Social Communication Disorder vs Autism: What’s the Difference?

When you’re engaged in conversation, do you actively think about what to say or worry about messing up? Do you monitor your body language? Or does the conversation flow naturally? For many, conversation flows naturally, but for people with Social Communication Disorder (SCD) or autism, these challenges can be significant.

Individuals with these conditions often struggle with communication, including understanding implicit cues. There are various types of communication disorders, each with its own criteria. This article explores what SCD is and how it differs from ASD. Despite their similarities in communication deficits, are they the same? Let’s find out.

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What does social pragmatics mean?

Social pragmatic language impairment refers to the ability of children to use language and interact with others within a social setting or group. It is the way we share and the manner in which we do, how our body language resonates with what is being said, and the ability to take turns throughout the conversation.

It is important to note that communication is not limited to verbal speech. Our ability to convey emotions, engage with others, and be present so that our thoughts and feelings are conveyed to those around us, all form part of communication.

To be socially competent means to have the ability to internalize and assess a situation, perceive the behavior and social cues presented, and respond accordingly. This includes our body language and the gestures we make.

What is social (pragmatic) communication disorder (SCD)?

Just as the name suggests, SCD impacts the social aspect of communication. Individuals with SCD are considered literal in thinking and find it difficult to understand non-verbal cues and non-literal language such as sarcasm, humor, idioms, and metaphors.

They also find it difficult to engage in conversation with ease, i.e. take turns during a conversation, using gestures, social greetings, and mannerisms.

As it stands, in order for social pragmatic communication disorder to be diagnosed, a child needs to have developed sufficient language skills. Typically, this means diagnosis cannot be made until the age of four to five years. 

Social communication disorder can occur in conjunction with other communication disorders, such as:

• language disorder, 
• speech sound disorder, 
• childhood-onset fluency disorder, and 
• unspecified communication disorder (as per the DSM-5).

It’s important to note that social communication disorder cannot be diagnosed if a child has autism.

Social communication disorder vs autism

Similarities between autism spectrum disorder (ASD) and SCD have raised questions on whether a diagnosis of SCD rules out autism. To answer this question, let’s differentiate between the two disorders.

In both cases, individuals diagnosed with autism or SCD experience difficulty with verbal and non-verbal communication.

Essentially, because both autism and social pragmatic communication disorder have similarities in terms of communication ability, in order to diagnose a child with SCD, a diagnosis of ASD needs to be ruled out.

Based on the criteria of the DSM-5, to diagnose a child with ASD, the child needs to have traits of repetitive patterns of behavior, special interests, or activities in addition to communication issues.

I cannot emphasize enough that it is wrong to assume SCD is a “milder form” of ASD. Yes, there are similarities, just like any other communication disorder included in the DSM-5, but these two conditions are significantly different from each other in their criteria. 

Managing social pragmatic communication disorder

As with all treatment strategies, it is important to make any form of intervention child-focused. Doing this allows the therapist, facilitator, or parent to understand the weaknesses of the child so that the child improves in those areas specifically.

When it comes to SCD, treatment should be within the frame of social interactions and work to eliminate factors that form barriers in order to facilitate communication and participation.

There are several forms of treatment that can help improve a child’s social communication skills. Some treatment modalities include augmentative and alternative communication (AAC) and video modeling.

Speech therapy is most commonly used to manage social communication disorder (SCD), but parents can also consider drama therapy. Let’s examine all the therapy types, tools, and methods available.

Speech and language therapy

Speech and language therapy is performed by qualified speech-language pathologists (SLPs). The goal of speech and language therapy is to improve a child’s communication through techniques such as speech articulation and language intervention activities.

During the session, the child engages in activities such as talking and playing, using books and pictures, and modeling sounds and syllables. A child with SCD can benefit from this form of therapy because they are able to work on conversation skills.

Role-playing can also be part of the activities, and it can cover areas such as interaction and turn-taking, ultimately working on communication and social skills.

Drama therapy

Drama therapy, created by Jacob Levy Moreno, uses drama and theatre techniques to achieve therapeutic goals. It’s a unique approach that allows children to express themselves through written, non-verbal, and verbal means inspired by theatre practices.

In drama therapy, the activities are tailored to each child’s needs. Sessions might include storytelling, social stories, role play, puppetry, and more. By providing a safe space, children can explore challenging aspects of themselves in abstract or metaphorical ways.

With the therapist’s guidance, they interact with the stories created during the session, delving into their internal world.

For social skills and communication, drama therapy helps children understand subtle social cues and words through teamwork and team-building activities. These scenarios aren’t directly aimed at the child, allowing them to naturally step into social roles and develop their skills.

Augmentative and Alternative Communication (AAC)

AAC is an alternative form of communication device that replaces natural speech with aided symbols such as picture communication, line drawings, and tangible objects. It can also include unaided symbols such as natural signs, gestures, and finger spelling.

AAC could be effective for children with social pragmatic communication disorder because it gives them a different form of expressing themselves and they are able to model what they’re trying to communicate.

Video modeling

Video modeling is an evidence-based practice where a child is recorded doing a task up until the desired response is achieved. When this is done, the video is edited to only include parts of the interaction from the beginning to the end where the child responds accurately, omitting any prompts or cues from the parent, therapist or facilitator.

The video is then shown to the child and ideally encourages the child to perform the task without assistance. Any inappropriate behavior is edited out so that the child only sees themselves doing the task entirely on their own. 

This method can be effective for children with SCD because it helps them see themselves as capable of achieving the task. The more times they do, the more the behavior becomes natural.

Social stories and comics

Using social stories allows the child to see themselves through the characters in the story. The story could explain social situations to the child and help them learn socially acceptable behaviors and responses. 

Comic strip conversations allow you to create dialogues between two or more people depicting real-life scenarios. Through these conversations, the drawings can illustrate what the characters are saying, doing, and thinking.

Ultimately, comic strips can be effective in building problem-solving skills, communicating feelings and perspectives, and conflict resolution.

Two completely different diagnosis

From our knowledge of the DSM-5, we understand that SCD and ASD are characteristically different based on their respective criteria. Although there exists some overlap, clinicians and parents need to consider all the criteria for each disorder in order to deliver an accurate diagnosis.

Remember, a diagnosis of social pragmatic communication disorder should not be considered a “milder” form of ASD. Each diagnosis is different. Thanks to improvements in medicine and therapy options, there are so many interventions that parents can take advantage of to help their child with either condition. Take time, do your research, and you can help your child achieve great things.

FAQs

Q: Is autism a communication disorder?

A: Autism is not solely a communication disorder. It is a neurodevelopmental disorder characterized by challenges in social interaction, communication, and repetitive behaviors. While communication difficulties are a core aspect of autism, they are part of a broader spectrum of symptoms.

Q: How is SCD different from autism?

A: Social Communication Disorder (SCD) is characterized primarily by difficulties in social use of verbal and non-verbal communication, without the presence of restricted and repetitive behaviors or interests that are seen in autism. Autism, on the other hand, includes both social communication challenges and a range of other symptoms such as repetitive behaviors and specific interests.

Q: Can you grow out of social communication disorder?

A: Social Communication Disorder (SCD) can improve with appropriate intervention and therapy, helping individuals develop better communication skills over time. However, while significant progress is possible, many individuals may continue to experience some level of difficulty in social communication throughout their lives.