What Are The Symptoms Of Social Pragmatic Communication Disorder?

We follow a wide range of unwritten social cues when we communicate with others each day.

For example:

• We greet people depending on the setting
• We adjust our tone when speaking to a child versus a colleague
• We maintain eye contact
• We take turns in conversation
• We stay on topic
• We notice when someone we are talking to seems confused or bored 

These skills fall under social pragmatics, also called pragmatic language. 

Pragmatic language refers to knowing what to say, how to say it, and when to say it in different social situations. It includes:

• Using appropriate greetings
• Understanding tone of voice
• Taking turns in conversation
• Staying on topic
• Interpreting body language and facial expressions
• Adjusting language based on the listener

For many people, these skills develop naturally over time. But for others, pragmatic language does not come as easily. Conversations with someone who struggles with pragmatic language may feel awkward, confusing, or frustrating and over time, this can impact their friendships, classroom participation, workplace performance, and overall confidence. 

Social communication skills begin developing in early childhood, but expectations increase greatly with age. What works on a playground does not always work in a college classroom or work meeting. Like reading or math, pragmatic language is a skill set that requires modeling, feedback, and practice. 

For those who struggle with social pragmatics, speech therapy can provide structured support and real-world strategies to help build skills. Get started with a speech therapist by scheduling your free introductory call today!

What is Social Pragmatic Communication Disorder?

Social Pragmatic Communication Disorder (also known as SCD) is a new diagnostic category in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It was formally introduced in 2013 by the American Psychiatric Association and is characterized by persistent difficulties in socially using verbal and nonverbal communication. The challenges are with how language is used socially and are not solely due to low cognitive ability, language delays, or hearing loss. 

Main areas of difficulty typically include:

• Using communication for social purposes (greeting, requesting, sharing information)
• Adjusting communication to match the context (classroom vs. playground vs. workplace)
• Following conversational rules such as turn-taking
• Understanding nonliteral language like humor and sarcasm

It is important to note that social communication norms can vary across different cultures, families, and communities. These items are considered during a speech evaluation. 

How Common is Social Communication Difficulty? 

The American Speech-Language-Hearing Association (ASHA) reports that nearly 1 in 12 children in the U.S between the ages of 3-17 has had a disorder related to voice, speech, language, or swallowing. The exact number of people affected by SCD is still being studied; however, it is known that these challenges are not rare, especially in children.

According to the Centers for Disease Control and Prevention (CDC), in 2020, approximately 1 in 36 children in the United States were diagnosed with Autism Spectrum Disorder (ASD). Although SCD is not the same as ASD, both do involve differences with social communication and research suggests that a subset of children who were previously diagnosed with ASD would now meet the criteria for SCD instead. 

Statistics like these show how common communication challenges are and why early support is important. You can read more about the benefits of early support in our blog post The Importance of Early Intervention for Speech and Language Disorders.

What Are The Symptoms of Social Pragmatic Communication Disorder?

Symptoms of SCD can greatly vary in severity and presentation. Some people appear very verbal but struggle socially, while others may avoid conversations altogether. 

Common signs of SCD include:

• Responding in ways that seem socially inappropriate or unrelated
• Frequently interrupting others/ not taking turns in conversations
• Limited eye contact
• Not using gestures like pointing or waving
• Trouble expressing thoughts, feelings, or emotions clearly
• Often changing topics or losing track of discussions
• Difficulty understanding jokes, sarcasm, or idioms
• Challenges with forming and maintaining relationships
• Delayed development of conversational skills

For school-aged children, teachers may notice difficulty participating in group discussions. In teens and adults, challenges often become more visible in workplace communication, interviews, or social networking. 

Is Social Pragmatic Communication Disorder on the Autism Spectrum? 

While social (pragmatic) communication disorder and autism spectrum disorder have several common traits, they are separate disorders and can affect individuals in very different ways. Both ASD and SCD involve challenges related to speech, language, verbal and nonverbal communication abilities, as well as navigating social and academic situations.

