Social (pragmatic) communication disorder: a research review of this new DSM-5 diagnostic category

The profile of social communication in Dravet syndrome

Dravet syndrome (DS) presents a multifaceted clinical picture marked by epilepsy, cognitive impairments and behavioral disorders that progresses throughout development. Behavioral disorders include impairments in social relationships and communication, with frequent diagnosis of autism spectrum disorder. This study focused on comprehensively evaluating and comparing social communication profiles among a group of 43 children with Dravet syndrome, 30 children with level 1 autism spectrum disorder, 36 with social (pragmatic) communication disorder, and 18 with intellectual disability. Using validated tools like the Childhood Autism Spectrum Test and Children's Communication Checklist, distinct patterns of social communication deficits were delineated. Our findings indicate that children with Dravet syndrome experience challenges in social relationships, primarily due to difficulties in use of pragmatic language. Areas such as range of interests and social interaction are less affected compared to those with ASD, emphasizing differing profiles between the conditions. While children with DS and ID may have similar intellectual functioning, the different social communication deficits in DS indicate their role in the DS phenotype beyond ID. These results underscore the unique social communication profile of DS and emphasizes the importance of tailored interventions and deep phenotyping efforts for effective DS management.

Exploratory Factor Analysis of the Social Communication Disorder Screener

Currently, there are no existing measures to screen for or diagnose Social (Pragmatic) Communication Disorder (SPCD). We conducted an exploratory factor analysis (EFA) of the Social Communication Disorder Screener (SCDS), a 14-item, parent-report measure based on the DSM-5 diagnostic criteria for SPCD. This EFA examined the internal consistency and factor structure of the SCDS for a sample of 500 parents of children, ages 5-18 years, representative of the U.S. census. Results yielded a correlated three-factor solution with good internal consistency reliability. Findings supported the presence of three subscale as well as the derivation of a total composite score reflecting overall verbal and non-verbal communication and limitations across contexts. Clinical and research implications are discussed.

Metaphor comprehension and production in verbally able children with Autism Spectrum Disorder

Research in the field of figurative language processing in Autism Spectrum Disorders (ASD) has demonstrated that autistic individuals experience systematic difficulties in the comprehension of different types of metaphors. However, there is scarce evidence regarding metaphor production skills in ASD. Importantly, the exact source of metaphor processing difficulties in ASD remains largely controversial. The debate has mainly focused on the mediating role of structural language skills (i.e., lexical knowledge) and cognitive abilities (i.e., Theory of Mind and executive functions) in ASD individuals' ability to comprehend and generate metaphors. The present study examines metaphor comprehension and production in 18 Greek-speaking verbally able children with ASD and 31 typically-developing (TD) controls. Participants completed two tasks, namely, a low-verbal multiple-choice sentence-picture matching task that tested their ability to comprehend conventional predicate metaphors, and a sentence continuation task that assessed their ability to generate metaphors. The study also included measures of fluid intelligence, expressive vocabulary, and working memory within the sample. The results show that the ASD group had significantly lower performance than the TD group in both metaphor comprehension and production. The findings also reveal that expressive vocabulary skills were a key factor in the metaphor comprehension and production performance of the children with ASD. Working memory capacity was also found to correlate significantly with metaphor comprehension performance in the ASD group. Conversely, no correlations were found in the TD group with neither of the above factors. Of note, children with ASD generated significantly more inappropriate responses and no-responses to the metaphor production task compared with the control group. The overall results reveal that children with ASD had difficulty with both comprehending and using metaphorical language. The findings also indicate that TD children may employ diverse cognitive strategies or rely on different underlying skills when processing metaphors compared with children with ASD.

Pragmatic Communication Deficit and Functional Outcome in Patients with Right- and Left-Brain Damage: A Pilot Study

Pragmatic communication abilities refer to the capacity to use language in a social context. Despite evidence to the contrary, the left cerebral hemisphere of the majority of right handers has been considered exclusively specialized for control of language phonology, syntax and semantics, whereas the right hemisphere has been specialized for the control of language pragmatics. Many studies have shown the non-exclusivity of the left hemisphere for language skills. Communication deficits observed in these studies for patients with right hemisphere damage confirmed the necessity for integrity of the right hemisphere across a number of language components. The aim of this study is to investigate the specific role of the right and left hemispheres across several aspects of communication deficits, with particular attention given to the influence of these deficits on functional outcome. The second aim is to characterize possible correlations between pragmatic and other cognitive deficits. We evaluated 22 patients, 15 with left- and 7 with right-brain ischemic or hemorrhagic damage, using cognitive, pragmatic and language tests. We deployed the Right Hemisphere Language Battery-Santa Lucia and Montreal d'Evaluation de la Communication to assess pragmatic abilities. The results showed no statistically significant differences between patients with left- and right-brain damage, highlighting the importance of integration between the two hemispheres in the communication process. Multiple significant correlations were found between pragmatic abilities and cognitive tests assessing global cognitive functioning, pantomime expression and comprehension. Pragmatic deficits were also shown to correlate with functional cognitive outcome. It is important to assess pragmatic abilities in patients with cognitive deficits after both left and right stroke for tailoring neuropsychological intervention to mitigate pragmatic disabilities in functional outcomes.

Friendship interventions for children with neurodevelopmental needs: A systematic review and meta-analysis

RATIONALE

Children with neurodevelopmental disorders such as attention-deficit hyperactivity disorder (ADHD), autism, developmental language disorder (DLD), intellectual disability (ID), and social (pragmatic) communication disorder (SPCD) experience difficulties with social functioning due to differences in their social, emotional and cognitive skills. Previous systematic reviews have focussed on specific aspects of social functioning rather than broader peer functioning and friendships.

OBJECTIVE

To systematically review and methodologically appraise the quality and effectiveness of existing intervention studies that measured friendship outcomes for children with ADHD, autism, DLD, ID, and SPCD.

METHOD

Following PRISMA guidelines, we searched five electronic databases: CINAHL, Embase, Eric, PsycINFO, and PubMed. Two independent researchers screened all abstracts and disagreements were discussed with a third researcher to reach consensus. The methodological quality of studies was assessed using the Cochrane Risk of Bias Tool for Randomised Trials.

RESULTS

Twelve studies involving 15 interventions were included. Studies included 683 children with a neurodevelopmental disorder and 190 typically-developing children and diagnosed with either autism or ADHD. Within-group meta-analysis showed that the pooled intervention effects for friendship across all interventions were small to moderate (z = 2.761, p = 0.006, g = 0.485). The pooled intervention effect between intervention and comparison groups was not significant (z = 1.206, p = 0.400, g = 0.215).

CONCLUSION

Findings provide evidence that some individual interventions are effective in improving social functioning and fostering more meaningful friendships between children with neurodevelopmental disorders and their peers. Effective interventions involved educators, targeted child characteristics known to moderate peer functioning, actively involved peers, and incorporated techniques to facilitate positive peer perceptions and strategies to support peers. Future research should evaluate the effectiveness of friendship interventions for children with DLD, ID and SPCD, more comprehensively assess peer functioning, include child self-report measures of friendship, and longitudinally evaluate downstream effects on friendship.

Usefulness of the autism spectrum quotient (AQ) in screening for autism spectrum disorder and social communication disorder

BACKGROUND

In the Diagnostic and Statistical Manual and Mental Disorders, Fifth Edition (DSM-5), autism spectrum disorder (ASD) and social (pragmatic) communication disorder (SCD) were described as a new category of psychiatry nosography. SCD involves impairments in social communication and social interaction but not restricted, repetitive patterns of behavior, interests, or activities. The autism spectrum quotient (AQ) was developed to screen for autism tendencies in adults with normal intelligence. However, AQ cutoff scores for screening ASD and SCD in the DSM-5 have not been established. This study examined whether the Japanese version of the AQ (AQ-J) total scores could discriminate between an ASD group, an SCD group, and a neurotypical (NT) group.

