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Social Communication

Disorder
What is it and the challenges ahead

Lauren Franke, Psy.D. CCC-SP


laurenkfranke@gmail.com
6/7/2013

Agenda
Overview of Social Communication Disorder
A look at pragmatics
Definition
Elements of pragmatics
Potential areas of weakness

Challenges
Intervention

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A Little History
1983

1987

1997

Rapin and Allen offered "semantic pragmatic


disorder (SPD)" to describe the communicative
behavior of children who presented traits such
as verbosity, word retrieval problems. Problems
with discourse comprehension, atypical choice
of terms and inappropriate conversational skills.
SPD referred to a group of children as having
mild autistic features and specific semantic
pragmatic language problems.

Bishop and Edmonson used SPD


as a diagnostic term for children
with communication profiles typical
of ASD but did not meet criteria for
ASD

2002

2013

SCD added to
the DSM V

Bishop and Norbury completed a


study and found a subgroup of
children with PLI who did not have
ASD.

Conti-Ramsden moved SPD to Pragmatic


Language Impairment

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http://www.psychologytoday.com/blog/making-sense-autistic-spectrumdisorders/201006/006-not-quite-autism-the-borderland-asd
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Social Communication Disorder


Social Communication Disorder

Social Communication Disorder (SCD) is an impairment of


pragmatics and is diagnosed based on difficulty in the social
uses of verbal and nonverbal communication in naturalistic
contexts, which affects the development of social
relationships and discourse comprehension and cannot be
explained by low abilities in the domains of word structure
and grammar or general cognitive ability.

The low social communication abilities result in functional


limitations in effective communication, social participation,
academic achievement, or occupational performance, alone
or in any combination.

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Social Communication Disorder


Social Communication Disorder

Rule out Autism Spectrum Disorder (ASD). Autism


Spectrum Disorder by definition encompasses pragmatic
communication problems, but also includes restricted,
repetitive patterns of behavior, interests or activities as part
of the autism spectrum. Therefore, ASD needs to be ruled
out for SCD to be diagnosed.

Symptoms must be present in early childhood (but may not


become fully manifest until social demands exceed limited
capacities).

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Symptoms must be present in early childhood (but may


not become fully manifest until social demands exceed
limited capacities).

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In other words
1) is an impairment of pragmatics
2) diagnosed based on difficulty in the social uses of
verbal and nonverbal communication in naturalistic
contexts,
3) which affects the functional development of social
relationships and discourse comprehension and
4) cannot be explained by low abilities in the domains of
word structure and grammar or general cognitive ability.

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A Look at Pragmatics

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Pragmatics/Social Communication &


Language

Pragmatics/Social
Communication
Difficulties using and understanding language in context
Context is important because most of what we say is
ambiguous

Were going to school but what I mean is get in the car


Most of what we intend to communicate is not explicit

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Definition
Pragmatics is the range of communicative functions
(reason for talking), the frequency of communication,
discourse skills (turn taking, topic maintenance and
change), and flexibility to modify speech for different
listeners and social situations

(Paul 2000, p. 28)

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Pragmatic Competence
The speakers competence is demonstrated by
their ability to:
continuously monitor
the setting [context]
purpose
needs of the listeners

readily make adjustments to the situation.


(Nippold et al (2005)

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Social
Cognitive
Abilities

Language
Abilities

Cognitive
Processing

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The Elements of
Pragmatics/Social
Communication

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Communication Functions
Intent of Communication
Intent involves the ability to generate message such as
requests, comments, questions, persuasion, refusals,
negotiations, or other functions as required by a
communication situation in daily life at a level appropriate
for ones age and experiences.

Frequency of Communication
Frequency involves the number of messages offered
during a conversation when compared to ones
communication partner. The objective in social
conversational situations is to have a balance between
partners and appropriate initiation by both.
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Discourse Management
(i.e., managing the conversation to keep it flowing
and effective)
Discourse Management
(i.e., managing the conversation to keep it flowing and effective)

Turn Taking

Initiation
Response
Repair/Revision
Pause time
Interruption/overlap
Feedback to speaker: verbal and nonverbal

Topics Management

Selection
Introduction
Maintenance
Change

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Register Variation
Politeness.
Polite manner of discourse - knowing how to say
something in terms of word choice and sentence form
while using suitable vocal tone and gestures/body posture
appropriate to the circumstances
For example, saying please, asking for a forbidden activity
or asking for a favor.

