Social Pragmatic Communication Disorder (SPCD): Signs, Autism and IEPs

Social Pragmatic Communication Disorder (SPCD) is one of those terms that sounds more complicated than it needs to be.

At its core, SPCD affects how a person uses and understands language in social situations. A child may have plenty to say and a great vocabulary, but still struggle with things like understanding implied meaning, knowing what information another person needs, following the back-and-forth of a conversation, or figuring out what to do when there’s a misunderstanding.

You’ll also hear terms like pragmatic language disorder, pragmatic language impairment, pragmatic communication disorder and pragmatic language difficulties. They don’t all mean exactly the same thing, even though people sometimes use them as if they do.

And then there’s autism. Autism and Social Pragmatic Communication Disorder can share some social communication characteristics, but they are not the same diagnosis.

Many parents don’t realize that difficulty making friends, reading social cues, or joining conversations can all be signs of a teenager struggling socially. People might have even suggested they are “just shy” or “awkward.”

When networking with other parents….and I even find myself saying this, you may have heard someone say, “Oh, sounds like pragmatics” after a parent has just described some struggles their child is having.

• Teenager Lacking Social Skills? What Schools Must Address in an IEP (and What Parents Can Do)
• Medical Autism vs Educational Autism, why do people keep saying this?

What is Pragmatic Language?

Pragmatics refers to the social rules and conventions that govern how we use language in different contexts. It’s not just about what we say but how we say it, why we say it, and how our words are understood in social interactions. Pragmatics involves understanding things like:

• Turn-Taking in Conversations: Knowing when it’s your turn to speak and when to listen.
• Nonverbal Cues: Reading body language, facial expressions, and tone of voice.
• Contextual Language Use: Adjusting the way you speak depending on the situation, like speaking formally to a teacher versus casually to a friend.
• Implied Meanings: Understanding jokes, idioms, sarcasm, or indirect requests (like understanding that “Can you open the window?” is not asking if you have the ability to open the window but is a polite way of asking you to actually open it).

Pragmatic language is the “social use of language” or how we use words and gestures to communicate effectively and appropriately in various social situations.

Over the years, I have had so many clients who are disciplined at school or home, not making friends, getting into scuffles on the playground–and so much of it is based in misunderstanding. You know the saying “read the room?” Yeah, kids with this…. they cannot read the room.

Pragmatic Meaning

Pragmatics however, differ slightly from the phrase pragmatic meaning. Pragmatic meaning refers to the intended meaning or message behind words and actions in a particular social context, rather than just their literal definition. It focuses on how language is used in real-life situations to convey more than just the surface meaning of the words.

This might help:

• Beyond the Literal: Pragmatic meaning involves understanding what someone really means, which can differ from the literal meaning of their words. For example, if someone says, “Wow, it’s cold in here,” the pragmatic meaning might be that they want the window closed or the heat turned up, even though they didn’t directly ask for it.
• Context Matters: The meaning of a phrase or word can change depending on the situation, the relationship between the speakers, and even the tone of voice or body language. For example, the word “fine” can mean everything from genuine agreement (“That sounds fine!”) to reluctant acceptance (“Fine, whatever”) depending on how and where it is used.
• Implied Intentions: Pragmatic meaning often involves implied or inferred meanings. For example, “Are you going to eat that?” can pragmatically mean, “I’d like to eat that if you aren’t.”
• Social Conventions: Pragmatic meaning takes into account the social norms and conventions of communication. This includes politeness strategies (e.g., saying “please” and “thank you”), knowing when to use formal versus informal language, and understanding cultural differences in communication styles.

In essence, pragmatic meaning is about interpreting what people mean in a given context, not just what they say. It’s crucial for understanding sarcasm, humor, indirect requests, and many other subtleties of communication.

But not everyone who struggles with pragmatics or pragmatic meaning occasionally has SPCD.

What is Social Pragmatic Communication Disorder (SPCD)?

Social Pragmatic Communication Disorder is a condition where a child has difficulty with the social use of verbal and nonverbal communication. Think about how we greet people, take turns in conversations, understand jokes, or even read body language.

Pragmatics is all that unwritten social stuff we do when communicating with others, and it’s a big deal in everyday life.

Kids with SPCD often struggle with:

• Following the rules of conversation (like taking turns)
• Understanding or using non-verbal signals (like facial expressions or body language)
• Adjusting their communication style to different social contexts (like talking to a teacher versus a friend)
• Understanding things that aren’t explicitly stated (like idioms or jokes)

If these sound familiar, you might be thinking: “Wow, this sounds a lot like autism.” And you’re right! There is some overlap. But here’s the key difference: SPCD specifically focuses on communication difficulties without the repetitive behaviors or intense focus on specific interests that are typically associated with Autism Spectrum Disorder (ASD).