METHODS

Participants were 127 ASD patients, 52 SCD patients, and 49 NT individuals. Receiver operating characteristic (ROC) analyses were used to examine AQ-J total score cutoff values to distinguish between ASD and NT groups, SCD and NT groups, and ASD and SCD groups.

RESULTS

In the ROC analysis for the ASD and NT groups, the area under the curve (AUC) was 0.96, and the optimum cutoff value was 23 points (sensitivity 92.9%, specificity 85.7%). The AUC for the SCD and NT groups was 0.89, and the optimum cutoff value was 22 points (sensitivity 84.6%, specificity 85.7%). The AUC for the ASD and SCD groups was 0.75; the optimum cutoff value was 32 points (sensitivity 67.7%, specificity 71.2%).

CONCLUSION

Our findings suggest the usefulness of the AQ-J in screening for ASD and SCD.

Vocal-friend: internet of social-things framework to aid verbal communication

PURPOSE

Deficits in social verbal communication in individuals with Social Communication Disorder (SCD) is of concern and SCD in the human community is prevalent in large population throughout the globe. Deficits in verbal social communication are prevalent in a large population. This paper aimed to propose internet connected multi-system architecture which is capable to support verbal communication in a social environment for individuals with social communication deficits.

MATERIAL AND METHODS

Implementation methodology was included with corpus collection for specific communication, deep learning based machine training for intelligent communication, and implementation of the trained algorithm on internet connected electronic multiple social communication devices. The implemented system is smart enough to initiate and maintain two types of communication; the first type includes communication between multiple individuals on the remote location and the second type includes communication with the individual present in the physical listening range.

RESULTS

The system was investigated in terms of its algorithmic parameters and found 97% to 100% in terms of training and testing accuracy with negligible mean squared error. Vocal-Friend analysed results based on audio-bot simulative conditions provide more than 91% accuracy, interaction rate and fallback rate. On the basis of the satisfaction analysis, above average results were noticed.

CONCLUSION

In terms of technical implementations and satisfaction analysis, results found acceptable with above average score.IMPLICATION FOR REHABILITATIONProposed framework is easy to use by caregivers with even having little knowledge.Support individual with deficit to learn social verbal communication skill to survive in society.Aiding parents, caregivers and professionals to understand the communication needs of individuals with communication deficits.Since technology is also grooming in the domain of rehabilitation, so this system could be used in various future applications such as social robots, social virtual assistants etc.

The fuzzy boundaries of the social (pragmatic) communication disorder (SPCD): Why the picture is still so confusing?

Introduction

Since the introduction of Social (Pragmatic) Communication Disorder (SPCD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) in 2013, a debate has arisen in the scientific community about its usefulness in differential diagnosis for other clinical categories such as Autism Spectrum Disorder (ASD) and Specific Language Impairment (SLI). Indeed, SPCD criteria share a common deficit in communication and pragmatic skills with these diagnostic entities. Available assessment tools seem scarce and not sensitive enough to clarify diagnostic criteria and clinical boundaries. This study aims to review the existing literature on diagnostic screening for SPCD to highlight confounding variables in the domains examined, overlap with other diagnostic entities, and lack of specificity of available assessment tools in identifying the core deficits of the disorder.

Methods

The search strategy was defined by combining the following keywords: "social pragmatic communication disorder," "DSM-5," "differential diagnosis," and "child." The search was performed in three databases: Medline (PubMed), Scopus, and Web of Science. All studies published between 2013 and April 2023, written in English, and with a major focus on SPCD were included in the review.

Results

After the screening for the eligibility, 18 studies were included in the review. Most of these studies aimed to investigate the differential diagnosis between SPCD and other diagnostic categories (e.g., specific language impairment and autism spectrum disorder). Of these researches, only 6 were ad hoc experimental studies, while the others were based on previously collected databases.

Conclusions

SPCD seems to have its own peculiarities and characteristics, indicating its clinical relevance, as emphasized by the DSM-5. However, the lack of specific instruments and a number of confounding variables make it difficult to identify and differentiate SPCD from other diagnostic entities. Further research is needed to overcome the lack of specific clinical instruments and lack of empirical studies.

Prevalence and functional impact of social (pragmatic) communication disorders

BACKGROUND

The aim of this study was to evaluate the Children's Communication Checklist-2 (CCC-2) for measuring social-pragmatic communication deficits and to ascertain their prevalence and functional impact in a community sample.

METHODS

We used parent and teacher responses to the CCC-2 to approximate inclusion (poor social-pragmatic skills) and exclusion (poor structural language skills or autistic symptomatology) criteria for social (pragmatic) communication disorder (SPCD). We tested the prevalence of social-pragmatic deficits in a population-based sample of children (n = 386) aged 5-6 years old using CCC-2 algorithms. We also investigated the academic and behavioural profiles of children with broadly defined limitations in social-pragmatic competence on the CCC-2.

RESULTS

Regardless of the diagnostic algorithm used, the resulting prevalence rates for social-pragmatic deficits indicated that very few children had isolated social-communication difficulties (0-1.3%). However, a larger proportion of children (range: 6.1-10.5%) had social-pragmatic skills outside the expected range alongside structural language difficulties and/or autism spectrum symptoms, and this profile was associated with a range of adverse academic and behavioural outcomes.

CONCLUSIONS

A considerable proportion of children in the early years of primary school has social-pragmatic deficits that interfere with behaviour and scholastic activity; however, these rarely occur in isolation. Exclusionary criteria that include structural language may lead to underidentification of individuals with social-pragmatic deficits that may benefit from tailored support and intervention.

Language and Communication Deficits in Chromosome 16p11.2 Deletion Syndrome

PURPOSE

Chromosome 16p11.2 deletion syndrome (OMIM #611913) is a rare genetic condition resulting from the partial deletion of approximately 35 genes located at Chromosome 16. Affected people exhibit a variable clinical profile, featuring mild dysmorphisms, motor problems, developmental delay, mild intellectual disability (ID), socialization deficits and/or autism spectrum disorder (ASD) traits, and problems with language. Specifically, a precise characterization of the speech, language, and communication (dis)abilities of people with this condition is still pending.

METHOD

We used standardized tests and samples of naturalistic speech to provide a longitudinal profile of the speech, language, and communication problems of a boy with Chromosome 16p11.2 deletion syndrome and without ID or ASD.

RESULTS

The proband shows impaired expressive abilities as well as problems with receptive language, dysprosody, and ASD-like communication deficits, such as impaired interactive skills, perseverative verbal behavior, overabundance of tangential responses, and lack of metapragmatic awareness and communicative use of gaze, meeting the criteria for social pragmatic communication disorder.

CONCLUSIONS

Our results support the view that language and communication impairment should be regarded as one core symptom of Chromosome 16p11.2 deletion syndrome, even without a diagnosis of ASD or ID. Clinical implications of our results, with a focus on therapeutic interventions for children with 16p11.2 deletion syndrome and no ASD or ID, are also discussed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21561714.

Developmental Language Disorder (DLD) and Autism Spectrum Disorder (ASD): similarities in pragmatic language abilities. A systematic review

Objective

Pragmatics can be defined as the appropriate use of language in social interactions. Children with Autism Spectrum Disorder (ASD) and children with Developmental Language Disorder (DLD) exhibit difficulties in pragmatic language (PL), but the nature and sources of these difficulties have not been fully investigated yet. The purpose of this paper is to critically review empirical literature on the PL of children with ASD as compared to that of children with DLD.

