Social Communication Disorder in Adults

ICD-10 Code: F80.82

Social (pragmatic) communication disorder is part of a cluster of diagnoses called communication disorders. Communication disorders are a group of psychiatric conditions that include:

Language Disorder
Speech Sound Disorder
Childhood-onset Fluency Disorder (Stuttering)
Social (Pragmatic) Communication Disorder

A communication disorder is an impairment in the processes of speech, language or communication. Speech is the expressive production of sounds and includes an individual's articulation, fluency, voice and resonance quality. Language includes the form, function, and use of a convention system of symbols (i.e., spoken words, written words, sign language, pictures) in a rule-governed manner for communication. Communication includes any verbal or nonverbal behavior that influences the behavior, ideas, or attitudes of another individual. A child with a communication problem may exhibit many different symptoms. These may include difficulty following directions, attending to a conversation, pronouncing words, perceiving what was said, expressing oneself, or being understood because of a stutter or a hoarse voice. An assessment of speech, language and communication abilities must take into account the individual's cultural and language context, particularly for individuals growing up in bilingual environments.

What is Social (Pragmatic) Communication Disorder?

Social (pragmatic) communication disorder was recognized as a disorder by the DSM-5 in 2013. Since it is a relatively new disorder, the prevalence of adults with social communication disorder is unknown.

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Social (pragmatic) communication disorder is characterized by the persistent difficulties in the social use of verbal and nonverbal communication as manifested by the following:

Deficits in using communication for social purposes (e.g., greeting, sharing information) that is appropriate for the social context
Impairment of the ability to change communication to match content or the needs of the listener, such as speaking differently in formal and informal settings, talking differently to a child than to an adult, and avoiding use of overly formal language
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
Difficulties understanding what is not explicitly stated (e.g., making inferences) and non literal or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation)

Adults with this disorder have difficulty with pragmatics. That is, the area of linguistics that dictates the social use of language and communication, and how meaning is created and interpreted in verbal and nonverbal interactions. Adults with this disorder are not impaired in understanding word structure or grammar, or in general cognitive abilities. They may demonstrate the following symptoms:

Little interest in social interactions
Go off topic or monopolize conversations
Not adapt language to different listeners or situations
Fail to give background information when speaking to an unfamiliar person
Not understand how to properly greet people
Unable to request information or gain attention
Tendency to be overly literal and not understand sarcasm
Trouble understanding facial expressions

Understanding Social Communication Disorder

Having social (pragmatic) communication disorder can affect an individual's occupational and academic progress. Children with this disorder may have trouble making inferences and understanding social subtleties. This can cause them to lag behind in developing reading and writing skills.

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They may also struggle with reading comprehension, and thus reading can be more difficult for adults with social (pragmatic) communication disorder. The weaknesses in pragmatics also negatively impact their ability to successfully navigate social situations. They may inadvertently offend other individuals or struggle to resolve conflicts. It is also common for children with social communication deficits to be concurrently diagnosed with attention-deficit/hyperactivity disorder (ADHD), behavioral problems, and specific learning disorders. The trajectory of outcomes for adults with social (pragmatic) communication disorder is currently unknown due to social (pragmatic) communication disorder being a relatively new diagnosis for the DSM-V.

There is no published research regarding the heredity or genetics of social communication disorder. There has been some research demonstrating that pragmatic language difficulties run in families of children with autism, as well as in families of individuals with specific language disorders. However, having a genetic predisposition to social (pragmatic) communication disorder does not necessarily mean that someone will develop social (pragmatic) communication disorder.

How is social communication disorder treated?

Social (pragmatic) communication disorder is treatable. There are no evidence-based intervention recommendations for the adult population. However, there are intervention recommendations for social communication disorder in children and adolescents as outlined in the American Speech and Language Association.

Clinical research suggests the following interventions are promising for the treatment of children and adolescents with social (pragmatic) communication disorder:

Applied Behavior Analysis- A systematic therapy that applies interventions based on the principles of learning theory to improve socially significant behaviors.
Cognitive Behavioral Therapy (CBT)- An intervention that combines cognitive and behavioral learning principles to shape and encourage desired behaviors. The underlying assumptions of CBT are that an individual's behavior is mediated by cognitive events and that change in thinking or cognitive patterns can lead to changes in behavior.
Parent Implemented Intervention- Parents provide individualized intervention to their child to improve a variety of skills and/or to reduce interfering behaviors. Parents learn to deliver interventions in their home or community through a structured parent-training program.
Social Communication Intervention- Group or individual instruction designed to teach learners ways to appropriately interact with peers, adults, and other individuals. Social skill meetings can include instruction on basic concepts, role-playing or practice, and feedback to help learners acquire and practice communication, play, or social skills to promote positive interactions with peers.
TEACCH Program- A university-based system that provides clinical services such as parent training and support groups, social play and recreation groups and individual counseling.