Social Communication Disorder: Signs, Diagnosis, and Speech Therapy
Social communication disorder is ongoing trouble knowing how to use language and engage in social situations. Sometimes it involves difficulty reading the room, taking turns, and interpreting what someone means.
Social communication disorder is a separate diagnosis from autism spectrum disorder. An evaluation can determine whether it's autism or social communication disorder. Speech therapy can help with social communication skills.
In this article, you'll learn what social communication disorder is, the signs in children and in adults, how it's diagnosed, and what speech therapy involves. This article is for adults who recognize the pattern in themselves and for parents who notice these struggles in their child.
Key Takeaways
What it is: Social communication disorder is ongoing difficulty using verbal and nonverbal communication with others. The main difficulty is using language in everyday social interactions.
Not the same as autism: The diagnosis is made only when the person does not have the pattern of restricted or repetitive behaviors that an autism diagnosis requires. The two are distinct disorders rather than points on one scale.
Adults have it too: Social communication difficulties often go unnoticed until the teenage years or adult life, when social demands grow. The difficulties begin during early development, even if they aren’t recognized until much later.
What helps: Speech therapy can improve social communication skills, and the work uses real conversations and role-play rather than drills.
What Is Social Communication Disorder?
Signs of Social Communication Disorder
Social Communication Disorder in Adults
How Social Communication Disorder Is Diagnosed
Speech Therapy for Social Communication Disorder
What We See Working with Clients
Frequently Asked Questions About Social Communication Disorder
What Is Social Communication Disorder?
Social communication disorder (SCD) involves persistent difficulties using verbal and nonverbal communication in social situations. The American Psychiatric Association lists it as a neurodevelopmental disorder in the Diagnostic and Statistical Manual of Mental Disorders. SCD may coexist with other communication disorders.
Someone with social communication disorder can have a strong vocabulary and use grammatically correct sentences, but have difficulty knowing how to use language appropriately in different social situations.
Pragmatics is the word for the social side of language. It covers greeting someone, giving the right amount of detail, taking turns, and changing how you talk to suit who is listening. Social communication disorder affects those skills rather than the words themselves.
You will also see it written as social pragmatic communication disorder, or SPCD. Older writing used the term "semantic pragmatic disorder," and some sources still use "pragmatic language impairment." Those older terms describe some of the same pragmatic difficulties, but they do not mean exactly the same thing as the current diagnosis.
The specific difficulties can look different from person to person. Someone may communicate well one-to-one but struggle to keep up in a group conversation, while someone else may struggle with social communication across many different situations.
What Causes Social Communication Disorder?
No one knows the cause of social communication disorder. The Diagnostic and Statistical Manual notes that a family history of autism, communication disorders, or learning disorders appears to raise the risk. That does not explain every case.
Signs of Social Communication Disorder
The signs of social communication disorder show up in everyday conversations and interactions. A person may:
Have trouble using communication for social purposes. They may not know how to greet someone, ask for something appropriately, start a conversation, or share information in a way that fits the moment.
Have difficulty changing how they communicate for different people or situations. They may talk to a teacher or manager the same way they talk to a close friend, or struggle to adjust their language for a younger child.
Struggle with the back-and-forth of conversation. They may interrupt, have trouble taking turns or staying on topic, give too much or too little information, or not realize when a listener is confused.
Take language too literally. Sarcasm, humor, idioms, hints, and indirect requests can be difficult to understand.
Nonverbal communication can be difficult too. A person may have trouble interpreting facial expressions, body language, tone of voice, or other signals that help us understand what someone means beyond their words.
Telling a story can also be challenging. A person may leave out important background information, tell events out of order, or assume the listener knows something they haven't explained.
In children, these difficulties often become more noticeable at school as social and conversational demands increase. A child may frequently interrupt, miss facial expressions or other social cues, have trouble joining conversations, or misunderstand what another person means. These difficulties can sometimes be mistaken for shyness, behavior problems, or simply social awkwardness.
Social Communication Disorder in Adults
Social communication disorder does not necessarily resolve during childhood, and some people do not recognize their social communication difficulties until adulthood. Because some of the signs overlap with autism, an adult may first wonder if they are autistic. However, SCD and autism are different diagnoses. You can read more about what it means to be diagnosed with autism as an adult.
For some people, the difficulties become clearer in the teenage years, as friendships and school get more complicated. In other cases, they surface at a first job, with meetings, small talk, and colleagues who expect quick back-and-forth.
At work, the difficulty shows up as conversations that stall, feedback that lands wrong, and instructions taken literally when something else was meant. In social relationships, missed cues and misunderstandings can make friendships harder to start and maintain.
