May 2019 By

Social (Pragmatic) Communication Disorder

Social (Pragmatic) Communication Disorder (SCD) is a disorder characterized by difficulty with pragmatics, or the social use of language and communication. This seen through deficits in understanding and following social rules of verbal and nonverbal communication in day-to-day contexts, an inability to change language according to the needs of the listener or situation, and difficulty following rules for conversations and storytelling.


The incidence and prevalence of social (pragmatic) communication disorder is not well known, as it is a new diagnosis in the DSM-5. It is estimated that some form of pragmatic language impairment can affect up to 7.5% of children. Males are typically affected more than females, by a ratio of 2:1.[1] SCD is rare in children younger than age 4. By age 4 or 5, most children will have adequate speech and language abilities that will reveal specific deficits in social communication. Milder deficits may not be obvious until early adolescence, when language and social interactions become more complex.


Attention-deficit/hyperactivity disorder, language disorders, specific learning disorders, and behavioural difficulties are more common in these individuals.

Criterion 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, talk ing 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 or ambiguous meanings of language (e.g. - idioms, humour, metaphors, multiple meanings that depend on the context for interpretation).
Criterion B

The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.

Criterion C

The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).

Criterion 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, global developmental delay, or another mental disorder.

Autism spectrum disorder must be ruled out in order for SCD to be diagnosed.

The right-hemisphere may be implicated in pragmatic language disorders.[2]

    • Autism spectrum disorder should be a primary differential diagnosis in individuals with social communication deficits. The presence of restricted/repetitive patterns of behaviour, interests, or activities should suggest a diagnosis of autism spectrum disorder rather social communication disorder. Since restricted/repetitive patterns of behaviour, interests, and activities may only occur during the early developmental period, a comprehensive history should be obtained. Even if there is a current absence of restricted/repetitive symptoms, but they were present in the past, a diagnosis of autism spectrum should still be considered.
    • ADHD symptoms can cause impairments in social communication and functional limitations of effective communication, social participation, or academic achievement.
    • The symptoms of social communication disorder can overlap with social anxiety disorder. The defining feature the timing and onset of symptoms. In social communication disorder, the individual has never had effective social communication. In social anxiety disorder, social communication skills have developed appropriately but are not used due to anxiety, fear, or distress about social interactions.
  • Intellectual disability and global developmental delay
    • Social communication skills can already be deficient in individuals with global developmental delay or intellectual disability. Thus, a separate diagnosis is not given unless the social communication deficits are in excess of what is expected with the intellectual disability itself.

Treatment includes behavioural interventions/techniques and speech therapy on social interactions. Educational accommodations can also be made to support the individual.