Pragmatic Communication Disorder Research Articles

Should social pragmatic communication disorder be included in DSM-5? On uncertainties, pragmatic considerations, and the psychiatric kind debate

Should social pragmatic communication disorder be included in DSM-5? On uncertainties, pragmatic considerations, and the psychiatric kind debate

Conduct disorder and hyperprolinemia type I: A case report

IntroductionHyperprolinemia is defined by high proline levels of blood and its primary type consists on a metabolic disorder that is the result of a number of different genetic defects affecting the degradation of proline. The complex relationship between this disease and different psychiatric phenotypes has been an important subject of study in recent years, suggesting a “common psychiatric phenotype” (Namavar et al. Am J Med Genet B Neuropsychiatr Genet 2021; 186(5), 289-317), though its exact characteristics are yet to be determined. A higher prevalence of psychotic disorders (Guo et al. Metab Brain dis 2018; 33 89-97) explained through altered glutamate metabolism, autism spectrum disorders, developmental delay and intellectual disability has been proposed.ObjectivesTo describe the case of a patient, recently diagnosed of hyperprolinemia type I, presenting a conduct disorder alongside with ADHD, oppositional defiant disorder and an unspecified pervasive developmental disorder.MethodsWe present the case of a 15-year-old male that has received follow-up care by our mental health services. The patient was born preterm (35+5 weeks) and required reanimation, oxygen therapy, antiretroviral therapy (biological mother was HIV positive) and pharmacological therapy with phenobarbital (in order to treat methadone withdrawal syndrome). It was adopted nationally when he was 18-month-old and experimented an adequate development during his first years, only highlighting slight psychomotor restlessness and distinctive facial features. During the next years, he receives diagnosis of ADHD (with little to no registered response to amphetamine derivatives), oppositional defiant disorder, social pragmatic communication disorder and fetal alcohol syndrome.ResultsDuring his first hospital admission, a neuropediatrician was contacted to study the patient and recommended for a metabolic screening to be done, where high blood levels of proline were detected (940.1μmol/L). After this, a procedure of massive exome sequencing of genes that were known to be related to alterations in the metabolism of proline was conducted, finding the mutation c.[1357C>T] in the gen PRODH. This translates to an amino acid replacement in the protein proline dehydrogenase (p.[Arg453Cys]; [Arg453Cys]), which has been studied (Bender et al. Am J Hum Genet 2005; 76 409–420) that it reduced its activity in a 70%, making it a very probable cause of the hyperprolinemia.ConclusionsThere is still scarce evidence of the psychiatric phenotypes presented in patients with hyperprolinemia. Further research is needed in order to accurately define the complex relationship between this metabolic disorder and its effect on the central nervous system.Disclosure of InterestNone Declared

Language and Communication Deficits in Chromosome 16p11.2 Deletion Syndrome.

Chromosome 16p11.2 deletion syndrome (OMIM #611913) is a rare genetic condition resulting from the partial deletion of approximately 35 genes located at Chromosome 16. Affected people exhibit a variable clinical profile, featuring mild dysmorphisms, motor problems, developmental delay, mild intellectual disability (ID), socialization deficits and/or autism spectrum disorder (ASD) traits, and problems with language. Specifically, a precise characterization of the speech, language, and communication (dis)abilities of people with this condition is still pending. We used standardized tests and samples of naturalistic speech to provide a longitudinal profile of the speech, language, and communication problems of a boy with Chromosome 16p11.2 deletion syndrome and without ID or ASD. The proband shows impaired expressive abilities as well as problems with receptive language, dysprosody, and ASD-like communication deficits, such as impaired interactive skills, perseverative verbal behavior, overabundance of tangential responses, and lack of metapragmatic awareness and communicative use of gaze, meeting the criteria for social pragmatic communication disorder. Our results support the view that language and communication impairment should be regarded as one core symptom of Chromosome 16p11.2 deletion syndrome, even without a diagnosis of ASD or ID. Clinical implications of our results, with a focus on therapeutic interventions for children with 16p11.2 deletion syndrome and no ASD or ID, are also discussed. https://doi.org/10.23641/asha.21561714.

