Introduction in social communication, the effectiveness of communicating and

 

Introduction

Social (Pragmatic) Communication Disorder as
a new diagnostic category that is included under Communication Disorders in the
Neurodevelopmental Disorders section of the Diagnostic and Statistical Manual
of Mental Disorders, Fifth Edition (DSM-5) (American Psychiatric Association
2013 cited Swineford et al., 2014). Grohol (2017) stated that children with Social (Pragmatic) Communication
Disorder face challenges in following the social
rules in conversation it might be verbal or non-verbal communication. With
these sorts of hurdles in social communication, the effectiveness of
communicating and their involvement in a social manner with others will lead
the children to struggle, and ‘can even affect academic performance’. Norbury (2014a) mentioned that to have successful
communication this requires the use of linguistic context (pragmatic) which
(Rhalmi 2013) refers to the language setting in which a word is used within a
text and, the use of language in social contexts (social communication) which
(Nugent 2013) defined as ‘the general environment or circumstances that are the
social framework for interpersonal and individual behaviour’. Communication
skills are a significant factor in life’s
experience of the individual, especially
for developing language critical to cognitive growth and learning among children.
To provide ideas effectively, we learn to read, write, make a gesture, listen, and speak. It will not offer
instant outcome but instead, it takes
place the process of communication. Having the skills to take part in a dynamic
and interactive communication with peers and adults in the educational setting
is very important for a child to succeed
in school (American Speech-Language-Hearing Association, 2005a).

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In
this assignment, I am writing the related controversial issues from different
arguments and findings surrounding inclusion of children diagnosed with Social
Pragmatic Communication Disorder. Currently, researchers, health and education
professionals are working together to provide effective intervention that help
children with speech language and communication needs in educational setting. There
is a significant change of educational policy that create an effort to deliver inclusion
education setting for all children with special educational needs (Lipsky &
Gartner 1989; Peck, Odom, & Bricker 1993; Sailor 1991; Will 1986; Wolery
& Wilbers 1994 cited American Speech-Language-Hearing Association 1996). 

 

with its ‘Background’ which will give you an
idea on how Social (Pragmatic) Communication Disorder got its term and what terminologies
that are used by other researchers and research bodies. In this paper, I am
also going share insights in the ‘Rationale’ section on why Social (Pragmatic)
Communication Disorder is one of subjects of debates and on-going researches related
to Autism Spectrum Disorder. I also included the latest description in the ‘Definition’
section by ‘American Psychiatric
Association’ despite the different terminologies referred by other prominent researchers.
In the ‘Identification’ section it comprises the diagnostic criteria of Social
(Pragmatic) Communication Disorder. It will be followed by ‘Assessment and
Diagnosis’ section where researchers provide the most suitable tools to provide
appropriate service to children with social communication deficiencies. Furthermore,
in the ‘Intervention’ section it covers one of the most common treatment that
is being used to provide at least the most effective intervention.

 

Background

 

•      
n 1983, Rapin and Allen proposed a classic?cation of children with developmental

•      
language disorders, which included children with autism as well as those
with

•      
special?c language impairments (SLI).

•      
n 1983, Rapin and Allen proposed a classic?cation of children with developmental

•      
language disorders, which included children with autism as well as those
with

•      
special?c language impairments (SLI).

•      
n 1983, Rapin and Allen proposed a classic?cation of children with developmental

•      
language disorders, which included children with autism as well as those
with

•      
special?c language impairments (SLI).

•      
n 1983, Rapin and Allen proposed a classic?cation of children with developmental

•      
language disorders, which included children with autism as well as those
with

•      
special?c language impairments (SLI).

