Social (Pragmatic) Communication Disorder and Its Relation to the Autism Spectrum: Dilemmas Arising From the DSM-5 Classification

Abstract

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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Notes

  1. 1.

    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.

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Acknowledgments

We are grateful to Dr. Raya Ariel for her useful comments on a previous version of this paper.

Funding

The first and last authors received funding for this study by the Israeli Ministry of Science, Technology, and Space (Grant Number 10842).

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The authors have each made substantial contributions to the creation of this commentary. The last author read and approved the final manuscript.

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Correspondence to Yael Brukner-Wertman or Ofer Golan.

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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

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Keywords

  • Social communication disorder
  • Autism spectrum disorder
  • Phenotype
  • Differential diagnosis
  • Treatment
  • Services