Social Role Recognition.


Awareness of social roles as a guide to discourse
patterns.

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Theory of Mind
Presupposition
(i.e., assumptions about what other people know)

Perspective-Taking.
Involves knowing that everyone has different thoughts,
feelings, and experiences and knowing that this must be
taken into account conversations. Requires making a
cognitive leap or guess at how the other person might be
viewing the situation as one adapts the conversation.

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General Rules of Conduct for the Speakers


Role in Relationship to the Communication
Partner
Quantity.
The speaker provides enough information so that a
communication partner understands but not so much as to
assume he knows nothing or needs to know everything about
a topic.

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Quality
The trust factor-what is said is sincere, valid, or true. This is a
trust factor that is important in conversations.

Relation
Add information that is relevant to the topic at hand.
Manner
Be clear and concise. The speaker needs to connect
information for the listener and not make the listener feel like
he must navigate a maze in order to find meaning.

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Para-linguistic Aspects
Intelligibility
Vocal intensity
Vocal quality
Prosody
Fluency

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Nonverbal Aspects
Physical proximity
Body posture
Extraneous movements
Gestures
Facial expression
Eye gaze

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Potential Underlying
Weaknesses
Weak central coherence
Theory of mind deficits
Executive functioning
Language processing
Context blindness
Weak joint attention

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Challenges
Where does SCD fit in?
In the medical arena is it clearly not a variation of autism
or autism lite?

Services
In the schools will the student be better served under the
eligibility category of speech and language impaired or
autistic-like features?

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Challenges
Assessment and eligibility
Limitations of standardized tests for assessment of SCD

Standardized test formats can actually destroy the social


pragmatic assessment. The spontaneous nature of social skills
defies assessing it through the more traditional structure of
standardized test. (Garcia Winner)

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Challenges
Assessment procedures will need to change to account
for nonverbal social pragmatic challenges.

Currently most standardized assessments are based


on social language competency and fail to evaluate
how one effectively reads nonverbal cues from the
context as well as the body and face of others.

Garcia Winner: http://www.socialthinking.com/what-is-social-thinking/michelles-blog/559-dsm-5-my-thoughts

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Potential Assessment Tools


for the SLP

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Childrens Communication
Checklist 2
Purpose

Identifies children with pragmatic language impairment


ages 4-16.11

Identifies children with possible speech and language


impairment

Assists in identification of those requiring further


assessment of an autistic spectrum disorder (ASD)

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Childrens Communication
Checklist 2

Consists of 70 items that are divided into 10 scales, each with 7 items.

4 scales focus on specific aspects of language and communications skills


(content and form).

4 scales assess the pragmatic aspects of communication.


2 scales measure behaviors that are usually impaired in children with ASDs.
The CCC-2 reports a sensitivity value of .89 and a specificity value of 97 for
identifying children with autistic symptomatology and pragmatic social
impairment (Bishop, 2006).

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The Social Thinking Social


Communication Profile

Severely Challenged Social Communicator (SCSC)

Challenged Social Communicator (CSC)

Emerging Social Communicator (ESC)

Nuance Challenged Social Communicator (NCSC)

Weak Interactive Social Communicator (WISC)

Socially Anxious Social Communicator (SASC)

Neurotypical Social Communicator (NSC)

Resistant Social Communicator (RSC)

http://www.socialthinking.com/images/stories/ST%20SCP%20%20Ver%20%206.12.pdf

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The Social Thinking-Social


Communication Profile
Based on concept of social radar system

A key factor in developing astute social thinking and


related social skills is the ability to observe social
context and how people share space within these
contexts, including the nuances of their social
interactions observation requires awareness of one's
surroundings and the people within it

Garcia-Winners group noticed that their students have


different levels of awareness of their environment;
logically a person has to be aware of his or her
environment before being able to actively make
increasingly sophisticated observations within it

http://www.socialthinking.com/images/stories/ST%20SCP%20%20Ver%20%206.12.pdf

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Social Radar
The weaker the social radar
The weaker the self-awareness the weaker the perspective
taking/reading of intentions
The more literal the more anxious about transitions and the
more rigid about how the world should work
The greater the struggle with reading comprehension of
social text and narrative language
The more detailed their view of the world, the less they
think and learn about concepts.

