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

Abstract

The 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.

Crossing the Threshold: An Epigenetic Alternative to Dimensional Accounts of Mental Disorders

“…Given that many threshold values are pragmatically or conventionally determined (for instance, symptoms lasting at least for fourteen days, or five out of nine criteria out of a checklist), one may legitimately wonder whether the distinction is just arbitrary (see 4 As we mention above, the shift towards dimensionality in DSM-5 may be characterized as uneven at best. Some categories, such as autism, have undergone major changes with the DSM-5 revision reducing many separate disorders to a spectrum defined in terms of two dimensions that extend into the general population, that is, social communication and interaction; restrictive and repetitive behaviour (for a review, see Amoretti et al [2021]). Other categories, such as schizophrenia spectrum and other psychotic disorders, maintain several independent nosological entities (as in DSM-IV).…”

The fuzzy boundaries of the social (pragmatic) communication disorder (SPCD): Why the picture is still so confusing?

“…Bishop and Norbury [ 23 ] proposed a classification along a continuum between SLI and ASD. Such a complex scenario in identifying clinical profiles, in addition to the confusion caused by the lack of a unified and common terminology (for a detailed review of this issue see Amoretti and colleagues [ 28 ] and Félix et al [ 29 ]), often led to a number of difficulties in the differential diagnosis between the above mentioned disorders.…”

Usefulness of the autism spectrum quotient (AQ) in screening for autism spectrum disorder and social communication disorder

“…Social (pragmatic) communication disorder (SCD) is a new disease concept included in the DSM-5, which involves impairments in social communication and social interaction but not restricted, repetitive patterns of behavior, interests, or activities (RRBs) [2]. SCD is included in the macro category of communication disorders, characterized by a primary difficulty with broadly conceived pragmatic abilities, including language disorders, speech sound disorders, and childhood-onset fluency disorders (stuttering), but not ASD [3]. Although the distinction between SCD and ASD is controversial, at least the DSM-5 indicates that ASD and SCD are independent diagnostic concepts, so it is worthwhile to distinguish between these groups and examine whether there are differences in prognosis and comorbidities.…”