Social (Pragmatic) Communication Disorder vs Autism: Differences And Similarities

Let's play "guess the diagnosis": 

• A reduced ability to communicate socially with others in a way most people would deem context-appropriate. 
• Trouble with the concept of "code-switching" — that is, being unable to change your use of language to suit the situation and, for instance, addressing an authority figure you meet for the first time in the same way you would a close friend. 
• Difficulties understanding and abiding by unspoken communication rules — like waiting your turn or rephrasing something a conversational partner didn't understand. 
• Finding it challenging to "read between the lines" — understanding metaphors, implied meanings, and puns, for instance.  

This particular set of diagnostic criteria is nearly finished, however, and the only things we still need to add are that, for a person to get this diagnosis, the symptoms must limit the person's life in social, educational, and professional realms, they must show up in childhood, and that another disorder can't better explain them. 

We're not looking at autism spectrum disorder, but at social (pragmatic) communication disorder, a diagnosis that was newly introduced in the fifth edition of the diagnostic and statistical manual of mental disorders, published in 2013. 

What are the differences between social (pragmatic) communication disorder and autism?

The similarities are obvious — and before the DSM-5 came into existence, many people who'd now be diagnosed with social (pragmatic) communication disorder often wound up with a diagnosis of pervasive developmental disorder not-otherwise-specified, which was considered part of the autism umbrella. 

Unlike social (pragmatic) communication disorder, however, autism spectrum disorder can feature all of the following:

• Unusual nonverbal social behaviors — like trouble making eye contact, understanding or making gestures, a flat tone of voice, showing objects, and facial expressions that are out of the ordinary. 
• A strong preference, and often need, for sameness and routine, and distress when faced with even small changes. 
• "Stereotyped" movements and behaviors, often referred to as stimming, to cope with stress or excitement. These can include hand-flapping, spinning, tapping a pen, rubbing a piece of fabric, and repeating a comforting phrase, for instance. 
• Strong and persistent passions for certain subjects, often to the exclusion of most other things — typically called "autistic special interests". 
• Certain sensory differences. An autistic person may easily become overwhelmed by stimuli like small sounds, flashing lights, or larger crowds, for example, but can also be less sensitive than most to other stimuli. 

Autism can be diagnosed with or without language and intellectual impairments, and is, in the DSM-5, also separated into several "levels" of severity, according to the amount of support an autistic person requires to function optimally. While some autistic people are non-verbal, those with social (pragmatic) communication disorder can speak, but have trouble with the social aspect of communication.

What is interesting is that it does seem like autism and social (pragmatic) communication disorder are members of the same extended diagnostic family, with people who have a family history of autism being more likely to end up with this diagnosis. Since SCD is a relatively newly introduced label, research is bound to fill in some of the questions currently still "at large" in the future.

How is social (pragmatic) communication diagnosed?

Parents, grandparents, teachers, family friends, pediatricians, family doctors, and anyone else in the life of a child with the symptoms of social (pragmatic) communication disorder is likely to first suspect the child is on the autism spectrum. A diagnosis of SCD can only be made after a thorough evaluation reveals that the patterns of repetitive and restricted behaviors and interests so characteristic of autism aren't present. 

Clinicians will also have to rule out other disorders that can present with similar symptoms, notably ADHD, social anxiety, and intellectual disability. If another disorder better explains the symptoms seen in a particular person, that diagnosis will be made instead. 

The most important thing parents can do is communicate with their child's primary healthcare provider about the concerns they have and the symptoms they have noticed. If they already suspect that social (pragmatic) communication disorder may be at play because their child doesn't have some of the defining features of autism, they can certainly communicate this, too. 

Social (pragmatic) communication disorder: Still a bit of a mystery?

Because social (pragmatic) communication disorder was established as its own separate diagnosis fairly recently, little is known about the long-term prognosis or the best ways to help affected people make strides in their communicative abilities. This should all change in the future as the disorder is researched further. In the meantime, people diagnosed with this disorder may benefit from some of the same therapeutic approaches that can help autistic people.