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Social Pragmatic Communication Disorder

Social Pragmatic Communication Disorder

Social pragmatic communication disorder (SPCD) is a disorder that is characterized by difficulties using verbal and non-verbal communication skills appropriately. SPCD is usually recognized in early childhood, after language skills have been somewhat developed, but can be seen into adolescence. SPCD was introduced in 2013 after some heated debate as to its origins and its effects. Many researchers have argued that SPCD is an offshoot of autism spectrum disorder (ASD), while others insist that it should be its own diagnosis. SPCD has been classified as a disorder that affects communication but does not share some of the symptoms of ASD such as repetitive behaviors or other learning delays. Symptoms of SPCD are sometimes difficult to diagnose. Cultural difference in communication styles, and ruling out other possible reasons for communication issues can be challenging. However, a mental health professional or a speech and language pathologist will be able to assess a child’s communication abilities and make the appropriate diagnosis. Research in the field of communication disorders has become more prevalent in recent years, but currently, there is no known cause for SPCD. Most professionals do agree that it is the result of a neurodevelopmental disorder.


Difficulty greeting others.

Difficulty sharing information in the appropriate social context.

Difficulty understanding or following basic rules of conversation such as taking turns or active listening (uh-huh, ok, wow, then what?)

Expressing nonverbal communication such as looking at the speaker.

Difficulty understanding humor, sarcasm, metaphors.

Difficulty changing communication style based on the environment, such as no concept of indoor voice, no understanding that communication at the dinner table is different than communication with friends at school, speaking to unfamiliar adults, vs. speaking to relatives.

Difficulty interpreting or inferring statements.

Only understanding the literal meaning of words.

No understanding of social or environmental context when speaking at home, at a restaurant, on the playground, adults vs. peers.


Access to treatment early on yields the best results. Treatment of SPCD is often done through behavioral therapy, speech therapy, and parental support. Behavioral therapy models and reinforces skills such as greeting someone, using manners, nonverbally engaging with the speaker, talking about relevant information, reciprocating ideas with another, active listening. Behavioral therapy relies on rewarding positive behavior until it becomes second nature. So, if a child says “hi, how are you today” to a friend and waits for a response, they would be rewarded with praise (or a treat), thus encouraging the child to continue the behavior. Correcting behaviors over and over again can help a child learn how to speak to others in an appropriate social and environmental context. A speech therapist would be able to work with a child one-on-one to develop the skills necessary to understand the context of words. Learning the meaning of humor, inferences, and metaphors can be addressed through role-playing and games. Helping parents fully understand SPCD and how to support behavioral intervention is valuable. Consistency at home will be key in making sure the appropriate learned behaviors are reinforced. Keeping a progress / token economy chart on the fridge, praising every appropriate interaction and correcting inappropriate communications will help keep your child on track.


Diagnosis of SPCD can often be a long and difficult task. Prepare and be patient.

Most schools will be able to provide a speech therapist. Talk to your child’s school about classroom support.

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Social Pragmatic Communication Disorder2018-02-20T14:43:22+00:00

Selective Mutism

Understanding Selective Mutism

Selective Mutism is a disorder usually identified in children over the age of five. It is a form of anxiety that inhibits children from speaking in situations where speaking would be expected. These situations may be at school, with friends, with safe adults, etc. The child may be talkative at home or in certain environments, but will not say a word at school or at daycare. Most often a child will appear shy or uncomfortable when expected to speak. They may shut down or withdraw from the environment. They will most likely avoid attention from others and isolate themselves. At school, these children may not want to answer questions, do any public speaking or participate in group activities. Too often this leads to disciplinary issues or further reinforces the child's anxieties when forced to participate. The inability to speak must be limited to certain situations and not as a result of a medical issue that would prevent speech.

