List of Mental Disorders DSM 5 / Aye, yai, yai!

Symptoms & Treatments of Mental Disorders, or LIFE AS PATHOLOGY

 

I was going to highlight those symptoms-disorders that the average person (foolishly) believes are merely variations of “normal” behaviors, physical conditions and/or disease, but the list is bat-crap crazy The categorizing of child academic difficulties with math and reading / writing as “mental disorders” is astounding! I’m amazed that constipation and diarrhea haven’t been sucked in by the DSM vacuum cleaner.

Links are live.

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The symptom lists below have been summarized from current diagnostic criteria most commonly used in the United States by mental health professionals (the Diagnostic and Statistical Manual of Mental Disorders). We’ve divided the disorders into three broad categories below: adult, childhood, and personality disorders; some disorders may fall under more than one category.

These disorder lists are in the process of being updated to reflect the changes from the latest edition of the diagnosis manual, the DSM-5.

Please keep in mind that only an experienced mental health professional can make an actual diagnosis. But who, exactly, are these people?

Looking for a DSM code? The DSM 5 is designed to ensure obscene profits for the “Mental” Health Industry and Big Pharma; actual people who need help have been abandoned – 

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ADULT DISORDERS

Common Disorders

Dissociative Disorders

Feeding & Eating Disorders

Sexual & Paraphilic Disorders

Sleep & Wake Disorders

CHILDHOOD DISORDERS

Childhood disorders, often labeled as developmental disorders or learning disorders, most often occur and are diagnosed when the child is of school-age. Although some adults may also relate to some of the symptoms of these disorders, typically the disorder’s symptoms need to have first appeared at some point in the person’s childhood.

PERSONALITY DISORDERS

These disorders typically aren’t diagnosed until an individual is a young adult, often not until their 20’s or even 30’s. Most individuals with personality disorders lead pretty normal lives and often only seek psychotherapeutic treatment during times of increased stress or social demands. Most people can relate to some or all of the personality traits listed; the difference is that it does not affect most people’s daily functioning to the same degree it might someone diagnosed with one of these disorders. Personality disorders tend to be an intergral part of a person, and therefore, are difficult to treat or “cure.” Learn more about personality disorders and personality traits

 Other Mental Disorders

 Disclaimers & Use Restrictions:

This listing is for personal use in education or research only. Any other use of this listing may be unlawful. Duplication or reproduction of these lists in any form is prohibited. We are not responsible for misuse of these listings. This listing is not meant to replace professional advice, diagnosis, or care from a licensed mental health practioner; its sole intent is for patient education. If you believe you may be suffering from one of these disorders, please consult a mental health professional. These symptom lists are summarized versions under the “Fair use” provision of U.S. copyright case law. They were summarized from the American Psychiatric Association’s 2013 Diagnostic and Statistical Manual of Mental Disoders, Fifth Edition (DSM-5).

Links / U.S. Chemical – Biological Weapons Hypocrisy

One of the largest human experiments in history’ was conducted on unsuspecting residents of San Francisco http://www.businessinsider.com/the-military-tested-bacterial-weapons-in-san-francisco-2015-7

Veterans Used In Secret Experiments Sue Military For Answers (Mustard Gas) http://www.npr.org/2015/09/051437555125/veterans-used-in-secret-experiments-sue-military-for-answers

DDT: A Review of Scientific and Economic Aspects of the Decision to ban its use as a pesticide https://books.google.com/books?id=K9XjbKUfYk8C United States. Environmental Protection Agency, ‎United States. Congress. House. Committee on Appropriations– 1975 – ‎DDT (Insecticide)

4 decades after war ended, Agent Orange still ravaging Vietnamese http://www.mcclatchydc.com/news/nation-world/world/article24751351.html

Biological warfare and bioterrorism: a historical review Proc (Bayl Univ Med Cent). 2004 Oct; 17(4): 400–406. Stefan Riedel, MD, PhDcorresponding author1 1From the Department of Pathology, Baylor University Medical Center, Dallas, Texas.

AND From GPF Global Policy Forum:

US Intelligence Helps Saddam’s Party Seize Power in 1963 | US and British Support for Saddam in the 1970s and 1980s

Saddam Key in Early CIA Plot (April 10, 2003)

According to former US intelligence officials and diplomats, the CIA’s relationship with Saddam Hussein dates back to 1959, when he was part of a CIA-authorized six-man squad that attempted to assassinate Iraqi Prime Minister Abd al-Karim Qasim. (United Press International)

A Tyrant Forty Years in the Making (March 14, 2003)

Roger Morris writes of the “regime change” carried out by the CIA in Iraq forty years ago. Among the CIA’s actions were attempted political assassinations and the handing over of a list of suspected communists and leftists that led to the deaths of thousands of Iraqis at the hands of Saddam Hussein’s Ba’ath Party. (New York Times)

 

CIA Lists Provide Basis for Iraqi Bloodbath

In this excerpt from his classic study of Iraqi politics, Hanna Batatu discusses how the Ba`ath Party seized power for the first time in a military coup in February 1963. He speaks of lists, provided by US intelligence, that enabled the party to hunt down its enemies, particularly the Communists, in a terrible bloodletting.

 

The Riegle Report (1994)

This report by the Senate Banking Committee analyzes the US’s exports of warfare-related goods to Iraq and their possible impact on the health consequences of the Gulf War. The report concludes that the US provided Iraq “with ‘dual-use’ licensed materials which assisted in the development of Iraqi chemical, biological and missile-system programs.” (Gulflink)

Officers Say US Aided Iraq in War Despite Use of Gas (August 18, 2002)

According to senior military officials, a covert program carried out during the Reagan Administration provided Iraq with critical battle planning assistance at a time when US intelligence agencies knew that Iraqi commanders would employ chemical weapons against Iran. (New York Times)

Did Saddam Die for Our Sins? (January 9, 2007)

The US-backed Iraq Tribunal sentenced Saddam Hussein to death for his role in the 1982 massacre of nearly 150 Shiites in Dujail, Iraq. But the same court has dropped all charges against Hussein, post mortem, for the killing of 180,000 Kurds during the 1980s – crimes committed with Western complicity. The author of this TomPaine piece concludes that if the tribunal does not look into US and British involvement in the genocide case, it will fail “to educate the world about Saddam and his barbarous regime.”

