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

2021 ◽  
Vol 43 (4) ◽  
Author(s):  
M. Cristina Amoretti ◽  
Elisabetta Lalumera ◽  
Davide Serpico

AbstractThe 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.

2015 ◽  
Vol 101 (8) ◽  
pp. 745-751 ◽  
Author(s):  
Gillian Baird ◽  
Courtenay Frazier Norbury

Changes have been made to the diagnostic criteria for autism spectrum disorder (ASD) in the recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and similar changes are likely in the WHO International Classification of Diseases (ICD-11) due in 2017. In light of these changes, a new clinical disorder, social (pragmatic) communication disorder (SPCD), was added to the neurodevelopmental disorders section of DSM-5. This article describes the key features of ASD, SPCD and the draft ICD-11 approach to pragmatic language impairment, highlighting points of overlap between the disorders and criteria for differential diagnosis.


2020 ◽  
Vol 63 (6) ◽  
pp. 1916-1932 ◽  
Author(s):  
Haiying Yuan ◽  
Christine Dollaghan

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.


Author(s):  
Rebecca McKnight ◽  
Jonathan Price ◽  
John Geddes

One in four individuals suffer from a psychiatric disorder at some point in their life, with 15– 20 per cent fitting cri­teria for a mental disorder at any given time. The latter corresponds to around 450 million people worldwide, placing mental disorders as one of the leading causes of global morbidity. Mental health problems represent five of the ten leading causes of disability worldwide. The World Health Organization (WHO) reported in mid 2016 that ‘the global cost of mental illness is £651 billion per year’, stating that the equivalent of 50 million working years was being lost annually due to mental disorders. The financial global impact is clearly vast, but on a smaller scale, the social and psychological impacts of having a mental dis­order on yourself or your family are greater still. It is often difficult for the general public and clin­icians outside psychiatry to think of mental health dis­orders as ‘diseases’ because it is harder to pinpoint a specific pathological cause for them. When confronted with this view, it is helpful to consider that most of medicine was actually founded on this basis. For ex­ample, although medicine has been a profession for the past 2500 years, it was only in the late 1980s that Helicobacter pylori was linked to gastric/ duodenal ul­cers and gastric carcinoma, or more recently still that the BRCA genes were found to be a cause of breast cancer. Still much of clinical medicine treats a patient’s symptoms rather than objective abnormalities. The WHO has given the following definition of mental health:… Mental health is defined as a state of well- being in which every individual realizes his or her own po­tential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.… This is a helpful definition, because it clearly defines a mental disorder as a condition that disrupts this state in any way, and sets clear goals of treatment for the clinician. It identifies the fact that a disruption of an individual’s mental health impacts negatively not only upon their enjoyment and ability to cope with life, but also upon that of the wider community.


Author(s):  
Lauren B Swineford ◽  
Audrey Thurm ◽  
Gillian Baird ◽  
Amy M Wetherby ◽  
Susan Swedo

2019 ◽  
Vol 17 (1) ◽  
pp. 39-53
Author(s):  
Agnieszka Siedler ◽  
Tadeusz Gałkowski ◽  
Maria Pąchalska

The aim of the study was to assess self-reported individual differences in the use of the inner speech of adolescents with Social (Pragmatic) Communication Disorder (SCD) and in particular to answer the questions: Do adolescent with SCD have inner speech and what is the direction of this speech? Is this a monologue and internal dialogue, i.e., do they speak to themselves (internal monologue) or to other people (internal dialogue)? We tested 22 adolescents with SCD, diagnosed according to the DSM-5 criterion. The average age was 16.48 years, SD = 2.71. The youngest patient was 12 years old and the oldest was 19 years old. The modified version of the Puchalska-Wasyl Scale of Inner Speech was used for the study. The questionnaire was tailored to the capabilities of the persons with SCD and included questions about the occurrence of internal speech and the direction of this speech, that is, internal conversations to yourself (internal monologue) or to other people (internal dialogue). The patients participating in the experiment were informed in detail about the whole procedure and they or their parents, if they were under age, provided written consent for their participation in the experiment (according to the guidelines of the Helsinki Declaration, 2008). Statistical analysis showed that in adolescents with SCD there is a statistically significant relationship in the frequency of the monologue and internal dialogue. Persons who declared a more frequent occurrence of internal dialogue also declared more frequent occurrences of internal monologue, which means that they had the general ability for inner speech. A comparison of the direction of inner speech, that is the internal monologue and internal dialogue has shown that during inner speech they more often use internal dialogue than internal monologue. It was found that in adolescents with SCD, inner speech is present, and it manifests itself in the form of an internal monologue and internal dialogue. However, far more often do they use internal dialogue than internal monologue.


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