During the 1950s and 1960s,
segregated programs were opened to serve children with disabilities. Then, in
the late 1960s and 1970s, children with special educational needs were included
in the mainstream programs. The term inclusion was defined by McCarthy (1994
cited by 1994
cited American
Speech-Language-Hearing Association 1996) “…a
state-of-the-art term that refers to placing children with disabilities in
integrated sites, which … means bringing support services to the child rather
than moving the child to a segregated setting to receive special services”

Before
the term, Social (Pragmatic) Communication
Disorder was used to diagnose children with difficulties in using pragmatic and
social context it was known to be ‘Semantic-Pragmatic Deficit Syndrome’ (Rapin
and Allen 1983 cited Adams 2001a). There are different labels that had been
used, but the commonly used until now is the term ‘Semantic-Pragmatic Language
Disorder (SPLD) (Bishop and Resebloom 1987 cited Adams 2001b). There are
debates regarding the labelling that draw attention to children with SLPD that
links to those on the autistic spectrum (Lister Brook and Bowler 1982, Boucher
1998 cited Adams 2001c). Moreover, more research results show that children
diagnosed at SPLD do not necessarily have additional grammatical or semantic
problem (Bishop et al. 2000 cited Adams
2001d). According to Bishop (2000a), the label ‘Pragmatic Language Impairment’
(PLI) ‘seems preferable’. He further explains that it is not required that semantic
and pragmatic problem will coincide rather ‘it is easier to accommodate a more dimensional
view of language impairment’, this will help to find a treatment in pragmatics
as one domain in which communication may be impaired. This issue is getting
more controversial (Adams 2001a) with the increase
related evidence that children diagnosed
with PLI are not necessarily to be included in autistic
spectrum. (Bishop 2000b) argues that children with autistic-like pragmatic
difficulties should be regarded as autistic? She emphasizes that there are crucial evidence
to be considered before jumping to that conclusion. First, she stated that ‘the
studies concerned with differential diagnosis
of autism and Specific Language Impairment (SLI), and reveal cases that are
hard to categorize as one or the other’. Second,
she added that ‘children who are identified as having semantic-pragmatic
disorder reveal that only a subset of them appear to have significant autistic
features in non-linguistic domains.

ore recent research (Bishop

et al.

2000) has

indicated that children diagnosed at SPLD do not
necessarily have additional

grammatical or semantic problems. This has led
Bishop (

 

In
2013, the American Psychiatric Association labelled
‘Social (Pragmatic) Communication Disorder as a new
diagnosis in the fifth edition of the Diagnostic and Statistical Manual
of Mental Disorders (DSM-5). It gives
better understanding and recognition of individuals ‘who have significant
problems using verbal and nonverbal communication for social purposes, leading
to impairments in their ability to effectively communicate, participates socially, maintains social relationships, or otherwise perform academically
or occupationally’. Studies related to Social (Pragmatic) Communication
Disorder is continually developing and updates of DSM-5 was recently released (Supplement
to Diagnostic and Statistical Manual of Mental Disorders 2016). There might be
arguments and debates from the previous findings and resulted in various challenges
to medical practitioners, clinics and treatment centres.
But the most important issue is how these individuals who have Social (Pragmatic) Communication Disorder
be given proper treatment and services that they need (American Psychiatric
Association 2017).

 

Rationale

 

The
understanding that inclusive service provides a wide-ranging goal, it should not
compromise to recognize the individual
service needs most especially specific children and families. Hence, with the
services given in schools, the term ‘inclusive practices’ rather than
‘inclusion’ is the appropriate description of services that are offered. Inclusive
practices serve as an intervention that is present in the educational setting
that is least restrictive. It may use ‘natural environment’ to serve as an
‘intervention context’, it also creates services that combine ‘classroom
content and curriculum activities, and collaborating with families, educators
and other personnel’. Thus, it is argued that ‘inclusive practices’ are
suitable to implement to the needs of children with communication disorders (American Speech-Language-Hearing Association 1996).