Materials and methods

Thirteen studies that met established inclusion criteria were identified and reviewed.

Results

Children with ASD and children with DLD demonstrated several similarities in PL. However, a lot of differences were observed and mainly children with ASD faced more profound difficulties than children with DLD, while PL may be a distinct marker between the two groups.

Conclusion

The differences observed in the language profiles of ASD and DLD show that even if there is an overlap in some domains, the PL abilities of children of both clinical populations are likely to be controlled by different mechanisms and therefore these differences in PL may be considered as a distinguishable feature between the two populations.

Pragmatic Profiles of Adults with Fragile X Syndrome and Williams Syndrome

Linguistic phenotypes of individuals with Fragile X (FXS) and Williams (WS) syndromes exhibit various degrees of pragmatic impairment, involving difficulties in social communication and in adapting to conversational principles. The goal of the present study was to explore syndrome-specific pragmatic profiles of adults with FXS and WS based on the assessment of the observance of Gricean maxims of conversation. The participants were 12 Spanish-speaking adults (6 FXS/6 WS), without a diagnosis of ASD, whose extensive naturalistic conversations (71,859 words) were transcribed and coded with the CHILDES/TALKBANK tools and the PREP-CORP pragmatic protocol. Violations of the maxims of conversation were analyzed, and indexes of cooperation and conversational response were obtained. Both groups showed reduced verbal production and repetitive dysfluencies; prominent features in the FXS profile were higher proportion of non-contingent language, perseverations of topic and form, and impulsive conversational responses; in the WS profile, salient characteristics were higher proportion of tangential utterances, reformulations, and conversational responses reflecting overly literal interpretation. Pragmatic profiles of violation of conversational maxims reflect specific communication skills impaired in adults with FXS and WS and raise the need for assessment and intervention methods that specifically address their social communication abilities.

A novel online assessment of pragmatic and core language skills: An attempt to tease apart language domains in children

It remains unclear whether pragmatic language skills and core language skills (grammar and vocabulary) are distinct language domains. The present work aimed to tease apart these domains using a novel online assessment battery administered to almost 400 children aged 7 to 13 years. Confirmatory factor analysis indicated that pragmatic and core language domains could be measured separately, but that both domains were highly related (r = .79). However, zero-order correlations between pragmatic tests were quite small, indicating that task-specific skills played an important role in performance, and follow-up exploratory factor analysis suggested that pragmatics might be best understood as a family of skills rather than a domain. This means that these different pragmatic skills may have different cognitive underpinnings and also need to be assessed separately. However, our overall results supported the idea that pragmatic and core aspects of language are closely related during development, with one area scaffolding development in the other.

Sensitivity and specificity of DSM-5 diagnostic criteria for autism spectrum disorder in a child and adolescent sample

BACKGROUND

Controversy exists regarding the DSM-5 criteria for autism spectrum disorders (ASD). Given the mixed results that have been reported, our main aim was to determine DSM-5 sensitivity and specificity in a child and adolescent Spanish sample. As secondary goals, we assessed the diagnostic stability of DSM-IV-TR in DSM-5, and clinical differences between children diagnosed with an ASD or a social (pragmatic) communication disorder (SPCD).

METHODS

This study was carried out in 2017, reviewing the medical records of patients evaluated in our service. Items from a parent report measure of ASD symptoms (Autism Diagnostic Interview-Revised) were matched to DSM-5 criteria and used to assess the sensitivity and specificity of the DSM-5 criteria and current DSM-IV criteria when compared with clinical diagnoses.

RESULTS

DSM-5 sensitivity ranged from .69 to 1.00, and was higher in females. By age, the DSM-5 and DSM-IV-TR criteria showed similar sensitivity. In the case of intellectual quotient, DSM-5 criteria sensitivity was lower for those in the "low-functioning" category. DSM-5 specificity ranged from .64 to .73, while DSM-5 specificity was similar for all phenotypic subgroups. With respect to stability, 83.3% of autism disorder cases retained a diagnosis of ASD using the DSM-5 criteria. With regard to differences between ASD and SPCD, we found that patients diagnosed with ASD received more pharmacological treatment than those diagnosed with SPCD.

CONCLUSIONS

Further research is required to confirm our results. Studies focusing on the SPCD phenotype will be necessary to determine outcome differences with ASD and the most effective diagnostic and therapeutic tools.

A preliminary epidemiologic study of social (pragmatic) communication disorder in the context of developmental language disorder

BACKGROUND

There is extremely limited population-based research on social (pragmatic) communication disorder (SCD). Population-based samples have the potential to better characterize the SCD phenotype by mitigating confounds and biases that are typical of convenience and clinical samples.

AIMS

The aims of this preliminary epidemiologic study were to advance our understanding of the SCD phenotype relative to developmental language disorder (DLD), obtain an estimate of prevalence, identify risk factors and lay the groundwork for future population level research of SCD.

METHODS & PROCEDURES

We analysed existing data from the EpiSLI Database to examine social communication skills in 393 8th grade (13-14 years) children with and without a history of DLD. The primary measure used to evaluate SCD was the Children's Communication Checklist (CCC-2). Two case definitions of SCD reflecting DSM-5 criteria were examined. Both definitions involved significant pragmatic impairment, employing a commonly adopted clinical cut-point of 1.5 SD. In one case, pragmatic deficits could occur along with structural language deficits and, in the other case (established using principal component analysis), pragmatic and social skills were disproportionately lower than structural language abilities.

OUTCOMES & RESULTS

When using the first case definition, SCD was much more common in children with a history of DLD than without DLD and history of language disorder at kindergarten was a significant risk factor for SCD in adolescence. However, it is important to note that SCD could be found in children with no prior deficits in other aspects of language. When the second definition was employed, SCD was equally distributed across children with and without a history of DLD. Male sex was a significant risk factor using this case definition of SCD. The estimated prevalence of SCD ranged from 7% (SE = 1.5%) to 11% (SE = 1.7%), acknowledging that prevalence depends on the cut-point selected to determine communication disorder.

CONCLUSIONS & IMPLICATIONS

These findings contribute to our understanding of the association between SCD and DLD by recognizing varying profiles of pragmatic and social communication difficulties, which in turn may help refine our diagnostic categories. Preliminary prevalence estimates of SCD can serve as an initial guidepost for identification and planning for intervention services for this condition.

WHAT THIS PAPER ADDS

What is already known on this subject There is considerable debate about the diagnostic category of SCD and its relation to other neurodevelopmental disorders. What this study adds to existing knowledge Using data from a US-based epidemiologic sample of DLD, this study offers new information about the association between SCD and DLD, provides preliminary estimates of SCD prevalence, and identifies risk factors for SCD. Clinical implications of this study Improved understanding of possible profiles of pragmatic and social communication deficits will help to clarify diagnostic categories and preliminary prevalence estimates may assist with ensuring availability of adequate intervention services.

The DSM-5 introduction of the Social (Pragmatic) Communication Disorder as a new mental disorder: a philosophical review

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included the Social (Pragmatic) Communication Disorder (SPCD) as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons-including bridging a nosological gap in the macro-category of Communication Disorders-in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close to that of (some forms of) Autism Spectrum Disorder (ASD). This opens up the possibility that individuals with very similar symptoms can be diagnosed differently (with either ASD or SPCD) and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography.