By adulthood, some people have found their own ways to make social situations easier. Scripts for phone calls, rehearsed openers, and staying quiet in groups can make conversations feel more predictable and manageable, but relying on these strategies can take a lot of effort. Speech therapy works on the social pragmatic communication skills themselves, not just on the workarounds.
How Social Communication Disorder Is Diagnosed
A speech-language pathologist can diagnose social communication disorder through a comprehensive speech and language evaluation. The evaluation looks at how the person understands and uses language, how they communicate in social situations, and how their communication has developed over time.
Information may come from standardized testing, observation, interviews, questionnaires, and reports from parents, teachers, or other people who know the person well. Because social communication changes depending on the situation and communication partner, no single test is enough to make the diagnosis.
The six areas described in the image above on Signs of Social Communication Disorder are based on the diagnostic criteria for SCD. For a diagnosis, difficulties must be present in all four areas, interfere with social participation, relationships, school, or work, and begin during early development.
Diagnosis can be difficult in very young children because they may not yet have developed enough language for higher-level social communication difficulties to become apparent.
An adult evaluation covers much of the same ground, with particular attention to early development and how communication affects relationships, work, and everyday life. School reports, the person's own memories, and information from a parent, sibling, or someone else who knew them as a child can help establish that the difficulties began during early development.
If there is not enough information about early childhood, the clinician documents what is known rather than making assumptions.
Differential Diagnosis and Related Disorders
Part of diagnosing social communication disorder is determining whether another condition better explains the person's difficulties. Depending on the person's symptoms and history, the speech-language pathologist may work with a psychologist, neuropsychologist, audiologist, physician, or other professional as part of that process.
One of the most important distinctions is between SCD and autism spectrum disorder. Both can involve significant social communication difficulties, but autism also includes restricted or repetitive behaviors, interests, or activities.
In everyday life, these may include a strong need for sameness, repeated movements or speech, highly focused interests, or unusual responses to sensory experiences such as sounds or textures. These features can look very different from one person to another.
| Condition | What it involves | How it differs from social communication disorder |
|---|---|---|
| Autism spectrum disorder | Social communication differences plus restricted, repetitive behaviors and deep focused interests | Autism includes the required pattern of restricted or repetitive behaviors, interests, or activities. Social communication disorder does not |
| Developmental language disorder | Difficulty learning and using grammar and vocabulary | The trouble is understanding or using language, rather than using it socially |
| ADHD | Differences in attention, impulse control, and activity level | Attention and impulse-control differences can cause similar communication problems, so the evaluation looks at what is driving them |
| Intellectual disability | Broader differences in reasoning and everyday living skills | Social communication is affected alongside reasoning and everyday living skills |
| Connected Speech Pathology | connectedspeechpathology.com | ||
Social communication disorder is diagnosed only when autism does not better explain the person's difficulties. The distinction matters because autism can involve needs beyond social communication. Some treatment goals may overlap with those addressed in speech therapy for autism, while others may be different.
Other conditions can also affect social communication. ADHD, for example, can affect attention, impulse control, and turn-taking. Intellectual disability, learning disabilities, and language disorders may also contribute to communication difficulties.
Developmental language disorder can sometimes look like a social communication problem. With a language disorder, however, difficulties with understanding or using vocabulary and sentence structure are part of the broader language impairment rather than the primary problem being the social use of language.
Hearing should also be considered. A person who does not consistently hear parts of a conversation may appear to miss information or social cues. An audiologist can evaluate hearing when there is a concern.
Social communication disorder can occur alongside some other conditions, including ADHD, learning disabilities, and language disorders. How often these conditions occur together is not well established.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders introduced social communication disorder as a separate diagnosis in 2013. Before then, people with similar communication profiles may have received other labels or diagnoses. Social communication disorder is its own diagnosis, not a milder form of autism.
Social Pragmatic Communication Disorder vs. Autism Spectrum Disorder
A side-by-side look at where the two diagnoses overlap, where they differ, and what each one means for speech therapy.
Speech Therapy for Social Communication Disorder
Speech therapy for social communication disorder targets the social side of language directly, rather than speech sounds or grammar.
A speech-language pathologist sets up real conversations, watches what happens, and gives feedback while you practice. Depending on your needs, the work uses role-play, video review, and rehearsals of specific situations, such as joining a group or ending a call.
Speech therapy also covers nonverbal communication skills. You practice noticing and using facial expressions, body language, and tone of voice in conversation.
What you practice depends on the situations that are hard for you, and the plan changes as they get easier.
