My ASD Child

Social Pragmatic Communication Disorder versus Autism Spectrum Disorder

“What is Social Pragmatic Communication Disorder? And how does it differ from Autism Spectrum Disorder?”

Social Pragmatic Communication Disorder (SCD) is characterized by “a persistent difficulty with verbal and nonverbal communication that can’t be explained by low cognitive ability.” Symptoms include:

inappropriate responses in conversation
difficulties with academic achievement and occupational performance
limited effective communication
difficulties in the acquisition and use of spoken and written language
complications in social relationships

Also, these symptoms must be present in early childhood (even if they are not recognized until later when language, speech or communication demands exceed abilities).

The new diagnosis of SCD more correctly identifies children who have significant problems with verbal and nonverbal communication for social purposes. These problems lead to impairments in their ability to perform academically and occupationally, participate socially, maintain social relationships, and effectively communicate.

Previous editions of the Diagnostic and Statistical Manual of Mental Disorders didn’t provide an appropriate diagnosis for children with such symptoms. As a result, inconsistent treatment was initiated in various clinics and treatment centers, and a lot of children were lumped under the “not otherwise specified” category of Pervasive Development Disorder.

While previous editions of the Diagnostic and Statistical Manual of Mental Disorders included diagnoses with related symptoms, the SCD diagnosis is needed to address the special needs of SCD children (e.g., while Autism Spectrum Disorder does include communication problems, it also includes restricted, repetitive patterns of behavior, interests or activities, and gives equal weight to both communication difficulties and repetitive behaviors).

Research shows that communication disorders are very treatable. Thus, identifying distinct communication difficulties is a crucial first step in getting these children appropriate care. The SCD label helps them get the services and treatment they need.

As a side note, Autism Spectrum Disorder must be ruled out for SCD to be diagnosed.

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Teaching Interpersonal Relationship Skills to the "Friendless" Asperger's Child

What comes naturally to “typical” kids does not come naturally to kids on the autism spectrum. The lack of interpersonal relationship skills makes it difficult for these boys and girls to make and keep friends – and often leads to social isolation. Now for the good news: Parents can learn to teach interpersonal relationship skills to their “special needs” youngsters.

In this post, we will discuss the following:

Practicing reciprocal interactions
Rehearsing social situations through role-play
Relationship skills groups
Teachers' crucial role in teaching social skills
Teaching the youngsters how to recognize the feelings of others
Making use of “social skills training” materials
Making use of social stories

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Social-Skills Training and Joint-Attention Training for Kids on the Autism Spectrum

“Can social skills training really help children with high functioning autism? What should a good training program consist of?”

There is some objective evidence to support traditional and newer naturalistic behavioral techniques and other approaches to teaching social skills. Joint attention training may be especially helpful in young, pre-verbal kids on the autism spectrum (e.g., Asperger's and High-Functioning Autism), because joint attention behaviors precede and predict social language development.

A randomized, controlled trial demonstrated that joint attention and symbolic play skills can be taught, and that these skills generalize to different settings and people. Parents can facilitate joint attention and other reciprocal social interaction experiences throughout the day in the youngster's regular activities.

A social skills curriculum should target the following:

initiating social behavior
minimizing stereotyped perseverative behavior while using a flexible and varied repertoire of responses
responding to the social overtures of other kids and grown-ups
self-managing new and established skills

The following are supported primarily by descriptive and anecdotal literature, but the quantity and quality of research is increasing:

peer-mediated techniques
play and leisure curricula
scripts
social games
social skills groups
social stories
video modeling
visual cueing

A number of social skills curricula and guidelines are available for use in school programs and at home.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism

Sensory Integration Therapy and Occupational Therapy for HFA Children

“What does sensory integration therapy entail? And is it effective for children with high functioning autism?”

Sensory integration therapy is often used alone or as part of a broader program of occupational therapy for kids on the autism spectrum.

The goal of this particular therapy is not to teach specific skills or behaviors, but to remediate deficits in neurologic processing and integration of sensory information to allow the youngster to interact with the environment in a more adaptive way.

Unusual sensory responses are common in young people with Asperger's and High-Functioning Autism (HFA), but there’s no good evidence that these symptoms differentiate HFA from other developmental disorders.

The effectiveness of sensory integration therapy has not been demonstrated objectively. “Sensory” activities may be helpful as part of an overall program that uses desired sensory experiences to reinforce a desired behavior, help with transitions between activities, and calm the HFA youngster.

Occupational therapy is often provided to promote development of self-care skills (e.g., using utensils, personal hygiene, manipulating fasteners, dressing, etc.) and academic skills (e.g., writing, cutting with scissors, etc.).

Occupational therapists also may assist in modifying classroom materials and routines to improve attention and organization, promoting development of play skills, and providing prevocational training. However, research regarding the effectiveness of occupational therapy in autism spectrum disorders is lacking.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

Gastrointestinal Problems in Asperger’s Children

“Is there a correlation between gastrointestinal issues and Asperger Syndrome? Our son seems to be very sensitive to certain foods, especially bread and milk (they cause him to cramp).”

The relationship between gastrointestinal problems and Asperger’s (high functioning autism) is unclear, because most studies have not examined representative groups of kids with Asperger’s compared with appropriate controls. Surveys published in the gastroenterology literature have stated that gastrointestinal problems (e.g., constipation, diarrhea) occur in 46% to 85% of Asperger’s kids. Lower rates in the range of 17% to 24% have been reported in other population-based studies.

One case-control study in the United Kingdom found that only 9% of young people with Asperger’s had a history of gastrointestinal complaints. Conversely, in one cross-sectional study that used structured interviews and matched control groups, a lifetime history of gastrointestinal symptoms (e.g., abnormal stool pattern, frequent constipation, frequent vomiting, frequent abdominal pain, etc.) was found in 70% of Asperger’s kids compared with 42% of the kids with other developmental disabilities and 28% of the kids without developmental disabilities.

In young people with Asperger’s undergoing endoscopy, colitis, duodenitis, gastritis, high rates of lymphoid nodular hyperplasia, and histologically subtle esophagitis have been described. Evidence suggests that some immunohistochemical features may be unique to inflammation associated with Asperger’s.

The existing literature does not support routine specialized gastroenterological testing for asymptomatic “Aspies.” However, if a youngster on the autism spectrum presents with symptoms (e.g., chronic or recurrent abdominal pain, vomiting, diarrhea, constipation, etc.), it is reasonable to evaluate the gastrointestinal tract.

Gastrointestinal discomfort also should be considered in a youngster who presents with a change in behavior (e.g., outbursts of aggression, meltdowns, self-injury, etc.). Radiographic evidence of constipation has been found to be more common in young people with Asperger’s than in controls with abdominal pain (36% vs 10%).

How to Prevent Meltdowns in Children on the Spectrum

Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

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