The Autism-Spectrum Quotient (AQ) Adolescent's Version in Turkey: Factor Structure, Reliability and Validity

We assessed the reliability and validity of the Turkish version of the autism spectrum quotient (AQ)-adolescent. Three assessment groups of adolescents, aged 11-18, were: 80 with Asperger syndrome/high-functioning autism (AS/HFA), 71 with other psychiatric disorders (PDs; 35 major depression, 18 obsessive-compulsive disorder, 18 social phobia), and 249 healthy controls. The scores of the AS/HFA group were significantly higher than the healthy control and PD groups. Cronbach α value was 0.829. Ordinal alpha value was 0.90. We showed the AQ-adolescent four-factor structure in the factor analysis. In the test-retest of AQ-adolescent and subscale scores, "very strong" significant correlation values were detected. A cut-off score of 24 best distinguished the autism group from healthy controls with 0.975 sensitivity and 0.991 specificity.

The Neural Substrate of Speech Act Recognition

Pragmatic competence demands linguistic, but also communicative, social and cognitive competence. Successful use of language in social interaction requires mutual understanding of the speaker's intentions; without it, a conversation cannot proceed. The term speech act refers to what a speaker intends to accomplish when saying something. The purpose of this study was to contribute to the identification of the neural substrate of speech act recognition and to the characterization of the cognitive processes that may be involved. The recognition of speech acts resulted in greater activation of frontal regions, precuneus and posterior cingulate gyrus. From all cognitive and behavioral measures obtained, only the scores in mental flexibility predicted the change in blood oxygen level dependent (BOLD) signal in the precuneus. These results, support the idea that speech act recognition requires the inference of intention, executive functions, including memory and entails the activation of areas of social cognition that participate in several brain networks i.e., the Intention Processing, the Default Mode and Theory of Mind networks, and areas involved in planning and guiding behavior.

Interpretation of familiar metaphors and proverbs by Polish people in middle and late adulthood

BACKGROUND

The ability to understand figurative language, including metaphors and proverbs, decreases with age, although the phenomenon is not universal. Cognitive capacities and education play an important role in the competence connected with figurative language use and comprehension in people during the second half of life.

AIMS

To identify possible similarities and differences in task performance by subjects representing middle adulthood (40-49 and 50-59 years old) and late adulthood (60-69 and 70-92 years old). Additionally, the analyses took into account factors significantly affecting the results, that is, tasks type (metaphors versus proverbs), the way the answer is given (open-ended versus multiple choice) and types of answers (abstract and concrete). This study also aimed to identify some cognitive correlates of task completion.

METHODS & PROCEDURES

A total of 86 Caucasian subjects, aged 40-92 years, participated in this study (M_{whole group} = 62.37, SD = 15.53); the group included 20 subjects aged 40-49 years (M_age = 45.4; SD = 3.05), 20 aged 50-59 years (M_age = 55.50; SD = 2.64), 20 aged 60-69 years (M_age = 64.40; SD = 2.78), and 26 aged 70-92 years (M_age = 79.15; SD = 6.27). A total of 20 well-known Polish metaphors and 20 popular Polish proverbs were used to assess the level of proverb and metaphor comprehension. The Montreal Cognitive Assessment Scale and Vocabulary subtest of the Polish version of WAIS-R were applied to assess the cognitive functions.

OUTCOMES & RESULTS

The results of the analyses suggest that there are differences as well as certain similarities between the groups. At 70+ years of age, the ability to explain and comprehend metaphors and proverbs decreases when compared with younger adults. In the 70+ group, the ability to grasp the meaning of both metaphors and proverbs is similar, unlike in the younger groups which present a better ability to explain and comprehend metaphors than proverbs. The conditions related to the types of tasks, that is, spontaneous interpretation and choice of responses, do not affect scores of the oldest subjects.

CONCLUSIONS

The analysis of response types, that is, abstract versus concrete, shows that, compared with younger groups, people aged 70+ years tend to less frequently provide abstract explanations and more often give concrete (but correct) responses, referring to situational data or examples from everyday life. Moreover, attention, short-term/delayed memory and lexical reserve influence the ability to use and comprehend figurative language to a varied degree.

WHAT THIS PAPER ADDS

What is already known on the subject Studies focusing on metaphor and proverb interpretation by people in middle and late adulthood are rather scarce, and what is more, they provide inconclusive results. Research has shown that the capacities related to attention and memory, as well as language resources and executive functions, all deteriorate in older people, which negatively affects their ability to understand metaphors and proverbs. However, varied methods are applied to assess these skills, which may explain why the related findings are inconsistent. What this paper adds to existing knowledge The novelty of this study lies in the fact that the analyses took into account the type of task (metaphors versus proverbs), the method of responding (open-ended versus multiple-choice) and the nature of the answer (abstract versus concrete). This allowed us to highlight intergroup differences and to show specific characteristics of proverb and metaphor spontaneous interpretation and choice of correct answers. The results were compared among the participants representing relatively narrow age ranges classified as middle and late adulthood. What are the potential or actual clinical implications of this work? Analysis of how people in middle and late adulthood interpret metaphors and proverbs might constitute an element of preliminary screening assessment showing whether a decrease in this capacity is in the normal range or if it reflects a serious cognitive decline. It would be worthwhile if the diagnostic process included varied task designs, that is, both metaphors and proverbs, as well as spontaneous interpretation and multiple-choice, as well as varied types of responses.

Social communication disorder and behavioural addiction: Case report and clinical implications

BACKGROUND

Social communication disorder (SCD) is a neurodevelopmental disorder that includes communication difficulties. Literature linking SCD and addictions is scarce, and there are only a few case reports regarding the co-occurrence of addiction and autism disorder spectrum, and only one of them addressed behavioural addictions.

CASE PRESENTATION

We report MC's case, who displayed an SCD and sexual addiction (SA). Clinical and neuropsychological evaluations suggested an alteration of social cognition, especially of affective theory of mind. This article also presents the adaptation made of the usual treatment.

DISCUSSION

This case report illustrates the importance of social cognition abilities in the development and maintenance of behavioural addictions, and specifically SA. It also highlights the possible comorbidity of these two disorders and the possibility to work on social cognition as an alternate therapy in the treatment of behavioural addictions.

CONCLUSIONS

The co-occurrence of SCD and a behavioural addiction triggered clinical adaptations and implications that may affect a patient's treatment presenting one of these disorders.

Age differences in broader autism phenotype traits from young adulthood to older adulthood

Much of past research has been dedicated to refining the operationalization and correlates of the broader autism phenotype (BAP) and less on how the BAP differs by socio-demographic characteristics, like age-particularly after midlife. This gap is important because other nonclinical trait-like characteristics (e.g., personality) have shown considerable age differences, leading to work assessing the malleability of psychological characteristics and improving outcomes for individuals and their significant others. In the current study, we examined cross-sectional age differences in the BAP in a large sample of adults ranging in age from 18 to 85. We recruited a sample of 2966 adults ranging in age from 18 to 85 (M_age = 36.53, SD = 12.61; 58.9% Female; 1.1% with an ASD diagnosis) recruited from an online survey service. We found that total BAP scores were higher in younger adults and lower among older adults. These differences were particularly true for pragmatic language difficulties, with this component of the BAP showing the most dramatic age differences. Aloofness showed similar negative associations with age, albeit much smaller. Rigidity was not significantly associated with age. The results are consistent with other research showing an abatement of symptoms among individuals with autism spectrum disorders (ASDs) across early life and theories predicting changes in other psychological characteristics (e.g., personality). The results are discussed in the context of the malleability of ASD and BAP traits across life, the clinical implications of these changes, and the origins and consequences for lifespan differences in BAP. LAY SUMMARY: Little is known about how subclinical autistic-like traits among middle-aged and older adults compare to younger adults. We found that these subclinical traits were highest in young adults and lowest in older adults. Knowing how these traits differ by age can provide researchers and clinicians with a sense of how much these traits might change across life, if the traits might be sensitive to interventions, and when in development it might be best to intervene.