Theophrastus's "Anaisthetos" ("The Obtuse Man"): the oldest "phenomenological" description of neurodevelopmental disorders in an adult.

Theophrastus (381-278 B.C.), was the first to adopt the term character for the description of distinct inner psychological and moral features of an individual. In his classic book 'Characters' in a simple style wording he analyses some of his contemporary individuals. The character "Αναίσθητος" (Anaisthetos) has been translated in English as "The Obtuse Man" and in Modern Greek both as "Αναίσθητος", meaning lack of appreciation and "Βραδύνους", meaning slowness of mind. Theophrastus' description of this particular character is compatible with the co-occurrence in an adult of two Neurodevelopmental Disorders: the Attention-Deficit Hyperactivity Disorder (ADHD) and the Social Pragmatic Communication Disorder (SPCD), according to the 5th Diagnostic and Statistical Manual of Mental Disorders. Ten out of the twelve statements support the possible occurrence of ADHD while five of them the occurrence of SPCD. The description does not justify a diagnosis of an intellectual disability; therefore, we consider that in the Modern Greek vocabulary the original term «Αναίσθητος» ("Anaisthetos"), meaning lack of appreciation, is more accurately corresponding to this particular Theophrastus's character than "Βραδύνους" ("Obtuse"), which indicates the presence of low intellectual capacities. Also the lack of repetitive and restrictive interests and behaviours excludes Autism Spectrum Disorder as a possible diagnosis. Minor psychiatric disorders and traits according to the Peripatic School were attributed to the lack of rational control over appetites and behavior. Accordingly, «Αναίσθητος» is a phenomenological description of a stigmatizing inappropriate social behavior and the only help that might give is in increasing self-awareness. In our contemporary clinical practice, though, the early recognition and appropriate treatment of Neurodevelopmental Disorders in affected individuals, leads to a better clinical care and may diminish stigmatization. The co-existence of these two disorders in a character in such a different historical context reinforces their validity as diagnostic constructs and provides an example of co-occurrence of Neurodevelopmental Disorders.

The comprehension of grammaticalized implicit meanings in SPCD and ASD children: A comparative study.

