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Breaking the Stigma: Advocating for Children with Social Pragmatic Communication Disorder

Social Pragmatic Communication Disorder (SCD) affects between 7-11% of eighth graders. This condition affects a child’s conversation skills. It’s harder for children with SCD to make friends and maintain close relationships. Their difficulties with social situations can lead to mental health issues and feelings of isolation.

As a caregiver, you want to advocate for your child to make sure that he or she receives the best education and the best opportunities at improving their social skills possible.

Below, we will dive into what SCD is, how the diagnosis has changed in recent years, and how this disorder affects children’s daily lives. Then, we will discuss ways you can advocate for your child and give them the preparation they need to be successful in every aspect of life.

What is Social Pragmatic Communication Disorder?

Social Pragmatic Communication Disorder, according to the American Psychiatric Association, “Is characterized by a persistent difficulty with verbal and nonverbal communication that cannot be explained by low cognitive ability.” Most of the difficulties have to do with social interaction, social understanding, pragmatics, and language processing. The disorder can encompass all or a mixture of these difficulties.

Children with this disorder have trouble with typical social behaviors such as eye contact, facial expressions, and body language. They struggle with pragmatic language, which is the when how, and why of communication.

The expectations for these behaviors can vary greatly between families, cultures, and even individuals. So, a trained clinician must evaluate a child for this condition. One who can discern between actual social barriers versus cultural differences.

According to the American Speech-Language-Hearing Association (ASHA), the symptoms of this disorder are the following:

  • Inappropriate greetings

  • Having trouble changing the style of speaking based on setting or person

  • Difficulties telling or understanding stories

  • Trouble initiating or entering a conversation

  • Trouble keeping up a topic during conversation

  • Inability to take turns, respond appropriately, or provide the right information in conversations

  • Difficulty rephrasing when misunderstood

  • Uses inappropriate verbal and nonverbal signals during interactions

  • Has difficulties interpreting verbal and non-verbal cues from others

  • Does not understand figurative or ambiguous language

  • Has trouble making inferences

  • Difficulty forming and maintaining relationships

Males are more likely to be diagnosed with this developmental disability. Also, people with schizophrenia, who were born preterm, and people with developmental language disorders were at a higher risk of developing SCD.

Children who had the following conditions were also more likely to have language pragmatic difficulties:

  • Aphasia

  • attention-deficit/hyperactivity disorder (ADHD)

  • Autism spectrum disorder (ASD)

  • Cerebral palsy

  • Down syndrome

  • Fetal alcohol syndrome

  • Traumatic brain injuries

This disorder is caused by a disruption in the language centers of the brain, but the exact reason those centers are disrupted is unknown.

These symptoms may not be obvious during early childhood. Social communication skills become most apparent in school-age children. It takes time for people to notice social communication problems, so many children will not get a diagnosis until they are adolescents.

Social Pragmatic Communication Disorder vs. Autism Spectrum Disorder

The diagnosis of social communication disorder can oftentimes be confused with autism spectrum disorder (ASD). The two share several of the same symptoms. For years, they were classified under the same umbrella of terms.

Yet, the main difference is that children with autism have trouble with social skills and exhibit repetitive behaviors such as repeated body movements, obsessive fixations, or repeating sounds, etc.

Whereas, children with SCD do not have these repetitive actions.

A professional diagnosis will help determine whether your child has a social communication disorder or if they are autistic.

What has changed about Social Pragmatic Communication Disorder in Recent Years?

Recently, Social Pragmatic Communication Disorder (SCD) was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This means that SCD is no longer simply treated as a speech disorder. Its addition to the DSM-5 represents new treatment options in the realm of psychiatry.

The reason for this change is that many children with SCD have normal phonological processing, vocabulary, and higher-order grammatical skills, which places them on the outside of many of the speech-language treatments.

Another reason for this change, according to Amoretti, Lalumera, and Serpico in an article for History and Philosophy of the Life Sciences, was the change in the definition of Autism Spectrum Disorder. Previously, SPD would have been grouped in with autism, but the diagnostic criteria for autism have changed.

How Does Social Pragmatic Communication Disorder ASffect a Child’s Daily Life?

SCD can make it difficult for your child to develop friendships and maintain effective communication with peers. Oftentimes, they will have inappropriate responses in conversation which can end up isolating them from their peers. Their inability to change their style of communication with different people can make it difficult for them to maintain close relationships with others.

Others may see their inappropriate responses as rude or unfeeling when they just don’t understand what is appropriate in certain contexts. They may also have trouble understanding jokes. They also may not complete instructions that are only implied rather than explicitly stated.

Their stories may go on too long or meander in an unconventional way, which can make them hard to understand or follow.

They can also struggle with the use of written language, which can make school difficult for them. Especially, since many children diagnosed with SCD are also diagnosed with other language disorders.

