Social communication differences

Also called Pragmatic language impairment, Social communication disorder, Social pragmatic communication disorder, SCD, Pragmatic difficulties

The unwritten rules of conversation, the people who don't use them, and why 'social skills training' is the wrong answer more often than the right one.

What it is

Social communication, or pragmatics, is the use of language with other people: taking turns, staying on topic, knowing how much to say, reading tone, working out that "can you pass the salt" isn't a question about ability. Social communication differences are what you get when someone uses these rules differently from the people around them, or doesn't use them at all.

Many autistic people have social communication differences, and the two overlap heavily, but they aren't the same thing. Social communication disorder is a separate diagnosis for people who have the pragmatic differences without the other features of autism. And the differences turn up after brain injury, in ADHD, with DLD and in some people with no other label at all.

Who it can help

Children described as "talking at people", interrupting, missing hints, or falling out with friends without knowing why. Adults who've been told they're rude when they thought they were being clear. Teachers and colleagues who want to bridge rather than correct.

It isn't a licence to train people into masking. The evidence on old-style social skills groups, where autistic children are drilled in eye contact and scripts, is poor, and autistic adults report the cost. The better aim is mutual understanding: the person learns what non-autistic people mean, and non-autistic people learn what the person means.

How it works

Pragmatics covers three broad areas. Using language for different purposes: greeting, informing, demanding, requesting. Changing language for the listener: differently to a toddler, a teacher and a friend. Following conversational rules: turn-taking, staying on topic, repairing a misunderstanding, using and reading tone, gesture and expression.

Support that works makes the rules explicit rather than expecting them to be absorbed. Social stories describe a situation and what people in it usually think. Comic strip conversations draw out what each person said and thought, which shows the hidden layer. For adults, plain agreements ("tell me directly, I don't pick up hints") do more than any course.

Explicitly teaching the majority to be clearer works too, and it's fairer. A workplace where people say what they mean is easier for everyone.

Getting started

Pick one rule that's causing trouble this week (interrupting, say) and make it visible: a card on the desk, a hand signal agreed in advance, a comic strip of what happened last time. Practise repair phrases: "sorry, I cut across you" and "I've lost the thread, can you say that again?"

Say what you mean. Skip the hints and sarcasm with a person who doesn't read them; you're not dumbing down, you're being accurate.

For a child, ask school what the speech and language therapist recommends and whether a social communication group exists that's built around understanding rather than compliance. Ask how the child feels about it.

Where to get help

Speech and language therapy through the GP or school is the assessment route; the RCSLT explains it. The National Autistic Society has plain guidance on communication differences for families and workplaces. Speech and Language UK covers social communication in children, and Afasic supports families.