Understanding Social Pragmatic Communication Disorder

Social pragmatic communication disorder (SPCD) refers to marked challenges with both nonverbal and verbal communication skills used in social settings.

Social-communication difficulties may be associated with other communication disorders. However, as of 2013, SPCD is now considered its own category as defined by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

SPCD is also considered separate from certain neurodevelopmental disorders that may also affect communication skills, including autism spectrum disorder (ASD).

Read on to learn more about SPCD, including symptoms, treatment, and how it differs from — or relates to — other conditions that may affect communication skills.

What is social pragmatic communication disorder (SPCD)?

Newly added to the DSM-5’s Communication Disorders section, SPCD refers to a “primary deficit” in both verbal and nonverbal communication used in social situations.

Such difficulties may include:

  • inappropriate communication in certain social contexts
  • difficulties with using language to socialize
  • not knowing how to use and understand both verbal and nonverbal cues
  • a lack of understanding regarding nonliteral language

Social pragmatic communication disorder symptoms

SPCD symptoms may vary in type and intensity between individuals. Below are just some of the signs of SPCD:

  • difficulties with adapting communication skills to different social contexts, such as greetings and initiating conversation
  • inability to switch between formal and informal language
  • problems with taking turns during conversations
  • difficulties with using nonverbal communication techniques during social interactions, such as eye contact and hand gestures
  • difficulty understanding nonliteral language, such as inferences, sarcasm, metaphors, and idioms made during conversation
  • making and/or keeping friends

Having one or more of these symptoms doesn’t automatically mean you have SPCD. To be diagnosed with this communication disorder, the DSM-5 notes that the symptoms must significantly interfere with:

  • interpersonal relationships
  • your ability to socialize
    • work
  • school

How is social pragmatic communication disorder different from autism?

As of the DSM-5, SPCD is considered a separate condition from ASD.

Some of the symptoms of SPCD may seem to overlap with those associated with ASD, including what is formerly known as Asperger’s. One 2017 study also concluded that SPCD may not seem completely different from ASD, but may include common traits.

However, the DSM-5 has placed SPCD in its own category as those that are not caused by any other underlying developmental disorder or medical condition.

Communication difficulties that may be noted in ASD include:

  • seeming “lack of attention” in social interactions
  • difficulty engaging with back and forth conversations
  • talking with others without giving them a chance to respond

How is social pragmatic communication disorder different from ADHD?

SPCD may sometimes be diagnosed with attention-deficit hyperactivity disorder (ADHD). While ADHD may lead to some communication difficulties, the causes and impacts aren’t the same as SPCD.

Communication difficulties that may be seen in ADHD include:

  • excessive talking
  • inability to concentrate on someone talking with you
  • interfering with others’ conversations
  • interrupting others who may be talking with you
  • having trouble waiting for your turn to talk

Why do people have social pragmatic communication disorder?

While the exact cause is unknown, some researchers believe that SPCD may have a genetic component. It may also run in families who have a history of pragmatic language difficulties.

Some of the signs of SPCD may overlap with neurodevelopmental disorders. These include ASD and ADHD.

Prior to the separate classification by DSM-5, SPCD was thought to coexist with ADHD and other genetic or neurological conditions.

However, the DSM-5 considers SPCD its own disorder. This means that it’s not caused by ASD, ADHD, or any other neurodevelopmental condition.

Children must have time to sufficiently develop their language skills before SPCD can be detected. Therefore, a diagnosis of SPCD shouldn’t be made until they are at least 4 to 5 years old.

Can you prevent social pragmatic communication disorder?

Because the exact causes of SCPD are unknown, there aren’t any known preventive measures. However, early screening is key to start treatments and provide better outcomes in interpersonal relationships, work, and school.

Other researchers have raised concerns about an SPCD diagnosis versus one of a neurodevelopmental disorder for fear that those affected may not receive the services they need — both at school and in clinical settings.

What are common risk factors for developing social pragmatic communication disorder?

SPCD may run in families. Other risk factors may include underlying:

    ADHD
  • intellectual or developmental disabilities
  • other language disorders
  • learning disabilities
  • hearing loss
  • traumatic brain injuries
  • dementia

How is social pragmatic communication disorder treated?

Treatment for SCPD focuses on speech therapy given by a speech-language pathologist (SLP). SLP services are available for children in schools who qualify, and you may also obtain speech therapy in private practices.

While individual, one-on-one sessions are essential, group therapy can also help improve social pragmatic skills. Group therapies are also used in school settings. Some private practices may also offer group social skills classes.

Before you can begin treatment for SPCD, you must be screened and assessed by professionals, such as SLPs. These assessments may be provided in school, private practices, or both.

They will use a combination of:

  • interviews (with yourself or parents, depending on your age)
  • questionnaires
  • self- assessments
  • reports from teachers or caregivers
  • hearing tests

What’s the outlook for people with social pragmatic communication disorder?

With early detection and treatment, the outlook for SPCD is positive. You may expect to attend speech therapy and/or social skills classes over the long-term for best results. Teenagers and adults may benefit from life skills groups.

SPCD itself may be lifelong, with some symptoms improving over time. It’s important to monitor progress to also prevent any regressions. With early therapy, however, social-communication skills may be improved, thus decreasing the need for intervention.

The takeaway

SPCD is a type of communication disorder that may adversely affect social interactions. While many of its symptoms can overlap neurodevelopmental disorders such as ADHD, the DSM-5 considers SPCD its own condition. It’s also considered as a separate disorder from ASD.

While it’s important to detect SPCD for early intervention, you shouldn’t self- diagnose this condition. If you suspect you or a loved one is having trouble with social communication, talk with a doctor for help with the next steps.

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