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Social Pragmatic Communication Disorder
(DSM 5)( )
Elham Shirazi M.D.
Board of General Psychiatry
Board of Child & Adolescent Psychiatry Board of Child & Adolescent Psychiatry
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Communication
1. The process of transferring information
2 F d t i2. From sender to receiver
3 To understand a similar meaning3. To understand a similar meaning
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Information transfering process:
55%: Nonverbal cues
38%: Paralanguage cues
7%: Spoken words (language)7%: Spoken words (language)
Social context
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Nonverbal cues:
Body language
Posture
Gestures (understanding & use)Gestures (understanding & use)
Eye contact
Facial expression
Distance
Integrated verbal & nonverbal communication
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Paralanguage cues:Paralanguage cues:
Pitch
Volume
Articulation
Silence
RateRate
Punctuation
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Semantics:Meaningg
Syntax:yGrammar
Pragmatics:Abstract meaning in context of social communication
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Social Pragmatic Social Pragmatic C i ti Di dC i ti Di dCommunication DisorderCommunication Disorder
(SPCD) (SPCD) ( )( )(DSM (DSM 55))
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SPCD
Persistent social communication deficit in:
Verbal & nonverbal communicationVerbal & nonverbal communication
In absence of restricted & repetitive interests & behaviors
Do not fulfill the criteria for ASD
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Difficulty in understanding & following:
Social rules of language (verbal)
Social rules of gestures (nonverbal)
Social rules of contextSocial rules of context
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Integration of language, gestures, & social context is necessary to correctly infer:correctly infer:
Intention of the interaction
Meaning of the interaction
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DSM 5 Criteria:
All of the followings:
Deficit in using appropriate communication for social purposes
Appropriate for the social context(e.g., greeting, sharing information)
Inability to match the communication to the social context
Inability to match the communication to the listener’s needs (e.g., tone modulation, vocabulary modulation, talking differently to a child than to an adult, speaking
differently in a classroom than on a playground, avoiding use of overly formal language, ...)
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(DSM 5 criteria)( c te )
Inability in following rules for conversation & story telling
(e.g., taking turns, rephrasing when misunderstood, appropriate use & recognition of & response to verbal & nonverbal signals & feedbacks,...)
Diffi l i d di h i li i l dDifficulty in understanding what is not explicitly stated(e,g., inferences,...)
Difficulty in understanding ambiguous meanings of language
(e.g., idioms, humor, metaphors, multiple meanings, abstract meanings,...)
Difficulty in interpreting socially ambiguous stimuli
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GreetingGreeting
Sharing information
Tone modulation
Vocabulary modulation
Talking differently to a child than to an adult
Speaking differently in a classroom than on a playground
Avoiding use of overly formal language
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Taking turns
Rephrasing when misunderstood
Appropriate use & recognition of & response to verbal & nonverbal signals & feedbacks
Inferences
Idioms
Humor
M t phMetaphors
Multiple meanings
Abstract meanings
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(DSM 5 criteria)
Results in functional limitations in at least one of the followings:
1. Effective communication
2. Social participation
3 Social relationships3. Social relationships
4. Academic achievement
5. Occupational performance
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(DSM 5 criteria)
Onset in early developmental period
M f ll if il i l i i d d d May not fully manifest until social communication demands exceed limited capacities
Not attributable to:
1. Another medical or neurological condition
2. Low ability in word structure
3. Low ability in grammary g
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(DSM 5 criteria)
Not better explained by:
1. ASD
2. Intellectual disability
3. Developmental disorder
Gl b l d l p l d l4. Global developmental delay
5. Another mental disorder
6. Structural languge ability
7. Structural cognitive ability
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By 4 or 5 years:
Most children should possess adequate speech & language abilitiesMost children should possess adequate speech & language abilities
Diagnosis is rarely made in children younger than 4 years
In milder cases:In milder cases:
Difficulties may not become apparent until adolescence
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Epidemiology of SPCD:p gy
These children have been identified for many years
Literature has documented a profile of children with this difficulty
Without meeting criteria for ASD
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Etiology of SPCD:
MultifactorialMultifactorial
Genetic influences
Developmental influencesDevelopmental influences
Environmental influences
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Comorbidity or Differential Diagnoses: Comorbidity or Differential Diagnoses:
Language disorders
Learning disorders
Intellectual disability
ADHD
Social anxiety disorders (avoid social interactions)Social anxiety disorders (avoid social interactions)
Behavioral problems
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SPCD is often associated with language impairment which supports diagnosis:
Delayed language aquisition
History of structural language problems
Or language disorder
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Social Anxiety Disorder:Social Anxiety Disorder:
May be comorbid or be differential diagnosis
Social communication skills are present
But not manifested in feared social situations
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Intellectual Disability:
May be comorbid or be differential diagnisis
Diagnosis of SPCD only when SPC skills are clearly more severethan the level of intellectual disability
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Only as Differential Diagnosis:
Autistic Spectrum Disorder (ASD)Autistic Spectrum Disorder (ASD)
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ASD:
Mild variants of ASD
SPCD is considered only when:
the restricted interests & repetitive behaviors have never been presentpresent
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Autistic Spectrum Disorder-ASD (DSM-5)
Persistent deficits in social communication & interactions, currentlyor by historyy
Restrictive, repetitive patterns of behavior, interests, or activities currently or by historyactivities, currently or by history
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ASD
Restrictive, repetitive patterns of behavior, interests, or activities (2 of the following):( g)
1. Resticted fixated interests, abnormal in intensity or focus
2. Insistence on sameness, adherence to routines, or ritualized patterns of verbal or nonverbal behavior
3. Stereotyped or repetitive motor movements, use of objects, or speech
4. Hyper/hyporeactivity to sensory input or interest in sensory aspects of the environment
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Resticted fixated interests, abnormal in intensity or focus
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Insistence on sameness, adherence to routines, or ritualized patterns of verbal or nonverbal behavior
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Stereotyped or repetitive motor movements, use of objects, or speech
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In many cases of ASD:
Restricted interests & repetitive behaviors manifest more prominently in the early developmental period
Are not obvious in older childhood
E f h b d b h ASD h dEven if they are obtained by history,ASD is the diagnosis
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Course & prognosis of SPCD:
1. Variable
M l if i l 2. Multifactorial
Some improve over time
In some continuing into adulthoodIn some continuing into adulthood
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Outcome depends on:
1. Severity
2. Potential interventions2. Potential interventions
3. Environmental demands
4. Environmental supports
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Treatment of SPCD:Treatment of SPCD:
Interventions are aimed at these areas:
1. Social understanding & social interaction
2. Verbal & nonverbal pragmatic skills
3. Language processing, making inferences, learning new words