Thoughts on Social Communication Delay in new DSM

Susan_KW

Thoughts on this new category of social communication delay?

DS *might* eventually get diagnosed with this. Before he turned three (and over the last five months) he had three complete evaluations. So far he has "no diagnosis" from our local regional center, developmental delay (primarily based on his prematurity) through the school district, and PDD-NOS (somewhat provisional, the diagnosing psych was on the fence and wanted to wait a few more years, but went ahead and gave it to him so our insurance would cover ST and OT for him). The consistent agreement between all three evaluations is that he isn't using language functionally the way he should. His receptive language is 97th percentile and his expressive language is 50th percentile. But, he doesn't seem to intuit HOW to use language to interact with others. It's a frustrating puzzle. He doesn't seem to fit the criteria for ASD (no stereotypic movements or special interests, little rigidity, seeks out interaction with others, etc), but his ability to use language functionally is delayed.

His play skills appear to be emerging on time according to his pre-school teachers (he's in an inclusion pre-school and play skills with peers are what they primarily focus on). He's pretty firmly in the parallel play developmental stage (they say he pays a lot of attention to what his peers are doing) and collaborative play skills are starting to emerge - which is still in the typical development range for a young three. The teachers in his district inclusion pre-school are very aware of ASD in pre-schoolers and they aren't seeing typical signs of a child on the spectrum other than possibly his difficulty using language functionally. It's difficult to tell whether this is a developmental delay and that it will come in eventually or if it is a true language disorder that he will continually need support with.

I hoped to have an answer by now - is it autism or isn't it? But, we're still in a wait and see. I guess the new social communication delay is a possibility, but most of the therapy for it seems to be similar to therapy for autism spectrum disorders. All three evaluations we've had gave recommendations that he should NOT be in an autism class room or have any of the ABA therapy protocols. Other than supporting him in a class room setting with communication with typically developing peers, what can be done to help him at age 3?

Susan_KW

Thanks for responding Auntie. I realized I used delay instead of disorder throughout after I hit post, but didn't know how to go back and edit. Right now DS has a "delay" and that's what was going through my mind. When I googled social communication disorder I mostly got a lot of blog posts about how it will be bad for kids with PDD-NOS, that it shouldn't be a stand alone diagnosis, and criteria for diagnosing it in later elementary/middle school age kids.

I don't know if he truly gets sarcasm or idioms yet. They aren't part of his vocabulary/interactions. For what it is worth, he doesn't seem overly literal in his language. He "gets" silliness (e.g. he loves it when we put something on top of our head and pretend that we don't know where it is, he loves watching slapstick cartons like Donald Duck or goofy). He likes to play around with language in some ways - he and his sister like to try to one up each other on who can use poop the most in naming each other and various toys (sigh). When watching shows he immediately picks up on funny vs scary. He likes to "hide" toys and then come up to us and ask where they are if we don't notice that said toy is missing.

But, something seems off in how he uses language sometimes that's hard to explain. He's never used our names to try to get our attention. He just shouts what he wants and waits for someone to respond or comes up to us and yanks on our shirt while yelling get me this or that. He doesn't get he should wave back or say hi/bye around greetings. The way he uses language to interact seems off. We know he understands what's going on at an advanced level (97th percentile for receptive - he's close to the test's ceiling). But, translating that into interactions is hard for him. He "gets" most of what should be delayed if he had a social communication disorder - but something gets scrambled in translating that into reciprocal interactions.

Susan_KW

@Auntie - yes, he imitates gestures. If you tell him to wave, he'll wave. If the teacher sings a song with accompanying gestures (e.g. Wheels on the bus or head, shoulders, knees and toes), he'll do the gestures too. He'll clap when others clap.

He understands names. He knows the names of class mates. He can answer who, what, where questions. He has no trouble with pronouns. He just doesn't use names to get someone's attention.

He's been able to do social referencing since before he talked. If a stranger came up to him in the grocery store and started fussing over him, he'd check for my reaction to make sure all was well. We'd play back and forth silly expression games, peek a boo and hide and seek games when he was younger. He comes up to show me his toys a lot (e.g. feeds me cookies and chocolate milk, set up a "truck" party, gives me a running commentary of the silliness going on in a show he's watching to make sure I share in the silliness). He's currently trying to convince my husband that my husband's beer is in fact poo poo. He doesn't do the hide toys thing often. I think he was playing a practical joke on me .

macchiatto

This is interesting to read through. One of my 5-year-olds possibly has SCD. His developmental pediatrician mentioned it when she evaluated him for ASD in Nov/Dec (and it was kind of a "close but no cigar" thing). He does have special interests that have existed since he was not quite 3, though they have evolved a little over time but we've kind of worked on that (i.e. "chaining" to get him interested in other things if we found a link between lions and the color purple and, say, superheroes or knights that his twin and other peers were into). Her emphasis was more on him being "at risk for ASD" (Asperger's, if it were still in the DSM) and while she put SCD on paper, among other things, I think I've focused more on the "at risk for ASD" piece. I read the diagnostic criteria for SCD and I could see a case made either way for him meeting them or not.

What seems familiar to me from your post is having good expressive and receptive language but something seeming off in how he uses language to interact; not "getting" how to respond to things like bye, good night, etc. He has *some* good social skills now at 5, especially in his structured preschool environment--his preschool teachers have no social concerns about him--but definitely struggles with the reciprocal side of things and has for a long time, in spite of EI, his former feeding therapist (an SLP) and us working with him on them. He has definitely evolved in these areas since he was 3 but things are still muddy, and while he's gained skills, he's not where we hoped he would be given some of his therapists' initial predictions that he would probably outgrow his delays by Kindergarten, with therapies. I know the "wait and see" approach can be tough when you're hoping for clearer answers and understanding. Just know you're not alone.