Social Communication Disorder

Social Communication Disorder What is it and the challenges ahead Lauren Franke, Psy.D. CCC-SP laurenkfranke@gmail.com 1

Agenda Overview of Social Communication Disorder A look at pragmatics Definition Elements of pragmatics Potential areas of weakness Challenges Intervention 2

A Little History 1983 1987 1997 2002 2013 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. 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. Bishop and Edmonson used SPD as a diagnostic term for children with communication profiles typical of ASD but did not meet criteria for ASD Conti-Ramsden moved SPD to Pragmatic Language Impairment 3

http://www.psychologytoday.com/blog/making-sense-autistic-spectrumdisorders/201006/006-not-quite-autism-the-borderland-asd 4

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. 5

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). 6

Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities). 7

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. 8

A Look at Pragmatics 9

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 We re going to school but what I mean is get in the car Most of what we intend to communicate is not explicit 11

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) 12

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) 13

Social Cognitive Abilities Language Abilities Cognitive Processing 14

The Elements of Pragmatics/Social Communication 15

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 one s age and experiences. Frequency of Communication Frequency involves the number of messages offered during a conversation when compared to one s communication partner. The objective in social conversational situations is to have a balance between partners and appropriate initiation by both. 16

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 17

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. 18

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. 19

General Rules of Conduct for the Speaker s 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. 20

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. 21

Para-linguistic Aspects Intelligibility Vocal intensity Vocal quality Prosody Fluency 22

Nonverbal Aspects Physical proximity Body posture Extraneous movements Gestures Facial expression Eye gaze 23

Potential Underlying Weaknesses Weak central coherence Theory of mind deficits Executive functioning Language processing Context blindness Weak joint attention 24

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? 25

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) 26

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 27

Potential Assessment Tools for the SLP 28

Children s 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) 29

Children s 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). 30

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 31

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-Winner s 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 32

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. 33

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 34

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). 35

Three Types of Communicators 36

Sample Assessment Protocol for the Emergent Communication http://div16perspectives.asha.org/content/11/3 /88.full.pdf+html 37

Caution! Test of Pragmatic Language-2 Test of Social Language Development Test of Problem Solving CASL: Pragmatic Judgment 38

Use Diagnostic Interview: Language sample with presses Narrative assessments In vivo situations 39

Intervention for a Complex Disorder Maladaptive Coping Skills/Secondary Reactions Behavior & Learning Deficits/Symptoms Core Deficits 40

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%2520Fern- Children%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 Disorders, Research Edition 41

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 42

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Intervention: Key Concepts The extent of a student s repertoire of knowledge about social situations, social communication, and social strategies. The student s 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 44

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 45