What do you think of DSM 5

New diagnostics for social communication disorders

The Social (Pragmatic) Communication Disorder (SCD) is a new addition to the Diagnostic and Statistics Manual for Mental Disorders, 5th Edition (DSM-5). The American Psychiatric Association released this new edition of their Diagnostic Guide in May 2013. It offers healthcare providers new guidelines for diagnosing mental and behavioral disorders.

SCD encompasses problems with social interaction, social understanding, and pragmatics. Pragmatics refers to using language in the right context. For example, it is important that children develop the ability to use language differently, for example when playing with a younger child or talking to a teacher.

Revision of the DSM-5

The addition of SCD to the DSM-5 came with a major overhaul of the diagnostic criteria in the Autism Spectrum Disorders (ASD) Manual.

Field tests of the new criteria showed that some children who were diagnosed with autism on DSM-IV (the previous edition - ICD-10) would receive the new diagnosis of SCD instead.

While SCD is newly incorporated into the DSM manual, it is nothing new to speech pathologists.

How is a social (pragmatic) communication disorder diagnosed?

SCD is diagnosed because of difficulty with verbal and non-verbal social communication skills. These skills include:

  • Respond to others
  • Use gestures (such as waving or pointing)
  • Take turns speaking or playing
  • Talking about emotions and feelings
  • Stay with the topic
  • Adapt language to different people or situations - for example, speaking differently to a young child than an adult, or not speaking out loud in a library.
  • Asking relevant questions during the conversation or responding with related ideas
  • Using words for a variety of purposes, e.g. B. Greeting people, commenting on things, asking questions, etc.
  • Find friends and keep them

Similarities to Autism

As with autism, there are also difficulties with social communication in SCD. However, autism has the additional defining characteristic of restricted and / or repetitive behavior. An assessment must therefore rule out autism before an SCD diagnosis is made.

This differential diagnosis can be difficult because many symptoms and behaviors between ASD and SCD overlap. In addition, speech impairments, language disorders, learning disorders, and attention deficit / hyperactivity disorders can also occur with SCD.

Speech pathologist

The good news is that most medical centers have speech pathologists - professionals trained to assess and manage social communication problems. Speech pathologists work with teachers and parents to develop children's social communication skills in the classroom and at home.

I recommend working with your child's doctor or school to find a speech pathologist experienced in assessing and treating SCD.

Speech pathologists also work with people who have problems with the nonverbal aspects of communication and social interaction. For example, some children do not use gestures such as waving to say goodbye or stretching their arms to be picked up. Or they shake their heads and say “no” even though they mean “yes”.

More options

In addition, one can develop visual support and other forms of alternative communication for people who are non-verbal or minimally verbal. This can be as simple as pointing to pictures on a picture board or as high-tech as a voice-generated computer or an electronic tablet.

A child can receive SCD therapy in a number of different situations. Some schools also employ language pathologists to offer such services as part of early intervention and special education programs. Many clinics and children's hospitals also offer social communication services.

The therapist works directly with the child and provides strategies to improve the child's social communication skills at home and in other settings.

What does the therapy include?

Language and language treatments are more successful with family involvement. This is especially important for a disorder that interferes with social communication. It is important that you offer the child many opportunities to practice skills in real situations.

It is also recommended to involve additional “communication partners” such as teachers, counselors and other special educators for the child such as occupational therapists or physiotherapists.

The therapy usually takes place in a one-on-one conversation with the therapist.

Strategies for families

There are many activities you can do at home to develop social communication skills in line with the goals you developed with his child's therapist.

  • Alternate. Try simple turn-taking activities that reflect the flow of social interaction. Examples are rolling or throwing a ball back and forth. Or you can repeat words and other noises your child is making. Start slowly.
  • Read and discuss.Read a book with your child and ask questions such as “What do you think about what, for example. a person in the book did ".
  • Talk about the feelings. Books and stories are a great opportunity to talk about feelings. For example, explain why a character in a story behaves or feels a certain way. Try to extend this to real situations and discuss what and why a friend or sibling might be feeling in that situation.
  • What's next?Let your child make predictions about what will happen next in a story. Help him find the clues. You can also work backwards. As soon as an event occurs, go back and find the clue that leads to the event. For example, tell a situation of spilled milk and food on the floor. Ask your child what might have happened.
  • Reference to pop culture.Introduce your child to popular child-appropriate shows and public figures so they can participate in similar conversations with friends and classmates. Talk about child-friendly topics that are happening in the world or are currently popular.
  • Schedule structured game dates . Start with only one friend at a time and plan this activity with a time limit - we start in 60 minutes. We play for 60 minutes.
  • Use visual assistance. Many children with SCD, like many children with autism, process information visually. Visual aids can be especially helpful in helping the child understand expectations and schedules.

For example, you can use visual assistance, e.g. For example, a picture of a child talking or an open mouth to let your child know when it is their turn to speak. This can help him reduce inappropriate interruptions and learn when to reply or comment.

Professional help is crucial

As mentioned earlier, children with SCD need professional intervention to develop their social interaction skills. It is not reasonable to expect that they will simply “learn” these skills on their own by spending time with other children. In fact, a child with SCD's participation in socially demanding settings without adequate support can do more harm than good, as it leads to bullying and isolation.

At the same time, participating in social activities with appropriate support can be a wonderful learning experience. A therapist trained in social communication intervention can teach the child - and you - the strategies they need to learn from them.