48 Neurodevelopmental Disorders
4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and
nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors,
multiple meanings that depend on the context for interpretation).
B. The deficits result in functional limitations in effective communication, social participa-
tion, social relationships, academic achievement, or occupational performance, indi-
vidually or in combination.
C. The onset of the symptoms is in the ear ly developmental period (but deficits may not
become fully manifest until social communication demands exceed limited capacities).
D. The symptoms are not attributable to another medical or neurological condition or to low
abilities in the domains of word structure and grammar, and are not better explained by
autism spectrum disorder, intellectual dis ability (intellectual developmental disorder),
global developmental delay, or another mental disorder.
Diagnostic Features
Social (pragmatic) communication  disorder is characterized by a primary difficulty with
pragmatics, or the social use of language an d communication, as manifested by deficits in
understanding and following social rules of verbal and nonverbal communication in nat-
uralistic contexts, changing language accordin g to the needs of the listener or situation,
and following rules for conversations and stor ytelling. The deficits in social communica-
tion result in functional limitations in effective communicatio n, social participation, devel-
opment of social relationships, academic ac hievement, or occupational performance. The
deficits are not better explaine d by low abilities in the domains of structural language or
cognitive ability.
Associated Features Supporting Diagnosis
The most common associated feat ure of social (pragmatic) co mmunication disorder is lan-
guage impairment, which is characterized by a history of delay in reaching language mile-