Unspecified Communication Disorder 49
Differential Diagnosis
Autism spectrum disorder. Autism spectrum disorder is  the primary diagnostic con-
sideration for individuals presenting with social communication de ficits. The two disor-
ders can be differentiated by the presence in  autism spectrum disorder of restricted/
repetitive patterns of behavior , interests, or activities and their absence in social (prag-
matic) communication disorder. Individuals wi th autism spectrum disorder may only dis-
play the restricted/repetitive patterns of behavi or, interests, and activities during the early
developmental period, so a co mprehensive history should be  obtained. Current absence of
symptoms would not preclude a diagnosis of autism spectrum  disorder, if the restricted
interests and repetitive behaviors were present in the past. A diagnosis of social (prag-
matic) communication disorder should be considered only if the developmental history
fails to reveal any evidence of restricted/repetitive patterns of behavior, interests, or ac-
tivities.
Attention-deficit/hyperactivity disorder. Primary deficits of AD HD may cause impair-
ments in social communication and functional limitations of effectiv e communication, so-
cial participation, or academic achievement.
Social anxiety disorder (social phobia). The symptoms of social communication disor-
der overlap with those of social anxiety diso rder. The differentiating feature is the timing
of the onset of symptoms. In social (pragm atic) communication di sorder, the individual
has never had effective social communication; in social anxiety disorder, the social com-
munication skills developed appr opriately but are not utilized because of anxiety, fear, or
distress about social interactions.
Intellectual disability (intellectual developm ental disorder) and global developmental
delay. Social communication skills may be deficient among individuals with global de-