DSM-5 introduced two diagnoses describing neurodevelopmental deficits in social communication (SC); Autism Spectrum Disorder (ASD) and Social (Pragmatic) Communication Disorder (SPCD). These diagnoses are differentiated by Repetitive and Restricted Behaviors (RRB), required for an ASD diagnosis and absent in SPCD. We highlight the gaps between the research into SPCD and DSM-5’s diagnostic criteria, and discuss the clinical implications of this diagnostic decision. We argue that DSM-5’s demand for full manifestation of both SC and RRB axes when diagnosing ASD, prematurely forced a categorical view on the continual nature of the potentially dependent SC and RRB phenotypes. We conclude by highlighting the implications of this differential diagnostic decision on public health policies, designated therapy, and the need for further research regarding SPCD.
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Partial representation of the RRB category may be found in tic disorders that are often accompanied by social deficits due to the social isolation caused by the tic behaviors. However, the current definition of tic disorders fails to fully cover the RRBs manifested in ASD.
Adams, C. (2002). Practitioner review: The assessment of language pragmatics. Journal of Child Psychology and Psychiatry, 438, 973–987.
Adams, C. (2015). Assessment and intervention for children with pragmatic language impairment. In D. A. Hwa-Froelich (Ed.), Social communication development and disorders (pp. 141–170). New York: Psychology Press.
Adams, C., Cooke, R., Crutchley, A., Hesketh, A., & Reeves, D. (2001). Assessment of comprehension and expression 6–11 (ACE 6–11). Windsor: NFER Nelson.
Adams, C., Lockton, E., Freed, J., Gaile, J., Earl, G., McBean, K., & Law, J. (2012a). The Social communication intervention project: A randomized controlled trial of the effectiveness of speech and language therapy for school age children who have pragmatic and social communication problems with or without autism spectrum disorder. International Journal of Language and Communication Disorders, 47(3), 233–244.
Adams, C., Lockton, E., Gaile, J., Earl, G., & Freed, J. (2012b). Implementation of a manualized communication intervention for school aged children with pragmatic and social communication needs in a randomized controlled trial: The social communication intervention project. International Journal of Language and Communication Disorders, 47(3), 245–256.
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders 3rd edition revised (DSM-III-R). Washington: American Psychiatric Association.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders 4th edition revised (dsm-iv). Washington: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders 5th edition text revision (DSM-V). Washington: American Psychiatric Association.
Bailey, A., Palferman, S., Heavey, L., & Le Couteur, A. (1998). Autism: The phenotype in relatives. Journal of Autism and Developmental Disorders, 28(5), 369–392.
Baron-Cohen, S., Golan, O., Chakrabarti, B., & Belmonte, M. K. (2008). Social cognition and autism spectrum conditions. In C. Sharp, P. Fonagy, & I. Goodyer (Eds.), Social cognition and developmental psychopathology (pp. 29–56). Oxford: Oxford University Press.
Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The autism spectrum quotient (AQ): Evidence from asperger syndrome/high functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31, 5–17.
Bertilsdotter Rosqvist, H., Brownlow, C., & O’Dell, L. (2013). Mapping the social geographies of autism—online and off-line narratives of neuro-shared and separate spaces. Disability and Society, 3(28), 367–379.
Bishop, D. V. M. (2003). Children’s communication checklist-2nd edition. London: Psychological Corporation.
Bowers, L., Huisingh, R., & LoGiudice, C. (2008). Social learning developmental test: elementry. East Moline: Linguisystems.
Brunsdon, V. E., & Happé, H. (2014). Exploring the ‘fractionation’ of autism at the cognitive level. Autism, 18(1), 17–30.
Carrington, S., Leekam, S., Kent, R., Maljaars, J., Gould, J., Wing, L., & Noens, I. (2015). Signposting for diagnosis of autism spectrum disorder using the diagnostic interview for social and communication disorders (DISCO). Research in Autism Spectrum Disorders, 9, 45–52.
Carter, J. A., Lees, J. A., Murira, G. M., Gona, J., Neville, B. G., & Newton, C. R. (2005). Issues in the development of cross-cultural assessments of speech and language for children. International Journal of Language & Communication Disorders, 40(4), 385–401.
Chakrabarti, B., Dudbridge, F., Kent, L., Wheelwright, S., Hill-Cawthorne, G., Allison, C., & Baron-Cohen, S. (2009). Genes related to sex steroids, neural growth, and social–emotional behavior are associated with autistic traits, empathy, and Asperger syndrome. Autism Research, 2(3), 157–177.
Christ, S. E., Kanne, S. M., & Reiersen, A. M. (2010). Executive function in individuals with subthreshold autism traits. Neuropsychology, 24(5), 590–598.