Signs of Selective Mutism

Child acts nervous around others

Child is always acting shy

Child does not want to speak to others

Child struggles to speak clearly and correctly in certain situations

Child struggles to communicate needs and wants

Child has been diagnosed with an anxiety disorder in the past

Teacher has talked with you about your child's resistance to class participation


Treatment for Selective Mutism has a great prognosis. Over time, the anxieties lessen, and the child is more willing to engage in verbal expression. Medications can be used to lower levels of anxiety however, various therapies can have a more dramatic impact. Behavior therapy is effective in that it reinforces any positive forms of communication. For example, a child’s teacher “says good morning. He timidly replies, “good morning.” If his teacher reinforces his use of communication positively his anxiety may be reduced and may encourage him to do it again tomorrow morning. Communication therapy helps the child effectively communicate needs and wants to adults and peers. Many children may shut down or use nonverbals to answer questions such as nodding or shaking their head. Having the child use “yes,” “no,” or “I don’t know” is a great place to start opening lines of appropriate communication. Small levels of exposure to the anxiety-producing situations can be helpful but must be taken slowly. For example, while out walking the family dog, a child gets nervous when a neighbor says “hello.” He might try to stay away from this neighbor hoping to avoid interaction. Exposure therapy would place the child in a situation where he would walk past the neighbor’s house regularly until the perceived threat subsides. He may then be able to respond with “hello” when his neighbor greets him again. This will take some time, and should be carefully monitored in order not to create more reasons to be nervous.

With respect to school, it is important to have open lines of communication with your child’s teachers. They need to understand your child’s strengths and weakness while not placing them in situations where they are bound to fail. Group participation, answering questions, and public speaking needs to be on their level with expectations increasing slowly over time.

The difficulty with Selective Mutism is that it can be tricky to diagnose. Make sure to consult with an experienced professional to get the correct diagnosis and treatment.

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Selective Mutism2018-02-12T12:07:34+00:00

Expressive Language Disorder

Understanding Expressive Language Disorder

Expressive Language Disorder, abbreviated ELD, is a type of communication disorder that affects a child's development of language and ways to communicate verbally. A child with ELD will have difficulty with verbal or written expression, but will not struggle with comprehension. They usually have no other academic or developmental impairments and will fall within a normal range of developmental and academic milestones. For example, if a six-year-old with ELD is asked a question, they may respond with a short incomplete sentence or may not be able to find the right words to use, but will be able to comprehend “put your toys away.”

Signs of Expressive Language Disorder

Below average vocabulary skills

Difficulty forming complex sentences

Speaking in short sentences

Using general and non-descriptive words

Difficulty remembering words

Improper use of words

Using words in the wrong order

Improper use of tenses – “I will threw the ball” instead of “I will throw the ball.”

Causes and Impact of ELD

There are two categories of ELD: Developmental and Acquired. Developmental ELD has no known cause. It is thought to perhaps be due to genetics, but this theory is still not fully understood. Acquired ELD has been linked to brain injury, seizures, and malnutrition.

Because ELD causes difficulty with communication, children often experience academic and social repercussions. Low self-esteem, difficulty making friends and academic issues are most commonly seen. Although ELD does not impact learning or development, some aspects of academia expect children to express their ideas verbally or in a written format. Without proper support and treatment, it may be extremely difficult for a student with ELD to reproduce what their teacher is asking for. For example, a class is instructed to give a presentation on an aspect of United States history; a child with ELD may not be able to use the necessary words, complex sentences, or correct terminology to complete this assignment.


A diagnosis of ELD will be made by a speech-language pathologist. The pathologist will conduct a series of tests to reach a diagnosis and will also try to rule out any other possible causes. Treatment and prognosis vary based on the severity of the symptoms. A child struggling with malnutrition will most likely have an easier time recovering than a child with a severe brain injury. Despite the cause of ELD, speech therapy has proven to be the best treatment. Speech therapists will use progressively more challenging activities to help increase the proper use of words, verbal expressions, and complex sentences. ELD will not cure itself, so early detection and treatment are key. If a child receives treatment for ELD (the earlier the better), they will most likely catch up to their peers quickly.

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Expressive Language Disorder2018-02-12T11:24:01+00:00