The Social Thinking-Social Communication Profile

Social Communication Learning Styles as a Guide to Treatment and Prognosis:

The Social Thinking-Social Communication Profile 
(formerly known as the Perspective Taking Spectrum)
A Practice-Informed Theory by Michelle Garcia Winner, Pamela Crooke and Stephanie Madrigal
January 2011

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Joe, a six-year-old boy with Asperger Syndrome and a passion for chemistry, was a client in our clinical practice. His amazingly sophisticated vocabulary and language skills were a reflection of his strong intelligence, measured to be in the superior range. While a number of Joe’s academic skills were quite high when compared to his developmental age, he presented with complex deficits in his ability to relate to others, especially his peers. In an effort to more fully understand Joe’s social communication and perspective-taking abilities during an assessment, he was asked to talk about his favorite topic, chemistry. This delighted Joe and he enthusiastically began his monologue. Initially, the therapist listened attentively, but then she stood up and walked out the door. While standing on the other side of the door, she could hear Joe continue to spout his chemistry knowledge… to an empty chair.

Diagnostic Soup

Joe’s seemingly oblivious response to his conversational partner’s exit is one example of how a person with Social Communication Learning Challenges (SCLC) may struggle with attending to the thoughts, emotions, and needs of those with whom they interact. In the same situation, another person with SCLC, perhaps one not as intellectually bright and academically skilled as Joe, might have noticed his conversational partner leaving the room; yet another person with SCLC might have noticed someone leaving the room but would not have considered switching to a different topic to keep the partner engaged. All three of these individuals could easily have a diagnosis of Asperger Syndrome (AS).

In the past, AS, High Functioning Autism (HFA), and Pervasive Developmental Disorders-Not Otherwise Specified (PDD-NOS) were all generally referred to as “autism.” Now with the latest anticipated changes to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (2012), Joe’s diagnosis of AS will no longer be included. Instead, the three categories (AS, HFA, and PDD-NOS) will be collapsed into one term and will be referred to as Autism Spectrum Disorder (ASD) with differing levels of severity. This broad term provides almost no direction for understanding an individual’s needs, prognosis, and/or treatment path. In fact, one of the greatest issues with collapsing the categories is captured in the well-known saying: “If you’ve met one person with autism, you’ve met one person with autism.”

Many researchers have attempted to differentiate HFA from AS. Although some argue for the relevance of diagnostic distinctions, many don’t. Further, a significant body of research addresses co-existence or co-mingling  of mental health problems (anxiety, OCD, depression) and ASD and ADHD, which simply muddies the diagnostic waters as it is difficult at times to clearly distinguish symptoms related to anxiety and symptoms related to social learning challenges (Reaven, Blakeley-Smith, Nichols, Dasari, Flanigan, & Hepburn, 2009; Pine, Guyer, Goldwin, Towbin, & Leibenluft, 2008). To complicate matters, other diagnostic labels also suggest the strong possibility of SCLC; these include but are not limited to Attention Deficit Hyperactivity Disorder (ADHD) and the related Attention Deficit Disorder (ADD), Tourette syndrome, hyperlexia, Mixed Expressive-Receptive Language Disorders, Non-Verbal Learning Disorder (NVLD), apraxia, etc. There are additional diagnostic labels, such as bipolar disorder, social anxiety, shyness, and social phobias that also affect one’s use of social communication. It is not uncommon to receive reports that diagnose the same child as having AS, bipolar disorder, ADHD, OCD, and anxiety—or, in other words, diagnostic soup.

Parents find the practice of diagnosis du jour, or “Label of the day,” both perplexing and frustrating:

“We have had him evaluated six times…. I am extremely frustrated with every therapy/treatment that we have tried thus far….It seems like I know more about Asperger Syndrome than the professionals I have engaged to help. He is now 21 and we are running out of time to find solutions. My husband is 66 and I am 63— we are at our wit’s end and we need some real solutions. We feel like we have been sucked in and sucked dry by the experts who profess to know what will help.”

Comments like this from parents, combined with our own clinical frustration with the diagnostic labeling system, led us to consider how we could better define an individual based on a profile of socially-related learning strengths and challenges across different developmental ages, with the objective of crafting a more individualized treatment approach....
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©2012 Social Thinking Publishing - Michelle Garcia Winner