Autism spectrum disorder (ASD) and social pragmatic communication disorder (SPCD) are two neurodevelopmental disorders with many similarities in affected individuals' impairments in social-communicative and pragmatic development. A central question pertaining to their differentiation concerns whether the distinction is truly qualitative or, instead, quantitative in nature, and indeed, defining the boundary between SPCD and ASD with IQ in the normal range often presents differential-diagnostic difficulties. While deficits in the comprehension of certain linguistically systematic implicit verbal meanings have been targeted by experimental research in ASD, to date they have not been investigated in controlled experiments in SPCD. The empirical objectives of our study are twofold. First, it is explored whether the comprehension of a set of highly systematic, grammaticalized implicit meanings is impaired in ASD and SPCD children compared to their typically developing (TD) peers, and whether ASD and SPCD children differ from each other in accessing these verbal meanings. Second, it is investigated whether receptive grammatical competence and first-order ToM abilities are associated with children's performance in any way and whether there is a difference in this regard between the ASD and the SPCD group. Our main experiment, using a sentence-picture verification task, tested the comprehension of highly systematic implicit verbal meanings, including grammaticalized implicatures, presuppositions, and entailments. The experiment was complemented with a false-belief (ToM) task and a test of receptive grammar, among other measures. Seventy-one 4-to-9-year-old children participated in the study (ASD: n=19, SPCD: n=13, TD controls: n=39). While both children with SPCD and children with ASD performed significantly more poorly than the TD group, only the comprehension profile of the SPCD group differed significantly from that of the TD group. Importantly, while ASDs' performance exhibited an association with their ToM results, the performance of SPCDs showed a correlation with their receptive grammar skills. By contrast, the performance of TDs correlated with neither. These findings reveal potential divergences in the cognitive developmental mechanisms that underlie the semantic-pragmatic difficulties in the two clinical groups, suggesting that the communicative impairments in ASD and in SPCD differ qualitatively, rather than quantitatively. Specific implications for theories of pragmatic impairments in ASD and in SPCD are discussed. What is already known on the subject Linguistically systematic implicit meanings are understudied both in ASD and in SPCD. Within this domain of verbal meaning, the majority of relevant experimental work on ASD, concentrated on generalized (mostly: scalar) implicatures, has yielded somewhat divergent results, while the comprehension difficulties in SPCD have remained barely charted territory. Linguistically more highly conventionalized implicit verbal meanings have not been experimentally investigated in either neurodevelopmental disorder. What this study adds A primary finding of our study is that although both the SPCD and the ASD group show significant deficit in the comprehension of highly conventional, grammaticalized implicit meanings, SPCD children may diverge more in their comprehension profile from their TD peers than ASD children. Another key result is that the comprehension of grammaticalized implicit meanings is linked with different cognitive functions in ASD and in SPCD. While comprehension performance is associated with ToM in ASD but not in SPCD or in TD, it is correlated with receptive grammar skills in SPCD but not in ASD or in TD. Clinical implications of this study These findings provide potential support for the hypothesis that the difference between ASD and SPCD is qualitative rather than quantitative in nature, thereby casting doubt on the conception that pragmatic limitations in SPCD are to be approached as a less severe form of similar deficits in ASD. Uncovering differences in the underlying cognitive sources and in the comprehension deficits of children with ASD and SPCD are critical for the improvement of the accuracy of SPCD children's early diagnosis and timely therapeutic intervention.

Pragmatic Communication Disorder

One patient has Pragmatic Communication Disorder. He had delayed communication up to age 6. He was a loner in Junio high school. He is stubborn but when you get him talking, he does not stop. He is full of interesting information. He has poor social communication skills.

الخصائص الاجتماعیة والسلوکیة لذوی اضطراب التواصل الاجتماعی النفعی واضطراب طیف الذاتویة فی ضوء المحکات التشخیصیة فی الدلیل التشخیصی والإحصائی الخامس Social and Behavioral Characteristics of Children with Social Pragmatic Communication Disorder and Autism Spectrum Disorder According to Diagnostic Criteria in the Fifth Diagnostic and Statistical Manual of Mental Disor

تستهدف الدراسة الحالية إلى التعرف على الخصائص التواصلية الاجتماعية والسلوکية للأطفال ذوي اضطراب التواصل الاجتماعي النفعي وأقرانهم الأطفال ذوي اضطراب طيف الذاتوية، وتألفت عينة الدراسة من (60) طفلا (30 طفلا لديهم اضطراب تواصل اجتماعي نفعي، 30 طفلا لديهم اضطراب طيف الذاتوية)، وقد تم استخدام مقياس اضطراب طيف التوحد للأطفال (إعداد/ جابر، 2018)، ومقياس اضطراب التواصل الاجتماعي النفعي للأطفال (إعداد/ جابر، 2018)، ومقياس التفاعل الاجتماعي (إعداد/ الباحث)، ومقياس المظاهر السلوکية (إعداد/ الباحث). وقد أشارت نتائج الدراسة إلى وجود فروق دالة إحصائيا عند مستوى دلالة (0.05) بين متوسطي درجات الأطفال ذوي اضطراب التواصل الاجتماعي النفعي والأطفال ذوي اضطراب طيف الذاتوية على مقياس التفاعل الاجتماعي لصالح الأطفال ذوي اضطراب التواصل الاجتماعي النفعي. کما أظهرت نتائج الدراسة وجود فروق ذات دلالة إحصائية عند مستوى دلالة (0.05) بين متوسطي درجات الأطفال ذوي اضطراب التواصل الاجتماعي النفعي والأطفال ذوي اضطراب طيف الذاتوية على مقياس المظاهر السلوکية غير المقبولة اجتماعيا لصالح الأطفال ذوي اضطراب طيف الذاتوية.