 

This Was a Guilty Verdict on America as Well (November 6, 2006)

The US-backed Iraq Special Tribunal sentenced the country’s former ruler and “one-time [US] ally” Saddam Hussein to death by hanging – a verdict which came as no surprise to many. The court sought to bring Saddam to justice for crimes against humanity, but failed to acknowledge past US and British administrations’ roles in facilitating these crimes. For decades, Washington provided economic and military support – including chemical weapons – to Saddam’s regime. Therefore, in light of the court’s ruling and its positive reception in Washington, the author of this Independent opinion piece asks, “Have ever justice and hypocrisy been so obscenely joined?”

 

The True Iraq Appeasers (August 31, 2006)

US Secretary of Defense Donald Rumsfeld has compared critics of the Bush administration’s policy in Iraq to those who appeased Adolf Hitler. The author of this Boston Globe article points out the hypocrisy of such a statement, noting the arming and financing of Saddam Hussein by the Reagan and first Bush administrations. As the article shows, many of the planners of the 2003 Iraq war supported Hussein in the 1980s during his ruthless and genocidal dictatorship.

 

Morality in Iraq, Then and Now (August 27, 2006)

This Washington Post opinion piece criticizes the historically inconsistent US policy towards Iraq. The author tracks US involvement in Iraq from the 1970s up until the trial of the country’s former leader Saddam Hussein, which began in 2005. Although the US helped to set up the Special Iraq Tribunal, contributing to the exposure of some of these crimes, the author warns against overlooking US complicity with the Hussein regime.

US Military Assistance to Saddam Hussein during the Iran-Iraq War (April 20, 2006)

This material highlights the various military, intelligence, and financial assistance given to Saddam’s regime by the US. In 1986, former Vice President George H.W. Bush traveled to the Middle East, repeatedly encouraging Saddam to step up Iraq’s bombing campaign against Iran. In addition, the US supplied Saddam with several big orders of helicopters and provoked a diversionary engagement with the Iranian navy in coordination with a major Iraqi offensive. (Global Policy Forum)

 

Saddam Hussein Trial: US-Iraq Military and Economic Relations (October 20, 2005)

Saddam Hussein’s trial has prompted discussions about US economic and military support to Iraq during the Iran-Iraq War. This bibliography offers a list of sources addressing US policy towards Iraq from 1979 to 1990. (Global Policy Forum)

 

Rumsfeld Visited Baghdad in 1984 to Reassure Iraqis, Documents Show (December 19, 2003)

While the US publicly maintained neutrality during the Iran-Iraq war, it privately attempted to forge a better relationship with the government of Saddam Hussein. This policy did not shift when Iraq used chemical weapons against Iran. (Washington Post)

 

Saddam’s Arrest Raises Troubling Questions (December 2003)

For decades Washington supported the regime of Saddam Hussein. US officials responsible for such policies could themselves be guilty of war crimes and might face allegations in an international tribunal. (Foreign Policy in Focus)

Crude Vision: How Oil Interests Obscured US Government Focus on Chemical Weapons Use by Saddam Hussein (March 24, 2003)

This report, by the Sustainable Energy and Economy Network, investigates the “revolving door” between the Bechtel Group and the Reagan administration that drove US policy towards Iraq in the 1980s. The authors argue that many of the same actors are back today, justifying military action against Iraq and waiting to reap the benefits of post-war reconstruction.

Britain’s Dirty Secret (March 6, 2003)

Britain secretly assisted in building a chemical plant in Iraq despite being fully aware that Saddam Hussein gassed Iranian troops in the 1980s. The warning about possibilities to make chemical weapons was dismissed by Paul Channon, British trade minister at that time, stating abandoning the project “would do our other trade prospects in Iraq no good.” (Guardian)

Shaking Hands with Saddam Hussein: The US Tilts Toward Iraq, 1980-1984 (February 25, 2003)

This extensive report from the National Security Archive uses declassified US documents to illustrate the nature of US involvement in Iraqi affairs under the administration of President Ronald Reagan.

America Didn’t Seem to Mind Poison Gas (January 17, 2003)

As part of his call for regime change in Iraq, George W. Bush has accused Saddam Hussein of using poison gas against his own people. However, in 1988 the US worked to prevent the international community from condemning Iraq’s chemical attack against the Kurdish village of Halabja, instead attempting to place part of the blame on Iran. (International Herald Tribune)

Rumsfeld “Offered Help to Saddam” (December 31, 2002)

As President Reagan’s Middle East envoy in the early 80s, current US Secretary of Defense and leading Bush administration hawk, Donald Rumsfeld, offered support to Saddam Hussein during the Iraq-Iran conflict with knowledge that the Iraqis were using chemical weapons. (Guardian)

 

US Had Key Role in Iraq Buildup (December 30, 2002)

This Washington Post article discusses the US role in the military buildup of Iraq preceeding the Gulf War. The administrations of Ronald Reagan and George H.W. Bush authorized the sale of poisonous chemicals and deadly biological viruses such as anthrax and bubonic plague.

 

Iraq and Poison Gas (August 28, 2002)

The US has always known about Baghdad’s deployment of chemical weapons and their use against his own people, especially during the Iran-Iraq War. “What did the US government do about it then? Nothing,” reports The Nation, “until ‘gassing his own people’ became a catchy slogan to demonize Saddam.”

Iraq Uses Techniques in Spying Against its Former Tutor, the US (February 5, 1991)

This 1991 article discusses the deep intelligence link between the US and Iraq in the 1980s, detailing the intelligence assistance that the US provided to Saddam Hussein during the Iran-Iraq war. (Philadelphia Inquirer)

Excerpts From Iraqi Document on Meeting with US Envoy (September 22, 1990)

Former US Ambassador to Iraq Ms. April Glaspie met with Saddam Hussein on July 25 1990, only 8 days before he invaded Kuwait. According to this excerpt from a transcript of their meeting, the two talked about oil prices, how to improve US-Iraq relations, and how the US has “no opinion on the Arab-Arab conflicts, like your border disagreement with Kuwait.” (New York Times)

And so much more: How does the U.S. dare take a “Holier than Thou” attitude toward the rest of the world’s nations?

