Social communication disorder: Causes, signs, and treatment


People with social communication disorder (SCD) have difficulty with verbal and nonverbal communication, but the symptoms are not due to an intellectual disability or autism.

Individuals with SCD understand language but may have difficulty processing it or responding, either with speech or in a nonspeaking way. They also have difficulty understanding social cues and social norms and may find it hard to form and maintain relationships.

Although autism also causes people to experience difficulty in social situations, it produces other symptoms in addition. Therefore, people with SCD do not meet the criteria for an autism diagnosis. However, doctors must rule out autism before diagnosing SCD.

SCD is a relatively new diagnosis that the Diagnostic and Statistical Manual of Mental Disorders only introduced in its fifth edition, the DSM-5.

Read on to learn more about social communication disorder, including the causes and symptoms and how to manage it.

SCD, which doctors may also call pragmatic communication disordercauses difficulties with language, social communication, and understanding social norms in people who are intellectually typical.

It can mimic some of the symptoms of autism, but, unlike autism, it does not cause restricted interests, repetitive behaviors, anxiety, or sensory differences.

People with SCD understand language but may not respond to it. The symptoms usually appear early in childhood. Parents or caregivers may notice that their child shows little interest in engaging with others. They may show some early signs of autismsuch as delayed development of language, lack of interest in pretend play, and not initiating social interactions with others.

The DSM-5 replaced conditions such as Asperger’s syndrome and pervasive developmental disorder with the broader diagnosis of autism spectrum disorder.

SCD does not fall under this umbrella. However, as doctors only recognized it relatively recently, some people whose original diagnosis was autism may find that SCD better explains their symptoms. This is likely the case if they only have social symptoms rather than a wider range of autism characteristics.

Researchers do not yet fully understand what causes SCD. Some evidence suggests that there is a genetic overlap between autism and SCD. Certain genes may increase the risk of SCD or be more prevalent among people with SCD. However, there is no evidence that any specific gene or combination of genes inevitably causes SCD.

Researchers have also identified some brain differences in people with SCD. The challenge is that these findings are often isolated, which means that one study finds one structural change associated with SCD, while another study identifies a different one.

Scientists do not know whether these brain differences cause SCD or whether some other factor — such as environmental effects — leads to the brain differences.

SCD affects verbal and nonspeaking communication, as well as social skills. People who have other symptoms, such as repetitive behaviors, restricted interests, or sensory processing issues, may have a different condition, such as autism.

The DSM-5 lists the diagnostic criteria for SCD, noting that a person must have all of the following symptoms:

  • Difficulties in social contexts with verbal and nonspeaking communication: These difficulties include:
    • trouble matching communication to the context
    • issues with the understanding rules of conversation
    • difficulty understanding communication that is not literal and explicit
  • Limitations in communication: A person’s communication and social skills challenges affect their life in meaningful ways, such as by undermining communication, social relationships, or academic performance.
  • Symptoms must appear early in development: However, they might not become evident until the child reaches an age where the expected level of social communication exceeds their abilities.
  • No other diagnosis: Another diagnosis, such as autism or an intellectual disability, does not better explain the symptoms.

A person will also only receive a diagnosis of SCD if they have the ability to speak and understand language. Children who never do either may need a different diagnosis. According to, most children get their diagnosis close to the age of 4 or 5 years rather than as an infant or a toddler.

Doctors diagnoses SCD based on the symptoms. In some cases, they might attempt to rule out another issue, such as a speech delay or a physical health issue that interferes with speech and communication.

They will only diagnose SCD if a person has symptoms that affect language, social skills, and nonspeaking communication. The symptoms must:

  • appear in childhood
  • interfere with relationships or daily functioning
  • not be due to another health condition

Treatment focuses on helping a person develop social and communication skills and providing accommodations that make it easier for them to function.

In most cases, a person will need the support of a speech-language pathologist. They may also need mental health support.

Some treatment options include:

  • Assistive communication devices: These devices can help a person communicate in settings where they might otherwise find it too difficult.
  • Communication training and support: Interventions that teach people communication skills may make communication easier. For example, social scripts can help teach children language strategies for social interaction, while social stories can build an understanding of social situations through stories.
  • Social skills Various interventions can help people practice their social skills. For example, peers without SCD may work with a child with SCD to practice social practice skills, or a person might skills with a therapist.
  • Culturally specific training: Communication norms vary from culture to culture, and the expectations of one culture might be unusual in another. For this reason, it is important for people to get support from culturally competent providers.
  • Behavioral interventions: Behavioral treatments reward the behavior that a healthcare professional wishes to see, such as making eye contact or communicating with peers. However, behavioral strategies are controversial in the neurodiversity community because of concerns about abuse and the stigmatization of neurodivergence. Behavioral interventions are not the only option for treatment.

No specific medication can treat SCD. However, a person might take medication to manage unrelated symptoms or to cope with some complications of SCD, such as anxiety in social settings.

There is no cure for SCD. As it is a relatively new diagnosis, research into how it develops and changes throughout a person’s life is ongoing.

With the right treatment and support structures in place, people with SCD can have happy, fulfilling lives. Importantly, a person with SCD may not crave the same social interactions or communication that neurotypical people often desire. Accommodating this difference in cognition is important to ensuring the well-being of a person with SCD.

People with SCD may also need accommodations at work or in school to reach their full potential.

Social communication disorder is distinct from autism, but the two conditions share some traits in common. This means that some people who received an autism diagnosis a while ago might actually have SCD instead. Getting the right diagnosis is important for identifying the necessary support.

As with other forms of neurodivergence, it is important to focus on the needs and treatment goals of the person with SCD rather than attempting to force them to conform to the norms of the wider culture. A compassionate treatment team, the right accommodations, and a collaborative approach can help.

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