Pragmatic Language and Social Communication Tests for Students Aged 8–18 Years: A Review of Test Accuracy

Purpose

The accuracy of commercially available pragmatic language and social communication tests was reviewed.

Method

Online sources were searched to identify tests providing stand-alone pragmatic or social communication scores. Test manuals were examined to extract information about clinical and typically developing group comparisons, including sample size, inclusionary/exclusionary criteria, and mean group differences. Classification accuracy metrics, including sensitivity, specificity, optimal cut scores, and likelihood ratios, were reviewed.

Results

Six domain-specific pragmatic language and social communication tests and four omnibus language tests were identified. Test content varied and included video and audio recordings and question-and-answer formats to address hypothetical social vignettes, retell and comprehend narratives, interpret nonliteral language and multiple-meaning words, identify and display emotions, and infer another's perspective. Sample size and inclusionary/exclusionary criteria for comparisons of students with typical development (TD), developmental language disorder (DLD), autism spectrum disorder (ASD), and social (pragmatic) communication disorder (SPCD) varied widely. Mean group differences between TD and ASD or SPCD groups were generally larger (i.e., > 0.5 SD to > 2.0 SD s) than TD and DLD comparisons. Test authors interpreted these results as support for the accuracy of tests to identify deficits associated with ASD and SPCD and not DLD. Classification accuracy was reported for five domain-specific tests. Optimal cut scores ranged from 85 to 92, with adequate sensitivity and specificity (i.e., ≥ 80%); however, positive likelihood ratios and associated confidence intervals revealed limited confidence in reported levels.

Conclusions

Inadequate sample description for comparison and classification studies limit a clinician's ability to compare a student's profile with those in the samples. Although none of the tests meet all standards for test accuracy reviewed in this report, a checklist to guide test selection is provided to assist in identifying the best available test for a student's profile, if a test is needed.

An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5

In 2013, the American Psychiatric Association (APA) published the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In 2019, the World Health Assembly approved the 11th revision of the International Classification of Diseases (ICD-11). It has often been suggested that the field would benefit from a single, unified classification of mental disorders, although the priorities and constituencies of the two sponsoring organizations are quite different. During the development of the ICD-11 and DSM-5, the World Health Organization (WHO) and the APA made efforts toward harmonizing the two systems, including the appointment of an ICD-DSM Harmonization Group. This paper evaluates the success of these harmonization efforts and provides a guide for practitioners, researchers and policy makers describing the differences between the two systems at both the organizational and the disorder level. The organization of the two classifications of mental disorders is substantially similar. There are nineteen ICD-11 disorder categories that do not appear in DSM-5, and seven DSM-5 disorder categories that do not appear in the ICD-11. We compared the Essential Features section of the ICD-11 Clinical Descriptions and Diagnostic Guidelines (CDDG) with the DSM-5 criteria sets for 103 diagnostic entities that appear in both systems. We rated 20 disorders (19.4%) as having major differences, 42 disorders (40.8%) as having minor definitional differences, 10 disorders (9.7%) as having minor differences due to greater degree of specification in DSM-5, and 31 disorders (30.1%) as essentially identical. Detailed descriptions of the major differences and some of the most important minor differences, with their rationale and related evidence, are provided. The ICD and DSM are now closer than at any time since the ICD-8 and DSM-II. Differences are largely based on the differing priorities and uses of the two diagnostic systems and on differing interpretations of the evidence. Substantively divergent approaches allow for empirical comparisons of validity and utility and can contribute to advances in the field.

A Longitudinal Study of Parent-Child Interactions and Language Outcomes in Fragile X Syndrome and Other Neurodevelopmental Disorders

Difficulties with pragmatic language (i.e., language in social contexts, such as conversational ability) are a noted characteristic of the language profiles of both fragile X syndrome (FXS) and autism spectrum disorder (ASD), conditions which show significant phenotypic overlap. Understanding the origins and developmental course of pragmatic language problems in FXS and other developmental conditions associated with language impairment is a critical step for the development of targeted interventions to promote communicative competence across the lifespan. This study examined pragmatic language in the context of parent-child interactions in school-age children with FXS (who did and did not meet ASD criteria on the ADOS; n = 85), idiopathic ASD (n = 32), Down syndrome (DS; n = 38), and typical development (TD; n = 39), and their parents. Parent-child communicative interactions were examined across multiple contexts, across groups, and in relationship to pragmatic language outcomes assessed 2 years later. Results showed both overlapping and divergent patterns across the FXS-ASD and idiopathic ASD child and parent groups, and also highlighted key differences in pragmatic profiles based on situational context, with more pragmatic language difficulties occurring for both ASD groups in less structured interactions. Differences in parental language styles during parent-child interactions were associated with child language outcomes, likely reflecting the complex interplay of discourse style inherent to a parent, with the inevitable influence of child characteristics on parent language as well. Together, findings help delineate the dynamic and multifactorial nature of impaired pragmatic skills among children with FXS and other neurodevelopmental disorders associated with language impairment, with potential implications for the development of targeted interventions for pragmatic communication skills.

A Preliminary Epidemiologic Study of Social (Pragmatic) Communication Disorder Relative to Autism Spectrum Disorder and Developmental Disability Without Social Communication Deficits

The goal of this preliminary investigation was to compare demographic and clinical characteristics in a sample of children with likely Social (Pragmatic) Communication Disorder (SCD) (N = 117) to those in children with possible (N = 118) and some (N = 126) SCD traits, other developmental delay (DD) (N = 91) and autism spectrum disorder (ASD) (N = 642). We used data from the Study to Explore Early Development (SEED), a multi-site case-control study. Items reflecting SCD DSM-5 criteria were selected from an autism diagnostic measure, with SCD categories identified by creating quartiles. Our results suggest that SCD may fall along a continuum involving elevated deficits (in comparison to DD with no SCD) in social communication and restricted and repetitive behavior that do not reach the clinical threshold for ASD.

How has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-analysis

We conducted a 5-year follow-up systematic review and meta-analysis to determine change in frequency of autism spectrum disorder (ASD) diagnosis since diagnostic and statistical manual 5 (DSM-5) publication and explore the impact of Social Communication Disorder (SCD). For 33 included studies, use of DSM-5 criteria suggests decreases in diagnosis for ASD [20.8% (16.0-26.7), p < 0.001], DSM-IV-TR Autistic Disorder [10.1% (6.2-16.0), p < 0.001], and Asperger's [23.3% (12.9-38.5), p = 0.001]; pervasive developmental disorder-not otherwise specified decrease was not significant [46.1% (34.6-58.0), p = 0.52]. Less than one-third [28.8% (13.9-50.5), p = 0.06] of individuals diagnosed with DSM-IV-TR but not DSM-5 ASD would qualify for SCD. Findings suggest smaller decreases in ASD diagnoses compared to earlier reviews. Future research is needed as concerns remain for impaired individuals without a diagnosis.