 

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Student Loan Abuse / Targeting Senior Citizens

I was pleased to find this article from cnn money: I have been telling people for years about this abuse, but no one believes that it exists! Neurotypicals truly believe that “The government” isn’t allowed to do stuff like this, despite having Friends, family or their own horrible experiences with the irs, the veterans administration, Child welfare services, or any number of agencies. Now maybe someone will believe me!

boot

For more than a year, Jamie Chastain had $177 withheld from his Social Security check each month because of an unpaid student loan from three decades ago.

“The 68-year-old has been struggling to pay off his debt since 1982 when he borrowed about $12,500 to get a Master’s degree in Liberal Arts from the University of Southern Florida. It took him nearly a decade to find a steady job, and he defaulted on his loans before finding work at a community college as a media technician and humanities instructor. The government garnished his wages by about $400 a month throughout most of his career to collect the debt.”

“Chastain estimates he’s paid back three times what he originally borrowed. But because of the interest, the loans still weren’t paid off when he retired in 2014. So the government began garnishing his Social Security checks.”

“There are more people over the age of 65 with student loan debt than ever before, according to a new report from the Government Accountability Office. And those who are in default may have faced decades of reduced wages and benefits. In 2015, the government reduced (garnished) Social Security checks for a total of 173,000 Americans, up 380% from 36,000 in 2002. That includes younger people receiving Social Security disability payments as well.”

“The growing number of seniors with student debt has gotten attention from some lawmakers.”

Really? Are we still trying to “raise awareness” that the Federal government is abusing Senior Citizens? My generation will all be dead before there is any relief.

“This report shows us that seniors clearly aren’t immune to the student loan crisis — they’re deeply impacted by this issue to the point that it’s leaving many of them in a dire financial situation,” said Senator Claire McCaskill.” (Count me in!)

The GAO recommends changing the rules so that Social Security checks can’t be reduced as severely. Over the past decade, the number of seniors whose Social Security benefits have been garnished to below the poverty line because of unpaid student loans has increased from 8,300 to 67,300, the report said.” (Count me in!)

“That’s because there are more people in default, but also because the threshold for Social Security garnishments set in 1998 was never adjusted for inflation. The GAO recommends raising that threshold, which was set to prevent undue financial hardship for borrowers who “may be unable, rather than unwilling, to repay their debts.” This would require Congress to act. The report also suggests that the garnishments are not successfully collecting outstanding debt. More than one-third of older Americans were still in default after two years of reduced Social Security payments.” (Two years? More like a decade)

 

I signed a contract with the Justice Department to pay my student loans; I paid on time, every month for 5 YEARS and then began being hounded by the collection agencies used by the Department of Education to collect student loan debt: The short story?

NONE OF MY PAYMENTS had been applied to my debt; neither had the Justice Dept. informed the Dept. of Ed that I was paying on a “consolidation contract” monthly. My payments had “vanished” somewhere into the sewer that is the U.S. Treasury. The contract with the Justice Dept. was a sham; they refused to account for the money I’d paid, to correct the situation, or to even acknowledge any responsibility on their part. So there I was, after 5 years, with my debt having been increased by thousands and thousands of dollars in interest and fees. Because I dared to ask for an explanation and an equitable solution, I was punished by having my social security check garnished by 15%.  

The garnishment is interest only. The debt itself NEVER GETS PAID down, but continues to grow, with interest and fees still being piled on. It’s a predatory “rest of your life” extortion scheme. 

Honestly? I would have been treated better by a loan shark or the Mafia!

“Part of the problem is that only a small portion of garnished payments went toward paying off the loan principals. Most of the money covered interest and the $15 monthly fee the government charges to reduce Social Security benefits.” It’s not $15.00! The “fee” charged by the Treasury Dept. for “garnishing” my check is nearly $1000.00 per year.

“Withholding part of a borrower’s federal tax return — another way the government collects debt in default — was more effective and charged a lower fee.”

“The hard-earned Social Security checks that are the sole source of income for millions of seniors should not be siphoned off to pay interest and fees on student loan debt,” said Senator Elizabeth Warren. (Yak, yak, yak. Either shut up or DO SOMETHING!)

The GAO also recommends the government simplify the disability discharge application process. Those who can no longer work because of a disability are eligible to get their outstanding debt wiped away, but the report found that the process is difficult.”

Try impossible! I applied THREE TIMES and was summarily rejected. No explanation. TWO physicians who had treated me for years wrote and rewrote applications; they wrote extra letters and called and asked for a reassessment and a justification for the rejection: I had been classified “permanently disabled” by Social Security years before, but their own “disability panel” refused to acknowledge this status. I was told not to bother to apply ever again. 

“The Obama Administration has made efforts to make the discharge process easier. Earlier this year, it started to proactively notify those who are disabled and might be eligible for the program. (Not me!) 

Chastain was one of the 387,000 borrowers notified because of a recent diagnosis that affects his ability to work. He applied for relief and was approved for a discharge this summer. The garnishment of his Social Security checks stopped and the outstanding $12,000 in student debt was wiped away.

He says he wasn’t looking for a free pass, but the system seemed “rigged” against him.

He’s happy to have the money back in his pocket each month, but is apprehensive about what comes next. The discharge will be taxed as income, so he’s saving the extra money until he knows how much he’ll owe the IRS and when. It could be more than $2,000.

And guess what? There’s nothing to prevent Congress from passing legislation in future to make the abuse even worse!

 

 

There is something terribly wrong with the neurotypical brain

Every Asperger knows this to be true, but we’re not allowed to say so.

The DSM-5: From the same people who gave us –2931701642_101fc4e860_o

The Head Crusher: The head crusher was a brutal torture device commonly used by the Spanish Inquisition. The person’s chin was placed over a bottom bar and the head under a upper metal cap. The executioner then slowly turned the screw, gradually compressing the head between the bar and cap. The teeth were smashed and disintegrated into the jaw. Some variants of the head crusher even included a small containers that received the eyeballs squeezed out of the person’s eye sockets. The agony could last several hours, until the victim’s brain was finally crushed.

