Semantic pragmatic disorder - could anyone explain?

[GreenPetalsForChristmas]

I have ds who nearly 8yo. There is something not quite right (Starting with big meltdowns/outbursts of anger at home) but I can't quite managed to put my finger on it.

I have considered AS but if it was it would be very mild. He certainly doesn't look 'quirky' enough if that makes sense (Hope I am not offending anyone here. Just don't now how else to put it).

However I have come across the semantic pragmatic disorder and from what I have read so far, he seems to be fitting the criteria much better.

Does anyone has some experience of it or has any links/books they could recommend to explain better what it is about? What I have found so far feels flaky and limited and I don't want to start harping on about something like this if I have completely misunderstood what it is about.

"He certainly doesn't look 'quirky' enough if that makes sense"

You didn't mean that in a visual sense, did you? Children with AS/ASD very often look no different to NT peers. Some children with AS/ASD have behaviours which make them stand out from their peers, though.

Semantic Pragmatic Disorder (not to be confused with Sensory Processing Disorder!) is thought by many to come under the autism spectrum. I'm not sure if it survives anymore as a separate DX under DSM 5. Aspergers certainly doesn't. TBH, it doesn't matter what you call it, so long as you get the right support and use strategies that work. To get schools to take a DX seriously can be tricky and more will have heard of ASD than SPD. May be worth thinking about from that point of view. What DX will work best for your DS?

Re quirky I really meant behaviour wise (It is obvious in a visual/physical sense they look exactly the same!). Perhaps a better description would be 'out of the norm' in his behaviour? Sorry if I have offended anyone here.

Could you correct me if I am wrong but I thought that semantic pragmatic disorder is a language issue that has often been associated with autism.
Some of the descriptions I have found were certainly very much geared towards a language issue rather than a behaviour type of issue such as AS. But does it mean then from 2013 it actually doesn't exist anymore? I thought that with the new definition of ASD, language issues were not included in the diagnosis so you would now have children with autism and language disorders instead of ASD as we knew it. So I thought that SPD would stay?

Re diagnosis, I have no idea which way to go atm. School don't want to involve EP because they don't see a problem. CAMHS sees some mild issues that do not warrant investigations at the mo (After having decided from a quick meeting with ds that they can't really do anything to support him anyway).

And in the mean time I have a child who has regular meltdowns/blows up, is clearly anxious (just adds complete panic to the meltdowns). Regularly doesn't understand/doesn't relay messages from school (with all the problems coming with that). Doesn't have friends (but because ds was able to give the names of a couple of children, CAMHS says he has friends ).
Teacher is now saying that ds 'is choosing not relay messages because he doesn't want to do X or Y' so is putting all the responsibility on his shoulders. If they were just putting a quick note in his bag, it would stop most issues....

Sorry it became a bit of a rant . Not a good day re ds and his teacher.

I wasn't offended, I was clarifying I read that line several times, and I couldn't work out from it whether you meant doesn't 'look ASD' or doesn't 'behave stereotypically ASD' and, tbh, both are misconceptions, because ASD is as varied as anything else.

SPD is not just about relaying messages, etc., but it can be hard with children who are not extreme, to pinpoint the issues. Perhaps if you can make a few notes of how your DS is, or how he reacts, or what he does, in certain areas, you'll be clearer?

So:

Eye contact - would you say it's normal, or forced, or unusual in any way? Friendships - why hasn't he got friends? Does he seek them, what happens when he does? Are his interests like other boys his age? Does he reciprocate with conversation, or is it all on his agenda? Etc.

A good example is what has happened tonight. We were trying to understand how he did a picture at school with some painting. It went like this:
Me- So how did you paint the sheet?
ds- We put the paint on the paper.
Me- Ok and what sort of paint did you use? Is the one you normally use or a different type?
ds- they were 3mm
Me- Oh, you mean the bits of paper were 3cm. 3 mm is very very small.
ds- NOOO it was 3 mm
Me- but 3mm is about this big (show my fingers). Are you sure?
ds- yes the gaps were 3mm
me- Ah the gap between the tiles were 3 mm. Ok I understand and what about the paint.
ds- I use some green and some blue.

And on it went for quote a while. We never managed to understand what sort of paint he was using. Thinking about it now, it might have been paint from a tube.
Usually though ds isn't as calm and the conversation stops right at the start with a big scream ,But you don't understand, we have use the paint on the pAAAper'. Or we just get 'I don't know...'