Social (Pragmatic) Communication Disorder: Another name for the Broad Autism Phenotype?

The Diagnostic and Statistical Manual of Mental Disorders' (5th ed.) Social (Pragmatic) Communication Disorder is meant to capture the social elements of communication dysfunction in children who do not meet autism spectrum disorder criteria. It is unclear whether Social (Pragmatic) Communication Disorder captures these elements without overlapping with Autism Spectrum Disorder or the Diagnostic and Statistical Manual of Mental Disorders' (5th ed.) Language Disorder. Standardized behavioral assessments administered during a family genetics study were used to evaluate the social communication impairment and the restricted interests and repetitive behaviors in persons with autism spectrum disorder, language impairment, or neither. Social communication impairment and restricted interests and repetitive behavior were significantly correlated in all family members regardless of affection status. Rates of social communication impairment and restricted interests and repetitive behavior were highest in individuals with autism spectrum disorder. One-third of family members with language impairment presented with at least mild/moderate levels of social communication impairment (36.6%) and restricted interests and repetitive behavior (43.3%). A subset of unaffected members also presented with mild/moderate levels of social communication impairment (parents = 10.1%, siblings 11.6%) and restricted interests and repetitive behavior (parents = 14.0%, siblings = 22.1%). The majority of child family members with mild/moderate levels of social communication impairment had similar restricted interest and repetitive behavior levels reflecting criteria representing the Broad Autism Phenotype. These data suggest that social pragmatic communication disorder does not capture the profiles of children who have both social communication impairment and restricted interests and repetitive behavior but are in need of clinical services.

Differentiating Autism from Typical Development: Preliminary Findings of Greek Versions of a Pragmatic Language and Social Communication Questionnaire

Objective: A social pragmatic communication disorder is one of the primary characteristics of children with autism. Although several measures of pragmatics and social communication exist, many are not comprehensive, do not examine the quality of interactions across contexts and interlocutors, and cannot be easily administered and interpreted. The aim of this article is to report on preliminary data collected using the Greek version of comprehensive social communication and pragmatic language questionnaires completed by parents and teachers interacting with young children in different contexts. Methods: A Greek translation of the social communication and pragmatic language questionnaires was administered to parents and teachers of 31 children diagnosed with autism and of 51 typically developing children aged 3.0–6.0 years. Analysis and Results: The performance on the Greek versions of the social communication and pragmatic language questionnaires of typically developing children was compared with the performance of the children with autism using a series of independent t tests. Descriptive statistics were used to summarize participant characteristics and performances on the measure. Preliminary results showed that significant differences with moderate effect sizes were found between groups on 63% of the 30 test items. Conclusions: The performance of children on questionnaires may lead to the development of easily administered and interpretable assessments for differentiating children with pragmatics and social communication impairments, such as children with autism, from typically developing children.

EDUTEA: A DSM-5 teacher screening questionnaire for autism spectrum disorder and social pragmatic communication disorder

Background/ObjectiveTeacher's reports about child psychopathology are often useful because they make it possible to compare children's development within their normative peer group. The EDUTEA questionnaire aims to provide clinicians and researchers with a brief tool that can be used to screen autism spectrum disorders and social communication disorders in school settings. Method: It was designed according to DSM-5 criteria and validated in a sample of 2,660 Spanish schoolers. Results: The EDUTEA showed a two-factor structure with high internal reliability: Social communication impairments (α=.95) and Restricted behaviour patterns (α=.93). The ROC curve showed that the area under the curve was highly predictive (.90). We propose using a cut-off score of 10, which gives high values of sensitivity (87%), specificity (91.2%) and positive predictive value (.87). Moderate correlations were found with the severity score of the Autism Diagnostic Observation Schedule (ADOS-2) and the child pragmatic competence. Conclusions: The EDUTEA could be useful in ASD screening protocols in schools.