This horrendous instrument was an effective way to extract confessions from the victims, as the suffering could be prolonged to indefinite time, if the executioner chose to. However, even if the torture was stopped midway, the person, although still alive, often had irreversible brain damage.

We’re talking about CHILDREN – innocent children who by nature, are curious, adventuresome learning machines – but CERTAIN PEOPLE want to crush the life out of them before they get a chance to “disobey” society’s enforcers of social slavery.  ______________________________________________________________________

Practitioner Review: Social (pragmatic) communication disorder conceptualization, evidence and clinical implications

Authors: Dr Courtenay Frazier Norbury, Department of Psychology, Royal Holloway, University of London, Egham, Surrey TW20 0EX, United Kingdom; Email: courtenay.norbury@rhul.ac.uk First published: 9 October DOI: 10.1111/jcpp.12154

Abstract

Background: DSM-5 sees the introduction of Social (Pragmatic) Communication Disorder (SPCD), characterized by persistent difficulties using verbal and nonverbal communication for social purposes, in the absence of restricted and repetitive interests and behaviours. There is currently much confusion about the precise diagnostic criteria for SPCD and how this disorder relates to autism spectrum disorders (ASD), previous descriptions of pragmatic language impairment (PLI) and more specific language disorders (LD).
Method: Proposed criteria for SPCD are outlined. A selective review of the evidence considers whether these criteria form a cohesive and distinct diagnostic entity. Approaches to assessment and intervention are discussed. So, no one knows if this is a legitimate disorder, but it’s already in the DSM-5 ?
Results: Implementing the new diagnosis is currently challenged by a lack of well-validated and reliable assessment measures, and observed continuities between SPCD and other neurodevelopmental disorders. High rates of comorbidity between SPCD and other seemingly disparate disorders (including conduct disorder, ADHD and disorders of known genetic origin) raise questions about the utility of this diagnostic category.
Conclusions: SPCD is probably best conceptualized as a dimensional symptom profile that may be present across a range of neurodevelopmental disorders, although there is an urgent need to investigate the latent structure of SPCD using consistent diagnostic criteria. In addition, social communication and aspects of pragmatic language may be dissociated, with the latter heavily influenced by structural language attainments. Finally, there is a dearth of reliable and culturally valid assessment measures with which to make a differential diagnosis, and few rigorously tested intervention programmes. The implications for research and clinical practice are outlined.
Enhanced PDF; Standard PDF (139.3 KB)
IntroductionSuccessful communication requires us to go beyond the literal words uttered and draw on our knowledge and experiences to construct meaning. Sometimes this requires the use of linguistic context (pragmatics), in which children are expected to infer meaning or resolve ambiguities by integrating the surrounding language with their prior knowledge and experience. At other times, successful communication requires the use of language in social contexts (social communication). Here, a broad definition would include a child’s understanding of speaker intentions and the verbal and nonverbal cues that signal those intentions, as well as the child’s interpretation of the environmental context, societal norms and expectations and how these coalesce with structural aspects of language (e.g., vocabulary, syntax and phonology) to achieve successful communication. That some children experience difficulties with social communication, or that pragmatic language development can follow a qualitatively atypical course, is incontrovertible. However, the diagnostic status of children with atypical pragmatic and social communication development has long been debated (cf. Brooks & Bowler, 1992), fuelled most recently by the introduction of a new disorder, Social (Pragmatic) Communication Disorder, to the DSM-5 (http://www.psychiatry.org/practice/dsm/dsm5; American Psychiatric Association, 2013a) and proposals for Pragmatic Language Impairment (PLI) to ICD-11 (World Health Organisation, 2013).A resolution of the debate is hampered by inconsistencies in terminology and diagnostic criteria, a paucity of reliable, culturally valid assessment tools supported by adequate normative data, and limited comparison of social communication profiles across different neurodevelopmental disorders.

But that’s never stopped us before, so let’s jump right into a new “fiasco”

The idea that some children may have significant social communication and/or pragmatic language impairments without meeting diagnostic criteria for autism is certainly not new (Bishop & Norbury, 2002); nosologies of developmental disorders have included children with atypical social pragmatic development for more than 30 years. For the most part, investigators have used the terms interchangeably, such that social communication and pragmatic language skills encompass the same behaviours. For instance, Rapin and Allen (1983) first described ‘semantic-pragmatic deficit syndrome’ as a constellation of symptoms including verbosity, comprehension deficits for connected speech, word finding deficits, atypical word choices, unimpaired phonology and syntax, inadequate conversation skills, speaking aloud to no one in particular, poor topic maintenance and answering beside the point of a question (Rapin, 1996). Wow! is this control-freak creepy or what? Just about any child will display some of these “pathological” speaking habits! Most adults also! Rapin and Allen used this as a descriptive term that was most commonly applied to the communication profiles of children with autism spectrum disorder (ASD), but they acknowledged that social communication and pragmatic language impairments were also seen in many other developmental disorders. Bishop and Rosenbloom (1987) considered ‘semantic-pragmatic disorder’ to represent a distinct subgroup of children who occupied a diagnostic space between ASD and specific language impairment (SLI). Both systems emphasized a deficit in social communication and/or pragmatic language abilities in the context of relatively age-appropriate phonology and grammar. In an effort to improve diagnostic accuracy and interrater reliability, Bishop (1998) created the Children’s Communication Checklist, which has rapidly become the most widely used, standardized measure of pragmatic ability in research and clinical contexts. However, Bishop (1998) reported that semantic items did not reliably distinguish children with suspected social pragmatic deficits from typically developing children or peers with SLI. As a result, the term ‘PLI’ became the generally accepted term for children with primary difficulties in the use of language in context (social or linguistic) who did not meet standard diagnostic criteria for pervasive developmental disorder. However, subsequent research made clear that many children identified with pragmatic deficits using the CCC had structural language impairments (Norbury, Nash, Baird, & Bishop, 2004) and that pragmatic deficits were manifest across a range of neurodevelopmental conditions, some of which involve impairments in general cognitive functioning (cf. Laws & Bishop, 2004). In ASD, deficits in pragmatic aspects of language are a recognized hallmark of the disorder (Tager-Flusberg, Paul, & Lord, 2005). However, children with ASD are commonly identified as having social communication disorders, rather than PLI, perhaps in an effort to emphasize the pronounced difficulties with face-to-face communication individuals with ASD may experience.