The primary difference between the two is that autism spectrum disorder also involves specific characteristic behaviors, for example, possessing an intense and almost obsessive focus on a specific area of interest or objects, as well as frequent repetitive behaviors. Individuals with autism spectrum disorder have difficulties with social communication, as well as exhibiting repetitive, destructive, and disruptive behaviors.

Examples of Repetitive or disruptive behaviors include things like:

• Repetition of Body Movements (such as jumping, spinning, rocking, or flapping)
• Obsessive Fixation on Specific Routines and Rituals
• Arranging Objects in the Desired Order (as well as a fixation on things being in a specific order or grouping)
• Excessive Repetition of Sounds, Words, Syllables, or Phrases
• Obsessive and Intense Fixation on Certain Objects or Subjects of Interest
• Significant Sensory Sensitivities (especially to sounds / chaotic environments)

For an individual with Autism Spectrum Disorder, any disruption to their daily routine, or any affront to their senses can sometimes cause an outburst that may be violent or aggressive (towards themself or others) in their immediate environment. 

If your child receives an ASD diagnosis but doesn’t display the typical restrictive, repetitive, destructive, or disruptive behaviors that are normally associated with autism spectrum disorder, it might be a good idea to have them reassessed. Accurate diagnosis matters because treatment approaches can be different.

Can Adults Have Social Pragmatic Communication Disorder? 

SCD is most frequently identified in children; however, adults can also experience ongoing social communication difficulties. 

Adults with SCD may have difficulties with:

• Professional communication
• Networking
• Job interviews
• Understanding implied expectations
• Navigating workplace dynamics
• Maintaining friendships
• Maintaining romantic relationships

Because awareness of SCD is relatively new, many adults were not evaluated as children; however, receiving support can be highly beneficial regardless of their age. 

Speech therapy for adults may focus on:

• Structured conversation practice
• Workplace communication strategies
• Social problem-solving
• Perspective-taking skills
• Nonverbal communication awareness

Someone who improves their pragmatic language skills often notices increased confidence, stronger relationships, and better professional success. 

How is Social Pragmatic Communication Disorder Treated? 

Treatment for social pragmatic communication disorder focuses on building functional, real-world communication skills. Speech therapy is individualised and goal-oriented. 

A speech-language pathologist (SLP) will:

• Conduct a full assessment
• Identify communication strengths and challenges
• Develop goals that are measurable
• Use role-play and structured practice
• Provide strategies for real-life situations

Speech therapy can help to improve both verbal and nonverbal communication abilities and can also improve social understanding and skills for social situations.

There is a variety of areas that should be focused on during speech and language therapy sessions, including:

Speech Pragmatics

Speech pragmatics exercises can help an individual learn to understand the meanings of common phrases and idioms, as well as teach them to use appropriate greetings in various social situations.

Conversation Skills

Individuals with SCD frequently struggle with back-and-forth exchanges (asking and answering questions during a conversation, for example). A speech-language pathologist will often use role-playing as a way to help develop these skills.

Non-verbal Communication

Interpreting and using non-verbal cues and expressions to gauge someone’s mood or emotions, or recognizing when someone is expressing discomfort or boredom, by repeatedly looking at their watch or a clock.

Perspective-Taking

Understanding what others might be thinking or feeling in social interactions. 

Early Support Matters

Research regularly shows that early intervention improves long-term communication abilities. Strong pragmatic skills are directly connected to academic success, emotional regulation, peer relationships, and employment opportunities. Regardless of age, seeking support with speech therapy can make a big difference. 

Taking the first step toward stronger communication skills can open doors socially, academically, and professionally.

If you or a loved one is experiencing pragmatic (social) communication difficulties, working with a licensed speech therapist at Great Speech can provide tools and structured guidance, all from the comfort of home through our virtual therapy model. 

Schedule your free call today.