Applying Item Response Theory Modeling to Identify Social (Pragmatic) Communication Disorder

Purpose No diagnostic tools exist for identifying social (pragmatic) communication disorder (SPCD), a new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition category for individuals with social communication deficits but not the repetitive, restricted behaviors and interests (RRBIs) that would qualify them for a diagnosis of autism spectrum disorder (ASD). We explored the value of items from a widely used screening measure of ASD for distinguishing SPCD from typical controls (TC; Aim 1) and from ASD (Aim 2). Method We applied item response theory (IRT) modeling to Social Communication Questionnaire-Lifetime (Rutter, Bailey, & Lord, 2003) records available in the National Database for Autism Research. We defined records from putative SPCD (n = 54), ASD (n = 278), and TC (n = 274) groups retrospectively, based on National Database for Autism Research classifications and Autism Diagnostic Interview-Revised responses. After assessing model assumptions, estimating model parameters, and measuring model fit, we identified items in the social communication and RRBI domains that were maximally informative in differentiating the groups. Results IRT modeling identified a set of seven social communication items that distinguished SPCD from TC with sensitivity and specificity > 80%. A set of five RRBI items was less successful in distinguishing SPCD from ASD (sensitivity and specificity < 70%). Conclusion The IRT modeling approach and the Social Communication Questionnaire-Lifetime item sets it identified may be useful in efforts to construct screening and diagnostic measures for SPCD.

Binaural interaction component of the auditory brainstem response in children with autism spectrum disorder

INTRODUCTION

There is ample evidence that auditory dysfunction is a common feature of autism spectrum disorder (ASD). Binaural interaction component (BIC) manifests binaural interaction and is valid and proven response which reflects ongoing binaural processing.

OBJECTIVES

To investigate the differences in binaural interaction component of auditory brainstem response (ABR-BIC) between children with autism spectrum disorder (ASD) and normal peers and to correlate between ABR-BIC amplitudes and the acquired communication skills in ASD children.

METHODS

ASD was diagnosed according to the criteria of 5th edition of diagnostic and statistical manual of mental disorders (DSM-V) and all children with ASD underwent test of acquired communication skills (TACS). Click evoked ABRs were elicited by left monaural, right monaural and binaural stimulation at intensity of 65 dBnHL in all participants. ABR-BIC was then calculated as the difference between the binaurally evoked ABR waveform and a predicted binaural waveform created by algebraically summing the left and right monaurally evoked ABRs. The difference in amplitudes that gives rise to ABR-BIC is at IV-VI waves.

RESULTS

ABR-BIC amplitudes were demonstrated to be significantly reduced in the ASD group compared to the control group. There was significant positive correlation between ABR-BIC amplitude and the language and social scores in TACS.

CONCLUSION

This study provided an objective evidence of binaural processing disorder in children with ASD.

Sensitivity and specificity of DSM-5 diagnostic criteria for autism spectrum disorder in a child and adolescent sample

BACKGROUND

Controversy exists regarding the DSM-5 criteria for autism spectrum disorders (ASD). Given the mixed results that have been reported, our main aim was to determine DSM-5 sensitivity and specificity in a child and adolescent Spanish sample. As secondary goals, we assessed the diagnostic stability of DSM-IV-TR in DSM-5, and clinical differences between children diagnosed with an ASD or a social (pragmatic) communication disorder (SPCD).

METHODS

This study was carried out in 2017, reviewing the medical records of patients evaluated in our service. Items from a parent report measure of ASD symptoms (Autism Diagnostic Interview-Revised) were matched to DSM-5 criteria and used to assess the sensitivity and specificity of the DSM-5 criteria and current DSM-IV criteria when compared with clinical diagnoses.

RESULTS

DSM-5 sensitivity ranged from 0.69 to 1.00, and was higher in females. By age, the DSM-5 and DSM-IV-TR criteria showed similar sensitivity. In the case of intellectual quotient, DSM-5 criteria sensitivity was lower for those in the "low-functioning" category. DSM-5 specificity ranged from 0.64 to 0.73, while DSM-5 specificity was similar for all phenotypic subgroups. With respect to stability, 83.3% of autism disorder cases retained a diagnosis of ASD using the DSM-5 criteria. With regard to differences between ASD and SPCD, we found that patients diagnosed with ASD received more pharmacological treatment than those diagnosed with SPCD.

CONCLUSIONS

Further research is required to confirm our results. Studies focusing on the SPCD phenotype will be necessary to determine outcome differences with ASD and the most effective diagnostic and therapeutic tools.

Social Abilities and Visual-Spatial Perspective-Taking Skill: Deaf Signers and Hearing Nonsigners

Social abilities relate to performance on visual-spatial perspective-taking (VSPT) tasks for hearing nonsigners but may relate differently to VSPT abilities for deaf signers because of their distinct linguistic and social experiences. This research investigated whether deaf adults approach VSPT tasks nonsocially (as previously suggested for deaf children) or socially (as seen for hearing adults). Adult hearing nonsigners (n = 45) and deaf signers (n = 44) performed a nonlinguistic VSPT task, mental rotation and spatial orientation tasks, and completed a questionnaire measuring social abilities and degree of socialness. No group differences were observed for any of the spatial tasks. Hearing nonsigners with better social abilities performed better on the VSPT task but deaf signers who were less social performed better on the VSPT task. Therefore, social abilities and VSPT skill relate differently for deaf and hearing individuals, possibly due to differences in communication modality and/or sociocultural experiences.

Pragmatic language impairment general and specific associations to mental health symptom dimensions in a child psychiatric sample

Background

The results of several international studies indicate a high prevalence of language and communication impairments among children who are referred to child psychiatric services. However, these impairments are likely to remain undetected unless language and communication impairments are evaluated during the psychiatric assessment.

Aims

The aim of the present study is to investigate the specific association between general and specific mental health problems, as expressed by the problem scales of Child Behavior Checklist (CBCL) and Teachers Report Form (TRF), and pragmatic skills and pragmatic language impairments (PLI) as defined the Pragmatic Composite of the Child Communication Checklist (CCC-PC).

Methods

Children aged from 8 to 13 years (n = 73) were recruited in sequence following referral to a child and adolescent psychiatry (CAMHS) outpatient clinic within 12 months. Children with possible or established autism or intellectual disability were excluded. Standardized instruments measuring language, communication and mental health symptoms were distributed to parents and teachers, an intelligence test administered for clinical purposes, and demographic information was included.

Results

The parent reports showed PLI among 38% of the children and revealed strong associations with the CBCL scales for emotional problems, thought problems and, especially, social and withdrawal symptoms, which mean more associations to internalized and non-externalized problems. PC-scores were at similar levels and PLI was reported by teachers at similar rates (compared to parent reports) with moderate agreement. Teacher PC-scores showed associations to only one TRF-scale, social problems. The CCC-PC subscale with the strongest associations to mental health symptoms was «Use of Context» («Social Relationships» do not contribute to the CCC-PC scores).

Conclusion

There was a general increase in PC-scores and increased prevalence of PLI in this clinical sample. PC-scores correlated with symptom scores for internalizing and non-externalizing problems scales. The strongest common factors appear to be related to the social aspects of mental health. Pragmatic skills should be considered as a protective factor for mental health rather than investigating pragmatic impairment as a risk or vulnerability factor.