Constantino, J. N. (2002). The social responsiveness scale. Los Angeles: Western Psychological Service.
Constantino, J. N., & Gruber, C. P. (2012). The social responsiveness scale, 2nd edition (SRS-2). Los Angeles: Western Psychological Services.
Constantino, J. N., Gruber, C. P., Davis, S., Hayes, S., Passanante, N., & Przybeck, T. (2004). The factor structure of autistic traits. Journal of Child Psychology and Psychiatry, 45, 719–726.
Constantino, J. N., Lajonchere, C., Lutz, M., Gray, T., Abbacchi, A., McKenna, K., et al. (2006). Autistic social impairment in the siblings of children with pervasive developmental disorders. The American Journal of Psychiatry, 163(2), 294–296.
Constantino, J. N., & Todd, R. D. (2003). Autistic traits in the general population: Twin study. Archives of General Psychiatry, 60, 524–530.
Davidson, J. (2008). Autistic culture online: Virtual communication and cultural expression on the spectrum. Social and Cultural Geography, 9(7), 791–806.
Dworzynski, K., Happé, F., Bolton, P., & Ronald, A. (2009). Relationship between symptom domains in autism spectrum disorders: A population based twin study. Journal of Autism and Developmental Disorders, 39(8), 1197–1210.
Farley, A., López, B., & Saunders, G. (2010). Self-conceptualisation in autism: Knowing oneself versus knowing self-through-other. Autism, 14(5), 519–530.
Folstein, S. E., & Rutter, M. L. (1977). Infantile autism: A genetic study of 21 twin pairs. Journal of Child Psychology and Psychiatry, 18, 297–321.
Frazier, T. W., Ratliff, K. R., Gruber, C., Zhang, Y., Law, P. A., & Constantino, J. N. (2014). Confirmatory factor analytic structure and measurement invariance of quantitative autistic traits measured by the social responsiveness scale-2. Autism, 18(1), 31–44.
Frith, U., & Happe, F. (1999). Theory of mind and self-consciousness: What is it like to be autistic? Mind and Language, 14(1), 1–22.
Georgiades, S., Szatmari, P., Zwaigenbaum, L., Bryson, S., Brian, J., Roberts, W., et al. (2013). A prospective study of autistic-like traits in unaffected siblings of probands with autism spectrum disorder. JAMA Psychiatry, 70(1), 42–48.
Goodman, R., Ford, T., Richards, H., Gatward, R., & Meltzer, H. (2000). The development and well-being assessment: Description and initial validation of an integrated assessment of child and adolescent psychopathology. Journal of Child Psychology and Psychiatry and Allied Disciplines, 41, 645–655.
Grove, W. M., & Meehl, P. E. (1996). Comparative efficiency of informal (subjective, impressionistic) and formal (mechanical, algorithmic) prediction procedures: The clinical–statistical controversy. Psychology Public Policy and Law, 2(2), 293.
Happé, F., & Frith, U. (2006). The weak coherence account: detail-focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders, 36, 5–25.
Happe, F., Ronald, A., & Plomin, R. (2006). Time to give up on a single explanation for autism. Nature Neuroscience, 9, 1218–1220.
Hoekstra, R. A., Bartels, M., Cath, D. C., & Boomsma, D. I. (2008). Factor Structure, reliability and criterion validity of the autism-spectrum quotient (AQ): A study in dutch population and patient groups. Journal of Autism and Developmental Disorders, 38, 1555–1566.
Kanner, L. (1943). Autistic disturbances of affective contact. The Nervous Child, 2, 217–250.
Kim, Y. S., Fombonne, E., Koh, Y., Kim, S., Cheon, K., & Leventhal, B. L. (2014). Developmental disorder and DSM-5 autism spectrum disorder prevalence in an epidemiologic sample. Journal of the American Academy of Child and Adolescent Psychiatry, 53(5), 500–508.
Kolevzon, A., Smith, C. J., Schmeidler, J., Buxbaum, J. D., & Silverman, J. M. (2004). Familial symptom domains in monozygotic siblings with autism. American Journal of Medical Genetics Part B Neuropsychiatric Genetics, 129(1), 76–81.
Landa, R., Piven, J., Wzorek, M., Gayle, J., Cloud, D., Chase, G., et al. (1992). Social language use in parents of autistic individuals. Psychological Medicine, 22, 246–254.
Leekam, S. R., Prior, M. R., & Uljarevic, M. (2011). Restricted and repetitive behaviors in autism spectrum disorders: A review of research in the last decade. Psychological Bulletin, 137(4), 562–593.
Lind, S. E. (2010). Memory and the self in autism: A review and theoretical framework. Autism, 14(5), 430–456.
Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule: ADOS-2. Los Angeles, CA: Western Psychological Services.
Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.
Losh, M., & Capps, L. (2003). Narrative ability in high-functioning children with autism or asperger’s syndrome. Journal of Autism and Developmental Disorders, 33(3), 239–251.
Lundstrom, S., Chang, Z., Rastam, M., Gillberg, C., Larsson, H., Anckarsater, H., & Lichtenstein, P. (2012). Autism spectrum disorders and autistic like traits, similar etiology in the extreme end and the normal variation. Archives of General Psychiatry, 69(1), 46–52.
Mandy, W., Charman, T., Gilmour, J., & Skuse, D. (2011). Toward specifying pervasive developmental disorder—not otherwise specified. Autism Research, 4(2), 121–131.
Mandy, W., Charman, T., Puura, K., & Skuse, D. (2014). Investigating the cross-cultural validity of DSM-5 autism spectrum disorder: Evidence from Finnish and UK samples. Autism, 18(1), 45–54.
Mandy, W. P., Charman, T., & Skuse, D. H. (2012). Testing the construct validity of proposed criteria for DSM-5 autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 41–50.
Mandy, W. P., & Skuse, D. H. (2008). Research review: what is the association between The social-communication element of autism and repetitive interests, behaviours and activities? Journal of Child Psychology and Psychiatry, 49, 795–808.
Mazefsky, C. A., Goin-Kochel, R. P., Riley, B. P., & Maes, H. H. (2008). Genetic and environmental influences on symptom domains in twins and siblings with autism. Research in Autism Spectrum Disorders, 2(2), 320–331.
Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., & White, S. W. (2013). The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 52(7), 679–688.
Murray, A. L., McKenzie, K., Kuenssberg, R., & O’Donnell, M. (2014). Are we under-estimating the association between autism symptoms?: The importance of considering simultaneous selection when using samples of individuals who meet diagnostic criteria for an autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(11), 2921–2930.
Norbury, C. F. (2014). Practitioner review: Social (pragmatic) communication disorder conceptualization, evidence and clinical implications. Journal of Child Psychology and Psychiatry, 55(3), 204–216.
Norbury, C. F., Nash, M., Baird, G., & Bishop, D. (2004). Using a parental checklist to identify diagnostic groups in children with communication impairment: A validation of the children’s communication checklist–2. International Journal of Language and Communication Disorders, 39, 345–364.
Norbury, C. F., & Sparks, A. (2013). Difference or disorder? Cultural issues in understanding neurodevelopmental disorders. Developmental Psychology, 49, 45–58.
Ochs, E., & Capps, L. (1997). Narrative authenticity. Journal of Narrative and Life History, 7, 83–89.
Ozonoff, S. (2012). Editorial: DSM-5 and autism spectrum disorders–two decades of perspectives from the JCPP. Journal of Child Psychology and Psychiatry, 53(9), e4–e6.
Perkins, L., Crisp, J., & Walshaw, D. (1999). Exploring conversation analysis as an assessment tool in aphasia: The issue of reliability. Aphasiology, 13, 259–281.
Phelps-Terasaki, D., & Phelps-Gunn, T. (2007). Test of pragmatic language (2nd ed.). Austin: Pro-Ed.
Piven, J. (2001). The broad autism phenotype: a complementary strategy for molecular genetic studies of autism. American Journal of Medical Genetics, 105(1), 34–35.
Polkinghorne, D. E. (1991). Narrative and self-concept. Journal of Narrative and Life History, 1(2&3), 135–153.
Pooni, J., Ninteman, A., Bryant-Waugh, R., et al. (2012). Investigating autism spectrum disorder and autistic traits in early onset eating disorder. International Journal of Eating Disorders, 45(4), 583–591.
Robinson, E. B., Koenen, K. C., McCormick, M. C., Munir, K., Hallett, V., Happé, F., et al. (2011). Evidence that autistic traits show the same etiology in the general population and at the quantitative extremes (5%, 2.5%, and 1%). Archives of General Psychiatry, 68, 1113–1121.
Robinson, E. B., Koenen, K. C., McCormick, M. C., Munir, K., Hallett, V., Happé, F., et al. (2012). A multivariate twin study of autistic traits in 12-year-olds: Testing the fractionable autism triad hypothesis. Behavior Genetics, 42(2), 245–255.
Ronald, A., Happé, F., Bolton, P., Butcher, L. M., Price, T. S., Wheelwright, S., et al. (2006). Genetic heterogeneity between the three components of the autism spectrum: a twin study. Journal of the American Academy of Child and Adolescent Psychiatry, 45(6), 691–699.
