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Social (pragmatic) communication disorder: clinical predicaments

Peixoto I.1; Marques C.1

1- Àrea de Pedopsiquiatria, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central,

- 16th ESCAP Congress (Poster)
- Peixoto et al. Social (pragmatic) communication disorder: clinical predicaments. Eur Child Adolesc Psychiatry (2015) 24 (Suppl 1):S1–S303 (Publicação de Abstract)

Background: The DSM-5 has introduced a new clinical diagnosis, social (pragmatic) communication disorder, for children who do not meet criteria for autism spectrum disorder but who show social communication and pragmatic language impairments. This has raised concern with the diagnosis in its current form, as such impairments are likely to be present in other neurodevelopmental disorders and in language and cognition disorders. It is our aim to outline the challenges evoken in clinical conceptualization and assessment.
Method: Selective review of the evidence was conducted with a computerized search on PubMed (MEDLINE). Assessment approaches and clinical implications are discussed and illustrated with a clinical case.
Results: This clinical case portraits well the clinical assessment and diagnostic challenges posed by social (pragmatic) communication impairments. Once pragmatic deficits are strongly associated with a number of clinical groups and developmental concerns, assessment measures are unlikely to help in the diagnosis as they lack sensitivity and specificity. The broad dimensional view of such impairments and the requirement of fulfillment of all four specified criteria may also preclude the diagnosis in young people.  Furthermore, although intimately related, the impairments of pragmatics and social communication are not necessarily the same and both are necessary for the diagnosis.
Conclusions: Existing evidence supports the view of social and pragmatic communication impairments as symptoms rather than a diagnostic entity. Clinical research in the future must develop valid assessment tools bearing this new entity in mind, and compare pragmatic profiles across different neurodevelopmental disorders in order to establish the validity of the diagnosis. Moreover, developmental trajectories and etiology studies may improve consistency as well as advance our understanding of the diagnosis.

Keywords: Social communication, Pragmatic disorder, Assessment; Child psychiatry