Social Pragmatic Communication Disorder

amother

Denim

Fri, Apr 16 2021, 7:34 am

It’s not a new disorder at all

It just means a social language disorder
It’s sometimes called pragmatic language disorder
Sometimes semantic-pragmatic language disorder
And sometimes a plain social communication disorder

It means your child has social-communication difficulties but doesn’t quite meet the criteria for autism.

It’s often confused with autism, non verbal learning disability, and/or other language disorders that may have some social component to them.

Make sure the professional who diagnosed you really knows his/her stuff. If it was just someone at school, for example, I’d get another opinion. It needs to be diagnosed through excellent formal testing, and not just school based testing for an IEP.

Often children with ADHD also have this, but not always.

It should be treated by an excellent speech language pathologist with particular social-language expertise.

amother

Fri, Apr 16 2021, 7:53 am

amother [ Denim ] wrote:

Thank you.

He was diagnosed by a doctor who screened him for about 8 hours. Maybe 10, I dont remember.

I had understood at the time that in the past, someone who presented like my son would have been diagnosed with Aspergers, but since they don't give that diagnosis anymore, they now call it a communication disorder.

They also said he has mild ADHD.

He is not in any treatment now, but was seeing a therapist for about 2 years. (He is almost 18 now). He is not taking any meds now either.

Can you recommend any books or literature I can read about this disorder?

amother

Denim

Fri, Apr 16 2021, 8:13 am

What kind of doctor diagnosed him?
Did he have neuropsych testing?

No...people who would’ve been diagnosed with Asperger’s would now get an autism spectrum diagnosis, not pragmatic language disorder.

This diagnosis and Asperger’s are actually mutually exclusive.

I would make 100% sure he’s not on the spectrum.
(He’s probably totally not - I’m just throwing that out).

Also, what type of therapist treated him?

A social worker is excellent for the emotional aspect of this, but probably didn’t do what a speech-language pathologist could do.

Where are you located?

Look up Michelle Garcia Winner.

She is excellent.

She has a great book ‘Thinking about me, thinking about you’.

She also has other fantastic stuff, both on her website and for sale.

You can also watch a lot of informative YouTube videos by her.

This is her expertise - she’s world famous.

amother

Fri, Apr 16 2021, 8:36 am

amother [ Denim ] wrote:

He was diagnosed at age 13, and he is almost 18 now. So I don't remember exactly about the doctor, but when I google his name, it just says Psychologist ..., PsyD is a clinical child & adolescent psychologist.

So my question about the "label" is like this:

I understand that the diagnosis of Aspergers is not used anymore..is that true?

The way I understood it is that in the past, people would be diagnosed as Aspergers, but since they dont have that diagnosis anymore, (is that true??) the doctor now has to give a diagnosis of Autism (if he is on the spectrum) or Communication disorder (if he is more high functioning) in which case, he would not qualify for any benefits.

Is this at all accurate or have I not understood this correctly?

The reason I ask this is because no one has ever heard of a Social Pragmatic Communication Disorder, or of any Communication disorder. But they have heard of Aspergers. If his teachers tell me that they are having difficultues with him, they don't know what they are dealing with. Would it be untrue if I say he has "aspergers"?
Based on what I read about Aspergers, he seems to fit the description, but I have no training. I am only his mother.

As I said, its a few years later, so I'm not sure what I am dealing with now. He is and always has been in a regular mainstream yeshiva.

I am not in the Tri-State area.

Thanks for taking the time to answer my questions.

amother

Fri, Apr 16 2021, 8:47 am

Is he too old for therapy with a speech language pathologist? Have I missed the window?
He had gotten speech therapy for a year for his lisp, but there was no focus on other aspects of speech language. (Though a year or so later the therapist told me that she had mentioned it at the time , but I don't think I knew what it meant.) He also had OT for a year or so.

EtA: after his diagnosis, he also had therapy for 2 years with a therapist that works with teens. Again, I don't know his official qualifications.
He also went to a highly qualified psychiatrist who prescribed his ADHD meds, and met with him about 6 times.
Today he is not taking any meds.(mainly because he is in a yeshiva dorm now and Im not on top of him to take it, so he fell out of the habit.)

amother

Slateblue

Fri, Apr 16 2021, 11:46 am

amother [ OP ] wrote:

8 HOURS?! How does that even work?

amother

Denim

Fri, Apr 16 2021, 11:49 am

It’s hard to know the answer to the question about whether he would really have Asperger’s or not.

Asperger’s was always considered on the spectrum, because of other criteria - not just the social communication part, so if he truly would’ve been diagnosed with Asperger’s in the past, he should have gotten a diagnosis of being on the spectrum at this point.

If not, he’d get a diagnosis of pragmatic language disorder.

It might be worth it to have a psychologist just do an ADOS test or something, or see what your doctor would say, because if he’s really on the spectrum he could still benefit a ton financially. Most states have special insurance rules (both for private and Medicaid insurances) that give extra coverage for autism.

You didn’t miss the boat and he could benefit a lot from a trained SLP - someone really skilled in social communication.

If you’re not in the tri-state area your best bet would be to contact Michelle Garcia Winner and see if she has any ppl she trained in your area.