Pragmatic Language Impairment and Social (Pragmatic) Communication Disorder (SCD) are very similar, but they’re not exactly the same thing. Think of it like this:

Pragmatic Language Impairment (PLI)

This is more of a descriptive term used by speech-language pathologists (SLPs) to explain specific challenges in the social use of language, like taking turns in conversation, understanding implied meanings, or using language differently depending on the context.

PLI isn’t an official diagnosis in the DSM (Diagnostic and Statistical Manual of Mental Disorders). It was often used before there was an official diagnostic label.

Social (Pragmatic) Communication Disorder (SCD)

This is a formal diagnosis that was introduced in the DSM-5 in 2013. It includes difficulties with:

• Using communication for social purposes (e.g., greeting, sharing info)
• Changing communication to match context or listener
• Following conversation rules (e.g., turn-taking)
• Understanding things that are not explicitly stated (e.g., humor, idioms)

To be diagnosed with SCD, these issues have to cause functional limitations in social, academic, or occupational performance and cannot be better explained by autism spectrum disorder (ASD).

• PLI = older/less formal term often used by SLPs
• SCD = the official DSM-5 diagnosis used by psychologists and some clinicians

If you’re looking at IEPs or evaluations and see either term, it’s always good to clarify with the team: “Are we using this as a clinical diagnosis or a description of language needs?”—because it can affect services and eligibility.

Signs of Social Pragmatic Communication Disorder

So, you’re wondering, “Does my child have this?” You know your child best, and if your gut is telling you something’s off, it’s worth investigating. Here are some signs to watch for:

1. Trouble Starting or Keeping a Conversation Going: Does your child find it hard to start a conversation or keep one going? They might struggle with knowing how to take turns or stay on topic.
2. Literal Understanding: They take things very literally. If you say, “break a leg,” they might look at you in horror (because who would want that?!).
3. Difficulty Understanding Jokes or Sarcasm: Humor can be tough! If your child often doesn’t get jokes, sarcasm, or idioms, this could be a red flag.
4. Challenges with Social Norms: They might not understand or follow social rules, like making appropriate eye contact, standing too close or too far away when speaking to someone, or modulating their voice in different settings.
5. Problems Reading Non-Verbal Cues: They miss out on body language or facial expressions, like not recognizing when someone is bored or angry.

Social Pragmatic Communication Disorder vs. Autism

This is probably where parents have the most questions because SPCD and autism can both involve social communication difficulties.

Autism, however, includes more than social communication differences. Current diagnostic criteria for autism also include restricted or repetitive patterns of behavior, interests or activities. Those can include things such as repetitive behaviors or speech, strong preferences for sameness or routines, highly focused interests, and sensory differences.

SPCD involves persistent social communication difficulties without the restricted/repetitive behavior patterns required for an autism diagnosis.

Under current DSM-5-TR diagnostic criteria, Social (Pragmatic) Communication Disorder is not diagnosed alongside Autism Spectrum Disorder. Both can involve significant social communication difficulties, which is why distinguishing between SPCD and autism requires a careful evaluation. For an SPCD diagnosis, autism should first be ruled out. (I’m not a doctor, nor do I play one on the internet–ask your child’s team if you have more questions about this)

Diagnosing autism and distinguishing it from other communication and developmental conditions requires a comprehensive evaluation. Speech-language pathologists can play an important role in evaluating social communication, and other professionals will be involved when autism or another developmental condition is being considered.

Who Does Evaluations for Pragmatic Language?

If any of these signs ring a bell, it’s time to consider an requesting a special education evaluation. Start with a Speech-Language Pathologist (SLP) who specializes in pragmatics. They can assess your child’s language use, comprehension, and how they apply these skills in social contexts.

Additionally, if you have concerns that there may be overlap with other conditions (like ADHD or Autism), you might also want to consult a developmental pediatrician, a child psychologist, or a neuropsychologist for a comprehensive evaluation.

How Is Social Pragmatic Communication Disorder Diagnosed?

An SPCD diagnosis should come from a comprehensive evaluation, not one checklist or one observation.

A speech-language pathologist is often an important part of this process. An evaluation may look at how the child communicates in different situations, how they understand and use language, conversation skills, nonliteral and implied language, communication repair and other aspects of social communication.

Information can come from multiple sources, including standardized and nonstandardized assessments, observations, interviews, questionnaires and input from parents and teachers.

Hearing should also be considered so that hearing loss isn’t contributing to the communication difficulties.

