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n Adding “anxiety about speaking or limitations in effective communication ... individually or in any combination” to Criterion B
n Adding Criterion D regarding rule out of the diagnosis due to a speech- motor or sensory deficit, dysfluency associated with neurological insult or another medical condition
n Adding a note that “later-onset cases are diagnosed as adult-onset fluency disorder”
Social (pragmatic) communication disorder
Also referred to as “pragmatic language impairment” in the scientific literature, this new DSM-5 disorder classifies persistent difficulties in the social uses
of verbal and nonverbal communication in children typically over age 5. This condition is distinct from language
and speech disorders because syntax, articulation, pronunciation and fluency are intact. Key diagnostic symptoms include marked and persistent deficits in the following areas:
n Greeting and sharing information
n Changing communication to match context
n n
Following social rules for conversation and storytelling
Understanding implicit statements Social (pragmatic) communication
the pervasive developmental disorders (autistic disorder, Rett’s disorder, childhood disintegrative disorder, Asperger’s disorder and pervasive developmental disorder not otherwise specified). Counselors are reminded that individuals with one of these well-established DSM-IV-TR pervasive developmental disorders should be given the diagnosis of autism spectrum disorder.
As pointed out on page 55 of the DSM- 5, “Standardized behavioral diagnostic instruments with good psychometric properties, including caregiver interviews, questionnaires and clinician observation measures, are available and can improve reliability of diagnosis over time and across counselors.”
For a helpful visual of the DSM-5 changes to the pervasive developmental disorders, I recommend that counselors download Bec Oakley’s DSM diagnostic criteria graphics at snagglebox.com/ downloads/dsm-graphics. For a discussion about the role of counselors during prediagnosis and postdiagnosis of autism spectrum disorder, read Christina Mann Layne’s article, “Early identification of
disorder is mutually exclusive with autism spectrum disorder and cannot be diagnosed in the presence of restricted repetitive behaviors, interests and activities (the other component of autism spectrum disorder). Research estimates that up to 9 percent of individuals diagnosed with DSM-IV-TR’s pervasive developmental disorder not otherwise specified may meet the DSM-5 criteria for social (pragmatic) communication disorder.
I encourage counselors to watch a video from Courtenay Norbury, professor in the Department of Psychology, Adult
and Child Cognition, at Royal Holloway, University of London, to learn more about the symptoms associated with this disorder (see youtu.be/Dk9kULgUkSQ).
Autism spectrum disorder
See my September 2013 Counseling Today article titled “Assessment and diagnosis of autism spectrum disorder” for discussion of the DSM-5 changes to
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December 2014 | Counseling Today | 13