 

  Children
with social communication deficits have hard times befriending others. Lack of
interaction hinders them to socially cooperate with peers. It very important to
let them feel that they are part of the group. They need to understand that
they might have similarities or differences to one another (Deiner 2009). Children’s
communication development requires
serious attention. Having good communication skills could help them to be
independent and achieve greater expectation in life. According to (Norbury 2014b),
to be effective in communicating we should possess a deeper understanding of the precise words we uttered and construct
meaningful ideas in relation to our
knowledge and experiences.  In addition. Children
with Social (Pragmatic) Communication Disorder is considered to have social and
learning difficulties which mean they are
entitled to a special educational
provision (Bristol City Council). As mandated in Special Educational Needs and
Disability Code of Practice (SEND) 2015, Chapter 6 Schools, Section 6.8
Equality, and Inclusion highlights the
necessity of services to students with Special Educational Needs (SEN) in every
school. Schools are obliged to work together with the local authority in any provision
and development for the benefit of the children. It is also the duty of schools
to collaborate with other local education providers and find different ways to effectively
meet the needs of the students (GOV.UK).

 

Even though that Social (Pragmatic) Communication Disorder has become a new term of diagnosis, there has been a lot of debates when it
comes to
terminologies and diagnostic criteria. In addition, there are inconsistencies
of reliable assessment tools and inadequate assessment of profiles across
different neurodevelopmental disorders (Norbury 2014c). Moreover, it has been
criticised due to a lack of experimental evidence showing that the disorder is
different from Autism Spectrum Disorder (ASD) (Ozonoff, 2012; Skuse, 2012; Tanguay,
2011 cited by Taylor and Whitehouse 2016). With
the issues of various terminologies, Norbury (2014d) pointed out that there are
disadvantages attached the new diagnosis plus the ‘different perspectives of
the clinical practitioners’ who will give influence on the outcome. There is an
argument related to the diagnostic criteria of Social (Pragmatic) Communication Disorder and Autism Spectrum Disorder. It
overlaps with each other making it complicated to diagnose. She even highlighted
that when the children will receive the diagnosis it might not receive the
‘clinical or educational services’ that are appropriate to them. It is also
being supported by Skuse (2012 cited by Norbury 2014a) that how these
diagnostic criteria are effectively utilized without overlapping the diagnostic
criteria for Autism Spectrum Disorder.

 

Definition

 

According
to the DSM-5 (American Psychiatric Association 2013a), children with Social (Pragmatic) Communication Disorder is described
mainly as with a difficulty with
pragmatics, and the social use of language and communication. The lack of
understanding and following social rules of verbal and nonverbal communication
in a realistic setting. It would be challenging to children with social communication
deficits to converse effectively, participate in any social interaction,
develop social relationships, and have academic achievement. In addition, the
mentioned symptoms must be present in the early developmental period of a child.
The Social (Pragmatic) Communication Disorder
may exist in other communication disorders in the DSM-5, but cannot be identified
in the presence of Autism Spectrum Disorder (Swineford et al. 2014a). Even though Social (Pragmatic) Communication
Disorder and Autism Spectrum Disorder have the identical requirements of the deficit in social communication needs, but
children with Social (Pragmatic) Communication Disorder have different specific
diagnostic features compared to Autism Spectrum Disorder with restricted repetitive
patterns of behaviour (Swineford et al.
2014b). Additional description is that Social (Pragmatic) Communication
Disorder shared a similar characteristic with Language Impairment. Children
with difficulties with using social communication tend to interact socially with their family and peers. Studies also
show that children with this diagnostic criterion can acquire similar characteristics
from Attention Deficit/Hyperactivity Disorder, behavioural
problems, and even Specific Language Disorder (DSM-5 American Psychiatric
Association 2013).