Why does this debate matter?

The emphasis on identifying and delineating pragmatic and social communication deficits is surely welcome, so could there be any reason to object to the creation of a diagnostic category designed primarily to identify children who might otherwise slip through the net? A revealing use of words – society wouldn’t want a bunch of “communication renegades” running loose! I would argue that there are reasons to be concerned with the diagnosis in its current form, particularly as diagnosis typically carries with it a promise of tailored intervention and educational support. As differences in terminology highlight, there is considerable confusion surrounding the new diagnosis, and the different perspectives of the clinical practitioners who will be charged with making it. There is particular concern about the inclusion and possible exclusion criteria, which may mean that few individuals actually meet diagnostic criteria. This is complicated by clear overlaps with the diagnostic criteria for language disorder and ASD, making differential diagnosis particularly challenging. There is also legitimate concern that children receiving this diagnosis would not receive the clinical or educational services that they may require. It has been documented that federal funding for research into ASD far outstrips that for language disorder (Bishop, 2010) and that children with ASD receive far more intensive and consistent educational support for language than peers with language disorder, even when the latter group have more severe language impairments (Dockrell, Ricketts, Palikara, Charman, & Lindsay, 2012).

In this review, I will outline proposed criteria for SPCD and consider the evidence that SPCD is a valid diagnostic construct. Most of the research I will review previously identified nonautistic children with social communication deficits as having PLI, although children with structural language impairments were not always excluded from these studies. For consistency, I will use the term SPCD to refer to the children included in past studies. However, I will argue that social communication and pragmatic language skills are not necessarily one and the same, with the latter closely associated with structural aspects of language. I will argue that to assess and treat SPCD, it is vital to understand the continuities between SPCD and both ASD and language disorder, as well as consider the high rates of comorbidity between SPCD and other developmental disorders. Finally, I will argue that as with most neurodevelopmental disorders, SPCD is best conceptualized along a set of symptom dimensions, rather than as a discrete categorical entity, although there is an urgent need to empirically establish the symptom profile that is associated with social pragmatic deficits in the absence of autism. ESPECIALLY SINCE IT’S A “DONE DEAL” IN THE DSM-5

DSM-5 criteria for social (pragmatic) communication disorder (SPCD)

One reason for the inclusion of SPCD within DSM-5 and PLI in ICD-11 is the well-publicized changes to criteria for autism and related conditions, and the potential impact of these changes on provision for individuals who no longer meet criteria for ASD Aha! The real reason for “invention” of this disorder and inclusion in the DSM-5 is political; now we have to put lipstick on this pig. (Huerta, Bishop, Duncan, Hus, & Lord, 2012; McPartland, Reichow, & Volkmar, 2012). Whereas previous diagnostic frameworks specified a triad of impairments, the new systems will focus on two symptom dimensions: social communication deficits and restricted and repetitive interests and behaviours (isn’t the latter “repetitive” stuff supposedly a symptom of  ASD? (see Lord & Jones, 2012 for discussion). There have been discrepant estimates of how many individuals with existing diagnoses would still warrant a diagnosis of ASD under the new classification. For example, McPartland et al. (2012) reported that only 60.6% of participants with a current diagnosis would meet new criteria for ASD, whereas Huerta et al. (2012) reported that 91% of their sample would retain their current diagnosis (although specificity in this sample was remarkably low at .53).

A shameless conspiracy of “symptoms” selected and organized to match invented disorders! It’s as if these “experts” are fighting over the seating chart at a political dinner!  

Neither study was able to establish how many individuals would meet criteria for SPCD as the operational criteria for the new disorder are currently rather limited. However, Huerta et al. (2012) reported that only 1.5% of their participant pool met social communication criteria for ASD, but did not meet threshold criteria for RRIBs.

Such studies give rise to the concern that SPCD will be treated as a residual category for ‘not-quite’ ASD, rather like the previous PDD-NOS category (Skuse, 2012). A definition by exclusion could be particularly problematic as SPCD will come under the umbrella of Communication Disorders, a set of disorders that are typically the remit of speech-language pathologists. In this arena (in case you doubt that these are turf wars)  restricted and repetitive interests and behaviours are not routinely assessed and definitively ruling out ASD may prove challenging.

Table 1 outlines inclusion criteria for SPCD (American Psychiatric Association, 2013b): Previous draft criteria acknowledged that SPCD could co-occur with disorders other than ASD, such as language disorder or intellectual disorder, but stipulated that social communication deficits could not be explained by deficits in vocabulary, grammar or general cognitive ability. Notably, current draft criteria for PLI in ICD-11 stipulate exclusion of both ASD and receptive/expressive language disorders. Aye, yai, yai!

Table 1. Social (pragmatic) communication disorder (American Psychiatric Association, 2013b)
1.Persistent difficulties in the social use of verbal and nonverbal communication in four key areas, all of which must be present for diagnosis:

using communication for social purposes such as greeting or exchanging information;

changing communication to match context or the needs of the listener;

following rules for conversation or storytelling, such as taking turns in conversation;

understanding what is not explicitly stated and nonliteral or ambiguous meanings of language.

Wow! This is REAL pathology: the obsessive need to prescribe and script ALL human communication, from birth, until death frees a person from fascist psychology!

2.Symptoms must be present in childhood and result in limitations to functional communication, social participation and relationships, academic achievement and occupational performance.

3. Rule out Autism Spectrum Disorder (i.e., does not meet threshold for repetitive behaviours or restricted interests)

THE FOLLOWING IS UTTERLY IRRATIONAL  NEUROTYPICAL NUTTINESS: The “magic word” world of concepts is totally detached from reality.

