Social Communication Disorder (SCD) in DSM 5

[Tokyomarie]

I'm currious as to whether one of your children or someone you know has received a diagnosis of social communication disorder based on the DSM 5 criteria. I'm currently taking a class on ASDs and realized that I haven't yet heard of a child who has actually received this new diagnosis.

 

ETA: Those of you who have straddled the DSM IV- DSM 5 shift, how are you feeling about the change in diagnostic criteria for autism? 

Edited June 30, 2017 by Tokyomarie

[Crimson Wife]

I met a mom who said her teen received a diagnosis of SCD + OCD. I didn't say anything to her, but I'd bet there is a 95+% chance her child would've met the criteria for an Asperger's diagnosis under the old DSM. Obviously I can't diagnose some teen I've never met so it's possible that the current diagnoses are correct and he doesn't actually have Asperger's. But I'm skeptical.

[PeterPan]

We saw an SLP who specializes in Social Thinking and was trained in doing the Dynamic Eval from Michelle Garcia Winner. She confirmed ds' ASD diagnosis, put an receptive/express lang delay (f.80.2 I think) and then also put SCD. My understanding is you don't usually put both, but she said the SCD was for insurance billing purposes, that if the person wanted their insurance to cover her services, she needed to put SCD. 

 

So that's ASD with an SCD label for bonus.

 

I think we've had someone on the board here get diagnosed with freestanding SCD, no ASD, and that was from a psych.

[PeterPan]

I met a mom who said her teen received a diagnosis of SCD + OCD. I didn't say anything to her, but I'd bet there is a 95+% chance her child would've met the criteria for an Asperger's diagnosis under the old DSM. Obviously I can't diagnose some teen I've never met so it's possible that the current diagnoses are correct and he doesn't actually have Asperger's. But I'm skeptical.

 

Yeah, that's pretty much the thing, but fine whatever. In our state it's a really huge money issue. SCD gets you NOTHING with the disability scholarships, and autism gets you $30K a year. For real. And the difference? Uh, when you add in SPD and OCD, I'm gonna wonder what they were splitting hairs over too. And sometimes in the homeschooling community it's that the mom is seeing it but enough other people aren't to get it on forms, get it tallied, get it diagnosed.

[PeterPan]

I think they're using SCD more freely, now that it has been out a while. I'm pretty sure I've been hearing more run-ins with it. I think it's getting used. I still think the issue is funding and access to services.

 

On an ethical level, that's a pretty funky burden to bear, telling someone it's not autism. Like you'd want to be DOGGONE sure before you did that. To me, for the SLP to use it as a label to get funding for insurance, that makes sense. That's like saying somebody has pain when they have pain. It's a symptom of something and she put the symptom so the insurance would say yeah, thanks, we can cover that. But to say SCD as an EXCLUSION, saying ASD minus 1 exists and ought to be normalized and assumed, I'm just not sure where the data is on that or that there was debate. Is that what we see going on in the wild, tons of kids with autism minus 1? (that was a question)

 

So just out of curiousity, like something you could ask, are there populations where use of SCD (by a psych or SLP, maybe for differing reasons) is more common? Like with a psych are they using SCD with ADHD kids to mean ADHD with social delay and needing social intervention? That could make a lot of sense. Or like the SLP, using it to mean social issues that need intervention, that makes a lot of sense. But to say there's this separate class of autism minus 1 that occurs by itself, freestanding, with no ADHD, nothing, that's a really interesting statement. I'm not sure they had that kind of data supporting that when they made it. That's why it was so controversial.

[PeterPan]

Nice to see you, btw! Did you get certified in your ed therapist thing, or are you still working on it? My dd is preparing to go away to college, and I've been discussing with dh whether we should hire someone or just use the on-campus services. I'm not really very confident in the on-campus services. I don't think they're really very cutting edge. Like I'm going to be teaching her the 360Thinking stuff, etc. There's really a lot out there if someone is up on it or cares to be up on it. I think it can go beyond merely get the work on your syllabus and go to study groups...