A child may communicate differently at home than at school. They may do fine one-on-one with a familiar adult but struggle in a fast-moving group conversation. Some students may mask difficulties in structured testing situations and have a much harder time using those same skills during the school day.

This is why I am forever telling parents: one test score is not your child.

If you’re concerned about your child’s social or pragmatic language skills, ask for an evaluation that looks at the areas you’re actually seeing. Be specific about your concerns and give examples.

Does Social Pragmatic Communication Disorder Qualify for an IEP?

Here’s where we switch from the clinical diagnosis to the school piece. A medical or clinical diagnosis does not automatically qualify a child for an IEP.

Under IDEA, the student must be evaluated and found eligible under one of IDEA’s disability categories and, because of that disability, need special education and related services. IDEA does not have an eligibility category called “Social Pragmatic Communication Disorder.”

That does not mean a student with SPCD cannot have an IEP.

Depending on the evaluation and the child’s individual needs, the IEP team may consider whether the student meets the criteria for an IDEA disability category, such as speech or language impairment or another applicable category.

And please don’t stop at grades.

Social communication difficulties can affect much more than whether a student is passing math.

They may affect classroom participation, group projects, peer relationships, asking for help, resolving misunderstandings, following classroom discussions, communicating with teachers, self-advocacy and other areas of functional performance.

IDEA requires IEPs to address both academic and functional needs resulting from the child’s disability.

So if you’re being told, “But she’s getting good grades,” and the conversation ends there, I’d be asking the team to look at the rest of the child’s school day.

• What happens during group work?
• Can the student ask for clarification when they’re confused?
• Are communication breakdowns interfering with learning?
• Can they communicate their needs?
• Are social communication difficulties affecting participation or access to instruction?
• What does the evaluation say?
• Where’s the data?

If pragmatic language is an identified educational need, the IEP may include specially designed instruction, speech-language services, accommodations, supports and measurable pragmatic language IEP goals, depending on what the individual student needs.

Who Evaluates for Pragmatic Language Skills

In a school setting, pragmatic language skills are often evaluated by a multidisciplinary team that may include:

1. Speech-Language Pathologists (SLPs): SLPs are trained professionals who specialize in assessing and treating communication disorders, including pragmatic language difficulties. They often play a central role in evaluating pragmatic language skills through standardized assessments, informal observations, and interactions with the student in various social contexts.
2. Special Education Teachers: Special education teachers work closely with students who have communication and social skills challenges, including pragmatic language difficulties. They may provide valuable insights into the student’s communication abilities and interactions within the classroom environment.
3. School Psychologists: School psychologists may contribute to the evaluation process by assessing the student’s overall social-emotional functioning, including their ability to engage in effective communication and social interactions.
4. Occupational Therapists (OTs): OTs may assess aspects of sensory processing and motor coordination that can impact pragmatic language skills. They may also provide strategies to address sensory sensitivities or motor challenges that affect social participation.
5. Educational Diagnosticians: Educational diagnosticians may administer assessments to evaluate various aspects of the student’s academic and functional abilities, including communication and social skills. They may collaborate with other team members to gather information and provide recommendations.
6. Behavioral Specialists: Behavioral specialists may observe the student’s behavior and interactions within the school environment to identify specific challenges and develop behavior intervention plans to support social skill development.
7. Parents/Caregivers: Parents and caregivers play a crucial role in providing information about the student’s communication abilities, social interactions, and any concerns they have regarding pragmatic language skills. Their input is valuable in understanding the student’s strengths, challenges, and individual needs.

Collaboration among these professionals allows for a comprehensive assessment of pragmatic language skills, leading to the development of targeted interventions and support strategies to help the student succeed in social communication and interactions within the school environment.

Pragmatic Language Deficits: What to Look For

Let’s dive deeper into what SPCD might look like, both at home and in school.

Academically:

• Trouble with Group Work or Classroom Participation: Kids with SPCD often struggle to work in groups or understand the back-and-forth of classroom discussions. They might dominate the conversation or fail to contribute.
• Literal Interpretation: They might misunderstand classroom instructions or reading materials if they contain idioms, metaphors, or implied meanings.
• Challenges with Storytelling or Writing: They may have difficulty organizing their thoughts into coherent stories or essays, especially when the assignment involves interpreting character motivations or non-literal language.

Socially:

• Difficulty Making Friends: Your child might come off as “awkward” or have a hard time forming friendships because they miss social cues or seem uninterested in others’ perspectives.
• Struggles with Conflict Resolution: They might not know how to resolve disagreements or may react inappropriately (like laughing when someone is sad).
• Isolation or Bullying: Kids with SPCD can sometimes be seen as “odd” or “different,” which can lead to social exclusion or bullying.