 

Identification

 

Based on DSM-5 (American Psychiatric
Association 2013b) diagnosis of Social (Pragmatic) Communication Disorder is
not common among children younger than 4 years old it is because social
(pragmatic) communication relies on the satisfactory developmental progress in
speech and language. When children reached 4 or 5 years old that would be the
appropriate level to identify any specific deficits in social communication. There
are even ‘milder forms of the disorder’ that may not become obvious until they
reach early adolescence. The outcome may
vary depending on the child’s development there are some children who extensively
improve in a certain amount of time and others may continue to have
difficulties into adulthood. Even though with the considerable improvement, difficulties
in ‘social relationships and behavioural problems
and acquisition of other related skills’ may still be present when a child has an early pragmatic deficiency. Furthermore, if
a family has hereditary issues with Autism
Spectrum Disorder, Communication Disorder, or even Specific Learning disorder
it may increase the possibility for a child to have Social (Pragmatic)
Communication Disorder. Norbury (2014e) justifies that findings showed most of
the children with Social (Pragmatic) Communication Disorder were being
evaluated having’ speech abnormalities associated with autism and used
stereotyped language’. Adams et. al (2012a) also provide clearer identification
that most of the children with this disorder possess ‘higher level language
impairments such as difficulty with interference generation, narrative
organization and comprehension of discourse and mild difficulties’.

 

Assessment and Diagnosis

 

Looking
at the broad picture of DSM-5 where Social (Pragmatic) Communication Disorder
is a new diagnostic category (American Psychiatric Association 2013c)
researchers are finding and developing the most suitable assessment to provide
the service to the children and to use in further studies.  It is emphasized by Norbury (2014f) that measuring
social communication and pragmatic language abilities are excessively difficult
in ‘standardized ways because they are a set of contextually dependent human behaviours that occur in dyadic exchanges’. To
support the argument, (Adams 2002, Volden et
al., 2009 cited by Norbury 2014b) according
to ‘the structure provided by a standardized testing situation makes it difficult
to capture social communication problems that may arise in everyday situations
where the rules of engagement are less explicit and highly dynamic’. When establishing
a standardized assessment, Carter et al.
(2005) point that large sample of respondents
from the ‘target population’ and if at all possible children with’ the same
ethnic, cultural and linguistic background, age, sex and educational level and
type’. Social communication assessment ‘should involve some examination of a
child’s comprehension of the social signals sent to him/her by others’. It is
very significant to learn and use the language in proper possibilities with a
social context. However, if a child has challenges in understanding ‘social
cues’ given in his/her communication experiences, the child is likely to
‘violate pragmatic rules’ and even face difficulties to language learning (Landa
2005).

 

The
use of standardized checklists for social communication and pragmatic disorder has become a ‘popular method of assessment’ (Norbury
2014g). Perhaps the most well-recognized
assessment material in both clinical practice and research development is the
Children’s Communication Checklist-2 (CCC-2) (Bishop 2003 cited by Norbury 2014c).
In spite of the result being used for the diagnosis, there are still issues and
clarifications that surround the reliability of the assessment. On the other
hand, (Bishop & Adams 1989 cited by Norbury 2014d) by using ‘quantitative
approaches’, the result of the assessment in ‘analysing
conversation in detail has been developed
with acceptable levels of interrater reliability’. It is supported by the
research findings that by using conversational analysis it provides a higher percentage of reliability (Adams et al.,
2006). We can see that it gives advantages related to the efficiency of the
assessment, however, Norbury (2014h) stresses out that it is ‘a time-consuming
assessment method, which may limit its clinical and research utility’.

Assessment of social community-

tion should involve some examination of

a child’s comprehension of the social sig-

nals sent to him/her by others. This is

because language is learned and used

within a social context. If a child does not

understand the social cues given by oth-

ers, he/she is likely to violate basic prag-

matic rules as well as
encounter chal-

lenges to language
learning.

Assessment of social community-

tion should involve some examination of

a child’s comprehension of the social sig-

nals sent to him/her by others. This is

because language is learned and used

within a social context. If a child does not

understand the social cues given by oth-

ers, he/she is likely to violate basic prag-

matic rules as well as
encounter chal-

lenges to language
learning.

