Many of us take for granted the social and communication skills needed to mingle with other people and take part in small talk or chit chat. For many children, teens and adults on the spectrum, conversing does not come naturally. The latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) explains the new diagnosis of social (pragmatic) communication disorder (SCD) which may be what your child/teen/young adult is struggling with. Let’s look at this new designation and what it means for treatment of social and communication disorders.
What is SCD?
SCD encompasses problems with social interaction, social understanding and pragmatics. Pragmatics refers to using language in proper context. Pragmatics also refers to the unspoken, subtle rules of spoken language that allow people to connect. For example children that exhibit signs of SCD have difficulties using language in social situations, such as greetings, sharing information, changing speech to suit different social contexts, understanding things that are implied but not explicitly stated, and functioning in conversation and storytelling.
Symptoms of SCD
Speech-language pathologists have the training and experience to identify common criteria that would lead to an SCD diagnosis. Both verbal and non-verbal skills are taken into account when looking at the common symptoms of this disorder. They include:
- not responding to others
- inappropriate gesturing or facial expressions
- monopolizing a conversation
- not talking about emotions and feelings
- inability to stay on topic
- inability to adjust speech to fit different people or situations – for instance, talking differently to a young child versus an adult or lowering one’s voice in a library.
- not understanding how to use words for a variety of purposes such as greeting people, making comments, asking questions, making promises, etc.
- difficulty making inferences and understanding things that are implied, but not stated explicitly
- tendency to be overly literal and not understand riddles and sarcasm
- an inability to make and keep friends (Source: Autism Speaks)
Diagnosis and Treatment
The American Speech-Language-Hearing Association (ASHA) recommends evaluating children in many different settings such as: observation in school and home settings, interviews/questionnaires for teachers and caretakers, and formal one-on-one testing to assess your child’s language and communication skills. While there is no specific treatment for SCD as of yet, it is presumed that speech and language therapy designed to improve language pragmatics will greatly assist these children, along with social skills training.
Ever wonder about the prevalence of speech disorders and how they can impact your child’s behavior and learning? According to the National Institute of Deafness and other Communication Disorders(NIDCD) the prevalence of speech sound disorders in young children is 8 to 9 percent. By the first grade, roughly 5 percent of children have noticeable speech disorders; the majority of these speech disorders have no known cause. How does autism fit into these statistics? Let’s look at communication issues and how they play a role in autism or autism spectrum disorders(ASD).
The word “autism” has its origin in the Greek word “autos,” which means “self.” Children with ASD often are self-absorbed and seem to exist in a private world where they are unable to successfully communicate and interact with others. Children with ASD may have difficulty developing language skills and understanding what others say to them. They also may have difficulty communicating nonverbally, such as through hand gestures, eye contact, and facial expressions. (Source: NIDCD)
Not every child with ASD will have a language problem but here are some of the common communication problems encountered by children with autism.
- Nonverbal conversation skill Issues – Children with autism are often unable to use gestures or eye contact to make their point or get their feelings and needs known. Occupational, physical and speech therapies can help the child practice situations where mannerisms and facial expressions are appropriate.
- Repetitive Language Issues – Autistic children may say things over and over that have no meaning or possibly repeat what they hear(called echolalia). Other children will use robot like speech, repeat phrases even when not appropriate or speak in high pitched or loud tones.
- Language Development Issues – Many children with ASD develop some speech and language skills, but not to a normal level of ability, and their progress is usually uneven.
- Specific Interests – Approximately 10% of autistic children have very specific interests in which they can speak at length about. Unfortunately carrying on a two way conversation about that same topic may not be as easy.
Speech disorders have a specific set of treatments to improve the disorder. Speech therapies can help children with the daily frustrations of getting their point across.
Speech-language pathologists are amazingly creative and patient therapists who specialize in treating language problems and speech disorders. They are a key part of the autism treatment team. Children struggling with autism have a wide range of developmental disabilities. These can include speech and communication problems starting from early childhood. Let’s look at some of the problems and solutions that speech therapists work on with autistic students on a daily basis.
Speech Behaviors –
Parents may first notice speech delays in a child who has been diagnosed with autism or one of the disorders on the autism spectrum at a very early age. Toddlers may not speak at all or may only grunt, shriek, cry, hum or babble nonsensically. As a child develops they may begin parrot talk also called echolalia (repeating back what was said to them only) or speak in an unexpressive tone of voice (robot speak(). Still other young children may speak but not make eye contact or even have trouble understanding the meaning and purpose behind the words. These are all challenges that face a speech and language pathologist when designing a therapy program specific to each child.
Treatment and goals for Speech Therapy
Because speech challenges for autistic children can range widely on the communication spectrum, speech therapists must find a way to not only teach a child to speak but also how to use the language effectively enough to hold a conversation and communicate with not only words but tone, eye contact, expression and body language. This is no easy feat. Here are some of the ways that specialists attempt to improve communication and thus the quality of life for many children with this disorder.
Speech therapy techniques might include:
- Electronic “talkers”
- Signing or typing
- Using picture boards with words, known as picture exchange communication systems that start out using pictures instead of words to help a child learn to communicate
- Using sounds to which a person is over- or under-sensitive to expand and compress speech sounds
- Improving articulation of speech by massaging or exercising lips or facial muscles
- Having individuals sing songs composed to match the rhythm, stress, and flow of sentences