Skuse (2012) raised a number of pertinent concerns about the SPCD diagnosis. First and foremost is how these diagnostic criteria will be operationalized and defined in such a way that they do not amount to ASD equivalent social and pragmatic deficits in the absence of restricted and repetitive interests and behaviours (RRIBs). Here, it may be helpful to consider whether SPCD is underpinned by the same cognitive constraints in different diagnostic groups. In ASD, there is an overriding assumption that SPCD is a consequence of core deficits in social cognitive processes such as theory of mind, while in other developmental populations, SPCD may occur in the absence of social cognitive deficit. Whether differences in the cognitive origins of SPCD yield qualitatively different communication profiles is an open question. A second concern is whether there is any evidence that children with SPCD form a coherent and etiologically distinct group, requiring a different course of intervention or educational support. A related issue is the developmental course and diagnostic stability of SPCD; at what point can a diagnosis be made reliably and how does the phenotype change over time? Finally, Skuse (2012) queries whether the presence of RRIBs yields a qualitatively distinct social communication profile, or confers more functional impairment relative to SPCD in isolation. In a similar vein, I suggest that it would be unwise to assume that co-occurring language and intellectual impairments necessarily cause SPCD, given the intimate developmental relationships that exist between social, linguistic and cognitive achievements (Chiat & Roy, 2008). We need to know much more about how individual differences in each of these developmental pathways influence social communication development and disorder.

To begin to answer these questions, however, we need to identify the relevant children. Below, I outline best practices for assessment of social communication and pragmatic language abilities and highlight some of the difficulties in measuring these skills. I will then consider differential diagnosis of SPCD from ASD and Language Disorder, as well as the presence of SPCD in other neurodevelopmental disorders.

Assessment and diagnosis of social communication and pragmatic language skills

Social communication and pragmatic language abilities are notoriously difficult to measure in standardized ways because they are a set of contextually dependent human behaviours that occur in dyadic exchanges; the structure provided by a standardized testing situation makes it difficult to capture social communication problems that may arise in everyday situations where the rules of engagement are less explicit and highly dynamic (Adams, 2002; Volden, Coolican, Garon, White, & Bryson, 2009). Social communication skills are also highly susceptible to cultural variation: discourse rules such as turn taking, interrupting, appropriate topic choices, use of eye contact and other nonverbal strategies for maintaining interaction, use of humour, and the ability to question and challenge communication partners, are largely determined by cultural rules and the child’s relationship with his or her interlocutor (Carter et al., 2005). Unlike structural aspects of language (e.g., vocabulary or grammar), there are also far fewer normative data for such behaviours (Norbury & Sparks, 2013).

Adams (2002) provided a summary of developmental social communication and pragmatic attainments and a detailed examination of popular methods for assessing these skills. A brief overview is provided below and in Table 2, focusing on methods of assessing conversational skill, narrative ability and the understanding/use of ambiguity (i.e. inferencing, multiple meanings and figurative language). Measures are organized according to the method of assessment, including checklist or rating scale, structured observation and formal assessments with pragmatic content.

Table 2. Methods of assessing social communication and pragmatic language abilities
Name of test Authors Age Aspects of social communication covered Pros/Cons
Checklists and rating scales
 Children’s Communication Checklist-2 Bishop (2003a, 2003b) 4–16 years Syntax, Speech, Inappropriate initiation, Coherence, Stereotyped conversation, Use of context, Rapport, Social interaction, RRIB Does not provide diagnosis, but can inform further assessment decisions
 Targeted Observation of Pragmatics in Children’s Conversations (TOPICC) Adams et al. (2011) 6–11 years Reciprocity, turn-taking, taking account of listener knowledge, verbosity, topic management, discourse style, response problems Quick index of conversational skill, but currently lacks adequate interrater and test–retest reliability
 Analysis of Language Impaired Children’s Conversation (ALICC) Bishop and Adams (1989) 4-adult Discourse participation; conversational dominance; assertiveness; verbosity; responsiveness; meshing (e.g., appropriate responses) Detailed profile of conversation that can distinguish SPCD from language disorder; time consuming
Structured observations
 Communication and Symbolic Behavior Scales Wetherby and Prizant (1993) 6–24 months Communicative, social, affective and symbolic abilities (including play) Most appropriate for young children; overview of nonverbal communication
 Early Social Communication Scales Mundy et al. (2003) 8–30 months Initiating and responding to joint attention; behavioural requests; social interaction behaviours Most appropriate for young children; overview of nonverbal communication
 Autism Diagnostic Observation Schedule (ADOS) Modules 1–4 Lord et al. (2001) 18 months – adulthood Play, Response to Name, Response to Joint Attention, nonverbal communication (gesture and facial expression), Functional and Symbolic Imitation, personal narrative, conversation, emotions, social relationships Later modules include ratings of conversation (4-part exchange) and aspects of social communication; does not specifically probe pragmatic language
 Yale Pragmatic Protocol Schoen and Paul (2009) 9–17 years Pragmatic probes within five conversational domains (discourse management, communicative function, conversational repair, presupposition, register variation) Structure probes of social communication in seminaturalistic setting; little evidence that it distinguishes SPCD from other language disorder
Formal assessments with pragmatic content
 Assessment of Comprehension and Expression (ACE 6-11) Adams et al. (2001) 6–11 years Sentence comprehension, Inferential comprehension, Naming, Syntactic Formulation and Semantic Decisions, nonliteral language, narrative retelling Combines structural language and pragmatic language tasks. Narrative is especially appropriate for school-aged children
 Test of Language Competence Wiig and Secord (1989) 5–18 years Ambiguous Sentences, Listening Comprehension, Making Inferences, Recreating Speech Acts Figurative Language Formal test which may not reflect abilities in everyday contexts
 Test of Pragmatic Language Phelps-Terasaki and Phelps-Gunn (2007) 8–18 years Physical setting, audience, topic, purpose (speech acts), visual-gestural cues, and abstraction Covers wide range of social communication behaviours
 Bus story Renfrew (1995) 3–8 years Narrative recall Good prognostic measure of persistent language deficits
 Expression, Reception and Recall of Narrative Instrument (ERRNI) Bishop (2003a, 2003b) 6-adult Narrative comprehension and recall Stories include a ‘theory of mind’ element
 Strong Narrative Assessment Procedure Strong (1998) 7–12 years Narrative generation and comprehension Unusual in that it does not involve a retelling and so may be more sensitive to social pragmatic deficits