 

Intervention

 

Again, successful experiences for all
learners must be carefully and intentionally planned. Prizant (1995)
suggested that modifications to the environment, activities, and child
interactions should all be considered when planning for a variety of inclusive experiencesSMA1 

There
are still ongoing debates on the findings of the effectiveness of
speech-language interventions that mainly will benefit the children with
language pragmatic or social communication needs.  Therefore, Adams et. al. (2012b) give emphasis to the need for suitable
communication interventions as preventative measures. Adams et al. (2012 cited by Norbury 2014e) released
the first randomized controlled trial of a social communication intervention with
an objective to provide appropriate intervention specifically at children with Social
(Pragmatic) Communication Disorder. The Social Communication Intervention
Project (SCIP) (http://www.psych-sci.manchester.ac.uk/scip/) ‘is an
individualized intervention approach that targets development in three areas:
social understanding and social interaction; verbal and nonverbal pragmatic
skills, including conversation; and language processing, including narrative,
inferencing, and developing word knowledge’. Moreover, Norbury (2014i) clarified
that despite the positive outcomes of the study through the period of intensive
intervention there are still challenges to overcome. According to Adams and
Gaile (2012 cited by Adams et al. 2012), they described that the experimental treatment
was an ‘intensive manualized social communication intervention’ that will
correct any deficits in ‘semantics and high-level language skills, pragmatic
difficulties, and social interaction and social cue interpretation’.

 

Based
on the result and findings of the research, Adams et al (2012c) determined that by the used of ‘manualized
experimental SCIP intervention’ there is a success in giving thorough treatment
procedure in order to provide consistent intervention that will give way to an
accurate support to children with social communication difficulties. We can
look at from this perspective that it has
provided a clearer picture that the effectiveness of research findings could
better intervention. In some way, Norbury (2014j) yielded a very significant
viewpoint that the most aims of intervention are
to improve language and communicative function rather the ‘cure’ disorder. Furthermore,
she gave emphasis to the whole efficacy of the diagnostic materials to provide clear
intervention. Nevertheless, it is still necessary to utilize ‘standardised assessment tools’ for it will be
very advantageous for future studies.

 

 

Conclusion

The
implementation of services to children with social pragmatic communication
disorder comes with a wide range of inclusive service models. There should be flexible
selections to consider as any changes depending on the children’s’ needs. Thus,
the inclusive setting provides opportunities
to develop their social and interactive skill and other specific competencies that
would benefit them by using the various service models. In the other (Guralnick
& Groom, 1988; Jenkins, Odom, & Speltz, 1989; Lamorey & Bricker,
1993; Notari & Cole, 1993; Wolery & Wilburs, 1994 cited by American Speech-Language-Hearing Association 1996). On
the other hand, there is a substantial advantage in early integration, but it
would not guarantee to have positive results all the time rather the success of
the intervention depends on organised plan and implementation (Lamorey & Bricker 1993; Notari & Cole 1993; Wolery & Wilbers  1994 cited by American Speech-Language-Hearing Association 1996). It also an issue
to consider the funding that may cause an approval or rejection of inclusive
service plus the administrative perceptions towards inclusion efficacy (Salisbury
& Chambers 1994 cited by American
Speech-Language-Hearing Association 1996). There is a need for
educational preparation for professionals who will be given responsibilities
that are essential in an inclusive
setting. In addition, inclusion is very challenging to achieve without the
presence of qualified personnel who collaboratively work and share roles among
speech-language pathologists, teachers, and family members. It should also
consider the effects of the children within inclusion. It was stressed by
Sharpe, York, & Knight (1994 cited by American
Speech-Language-Hearing Association 1996) that there are possibilities that children
with special needs may affect the ability of regular students to benefit from
the general education. Presently, there are
positive research findings about the effectiveness of inclusive practices.
Thus far, further studies should be conducted to provide more concrete findings
and assessment to inclusive practices for children with communication disorders
(American Speech-Language-Hearing Association 1996).

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