Tulburarea de comunicare socială pragmatică – (TCSP). Studiu ilustrând percepția specialiștilor în terapia limbajului din România

Tulburarea de comunicare socială pragmatică – (TCSP). Studiu ilustrând percepția specialiștilor în terapia limbajului din România

Answers to Your ICD-10-CM Coding Questions

Answers to Your ICD-10-CM Coding Questions

Autism, Language Disorder, and Social (Pragmatic) Communication Disorder: DSM-V and Differential Diagnoses.

• Based on strong research evidence (1), the prevalence of autism spectrum disorders (ASDs) has increased over the past decade, with a 2010 prevalence of 1:68 (1.5%) in children age 8 years. • Based on some research evidence as well as consensus (3), the most recent revision of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V) identifies two core dimensions for the diagnosis of ASD: social (social communication and social interaction) and nonsocial (restricted, repetitive patterns of behaviors, interests, or activities). • Based on some research evidence as well as consensus (3) (31) (32) (33) (34), DSM-V identifies social pragmatic communication disorder (SPCD) as a dissociable dimension of language and communication ability that affects how individuals use language for social exchanges. SPCD is often found in children with language impairments and children with attention-deficit/hyperactivity disorder and other genetic/neurologic conditions. • Based on strong research evidence (2) (26) (27) (28), childhood language disorders affect 7.4% of kindergarteners, and 50% to 80% of these children experience persistent language, academic, and social-emotional difficulties into their adult years, despite having normal nonverbal cognitive abilities. • Based primarily on consensus due to lack of relevant clinical studies, differential diagnosis of autism and language disorders may require a multidisciplinary evaluation that takes into account a child’s overall development, including cognitive, communication, and social abilities. Monitoring the response to appropriate interventions and trajectory of development over time may improve the accuracy of diagnosis, especially in very young children.

Pragmatic communication disorders and cognitive functions in traumatic brain injury

Pragmatic communication disorders and cognitive functions in traumatic brain injury

Conversation after right hemisphere brain damage: Motivations for applying conversation analysis

Despite the well documented pragmatic deficits that can arise subsequent to Right Hemisphere Brain Damage (RHBD), few researchers have directly studied everyday conversations involving people with RHBD. In recent years, researchers have begun applying Conversation Analysis (CA) to the everyday talk of people with aphasia. This research programme has provided novel insights into the complex inter-relationship between impairment, language use, and interactional organization. This paper will argue that the detailed, inductive approach of CA is well suited to investigating pragmatic communication disorders resulting from RHBD, and will help to elaborate previous findings about RHBD and conversation. In particular, this paper will review and discuss previous investigations of conversation after RHBD, and put forward arguments relating to how CA might be applied to talk-in-interaction involving people with RHBD.

Pragmatic Communication Disorders: New Intervention Approaches

Pragmatic Communication Disorders: New Intervention Approaches

Pragmatic communication disorders following stroke

This article provides the rehabilitation professional with a summary of current knowledge regarding the nature, implications, and management of pragmatic communication disorders following stroke. Alternative views and definitions of pragmatics are discussed. Pragmatic communication strengths and weaknesses following right and left cerebral hemisphere damage are described within the framework of verbal expression, verbal comprehension, paralinguistic skills, and nonverbal abilities. Assessment principles and practices are presented, and specific assessment tools and methodologies are described. The article includes a review of current treatment strategies for pragmatic communication disorders following stroke and provides a rationale for an emphasis on pragmatics in the rehabilitation of persons with communication disorders following stroke.