When the new Diagnostic and Statistical Manual (DSM-5) came out in 2013, Asperger's syndrome was no longer included. Instead, the umbrella diagnosis of autism spectrum disorders (ASD) was included. According to Autism Speaks, a national advocacy group for individuals with ASD and their families, 83 percent of those previously diagnosed with autism would continue to meet the criteria for ASD. Those that no longer met the criteria might fit the new diagnosis of social communication disorder (SCD). This diagnosis fits individuals who have communication difficulties but don't show other symptoms of autism such as repetitive behaviors or restricted interests.
Social communication disorder causes difficulties in both verbal and non-verbal communication. The following must all be present:
- Deficits in social communication including greeting and sharing information
- Impairment in changing communication to match the context or needs of the listener, such as changing tone of voice from classroom to playground or talking differently to adults and children
- Difficulty following rules of conversation and storytelling, such as taking turns during conversation, rephrasing when misunderstood, knowing and using verbal and nonverbal signals
- Difficulty understanding what is not said, such as making inferences, sarcasm, idioms, humor, metaphors
The difficulties in communication must cause limitations in communication, social relationships, academic achievement and/or occupational performance. Social communication problems are also present in other disorders, such as autism, learning disabilities or developmental delays. To be diagnosed with SCD, the communication difficulties must not be attributed to any of these other disorders.
As with autism, the symptoms of SCD appear in early childhood and SCD can be diagnosed prior to or around the age of five years old, it might not be diagnosed until later, when required communication skills become more complex.
When diagnosing and treating SCD, different cultural considerations should be taken into consideration, for example, in some cultures, certain social interactions might not be considered appropriate and therefore, not completing these actions should not be seen as part of a disorder.
As of now, there are no specific treatment guidelines for SCD. Social training and speech and language therapy might all play a role in helping to develop the skills needed for effective communication. These can be in the form of personal training, computer-based training, video training or a combination of different methods.
The goal of treatment should be tailored to the individual, with individual deficits taken into consideration. Treatment should improve social interactions rather than teach specific behaviors or skills as those with SCD might have difficulty generalizing skills from one situation to the next. Because of this, a combination of treatment options is often best.
The Change in Diagnosis
For many people, the change in diagnosis, and the removal of Asperger's syndrome from the DSM, was confusing. Many parents, experts and individuals are concerned that this change would eliminate services for those who fit into the diagnosis of Asperger's syndrome. The addition of SCD was meant to fill this gap. It specifically addresses individuals who have difficulty with communication but do not show other symptoms associated with autism, such as repetitive actions and restricted interests. Some who did not previously meet the diagnostic criteria for ASD or Asperger's syndrome might not meet the criteria for SCD. Medical experts hope that creating this new diagnosis will result in more consistent care for those with SCD.
"DSM-5 Diagnostic Criteria," 2013, Autism Speaks
"Social Communication Disorders in School-Age Children," Date Unknown, Staff Writer, American Speech-Language-Hearing Association
"Social (Pragmatic) Communication Disorder," 2013, Staff Writer, dsm5.org