It's not as if the conversation isn't reciprocate (he can do that) or that it is one sided, it just doesn't flow the normal way iyswim?

BTW, the 'quirky enough' is what I have been told by some health professional about ds. ie he doesn't show any obvious signs of AS.

I know that it doesn't mean anything.

But it feels like that because it's not 'obvious' then it probably isn't (according to those professionals) or that because it's not that easy to put your finger on it, then no one can be bothered to look any further :(

Is his conversation reciprocal, though, in the sense that you can have a backwards-forwards conversation, if you aren't asking questions? Or do you find that you only have a 'conversation' if it's a question and answer session?

Humm good question.
My first reaction is to say that no most conversations are questions and answers only.
ds never 'narrates' events such as what has happened at school, at a party etc...

If I was talking about an adult, I would say he sin't good at doing 'small talk'. He tends to ask questions or to answer mines (or DH).

I will be more careful about it though.

Demands? Not as long as he is well prepared, knows what is going to happen (or knows he doesn't know iyswim). Otherwise, it doesn't go down well.

I can't quite talk about other children in general. He used to do his own thing on the side of other children but seems to have improved on that in the last 6 months or so.
One thing is sure, whatever he is doing isn't going down very well. Not bad enough that children don't want to talk to him. But not good enough he really has friends (eg The children he is calling friends have never invited him to a b'day party).

Leonie do you know what would be the 'key issues' you would look in a conversation with a child with SPD?

Thank you so much for the links. The last article from MS is the one I have come across that made me wonder about SPD.
From the signs she is talking about, ds has:

• difficulty with language, was very late to have a clear language (over 6yo) with big issues with phonology (Could not hear some sounds, difficulty in pronouncing them)
• No or few friends
• Written language at a higher level than spoken one (according to last year's teacher)
• difficulties with narrative, writing stories etc... (Big issue this year where they are asked to write stories)
• difficulties with open ended questions (How was your day, what did you do at school etc...)
• but a very good vocabulary, especially when it comes to areas he likes (always concrete stuff such as animals)
• seemed to know complex words but to struggle with the easy/common ones (This is probably not as noticeable now)
• the type of discussions I've highlighted above

One think that I have noticed from your link is the fact that SPD is a language issue but that it is also considered to be part of the autism spectrum.

So the best would try and get an assessment with a SLT first to evaluate the extend of the language issue?

DS2 has had NHS SALT assessments - Assessment of Comprehension and Expression (ACE), Clinical Evaluation of Language Fundamentals (CELF-4), including pragmatics profile competed by teachers, Test of Abstract Language Comprehension, Test of Auditory Perception (TAPS 3) and Narrative Assessment. He is also going to be tested using the Childhood Communication Checklist (CCC2). These assessments target the problems you mention.

The key thing in determining educational needs seems to be whether the child has 'stand alone' Speech Language and Communication Needs (SLCN) or whether they are associated with another condition such as ASD. DS2 is only 6 but I would imagine that in future, issues with social communication will become more noticable due to the increase in demand in the curriculum from KS1 and KS2 and the 'normal' emotional and social development of peers.

I would definitely get a referral to a speech and language therapist. Asks your gp to refer if school won't. Or you can actually self refer although this is not 'encouraged'. It sounds like he has receptive language problems so ask the salt to assess his comprehension thoroughly and write down all the examples you mentioned on paper to show her!
Good luck!

Thank you all again.

Writing all that down has actually been very helpful because I know there is something wrong but I am quite often struggling to pinpoint where the problem is. Then my head goes all over and I can't give an clear picture of what is going on to professionals.

@KeepOn: did you ds have similar issues?

I have referred ds to a SALT so we might be able to see someone in the next 6 months (...). In the mean time, I want to go and see a SLT privately but I need to be clear on what I can ask/what to look for. (And if it is reall a language issue in the first place. There are so many other things going on, including the rages and meltdowns...)

xpost Leonie.

He is 'followed' by CAMHS (no referral to paed where I am) and in effect they don't want to do anything atm. 'Not quirky enough'...

Can i ask what exactly is reciprocal conversation? i know its back and forth talking but is there anything in particular about it? the majority of ds's talking is questions he asks me questions inncessantly and if i dont know the answer thats not good enough he rarely fully undertands so keeps asking. If i ask him how was his day at school he says fine or cant remember but will randomly tell me little bits later that day or the following day for eg 'mum guess what 'X' at school done today? what ds? he said a bad word to me, did he well thats not very nice is it? no hes a naughty boy is he? yes ds. Is this reciprocal conversation then?