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[Tokyomarie]

Nice to see you, btw! Did you get certified in your ed therapist thing, or are you still working on it? My dd is preparing to go away to college, and I've been discussing with dh whether we should hire someone or just use the on-campus services. I'm not really very confident in the on-campus services. I don't think they're really very cutting edge. Like I'm going to be teaching her the 360Thinking stuff, etc. There's really a lot out there if someone is up on it or cares to be up on it. I think it can go beyond merely get the work on your syllabus and go to study groups...

 

Thanks, Elizabeth! I am mostly reading these days and rarely posting. Sometimes a few days go by before I catch up on posts. But some of the most interesting conversation takes place here.

 

I finished my Certificate in Educational Therapy and am now an Associate Member of AET. I am also finishing my NILD Level III training this summer as well as working on a master's degree in Exceptional Student Education. I'm keeping a smallish client load at the moment because of my full-time studies, which I hope to finish next May.

 

What specific support will your daughter need on campus?

 

I want to do some more training in EF coaching. I know about EF and get it, but I don't yet have a good feel for how to approach the work with someone who just wants/needs EF coaching. I'm most comfortable at the moment with literacy and cognitive structures/critical thinking.

 

I also want to do some training in Social Thinking, but time and money, you know!

Edited June 30, 2017 by Tokyomarie

[Tokyomarie]

Yeah, that's pretty much the thing, but fine whatever. In our state it's a really huge money issue. SCD gets you NOTHING with the disability scholarships, and autism gets you $30K a year. For real. And the difference? Uh, when you add in SPD and OCD, I'm gonna wonder what they were splitting hairs over too. And sometimes in the homeschooling community it's that the mom is seeing it but enough other people aren't to get it on forms, get it tallied, get it diagnosed.

 

I was reading an article that stated this exact concern- that kids getting the SCD diagnosis wouldn't get funding for their therapy needs, even though they have the same social communication issues that kids who get the ASD diagnosis have. And those are the things that will trip up these kids when they get to be adults and need to be able to hold a job and deal with social relationships in their communities.

[Tokyomarie]

I met a mom who said her teen received a diagnosis of SCD + OCD. I didn't say anything to her, but I'd bet there is a 95+% chance her child would've met the criteria for an Asperger's diagnosis under the old DSM. Obviously I can't diagnose some teen I've never met so it's possible that the current diagnoses are correct and he doesn't actually have Asperger's. But I'm skeptical.

 

It would be interesting to know whether the clinic used the ADI-R. I was reading a journal article last night that indicated that teens with high ability often get missed for an ASD diagnosis because they have learned enough strategies for managing social situations that they may not exhibit the repetitive and restricted behaviors in the course of a 40 minute assessment. The structured ADI-R with the parents brings out that information.

 

I, too, become skeptical at any point that multiple diagnoses are combined with the SCD diagnosis.

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[Crimson Wife]

Under the DSM-IV criteria for Asperger's, criterion II-B said:

 

"apparently inflexible adherence to specific, nonfunctional routines or rituals"

 

Under the DSM-V criteria for Autism Spectrum Disorder, it's all about stereotypical motor movements, preoccupation with unusual objects, and sensory issues. I can totally see how the new DSM-V criteria could lead an evaluator to label the rituals as "OCD" rather than being part of ASD if they're not the obvious kind of hand-flapping that my daughter used to do (her ABA team "shaped" the stimming behavior into a more socially appropriate squeezing a stress ball).

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[kbutton]

I was reading a journal article last night that indicated that teens with high ability often get missed for an ASD diagnosis because they have learned enough strategies for managing social situations that they may not exhibit the repetitive and restricted behaviors in the course of a 40 minute assessment. 

