmatic language skills need to be taught explicitly and practised in real contexts in order to support generalisation of any new skills learnt.
Pre-teaching topic vocabulary has been found to be successful in improving language comprehension skills and promoting engagement in learning.
Ensure that supportive strategies are applied consistently throughout the whole day at school and at home.
The Role of SaLT
As with ASD, SaLTs can be involved at any stage of the care of a person with SCD. A SaLT will usually be involved in the process of diagnosing SCD either as part of a multidisciplinary diagnostic panel or to conduct a separate assessment of the child’s language and communication skills to provide additional information for the panel to consider. If a child requires intervention to develop their social communication skills, a SaLT might carry out direct therapy or work with the child indirectly by recommending a therapy programme or strategies to be carried out by familiar adults. It’s often better for therapy targeting social communication skills to be embedded into real-life contexts or developed in structured small-group situations with familiar people, rather than being completed by the SaLT.

Further Information
Afasic – www.afasic.org.uk

Read more about developing social skills in The Link magazine, issues 15 & 10