You can also call Relief and and ask for a recommendation and maybe they’d see your son over zoom.

paperflowers

Fri, Apr 16 2021, 12:15 pm

ASD includes difficulty with socializing, communication, and stereotypical behaviors. That last category includes things like repetitive movements, rigid thinking, and restricted interests. Aspergers was a form of high functioning autism, diagnosed when the individual didn’t have early language delays.

Social Pragmatic Communication Disorder includes having trouble with social communication, but not stereotypical behavior. It was new in the DSM 5.

So can you call it Aspergers? They are different things because Aspergers criteria includes the rigid thinking and restricted interests. I might say he has something similar to Aspergers. According to some, most people diagnosed with Social Pragmatic do have stereotypical thinking, just more subtle so it gets overlooked. So he may actually have met criteria for Aspergers, but it’s hard to say.

I agree with others above that it’s not too late for therapy for social communication.

Why are you asking now? How is it affecting his life in a way that you want to address?

amother

Fri, Apr 16 2021, 1:40 pm

paperflowers wrote:

Why am I asking now? That's a good question. There is no special reason. Maybe its because here on Imamother, I see so many women complaining about their difficult husbands, and I worry that we have not done all we could to help our son be the best version of himself, to be the best future husband and father he could be.

I also think about who will marry him, though I know we have a few years to go before srarting to worry about that.

Also, every now and then, I need to explain why my son is "different" so I say something like, "he has a mild form of aspergers". Which I have no idea if it's accurate, but I feel I need to explain that it's the way he is wired.

Btw, we never gave my son any info about his diagnosis. He just thinks he has ADHD, which is true as well.

I don't know exactly what you mean by stereotypical behaviors; but my son definitly has rigid thinking, and limited interests. He obsesses over those interests and will talk and think about them for hours. He had many repetitive movements when he was younger
.Like, for a while, he used to play with his tzitzis all day. Or throw his yarmulke in the air and catch it as if its a baseball.

These days he will randomly catch an imaginary ball and "throw" it into an imaginary hoop. He does this all day. (He loves sports). He listens to sports radio all day and can tell you all the stats from almost any team (at least it seems that way to me.)
When he was very little, (around 5 and 6), he used to sit with a Stone Tanach and read the whole Tanach. And ask questions about discrepancies between the kings in Melachim and divrei Hayamim.

So he has the "proffessor" part and also the OCD tendencies.

He often will not make eye contact, but when he does, it's like his eyes are boring into you. He has sensory issues, and it took him until age 12 to agree to take showers (as opposed to baths), and he refused to wear his glasses , which he needed badly, for many years. He is very bothered by certain noises.

He perseverates a lot. When he wants sometthing, he simply won't give up until he has it.

amother

Royalblue

Fri, Apr 16 2021, 2:54 pm

amother [ OP ] wrote:

No! Never too late. I'm an SLP and I work with adults and high school students your sons age

amother

Fri, Apr 16 2021, 3:07 pm

amother [ Denim ] wrote:

Your son sounds like he has high functioning autism, not pragmatic language disorder. Please get him re-evaluated; he can qualify for a lot of services.

And please do get good social communication help. This is a must so that he can have a healthy marriage and be able to hold down a job...

Social communication help means a therapist who will work with him in his social skills or something else?

The therapist that he worked with for 2 years recommended that he move into the yeshiva dorm so that he is forced to be in a social setting. At home he basically kept to himself, and never got together with friends. Now he is in the dorm and he does have a lot of friends. He enjoys being in the dorm and he is happy in Yeshiva.

He is pretty sharp and funny, and I think kids like him. At home, he doesnt communicate at all with the brother closest to him in age, but he loves to play with the babies.

He has a lot of trouble following directions. Like, I'll say, go to the kitchen and bring me the mayonnaise, he will never find it or somehow not understand what I am asking. He is extremely time challenged.

He has a very difficult time with transitions and new experiences. He used to get all bent out of shape if I made an appointment for him without telling him in advance. Or even worse, if I told him the day before that he had an appointment. A few years ago, I got new soup bowls but he still refuses to eat soup in them. So I always serve his soup in the old set.

He is a very black and white thinker, and always asked "what if" questions.

amother

Burgundy

Fri, Apr 16 2021, 3:13 pm

amother [ OP ] wrote:

This sounds about right, my child is the same way. Speech therapists help them with theory of mind and how to put their thoughts out there in a more organized way. The time issue probably hasto do with slow processing speed, I would get that checked out so your child can have more time in tests if needed.

amother

Denim

Fri, Apr 16 2021, 3:22 pm

So actually, the time management issue is an executive functioning skill. ADHD, by definition, is an executive functioning disorder. It is not usually due to a slow processing speed.

The problems following directions may be attention related, comprehension related, or working memory related (working memory is a component of your IQ, an executive planning skill, and heavily dependent on good internal focusing skills. It involves keeping information in your brain and manipulating it without losing it. It is essential for all learning, following a conversation, carrying out instructions, etc.)

Aside from getting an actual diagnosis of autism so you can maximize insurance benefits, I would recommend an excellent speech and language evaluation to get an exact picture of strengths and weaknesses.

A speech language pathologist could address all the social concerns as well as executive planning difficulties and other language disorders.

Please go to someone very skilled so you don’t waste time.

amother

Burgundy

Fri, Apr 16 2021, 3:51 pm

amother [ Denim ] wrote:

Not always. Sometimes it's slow processing speed and it gets misdiagnosed as ADHD. That's why it's important to get a very thorough evaluation.