Functionally distinct language and Theory of Mind networks are synchronized at rest and during language comprehension

Communication requires the abilities to generate and interpret utterances and to infer the beliefs, desires, and goals of others ("Theory of Mind"; ToM). These two abilities have been shown to dissociate: individuals with aphasia retain the ability to think about others' mental states; and individuals with autism are impaired in social reasoning, but their basic language processing is often intact. In line with this evidence from brain disorders, functional MRI (fMRI) studies have shown that linguistic and ToM abilities recruit distinct sets of brain regions. And yet, language is a social tool that allows us to share thoughts with one another. Thus, the language and ToM brain networks must share information despite being implemented in distinct neural circuits. Here, we investigated potential interactions between these networks during naturalistic cognition using functional correlations in fMRI. The networks were functionally defined in individual participants, in terms of preference for sentences over nonwords for language, and for belief inference over physical-event processing for ToM, with both a verbal and a nonverbal paradigm. Although, across experiments, interregion correlations within each network were higher than between-network correlations, we also observed above-baseline synchronization of blood oxygenation level-dependent signal fluctuations between the two networks during rest and story comprehension. This synchronization was functionally specific: neither network was synchronized with the executive control network (functionally defined in terms of preference for a harder over easier version of an executive task). Thus, coordination between the language and ToM networks appears to be an inherent and specific characteristic of their functional architecture. NEW & NOTEWORTHY Humans differ from nonhuman primates in their abilities to communicate linguistically and to infer others' mental states. Although linguistic and social abilities appear to be interlinked onto- and phylogenetically, they are dissociated in the adult human brain. Yet successful communication requires language and social reasoning to work in concert. Using functional MRI, we show that language regions are synchronized with social regions during rest and language comprehension, pointing to a possible mechanism for internetwork interaction.

Social (Pragmatic) Communication Disorder: Another name for the Broad Autism Phenotype?

The Diagnostic and Statistical Manual of Mental Disorders' (5th ed.) Social (Pragmatic) Communication Disorder is meant to capture the social elements of communication dysfunction in children who do not meet autism spectrum disorder criteria. It is unclear whether Social (Pragmatic) Communication Disorder captures these elements without overlapping with Autism Spectrum Disorder or the Diagnostic and Statistical Manual of Mental Disorders' (5th ed.) Language Disorder. Standardized behavioral assessments administered during a family genetics study were used to evaluate the social communication impairment and the restricted interests and repetitive behaviors in persons with autism spectrum disorder, language impairment, or neither. Social communication impairment and restricted interests and repetitive behavior were significantly correlated in all family members regardless of affection status. Rates of social communication impairment and restricted interests and repetitive behavior were highest in individuals with autism spectrum disorder. One-third of family members with language impairment presented with at least mild/moderate levels of social communication impairment (36.6%) and restricted interests and repetitive behavior (43.3%). A subset of unaffected members also presented with mild/moderate levels of social communication impairment (parents = 10.1%, siblings 11.6%) and restricted interests and repetitive behavior (parents = 14.0%, siblings = 22.1%). The majority of child family members with mild/moderate levels of social communication impairment had similar restricted interest and repetitive behavior levels reflecting criteria representing the Broad Autism Phenotype. These data suggest that social pragmatic communication disorder does not capture the profiles of children who have both social communication impairment and restricted interests and repetitive behavior but are in need of clinical services.

Vagal Tone as a Putative Mechanism for Pragmatic Competence: An Investigation of Carriers of the FMR1 Premutation

Pragmatic language skills exist across a continuum in typical and clinical populations, and are impaired in many neurodevelopmental disorders, most notably autism. The mechanisms underlying pragmatic impairment are poorly understood, although theory suggests dampened vagal tone plays a role. This study investigated the FMR1 premutation as a genetic model that may lend insight into the relationship between vagal function and pragmatic ability. Participants included 38 women with the FMR1 premutation and 23 controls. Vagal tone accounted for significant variance in pragmatics across both groups and statistically mediated the effect of FMR1 premutation status on pragmatic ability. Results support vagal tone as a biophysiological correlate of pragmatic ability, which informs potential mechanistic underpinnings and could have implications for targeted treatment.

Emergency, Pictogram-Based Augmented Reality Medical Communicator Prototype Using Precise Eye-Tracking Technology

This article details the process involved in the development of a new and revolutionary solution for medical communication. Our solution precisely tracks head and eye movement and allows the user to interact with an intuitive, pictogram-based interface. Around the world, many people rely on written instruction and verbal or nonverbal communication to accompany medication or provide additional information on a patient's symptoms. However, poor language skills and a host of health problems, psychological disorders, and trauma can limit a person's ability to speak or move. Our solution could drastically improve the quality of life of patients suffering from brain injury, hearing loss, and many other communication disorders and disabilities. They can begin to communicate with greater ease and fluency, feel connected to the world, and experience better and more accurate medical care. The potential applications have many incredible advantages, ranging from improved communication with family to emergency medical uses that can save the life of an affected individual. The use of augmented reality in our solution, as well as the secondary camera to improve accuracy in eye tracking, makes this solution for more accuracy, whereas the inclusion of a pictogram-based interface makes it a practical solution that cuts down on the error margins of traditional accessibility devices and makes it equally accessible to children and speakers of foreign languages. According to the data gathered, we confirm that the solution we propose has many possible practical applications in improving the health, safety, and quality of life of the user.

Autism Spectrum Disorder Diagnosis in Diagnostic and Statistical Manual of Mental Disorders-5 Compared to Diagnostic and Statistical Manual of Mental Disorders-IV

Objectives:

The objective of this study was to investigate the concordance of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and DSM-5) diagnostic criteria for autism spectrum disorder (ASD).

Methods:

We retrospectively reviewed the medical records of 170 subjects (age range: 3–23, 140 boys) with developmental delay or social deficit from January 2011 to July 2016 at the Department of Psychiatry of Asan Medical Center. The Autism Diagnostic Interview-Revised (ADI-R), the Autism Diagnostic Observation Schedule (ADOS), and intelligence tests were performed for each subject. Diagnosis was reviewed and confirmed for each subject with DSM-IV Pervasive Developmental Disorder (PDD) and DSM-5 ASD criteria, respectively.

Results:

Fifty-eight of 145 subjects (34.1%) who were previously diagnosed as having PDD in DSM-IV did not meet DSM-5 ASD criteria. Among them, 28 (48.3%) had Asperger’s disorder based on DSM-IV. Most algorithm scores on ADOS and all algorithm scores on ADI-R were highest in subjects who met both DSM-IV PDD criteria and DSM-5 ASD criteria (the Convergent group), followed by subjects with a DSM-IV PDD diagnosis who did not have a DSM-5 ASD diagnosis (the Divergent group), and subjects who did not meet either DSM-IV PDD or DSM-5 ASD criteria (the non-PDD group). Intelligence quotient was lower in the Convergent group than in the Divergent group.

Conclusion:

The results of our study suggest that ASD prevalence estimates could be lower under DSM-5 than DSM-IV diagnostic criteria. Further prospective study on the impact of new DSM-5 ASD diagnoses in Koreans with ASD is needed.

Cognitive aspects of social competence in the current New South Wales Kindergarten to Grade Six Syllabuses

BACKGROUND/AIM

Occupational therapists are commonly referred children who find reduced social competence a barrier to participation in school activities. Little is known about the social skills expected of children at school and the thinking strategies children use during social interactions. This study aimed to investigate the social skills expected of children during school-based learning activities in the current NSW K-6 Syllabuses and the types of cognitive strategies expected during social interactions.

METHODS

A qualitative text-based approach was adopted to explore the range of social skills expected of children at school. A content analysis of text-based data was used to identify specific social skills represented in the current NSW K-6 Syllabuses and the types of cognitive strategies required. Cognitive strategy use items from the PRPP System of Task Analysis were used to identify expected ways of thinking that related to social competence outcomes as stated in the Syllabus.

RESULTS

Findings revealed a high number of social skills represented in expected learning outcomes for all six subjects included in the analysis. Four categories representing expected social behaviours across the syllabuses were identified: intrapersonal skills: communication by language; interpersonal skills and responding to others. Each desired social competence phrase embedded within syllabus objectives aligned with at least one item from the PRPP System of Task Analysis. The highest representation of expected strategy use was items from Recall (memory) and Planning (problem solving and evaluating) Quadrants.