Ronald, A., Larsson, H., Anckarsäter, H., & Lichtenstein, P. (2011). A twin study of autism symptoms in Sweden. Molecular Psychiatry, 16, 1039–1047.
Rutter, M. (2000). Genetic studies of autism: from the 1970s into the millennium. Journal of Abnormal Child Psychology, 28(1), 3–14.
Rutter, M. (2014). Addressing the issue of fractionation in autism spectrum disorder: A commentary on Brunsdon and Happé, Frazier, Hobson, and Mandy et al. Autism, 18, 55–57.
Schoen-Simmons, E., Paul, R., & Volkmar, F. (2014). Assessing pragmatic language in autism spectrum disorder: The yale in vivo pragmatic protocol. Journal of Speech Language and Hearing Research, 57, 2162–2173.
Semel, E., Wiig, E., & Secord, W. (2000). Clinical evaluation of language fundamentals–3rd edition (UK). Hove: Psychological Corporation.
Skuse, D. H. (2012). DSM-5’s conceptualization of autistic disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 51(4), 344–346.
Skuse, D. H., Mandy, W. P., & Scourfield, J. (2005). Measuring autistic traits: Heritability, reliability and validity of the social and communication disorders checklist. The British Journal of Psychiatry, 187(6), 568–572.
Skuse, D. H., Warrington, R., Bishop, D., Chowdhury, U., Lau, J., Mandy, W., & Place, M. (2004). The developmental, dimensional and diagnostic interview (3di): A novel computerized assessment for autism spectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 43(5), 548–558.
Sucksmith, E., Roth, I., & Hoekstra, R. A. (2011). Autistic traits below the clinical threshold: Re-examining the broader autism phenotype in the 21st. Neuropsychology Review, 21(4), 360–389.
Sumiyoshia, C., Kawakubob, Y., Sugab, M., Sumiyoshie, T., & Kasaib, K. (2011). Impaired ability to organize information in individuals with autism spectrum disorders and their siblings. Neuroscience Research, 69, 252–257.
Tanguay, P. E. (2011). Commentary: Autism in DSM-5. American Journal of Psychiatry, 168(11), 1142–1144.
Towbin, K. E. (2005). Pervasive developmental disorder not otherwise specified. In F. R. Volkmar, R. Paul, A. Klin, & D. J. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (pp. 165–200). New York: Wiley.
Volden, J., Coolican, J., Garon, N., White, J., & Bryson, S. (2009). Pragmatic language in autism spectrum disorder: Relationships to measures of ability and disability. Journal of Autism and Developmental Disorders, 39, 388–393.
Volkmar, F., State, M., & Klin, A. (2009). Autism and autism spectrum disorders: diagnostic issues for the coming decade. Journal of Child Psychology and Psychiatry, 50(1–2), 108–115.
Walker, D. R., Thompson, A., Zwaigenbaum, L., Goldberg, J., Bryson, S. E., et al. (2004). Specifying PDD-NOS: A comparison of PDD-NOS, Asperger syndrome, and autism. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 172–180.
Weiss, J. A., Thomson, K., & Chan, L. (2014). A systematic literature review of emotion regulation measurement in individuals with autism spectrum disorder. Autism Research, 7(6), 629–648.
Wiig, E., & Secord, W. (1989). Test of language competence–expanded. Hove: Psychological Corporation.
Williams, D. (2010). Theory of own mind in autism, evidence of a specific deficit in self-awareness? Autism, 14(5), 474–494.
Wilson, C. E., Gilan, N., Spain, D., Robertson, D., Roberts, G., et al. (2013). Comparison of ICD-10R, DSM-IV-TR and DSM-5 in an adult autism spectrum disorder diagnostic clinic. Journal of Autism and Developmental Disorders, 43, 2515–2525.
Wing, L., & Gould, J. (1979). Severe impairments of social interaction and associated abnormalities in children: Epidemiology and classification. Journal of Autism and Developmental Disorders, 9(1), 11–29.
World Health Organization. (1992). International statistical classification of diseases and related health problems (ICD-10). Geneva: WHO.
We are grateful to Dr. Raya Ariel for her useful comments on a previous version of this paper.
The first and last authors received funding for this study by the Israeli Ministry of Science, Technology, and Space (Grant Number 10842).
The authors have each made substantial contributions to the creation of this commentary. The last author read and approved the final manuscript.
Conflict of interest
All authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
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Brukner-Wertman, Y., Laor, N. & Golan, O. Social (Pragmatic) Communication Disorder and Its Relation to the Autism Spectrum: Dilemmas Arising From the DSM-5 Classification. J Autism Dev Disord 46, 2821–2829 (2016). https://doi.org/10.1007/s10803-016-2814-5
- Social communication disorder
- Autism spectrum disorder
- Differential diagnosis