Impairment in social functioning including but not limited to anxiety caused by social situations or lack of ability to form or understand relationships. Autism spectrum disorder is commonly thought of when referring to social disability.
There is no specific DSM-V classification of social disability; despite this, there are disorders that negatively influence social behavior and therefore may be considered social disabilities. These disorders, which are often categorized as pervasive developmental disorders (PDDs), delay or inhibit the socialization and development of communication in humans (American Psychiatric Association 2013). The PDD category includes disorders such as Autism Spectrum Disorder (ASD) and Rett syndrome. However, there are other disorders, such as social communication disorder and social anxiety disorder that are not considered part of the PDD category but still negatively influence social behavior. This entry will describe the symptoms and potential causes of the following social disabilities: ASD, Rett syndrome, social communication disorder, and social anxiety disorder.
Autism Spectrum Disorder
ASD refers to a continuum of social disability symptoms – listed on the continuum in order of prevalence and severity. Because this spectrum encapsulates a variety of social impairments, ASD may be viewed as the social disability that affects the most people. ASD is considered part of the PDD diagnostic category and contains many disorders that may be considered social disabilities. For instance, individuals on the mild end of the Autism spectrum are often diagnosed as having Asperger’s syndrome. Asperger’s syndrome differs from ASD in that individuals with Asperger’s may attempt social situations but are often perceived as being socially awkward.
Individuals with ASD experience lifelong impairment of social functioning. ASD affects about 1% of the population and is approximately 4.5× more common in boys compared to girls (American Psychiatric Association 2013; Center for Disease Control and Prevention 2017). There is a wide range of difficulties associated with ASD, ranging from mild social impairment to the inability to care for oneself without assistance. Arguably, one of the most debilitating social impairments caused by ASD is the inability to understand relationships or display social-emotional reciprocity (American Psychiatric Association 2013). Other symptoms common in ASD patients include strong fixated interests, issues with sensory input (e.g., sensitivity to fabric in clothing), and insistence on “sameness” or extreme consistency and familiarity within one’s social environment (American Psychiatric Association 2013). It is not unusual for ASD to be comorbid with intellectual disabilities, although some individuals with ASD may have above average intelligence (American Psychiatric Association 2013).
The most commonly used treatment for ASD is Applied Behavioral Analysis (ABA), which rewards positive behaviors and discourages maladaptive behaviors. There is a growing trend within school environments to utilize ABA therapy to treat students with ASD (Center for Disease Control and Prevention 2017). ABA essentially uses operant conditioning to influence behavior, as individuals generally make connections about behaviors and their consequences (Mash and Wolfe 2016).
While there is no known exact cause of ASD, researchers have found several links between ASD and various potential biological and environmental determinants that has helped shed light on the potential cause(s) of ASD. For instance, twin studies have shown that there may be a genetic component, and that the disorder is comorbid with chromosomal disorders such as Down syndrome or Fragile X syndrome (Center for Disease Control and Prevention (2017). Researchers have also found a link between elevated testosterone levels and ASD symptoms – indicating that children with ASD may possess an “extreme male brain” that causes these ASD patients to lack empathy and interest in social relationships (Baron-Cohen 2002). Other data has revealed that children from obese mothers are at an increased risk of being born with ASD (Li et al. 2016). Scientists across the world continue to research ASD in hopes of finding the exact cause(s) and better treatments.
Rett syndrome is somewhat similar to ASD in presentation. It is a rare neurological developmental disorder that is more prevalent in females; in males, it is normally fatal during infancy, but in rare cases, it may present as a milder form of what occurs in females (Mayo Clinic 2018). Individuals with Rett syndrome develop normally until about 6 months of age; at this time, there is a regression of milestones that marks the beginning of the first of four stages of progression (Mayo Clinic 2018). The second stage occurs between 1 and 4 years of age and features slow head growth, problems with motor skills, continued degeneration of social skills, and hyperventilating or screaming without reason (Mayo Clinic 2018). The third stage is considered a plateau, which may occur between 2 and 10 years. There may be some limited social improvements but seizures generally begin to occur during this time (Mayo Clinic 2018). The fourth and final stage of Rett syndrome generally begins after 10 years of age and features continued motor degeneration (Mayo Clinic 2018).
Experts believe Rett syndrome is caused by random mutations on the MECP2 gene, although some cases appear to be inherited (Mayo Clinic 2018). Researchers suspect the gene interferes with protein production involved in brain development, but the reason for the development of the disorder is unknown (Mayo Clinic 2018). There is no cure for Rett syndrome nor is there a known way to prevent the disorder. Current interventions for the disorder focus on communication and motor skills (Mayo Clinic 2018).
Social Communication Disorder
Social communication disorder, also called social pragmatic disorder, is similar to ASD in nature but lacks the presence of restricted behavior patterns, interests, or activities (American Psychiatric Association 2013). Key features of social communication disorder include difficulties understanding “rules” of conversation and storytelling, along with difficulty understanding things not explicitly stated (American Psychiatric Association 2013). Diagnosis of the disorder is unusual under the age of 4 years old but may not be realized until adolescence when the individual struggles to understand complex conversation or interactions (American Psychiatric Association 2013). Individuals with social communication disorder may display similarities to social anxiety disorder symptoms, attention-deficit/hyperactivity disorder, and intellectual disabilities. A family history of ASD and specific learning disorder may increase chances of being born with social communication disorder (American Psychiatric Association 2013).
Social Anxiety Disorder
Unlike the preceding disorders, where there is a lack of understanding of social interaction, patients with social anxiety disorder possess an intense and persistent fear of social interaction. For an individual to be diagnosed with social anxiety disorder, his/her fear of social interaction must be out of proportion for the situation; for juvenile patients, their fear of social interaction must not be limited to conversing with adults (American Psychiatric Association 2013). This fear of social interaction is persistent over a long period and causes dysfunction in one’s daily life. However, to be diagnosed with social anxiety disorder, the patient’s fear and anxiety must not be caused by other disabilities such as ASD (American Psychiatric Association 2013).
Social anxiety disorder is more prevalent in women, and onset typically occurs around 13 years of age (American Psychiatric Association 2013). Social anxiety disorder is distinctly different from agoraphobia in that the fear is of judgment by others, not the inability to escape the situation (American Psychiatric Association 2013). As noted before, social anxiety disorder has similarities to social communication disorder, and these symptoms are also found in children with ASD as well (American Psychiatric Association 2013).
Although this entry focused on four specific social disabilities, it is important to note that social disabilities are not necessarily limited to ASD, Rett syndrome, social communication disorder, and social anxiety disorder. ASD features social difficulties along with stringent interest and insistence on sameness. Rett syndrome presents similar symptoms to ASD but features severe motor degeneration along with the social impairment. Social communication disorder presents with similar social difficulties to ASD but does not feature symptoms such as stringent interest. Social anxiety disorder includes fear of social situations, although there is ability to understand the social situation. There is no ubiquitous system of accommodations in place strictly for individuals with social disabilities in schools. However, school administrations can grant accommodations to socially disabled students if they possess certain comorbid intellectual disorders, learning disabilities, or PDDs.
- Center for Disease Control and Prevention. (2017). Autism spectrum disorder (ASD). Retrieved from https://www.cdc.gov/ncbddd/autism/index.html
- Mash, E. J., & Wolfe, D. A. (2016). Abnormal child psychology (6th ed.). Boston: Cengage Learning.Google Scholar
- Mayo Clinic. (2018). Rhett syndrome. Retrieved from https://www.mayoclinic.org/diseases-conditions/rett-syndrome/symptoms-causes/syc-20377227?p=1