Friday, 24 October 2014

Autism, siblings and DSM-5 Social Communication Disorder

A quick post to bring to your attention the paper by Meghan Miller and colleagues [1] who concluded that: "Pragmatic language problems are present in some siblings of children with ASD [autism spectrum disorder] as early as 36 months of age". Further: "As the new DSM-5 diagnosis of Social (Pragmatic) Communication Disorder (SCD) is thought to occur more frequently in family members of individuals with ASD, it is possible that some of these siblings will meet criteria for SCD as they get older".
Isn't this a school day?

The DSM-5, as many in the autism community will already know, has been the source of quite a bit of discussion/argument as to how it has started to re-define what we label as autism or autism spectrum disorder. The initial signs have been that use of the DSM-5 criteria does indeed impact on the numbers of cases of autism (see here) and in particular, that the category termed 'Social Communication Disorder' (SCD) is filling up with those who might present with social communication issues without the repetitive or restricted behaviours required to fulfil the ASD label. Whether this implies the same levels of services and resources will be available to those with SCD as it is supposed to for those with ASD remains to be seen.

I did wonder whether the Miller findings were an important indication (although not the first [2]) that science might also be putting a bit more flesh on to the bones of the concept of a broader autism phenotype (BAP). Describing the subtle speech and language and social interactive issues described on the diagnostic borderlands of autism [3], it strikes me that there is more than a smidgen of overlap between SCD and the BAP (at least with more strength of data than the suggestion of a link between the BAP and postnatal depression). With cautions down the years about assuming "all children with pragmatic difficulties have autism" [4], does the advent of the SCD diagnostic category offer a viable alternative?

Music to close, and the sheer brilliance of Morrissey (live). And for those who might want to know a little more about the man behind the music: The Importance Of Being Morrissey.


[1] Miller M. et al. Early pragmatic language difficulties in siblings of children with autism: implications for DSM-5 social communication disorder? J Child Psychol Psychiatry. 2014 Oct 15.

[2] Botting N. & Conti-Ramsden G. Pragmatic Language Impairment without Autism. Autism. 1999; 3: 371-396

[3] Dawson G. et al. Defining the broader phenotype of autism: genetic, brain, and behavioral perspectives. Dev Psychopathol. 2002 Summer;14(3):581-611.

[4] Bishop DV. & Norbury C. Exploring the borderlands of autistic disorder and specific language impairment: a study using standardised diagnostic instruments.  Journal of Child Psychology and Psychiatry. 2002; 43: 917–929. doi: 10.1111/1469-7610.00114

---------- Miller M, Young GS, Hutman T, Johnson S, Schwichtenberg AJ, & Ozonoff S (2014). Early pragmatic language difficulties in siblings of children with autism: implications for DSM-5 social communication disorder? Journal of child psychology and psychiatry, and allied disciplines PMID: 25315782