2. Impairment of the ability to change communication to match context or the needs of the listener. such as speaking differently in a classroom than on a playground. talk- ing differently to a child than to an adult, and avoiding use of overly formal language.
3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
B. The deficits result in functional limitations in effective communication, social participa- tion, social relationships, academic achievement, or occupational performance, indi- vidually or in combination.
C. The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
D. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.
Social (pragmatic) communication disorder is characterized by a primary difficulty with pragmatics, or the social use of language and communication, as manifested by deficits in understanding and following social rules of verbal and nonverbal communication in nat- uralistic contexts, changing language according to the needs of the listener or situation, and following rules for conversations and storytelling. The deficits in social communica- tion result in functional limitations in effective communication, social participation, devel- opment of social relationships, academic achievement, or occupational performance. The deficits are not better explained by low abilities in the domains of structural language or cognitive ability.
The most common associated feature of social (pragmatic) communication disorder is lan- guage impairment, which is characterized by a history of delay in reaching language mile- stones, and historical, if not current, structural language problems (see ”language Disorder” earlier in this chapter). Individuals with social communication deficits may avoid social inter- actions. Attention-deficit/hyperactivity disorder (ADHD), behavioral problems, and specific learning disorders are also more common among affected individuals.
in speech and language, diagnosis of social (pragmatic) communication disorder is rare among children younger than 4 years. By age 4 or 5 years, most children should possess adequate speech and language abilities to permit identification of specific deficits in social communication. Milder forms of the disorder may not become apparent until early ado~ lescence, when language and social interactions become more complex.
The outcome of social (pragmatic) communication disorder is variable, with some chil- dren improving substantially over time and others continuing to have difficulties persist- ing into adulthood. Even among those who have significant improvements, the early and also in acquisition of other related skills, such as written expression.
Genetic and physiological. A family history of autism spectrum disorder, communica- tion disorders, or specific learning disorder appears to increase the risk for social (prag- matic) communication disorder.
Autism spectrutn disorder. Autism spectrum disorder is the primary diagnostic con- sideration for individuals presenting with social communication deficits. The two disor- ders can be differentiated by the presence in autism spectrum disorder of restricted/ repetitive patterns of behavior, interests, or activities and their absence in social (prag- matic) communication disorder. Individuals with autism spectrum disorder may only dis- play the restricted / repetitive patterns of behavior, interests, and activities during the early developmental period, so a comprehensive history should be obtained. Current absence of symptoms would not preclude a diagnosis of autism spectrum disorder, if the restricted interests and repetitive behaviors were present in the past. A diagnosis of social (prag- matic) communication disorder should be considered only if the developmental history fails to reveal any evidence of restricted/repetitive patterns of behavior, interests, or ac- tivities.