Social skills groups give people a chance to practice with several others at once, which a one-to-one session cannot offer. Working with peers who have similar difficulties is a step toward using social communication skills in harder social contexts.
In social communication therapy for children, speech therapists sometimes use a visual support, such as a card showing the steps of a conversation, while the child practices.
Support outside sessions helps social communication skills carry over into daily life. Teachers and managers who understand the difficulty can give clearer instructions and check that both people understood the same thing. For that reason, speech therapists often coach parents, partners, and teachers.
Research specifically on speech therapy for social communication disorder is still limited. In practice, the work centers on the communication problems that get in the person's way.
What We See Working with Clients
The examples below are based on real clients we have worked with. Identifying details have been changed to protect privacy.
One man came to us at 34, after a performance review described him as blunt. He had never had trouble with words. In meetings, he answered the question asked and missed the one underneath it, and his team started routing decisions around him.
We started with recordings of his own meetings, looking for the moments where a colleague's tone shifted while he kept talking. He practiced saying out loud what he thought a colleague meant, asking one clarifying question before answering, and giving his reasoning before a recommendation, not after.
He reported fewer misread exchanges and said his team had started bringing decisions back to him.
A teenager worked with us because she often talked over her friends and struggled to show interest in what they had to say. Over time, she was being left out socially and had started eating lunch alone.
In therapy, she practiced having back-and-forth conversations, including asking follow-up questions, giving the other person time to talk, and noticing when it was time to listen rather than keep talking. As these skills became more natural, she needed fewer reminders to use them.
Her parents also began noticing changes outside of therapy. She asked other kids more about themselves, conversations became more balanced, and lunchtime got easier.
Frequently Asked Questions About Social Communication Disorder
1. Is social communication disorder a form of autism?
No. Social communication disorder and autism spectrum disorder are separate diagnoses in the Diagnostic and Statistical Manual of Mental Disorders. The diagnosis of social communication disorder is made only when the person does not have the pattern of restricted or repetitive behaviors, interests, or activities required for an autism diagnosis.
2. At what age can social communication disorder be diagnosed?
Before about age 4 or 5, social communication disorder is hard to diagnose. Normal variation in social language makes the pattern difficult to separate from typical development. The difficulties have to begin in early childhood, so a later diagnosis rests on that history.
3. Can adults have social communication disorder?
Yes. Some people are not identified until adulthood, when social demands at work or in relationships make the difficulty easier to see. Difficulties that were manageable at school get harder to work around.
4. Does social communication disorder go away?
Social communication disorder looks different over time and from person to person. Some people improve a great deal, and others still find social communication hard as adults. Many people build skills and strategies that make conversations easier.
5. Can speech therapy help social communication disorder?
Yes, though how much someone improves varies from person to person. The work targets real conversation, and progress depends on your goals and how often you get to practice.
6. Does online speech therapy work for social communication disorder?
Online speech therapy can be a good fit, though not for everyone. Many social communication skills can be practiced through conversation during a video session. A speech-language pathologist can help you decide what makes sense for you.
How Connected Speech Pathology Can Help
At Connected Speech Pathology, our licensed speech-language pathologists work with children, teenagers, and adults who have difficulty with social communication. Online sessions focus on the situations that matter in everyday life, such as joining a conversation, making friends, participating in a group, or communicating more effectively at school or work.
We respect each person's individual communication style. The goal is not to change who you are or make you communicate like everyone else. Online social skills training provides individualized support for understanding social cues, navigating conversations, and communicating more comfortably and effectively with other people.
Summary
Social communication disorder involves persistent difficulty using verbal and nonverbal communication in social situations. A person may have a strong vocabulary and speak in complete sentences but struggle with conversation, social cues, nonliteral language, or adjusting how they communicate in different situations.
SCD is a separate diagnosis from autism spectrum disorder, although the two can share some social communication difficulties. A comprehensive evaluation looks at the person's communication skills, developmental history, and whether another condition better explains the difficulties.
Speech therapy can help children, teenagers, and adults build social communication skills they can use in everyday life. Treatment is individualized and may focus on skills such as starting and maintaining conversations, taking turns, reading social cues, understanding what others mean, and communicating more effectively in different situations.
About the Author
Allison Geller, M.A., CCC-SLP, is a communication coach, speech-language pathologist, and founder of Connected Speech Pathology, an international online practice providing professional communication coaching and speech therapy for children, teens, and adults. With more than two decades of experience, she has worked in medical and educational settings and published research on aphasia. Today, she leads a team of specialists who help clients improve their skills in public speaking, vocal presence, accent clarity, articulation, language, fluency, and interpersonal communication.