Parent teacher report of children’s communication

Given the inherent difficulties of extrapolating pragmatic performance in clinical settings to everyday communicative competencies (Volden et al., 2009), standardized checklists of pragmatic and social communication behaviours have become a popular method of assessment. The Children’s Communication Checklist (CCC, Bishop, 1998; CCC-2, Bishop, 2003a, 2003b) is perhaps the most widely used checklist in clinical practice and research. The CCC-2 is a 70-item checklist comprised of 10 scales; eight scales tap structural and pragmatic language and two scales measure the social impairments and restricted interests more typical of ASD. Normative data are available on over 500 UK children and over 900 US children aged 4 to 17 years and it has been translated into more than 30 different languages. Respondents are asked to rate the frequency of communication behaviours on a four-point scale. In the original CCC, a pragmatic composite was derived by summing the scores of scales that tapped pragmatic language competence. These included inappropriate initiation, coherence, stereotyped language, use of context and conversational rapport. However, in the validation sample, this composite score had poor levels of interrater reliability and was not successful at discriminating children identified as having PLI from children with diagnoses of more specific language impairment (Norbury et al., 2004). One reason is that children with SLI obtained low scores on the pragmatic composite, highlighting an association between structural language and pragmatic language skill that has been consistently replicated (cf. Ketelaars, Cuperus, van Daal, Jansonius, & Verhoeven, 2009; Volden et al., 2009).

To address this issue, Bishop (2003a, 2003b) devised the Social Interaction Deviance Composite (SIDC), which identifies pragmatic abilities that are disproportionately impaired relative to structural language competencies. Thus, a positive score indicates relatively mild pragmatic difficulties in conjunction with more severe deficits in structural language. Scores around zero are indicative of a child with equally severe pragmatic and structural language deficits (i.e., a significant proportion of children with ASD) and negative scores would be more consistent with a profile in which scores on structural language tests were within normal limits, but the child experienced pronounced social communication deficits. An important caveat is that amongst a large cohort of children with communication disorders, scores on the SIDC were continuously distributed, with no clear categorical boundaries between specific language impairment, SPCD or ASD (Norbury et al., 2004). Therefore, the CCC-2 should be used to signpost aspects of communication for further assessment, rather than providing a clear diagnosis itself.

In addition to parent or teacher report measures, clinicians may wish to rate aspects of a child’s communicative behaviour more directly. Three main criteria for SPCD centre on the individual’s conversational skills, specifically initiation and response to conversational bids, adapting conversation to listener needs and environmental expectations and following conversational rules, such as turn taking. Quantitative approaches to analysing conversation in detail have been developed with acceptable levels of interrater reliability (Bishop & Adams, 1989). Conversational analysis may also provide an ecologically valid tool with which to demonstrate improvements in pragmatic and social communication competence following intervention (Adams, Lloyd, Aldred, & Baxendale, 2006). Despite these advantages, it remains a time-consuming assessment method, which may limit its clinical and research utility. Measures such as the Targeted Observation of Pragmatics in Children’s Conversation observation scale (Adams, Gaile, Freed, & Lockton, 2010) shows promise as a method of rating the quality of conversational exchanges, and is sensitive to developmental change (Adams et al., 2012). However, there is little research at present regarding its diagnostic sensitivity and specificity.

Structured observation

An advantage of structured observations is that the examiner can create naturalistic contexts specifically designed to elicit social communication behaviours, thus judging whether or not they occur and whether there are qualitative differences in the child’s communicative behaviours. ‘Conversational’ behaviours can also be assessed prior to the advent of spoken language. Three measures, the Early Social Communication Scales (Mundy et al., 2003), the Communication and Symbolic Behavior Scales (Wetherby & Prizant, 1993) and the Autism Diagnostic Observation Schedule (ADOS)-Toddler Module (Luyster et al., 2009) assess how infants and toddlers initiate and respond to interactions with adults. This may include observation of whether the child uses eye gaze, gesture or vocalizations to gain the adult’s attention, direct attention or respond to a direct request. Such measures usually include ‘presses’, which attempt to elicit specific communicative acts. For example, the child might be shown a very tempting wind-up toy. After demonstrating what the toy can do, the examiner will hold back and wait to see whether and how the child obtains help from an adult to make the toy move again. For older children and adolescents, measures such as the ADOS and ADOS-2 (Lord, Rutter, DiLavore, & Risi, 2001) and the Yale in vivo Pragmatics Protocol (Schoen & Paul, 2009) include more sophisticated ‘presses’ including observation of how the child greets an unfamiliar adult, whether the child spontaneously offers information about his/her own experiences and how the child integrates verbal and nonverbal (e.g., eye gaze, gesture) communication behaviours.

A rather blunt measure of conversational skill is also included in the ADOS (Lord et al., 2001). Here, the examiner attempts to engage the individual in a conversational exchange, providing ‘hooks’ to which the child is expected to comment or question the examiner further. The conversation is scored on a 4-point scale, with a score of 3 indicating total absence of conversation, and a score of 0 representing a conversation that has at least four coherent turns (e.g., examiner comments, child questions, examiner responds and child comments). Separate codes tap quality of initiations or response, use of facial expression and gesture, and the integration of verbal and nonverbal information for communicative purposes.

One strength of structured observations such as the ADOS is that they provide a consistent context in which to observe qualitatively different or unusual communication behaviours. A limitation of these assessments is that there are few normative data available on which to make judgements of conversational adequacy. Modules 3 and 4 of the ADOS cover a wide age range from 4 years to adulthood. While typically developing four-year olds are capable of sophisticated conversational exchanges, we might expect qualitative differences between conversational skills of children and adults. In addition, the degree to which children feel able to comment or question unfamiliar adults is culturally dependent (cf. Norbury & Sparks, 2013).

