Social-Pragmatic Communication Disorder
Author: Anna Pasternak, Reg. CASLPO, Speech-Language Pathologist
Date: Wednesday, September 24, 2025
Table of Contents
We all know communication is much more than the words we speak. It includes non-verbal communication such as tone of voice, facial expressions, and body language. Interpreting and understanding these social cues and context helps us build relationships and have pleasurable conversations. For those who have been diagnosed with social pragmatic disorder, there may be difficulties with interpreting these things, making communication and conversation a daily challenge. Social Pragmatic Communication Disorder is defined by difficulties with the pragmatic use of language. This means how context influences the meaning of what is being said, going beyond just listening to the words but taking in the whole picture to understand the intended message.
Definition
Social Pragmatic Communication Disorder is a neurodevelopmental disorder where the person may have difficulties in the social use of verbal and non-verbal communication. It involves the functional use of language such as non-verbal communication, turn-taking when in conversation, interjecting, over-talking, staying on topic, and greeting someone.
According to the DSM-5, the main diagnostic features of Social Pragmatic Communication Disorder include:
Challenges using communication for social purposes (e.g., initiating greetings, sharing information).
Difficulty adjusting communication to fit the context (e.g., speaking differently in professional settings compared to casual conversations with friends).
Struggles with conversational rules (e.g., turn-taking, maintaining topics, or repairing misunderstandings).
Difficulty interpreting non-literal language (e.g., humor, idioms, sarcasm, or indirect requests).
Social Pragmatic Communication Disorder is only diagnosed when these social communication difficulties cannot be explained by something else such as autism spectrum disorder, cognitive ability, or other language disorders.
Signs and Symptoms
Social Pragmatic Communication Disorder can appear differently in every individual, though most commonly the following signs and symptoms can be seen:
Starting conversation – the person may be quiet in social settings, not knowing when to join and start a conversation. They may also have difficulties with asking questions and participating in group conversations. Group conversations move quickly and have more changes, making it even more difficult to read cues and participate.
Keeping conversations going– may give short answers, change topics too quickly, or have difficulties extending or continuing a conversation. They may talk more about themselves and their interests, rather than checking in with their communication partner to see if they are engaged or have something to say.
Understanding social cues – difficulties interpreting facial expressions, tone of voice, and body language. They may also have difficulties understanding jokes vs. serious comments or sarcasm.
Changing language – may speak the same way to adults, peers, and professionally, without adjusting tone, vocabulary, or formality. They may use language that is overly technical in casual settings or overly simple in professional ones.
Non-verbal communication – may struggle to maintain eye contact, use body language to support their message, or show little facial expression (flat affect). They may also use inappropriate gestures that distract the person they are talking to.
Social challenges – may have difficulty working in groups and forming friendships, may appear shy or socially awkward.
Causes
The direct causes of Social Pragmatic Communication Disorder are believed to be influenced by multiple factors. This may include neurological and developmental factors, such as differences in brain regions responsible for social cognition and language processing. Genetics can also have an impact, such as a family history of communication disorders. Language impairments or social difficulties may also play a role. Co-occurring conditions, such as ADHD, language disorders, or learning disabilities, also often overlap. Lastly, environmental factors may also contribute, such as limited exposure to varied social interactions.
Impact on Daily Life
Social Pragmatic Communication Disorder can have a daily effect on many parts of life, including social interaction, though this varies depending on the severity of the disorder, support systems, and access to therapy. Areas that may be affected include school, where students may struggle with group work, classroom participation, or understanding figurative language. Friendships and relationships may also be impacted, as difficulties initiating or maintaining conversations can lead to social isolation or misinterpretation by peers and colleagues. Workplace communication may also be affected, as adults may struggle with networking, workplace small talk, or interpreting indirect requests from supervisors. Lastly, mental health may also be impacted, as constant communication challenges can lead to frustration, anxiety, or low self-esteem.
Diagnosis
Assessment requires in-depth evaluation by Speech-Language Pathologists working together with psychologists, educators, and family members. Psychologists and psychiatrists are licensed to provide a formal diagnosis in Ontario. Speech-Language Pathologists (S-LPs) in Ontario cannot provide a DSM-5 diagnosis, though they can assess pragmatic language, describe social communication challenges, and recommend intervention. This plays a key role in diagnosis, as this information is passed on to the psychologist for formal confirmation. Pediatricians or developmental pediatricians may also be involved, particularly for children, often in consultation with psychologists and Speech-Language Pathologists. Diagnosis usually involves comprehensive history-taking (developmental, medical, educational, and social). Standardized testing is also required by an S-LP, focusing on pragmatic skills, conversational skills, and non-verbal communication. Social Pragmatic Communication Disorder can only be diagnosed when all difficulties cannot be explained by another disorder. Formal diagnosis must be made by a psychologist or psychiatrist.
Once diagnosis takes place, the person may be referred to a Speech-Language Pathologist to work on conversational skills, social interaction, and non-verbal communication. Counseling and psychologists may also be recommended to support mental health if the person has low self-esteem or social anxiety. Educational and workplace accommodations may also be put into place. The person may receive individualized support and accommodations based on their needs.
Treatment
Treatment for Social Pragmatic Communication Disorder focuses on improving communication in real-life settings. Treatment and intervention will be different for each individual depending on their needs and areas of difficulty. Individuals may work directly one-on-one with a Speech-Language Pathologist using role-playing exercises to practice greetings, small talk, asking questions, and longer conversations. Video modeling may also be used to demonstrate effective conversation and analyze how people use non-verbal communication and social cues. Social stories may be used more with children to model expected behaviors in various social contexts.. Group therapy may also be effective, allowing individuals to practice conversational skills with peers such as topic maintenance, turn-taking, and joining group conversations. Adults may work on conversational therapy including small talk, asking questions and answering questions, following up in conversations, and pausing to allow smoother topic transitions. Parent training may also be used, especially when working with children. Parents may be taught strategies to implement goals at home.
With proper therapy and support, those diagnosed with Social Pragmatic Communication Disorder can make significant improvements. Early intervention and consistent practice increase the likelihood of generalizing skills to everyday life. The older the person is at diagnosis, the harder it may be to change ingrained habits, though consistent practice and high motivation can still achieve noticeable results.
Social Pragmatic Communication Disorder may often be overlooked as it is a fairly new diagnosis and many may not realize they are struggling with it. It is important to understand that communication goes far beyond words, involving everything else that makes communication whole. Though the disorder may negatively impact a person’s life, with proper support, practice, and motivation, positive results can be achieved, and quality of life improved.
Final thoughts
Small talk is an important skill for starting conversations and building connections. It requires a combination of other skills that can be practiced and improved over time. By focusing on your weaker areas, you can build confidence and make carrying small talk feel more comfortable and natural.
To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.