Children with social communication disorders are smart and can learn. They just need to practice communication skills to improve their interactions. However, many times people think that since these children say the wrong thing or don’t interact in a typical way in social situations that they are “weird” or intentionally acting callous.

Children with SCD take things very literally. They do not understand the social norms expected of them in the classroom, peer-to-peer interactions, and other social situations.

Since this disorder is often mistaken for ASD, the stigmas associated with it also affect children with SCD.

With time and proper treatment, these kids can thrive in social situations. Many of the social skills they lack can be taught in speech therapy.

Ways to Advocate for a Child With Social Pragmatic Communication Disorder

As a caregiver, advocacy for your child in school and other social situations is essential. They may need extra support and patience to be able to achieve at the same level as their peers. The following tips are ways to ensure your child has the best opportunities possible.

#1 Get Your Child Evaluated for SCD

The first step in advocating for your child is to make sure they are properly diagnosed. If you suspect your child is struggling with pragmatic language impairments, let your child’s pediatrician know. They can evaluate your child informally. Then, if they suspect SCD, they can refer you to a Speech-Language Pathologist (SLP).

Once you get an SLP, they can do a thorough evaluation of your child to determine how they use and understand pragmatic language. If your child gets diagnosed with a social communication disorder, they will recommend a treatment plan that is individualized to your child’s specific needs.

This will involve a combination of interventions between the SLP, parent, and teacher. A clinician will offer one-on-one language therapy to help teach and practice interactions in a social setting. Early intervention makes a world of difference.

In speech therapy, your child will get help building their language skills to succeed in social contexts. SLP's often use role-playing during their sessions to help their child practice social skills as if they were in a real setting. This will teach your child the ways to interact with his or her peers. They will also give your child a toolbox of strategies to help with communication problems.

Speech therapists are trained to provide children with SCD with the knowledge they need to tackle social situations.

#2 Inform the School

If your child has received a diagnosis of SCD, it is important to let your child’s teacher know. This will help the teacher understand that your child may need accommodations. The teacher may even be able to give you more insight into how your child interacts with peers. Your SLP may even request an interview or statement from the teacher.

Also, once the diagnosis is made, your child may need special education services, especially if their condition is paired with learning disabilities. An Individualized Learning Plan (IEP) or 504 plan may be needed. These plans are ways for you to ensure your child’s special learning needs are being taken into consideration by the school. Schools can assist with speech-language pathology services and communication intervention. These plans also give your child accommodations in the classroom to make them more successful.

Contacting your school and keeping open communication with them will make sure that your child is getting the best available resources.

#3 Practice at Home

There are several ways you can support your child with SCD at home. You can read books with them and take turns communicating about the book to practice a conversation-like setting. This will also help your child to understand the structure of stories. Make sure to practice taking turns. Also, try to get your child to consider what the different characters must be thinking and why.

Play games with your child. This will help them practice turn-taking. You can practice dialogue while playing games and even ask open-ended questions.

If your child is having trouble communicating themselves, they could use props, toys, or pictures to show you what they mean when they can’t find the right words.

More than anything, just give your child the affection, time, and patience they need. Your stability and care will go a long way in helping them to be successful. They are so much more than their SCD, and sometimes they need a reminder that their other interests and accomplishments matter, too.

#4 Give Your Child Opportunities to Practice Social Skills

Invite similarly aged children over for a playdate. Start with only one child, at first. Let your child practice interacting with them. Guide them, as needed.

As your child becomes better at interacting with one peer, introduce another. Try inviting the children out to different settings such as your home, the other child’s home, or the playground. This will give your child the opportunity to practice their social skills with people their age.

Eventually, you should be able to allow your child to interact with a small group of children. This will help them to learn how to deal with different situations that may arise.

#5 Get Augmentative and Alternative Communication (AAC)

If your child is younger, they may not be able to find the right words or even know the right words to communicate with others. AAC can give children another way to communicate. There are several options. These include the following:

  • Pointing at pictures

  • Drawings

  • Gestures

  • Technology devices

  • Sign language

AAC can give a child with communication difficulties the ability to get their ideas and thoughts across, which goes a long way in making them able to interact in social situations.

Many children will learn to lean less on AACs as they get older, but others rely on them throughout their lifetime.

These communication alternatives are a great way to boost confidence in your child with small successes and give them a way to make their needs and wants known.


There are many ways to advocate for your child with Social Pragmatic Communication Disorder. With regular speech therapy, additional support at school, practice at home, practice with peers, and Augmentative and Alternative Communication, your child can learn to function well in social situations.

If you are looking to get a speech-language pathologist, it is easy with the California Scottish Rite Foundation. With locations throughout California, you can get free speech, language, and learning programs to support your child and give them the confidence they need to succeed. We partner with private providers as well as universities to offer a large range of services for every individual need.


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