 

I totally believe that. There is a local big time children's hospital that has a reputation for that. Basically, if you are gifted, you have to present with some really resistant and entrenched problems. For a long time, it's been more of an impression I've gotten about that hospital, but I've heard someone be very vocal about this recently--this person is in a position to have worked with numerous kids with autism (many of them high IQ) over a decade or so in an educational setting for kids with autism.

 

For kids who have responded well to therapy or coped quite well with structure and support, it's possible even as a parent to forget how difficult things can be for them until something destabilizes them. If only the people making these huge decisions had a little pager that let them be a fly on the wall at a moment's notice...

 

Do you have a link or reference for the journal article?

[Tokyomarie]

 

Do you have a link or reference for the journal article?

 

Here is the reference:

 

Foley-Nicpon, M., Fosenburg, S. L., Wurster, K. G., & Assouline, S. G. (2016). Identifying High Ability Children with DSM-5 Autism Spectrum or Social Communication Disorder: Performance on Autism Diagnostic Instruments. Journal of Autism and Developmental Disorders, 47(2), 460-471. doi:10.1007/s10803-016-2973-4

 

I'm not coming up quickly with a link to a free pdf. It was just published in February 2017.

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[Storygirl]

DS's diagnosis is not ASD or SCD, but I suspect he could be diagnosed with one or the other if we pursued a formal autism evaluation. Right now his labels are NVLD, ADHD, ODD, SPD, GAD, Tourettes, DCD, plus LDs, pragmatic language deficits, lacks theory of mind. His SLP insisted verbally that he has expressive and receptive language delays, but he scored average in those areas on testing.

 

When he was younger, he perseverated in his thinking and his conversation, and he had unusual repetitive behaviors (tapping on toys to hear their sounds, for example), obsessive interests, and unusual favorite toys. He used to frequently use scripted speech, repeating tv shows and movies, and still does occasionally. He had speech delay as a toddler.

 

But nope. No one who works with him ever thinks he has ASD. :confused1:.

 

Our current psychologist said, "Autism is a spectrum, so there are of course going to be people who are just on the other side and have many characteristics but not be autistic."

 

I think that if SCD had been a thing when DS had his NP evaluations, he likely would have been given that diagnosis, along with the NVLD.

 

I find it frustrating. We're working through whether we should have a full ASD evaluation (the NP only ran a small screening tool to rule it out, because she didn't think he had it). But I'm jaded, I guess. I feel like we might go through the trouble and expense just to end up with SCD instead of ASD. And that would not be any use to us. That diagnosis would just tell us what we already know.

 

Edited July 1, 2017 by Storygirl

[Storygirl]

By the way, about a year and a half ago, we were really debating whether to have DS screened for autism, and we found a place that would do it without a big wait, but they would only run the ADOS. And we really felt iffy that the ADOS would reveal enough symptoms for a diagnosis, because DS is so borderline. So we passed and didn't do it.

 

We felt at the time that the ADOS plus the ADI-R would be a better evaluation, so it's really interesting to see that a study has indicated that the combination may give a more accurate result.

 

[PeterPan]

Tokyo-- yes EF support. Any rec on how to find that? Yes to the ADI-R, way better than GARS.

 

https://www.socialthinking.com/Articles?name=Social%20Thinking%20Social%20Communication%20Profile

 

Compare the DSM labels to the social communication profiles. ODD has a spot and is unique but SCD?

[kbutton]

Here is the reference:

 

Foley-Nicpon, M., Fosenburg, S. L., Wurster, K. G., & Assouline, S. G. (2016). Identifying High Ability Children with DSM-5 Autism Spectrum or Social Communication Disorder: Performance on Autism Diagnostic Instruments. Journal of Autism and Developmental Disorders, 47(2), 460-471. doi:10.1007/s10803-016-2973-4

 

I'm not coming up quickly with a link to a free pdf. It was just published in February 2017. 

 

I thought that if you had a free link, you probably would've posted it already, so thank you for posting the reference!