CONCLUSION

Investigation into the types of cognitive strategies embedded within Syllabus objectives which relate to social competence can assist therapists more accurately target social skills and associated cognitive strategies required for occupational performance at school. Findings from the study support the use of the PRPP System of Task Analysis for identifying and addressing cognitive strategy use during occupational therapy assessment and intervention.

Why Pragmatics and Theory of Mind Do Not (Completely) Overlap

Aim of the paper is to discuss the extent to which pragmatics, i.e., the ability to use language and other expressive means to convey meaning in a specific interactional context, overlaps with Theory of Mind (ToM), i.e., the ability to ascribe mental states to oneself and the others. We present empirical data available in the current literature concerning the relation between these two faculties, with specific reference to the developmental and clinical domains. Part of the literature we take into account appears to show that ToM does correlate with pragmatic ability; however, other studies appear to show that pragmatic ability alone cannot explain the empirical differences of performance across different kinds of pragmatic tasks, and therefore that another, at least partially different faculty is required to account for human communication. We argue that to conceive pragmatics as a sort of subcomponent of ToM, and thus to conflate or reduce the notion of pragmatics into the (wider) notion of ToM, is not theoretically correct and a possible cause of methodological confusion in the relevant empirical research. It thus turns out to be necessary that the two faculties be investigated with separate theories as well as different experimental tasks.

Exploring Visual Perspective Taking and body awareness in children with Autism Spectrum Disorder

INTRODUCTION

Recent evidence suggests that impairments in social cognition are associated to the cognitive abilities needed to take several viewpoints in perceptual situations and body awareness. The aim of the current study was to investigate Visual Perspective Taking (VPT) and Body awareness performance in a group of children with Autism Spectrum Disorders (ASD) compared with a group of children with Intellectual Disability (ID) and typically developing (TD) children.

METHODS

Our groups were administered an IQ test and a VPT task, and body awareness tests.

RESULTS

Children with ASD or ID were more impaired in body awareness development compared to TD (p < .001) children. The ASD group differentiates largely from the other two groups in the mean VPT (p < .001) scores.

CONCLUSIONS

The current study provides a framework for considering social impairments in autism on a broader scale, including visuoperceptual and body awareness difficulties as a core contributor to social interaction difficulties.

Measuring the Diagnostic Features of Social (Pragmatic) Communication Disorder: An Exploratory Study

PURPOSE

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition introduced a new neurodevelopmental disorder, social (pragmatic) communication disorder (SPCD), that is characterized by deficits in 4 areas of communication. Although descriptions of these areas are provided, no assessment tools for SPCD are recommended. The purpose of this study was to examine the extent to which items from measurement tools commonly used in assessing pragmatic language impairment and related disorders might be useful in assessing the characteristics of social communication that define SPCD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

METHOD

Based on a literature search, 594 items from assessment tools commonly used to measure social communication abilities in people with pragmatic language impairment were identified. The first author judged whether each item reflected 1, more than 1, or none of the 4 SPCD diagnostic characteristics. After a brief training process, 5 second raters independently mapped subsets of items to the 6 categories. We calculated the percentage of agreement and Cohen's kappa for each pair of raters in assigning items to categories.

RESULTS

Percentages of agreement ranged from 76% to 82%, and Cohen's kappa values ranged from .69 to .76, indicating substantial agreement. Sources and item numbers for the 206 items that both raters assigned to the same SPCD feature are provided.

CONCLUSIONS

These items may provide guidance in assessing SPCD and in designing standardized screening and diagnostic measures for SPCD.

Figurative language comprehension in individuals with autism spectrum disorder: A meta-analytic review

We present a meta-analysis of studies that compare figurative language comprehension in individuals with autism spectrum disorder and in typically developing controls who were matched based on chronological age or/and language ability. A total of 41 studies and 45 independent effect sizes were included based on predetermined inclusion criteria. Group matching strategy, age, types of figurative language, and cross-linguistic differences were examined as predictors that might explain heterogeneity in effect sizes. Overall, individuals with autism spectrum disorder showed poorer comprehension of figurative language than their typically developing peers (Hedges' g = -0.57). A meta-regression analysis showed that group matching strategy and types of figurative language were significantly related to differences in effect sizes, whereas chronological age and cross-linguistic differences were not. Differences between the autism spectrum disorder and typically developing groups were small and nonsignificant when the groups were matched based on the language ability. Metaphors were more difficult to comprehend for individuals with autism spectrum disorder compared with typically developing controls than were irony and sarcasm. Our findings highlight the critical role of core language skills in figurative language comprehension. Interventions and educational programmes designed to improve social communication skills in individuals with autism spectrum disorder may beneficially target core language skills in addition to social skills.

Social communication disorder: a narrative review on current insights

Social communication disorder (SCD) is a novel diagnosis listed under the rubric of communication disorders within the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) and it is reported to be characterized by impairment in use of verbal and nonverbal communication for social aims. This review attempts to summarize the current understanding of the SCD concept along with its evolution and presents data from previous studies conducted. Suggestions for further research are also delineated. As listed in DSM-5, the criteria for this novel diagnosis are vague, display elevated comorbidity with other neurodevelopmental disorders and other childhood psychopathologies, and show partial overlap with autistic spectrum disorders both in terms of genetics and family histories. Data on cross-cultural presentations and temporal stability are also limited. The social communication model proposed by Catani and Bambini may help integrate the neurobiological findings pertaining to SCD. Valid and reliable assessment methods need to be developed for SCD. This may involve either development of novel instruments capturing the DSM-5 criteria or application of statistical methods such as item response theory to existing instruments. The relationships between broad autism phenotype, pragmatic language impairment, nonverbal learning disorder, learning disorders, autistic spectrum disorders, and SCD should be evaluated with further studies.

Evaluating social (pragmatic) communication disorder

BACKGROUND

Social (pragmatic) communication disorder (SPCD) is a new diagnosis introduced by DSM-5, characterised by problems with verbal and nonverbal social communication. It is currently unclear whether SPCD is a valid diagnostic category, because little is known about the characteristics of those who meet its criteria. We sought to identify and describe cases of SPCD, to contribute to debates about its validity. We investigated whether the symptoms of SPCD cluster together to form a coherent syndrome that is distinct from autism spectrum disorder (ASD) in terms of its core and associated features.

METHODS

Participants were young people (N = 1,081, age range = 4-18 years) who had attended a specialist social communication disorders clinic for children with fluent language and normal-range intelligence. Standardised parent-report data were collected using the Developmental, Dimensional and Diagnostic Interview (3Di), Child Communication Checklist (CCC) and Strengths and Difficulties Questionnaire (SDQ). An algorithm was designed using 3Di and CCC items to implement DSM-5 SPCD criteria.

RESULTS

Eighty-eight young people met our criteria for SPCD, with 801 meeting DSM-5 ASD criteria and the remaining 192 having neither SPCD nor ASD ('clinical comparison group'). The core symptoms of SPCD co-occurred to a moderate degree (average interitem correlation = .22). SPCD cases had autistic social difficulties that were intermediate between ASD and the clinical comparison group. SPCD was associated with high rates of nonautistic psychopathology, with 63.5% scoring in the abnormal range of the SDQ's Total Problems scale.

CONCLUSIONS

We did not find evidence that SPCD is qualitatively distinct from ASD. Rather, it appears to lie on the borderlands of the autism spectrum, describing those with autistic traits that fall just below the threshold for an ASD diagnosis. SPCD may have clinical utility for identifying people with autistic traits that are insufficiently severe for ASD diagnosis, but who nevertheless require support.