Prevalence of Social Communication Disorder in Children at Risk for Autism Spectrum Disorder

Background: In the years since the DSM-5 was released, concerns have been raised about the relationship between Social Communication Disorder (SCD) and Autism Spectrum Disorder (ASD).

Objectives: In the present study, we examined rates of DSM-5 SCD symptoms and diagnoses in youth at risk for ASD. We also compared how participants with and without diagnoses of ASD scored on the Children’s Communication Checklist (CCC) in order to explore differences in social communication and pragmatic language as this might inform diagnosis of SCD.

Methods: Data for this study come from an epidemiological study examining the prevalence of ASD. Diagnostic evaluations were performed on 292 participants who had previously screened at risk for ASD via the Social Communication Questionnaire-Lifetime Version (SCQ). DSM-5 diagnoses were assigned by clinician best-estimate procedures by one of three doctoral level clinicians. Measures of autism symptoms, cognitive and adaptive skills, and behavioral checklists, including the CCC were included in assessment. The CCC was completed by all English-speaking parents whose children had at least phrase speech (n = 258) in order to measure communication and language issues common to both ASD and SCD.

Results: Out of 292 youth at risk for ASD, only 1 met diagnostic criteria for SCD. While 20 participants met all 4 clinical criteria for SCD, 19 of these (95%) also met criteria for DSM-5 Autism Spectrum Disorder, effectively ruling out a diagnosis of SCD. Analyses of the CCC scores indicated that participants with ASD also experienced impairment in scales measuring pragmatic communication (the hallmark feature of SCD) as well as impairment in the social relations and interests scales.

Conclusions: Results indicated that while a number of children met DSM-5 criteria for SCD, they were almost entirely children also meeting criteria for ASD. Further research is needed to evaluate the overlapping relationship between these disorders to inform diagnostic procedures and treatment recommendations, particularly as many the supports and services available for children with ASD may be difficult for children with SCD to access.