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Areas of Observation
Social Attention
(Social Radar)

Self Awareness
Emotional Coping and
Anxiety

Understanding Own
and Others Minds

Academic Skills
Bullying
Interacting with Peers
Sensory Management
Special Skills

Expressive Language
Social Problem
Solving
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Comprehensive Multidisciplinary
Assessment Protocols-ASD (CMAPs-ASD)
Dodd, J. L. (2010). Thinking outside of the assessment box:
Assessing social communicative functioning in students with
ASD. Perspectives on School-Based Issues, 11(3), 88-98.

The assessment of a student suspected of an autism spectrum


disorder (ASD) diagnosis requires the integration of information
collected by a variety of professionals across various domains of
functioning. One of the core deficits of students with ASD is a
deficit related to social communicative competence (SCC). SCC
requires the integration of language, social cognition, and higher
order executive functions (Coggins, Olswang,Carmichael Olsson,
& Timler, 2003) This article will propose an assessment model of
social communicative functioning that was developed based on the
SCC framework of Coggins and colleagues as a component of the
Comprehensive Multidisciplinary Assessment Protocols for Autism
Spectrum Disorders (CMAPS; Dodd & Franke, 2010).

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Three Types of Communicators

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Sample Assessment Protocol for the


Emergent Communication

http://div16perspectives.asha.org/content/11/3
/88.full.pdf+html
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Caution!
Test of Pragmatic Language-2
Test of Social Language Development
Test of Problem Solving
CASL: Pragmatic Judgment

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Use
Diagnostic Interview: Language sample with presses
Narrative assessments
In vivo situations

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Intervention for a Complex Disorder

Maladaptive Coping
Skills/Secondary Reactions

Behavior & Learning


Deficits/Symptoms

Core Deficits

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Intervention
Core Deficits

Weak central coherence


Big Picture Thinking - Using Central Coherence Theory to Support
Social Skills: A Book for Students

Theory of mind deficits


Thinking About You, Thinking About Me
Thinking About You, Thinking About Me
http://www.iidc.indiana.edu/?pageId=424
https://docs.google.com/viewer?url=http%3A%2F%2Fwww.txsha.org
%2F_pdf%2Fpdf%2FSussman%2C%2520FernChildren%2520with%2520Autism.pdf

Executive functioning
Sara Ward: http://cognitiveconnectionstherapy.com/
Unstuck and on Target!: An Executive Function Curriculum to
Improve Flexibility for Children With Autism Spectrum 6/7/2013
Disorders,
Research Edition

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Language processing
http://www.autismone.org/content/its-time-we-had-talkabout-talk-marion-blank-phd-and-mary-beth-cull

Context blindness
Autism as Context Blindness

Weak joint attention


SCERTS
Pivotal Response Treatment
Relationship Development Intervention with Children,
Adolescents and Adults

There are many others


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Intervention: Key Concepts


The extent of a students repertoire of knowledge about social

situations, social communication, and social strategies.


The students ability to apply his social knowledge in various
situations and the conditions under which he/she is both able or
unable to perform.
The cognitive/emotional cost to the student when he must
remember many rules or bits of information, apply them
appropriately, and then self monitor.
The need to match strategy to specific challenge.
The need to consider many underlying or co-occurring
elements during the selection/implementation stages such as
joint attention ability, executive function, theory of mind ability,
language comprehension, and metalinguistic ability.

http://www.iidc.indiana.edu/?pageId=496
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The need for planned generalization of skills, particularly to peer situations.


The need to teach self monitoring if the person with ASD is to develop
independent, flexible skills.

The need for many people to be involved in developing the skills.


An understanding that acquisition of some skills will be easier than others;
some may take a long time to acquire.

An understanding that multiple strategies may be needed to work on a


singular skill.

An understanding of the complexity and interrelatedness of social pragmatic


skills within the social communication/social skills realm.

http://www.iidc.indiana.edu/?pageId=496
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