Formal assessments with pragmatic content

Narrative analysis constitutes an important tool for revealing pragmatic deficits, as it taps the integration of linguistic, cognitive and social pragmatic abilities. Narrative measures allow assessment of the child’s ability to convey a coherent sequence of events, provide the right amount of key information to the listener and use cohesive devices consistently. In addition, unusual or bizarre comments thought to be indicative of ASD may be revealed, although interrater reliability of ‘bizarre’ comments can be disappointingly low (Norbury & Bishop, 2003) and are present in only a minority of ASD narratives (Norbury, Gemmell, & Paul, 2013). Several standardized assessments of narrative exist, including the Bus Story (Renfrew, 1995), the Expression, Reception and Recall of Narrative Instrument (Bishop, 2003a,2003b) and the Strong Narrative Assessment Procedure (Strong, 1998). Less formal assessment measures include telling a story from a picture book (Norbury & Bishop, 2003) or generating narrative in response to a story stem (Demir, Levine, & Goldin-Meadow, 2010).

Narrative is an important part of clinical assessment not least because it is a foundational skill for academic achievement (Boudreau, 2008). However, narrative skills are vulnerable across a range of developmental disorders and direct comparisons of different clinical populations have yielded few quantitative or qualitative differences in narrative performance (Norbury & Bishop, 2003; Norbury et al., 2013; Finestack, Palmer, & Abbeduto, 2012). Furthermore, measures of structural language ability are typically the strongest predictors of narrative competence within clinical populations (Kay-Raining Bird, Cleave, White, Pike, & Helmkay, 2008).

More direct assessment of pragmatic language ability may also include measures of inferencing, understanding of humour or figurative expressions such as metaphor, idiom or irony, and referential communication, including the child’s ability to request clarification or identify messages that are ambiguous or underinformative. Standardized measures, such as the Test of Language Competence (Wiig & Secord, 1989) or the Test of Pragmatic Language-2nd Edition (Phelps-Terasaki & Phelps-Gunn, 2007) have distinguished groups of children with known pragmatic deficits from comparison groups (Young, Diehl, Morris, Hyman, & Bennetto, 2005). However, Adams (2002) argues that such formal testing measures are unlikely to reveal an accurate or comprehensive picture of the child’s pragmatic competence in more dynamic, context dependent communicative exchanges.

Social communication and pragmatic language: same or different?

Social (Pragmatic) Communication Disorder criteria stipulate that impairments should be evident in all four of the aspects of communication specified: using communication for social exchange, adapting communication style to the context, following rules of conversation or narrative convention and understanding implicit or ambiguous language. It would appear that this requirement presumes that social communication and pragmatic language skills are manifestations of the same underlying cognitive process(es). Indeed, these skills are closely associated; a recent population study demonstrated that pragmatic language skills were highly predictive of social competence, even after expressive language abilities had been taken into account (Ketelaars, Cuperus, Jansonius, & Verhoeven, 2010). However, there is mounting evidence that even within the autism spectrum, social communication deficits and pragmatic language impairments may be dissociated, and can arise from different underlying constraints.

Traditionally, social pragmatic impairments in ASD have been attributed to the absence or attenuation of the social instinct (Wing, Gould, & Gillberg, 2011) and a fundamental impairment in ‘theory of mind’ (Baron-Cohen, Leslie, & Frith, 1985). A lack of social motivation can readily explain conversational impairments such as a lack of initiation or minimal contingent responses. Reduced experience with social interaction may alter the course of pragmatic development, in that it limits exposure to nonverbal communicative gestures (facial expression, gesture) and the flexible nature of language use. Social cognitive deficits are hypothesized to lead to reduced ability to represent a listener’s state of mind; this could contribute the recognized limitations in providing the appropriate amount of information to minimize ambiguities in conversation (Capps, Kehres, & Sigman, 1998; Tager-Flusberg & Anderson, 1991) or conveying sufficient information of interest to the listener in conversation and narrative tasks (Capps, Losh, & Thurber, 2000). Difficulties understanding speaker intentions have also been attributed to reported deficits in understanding figurative language such as metaphor and irony (Happé, 1993; Martin & McDonald, 2004), and deficits in referential communication (Nadig, Vivanti, & Ozonoff, 2009).

However, it is important to realize that there is usually considerable variation within ASD groups on these tasks and that social communication abilities have been linked not only to mentalizing, but are often associated with structural language abilities (see Gernsbacher & Pripas-Kapit, 2012 for discussion in relation to figurative language). For instance, Norbury (2005) investigated metaphor comprehension in children with ASD and compared those with additional language impairments (ALI) with those who scored within normal limits on assessments of structural language competence (ALN). Notably, these groups did not differ with respect to social communication deficit, as measured by the Social Communication Questionnaire (Rutter, Bailey & Lord, 2003), nor do they typically differ on ADOS or Vineland Adaptive Behavior Scales social indices (cf. Norbury et al., 2009). Children with ALN did not differ from typically developing peers on the metaphor task, whereas those with ALI had significantly lower scores. Moreover, scores on measures of structural language predicted unique variance in metaphor understanding, whereas scores on Theory of Mind tasks did not.

Furthermore, studies employing experimental measures of inferencing ability and ambiguity resolution have found few differences between individuals with ASD and typically developing peers, providing the individuals with ASD had age-appropriate structural language abilities (Brock, Norbury, Einav, & Nation, 2008; Norbury, 2005; Pijnacker, Hagoort, Buitelaar, Teunisse, & Geurts, 2009). Structural language abilities reliably predict performance on these tasks, even within ASD populations (Volden et al., 2009). Thus, it would seem that social communication deficits may be evident in children who are indistinguishable from TD peers on measures of pragmatic language functioning.

Social communication undoubtedly draws on a number of skills, of which social cognition (as measured by theory of mind tasks) is just one. And it is possible that a stronger relationship would be found between social communication and pragmatic language abilities if different tasks were employed to measure pragmatic language skill. Nevertheless, the studies cited above suggest that to require both social and pragmatic deficits to be present may preclude diagnosis in young people with average or above average structural language skills. Conversely, those most likely to demonstrate impairments in both are very likely to have additional impairments in word knowledge and grammar, which may also preclude diagnosis.

Differential diagnosis of SPCD

Is SPCD a milder form of ASD?

Crucially, DSM-5 and ICD-11 will require that children with SPCD do not exhibit clinically significant RRIBs. There has been some disagreement in the literature regarding the extent to which children identified as having primary SPCD show evidence of RRIBs. Reisinger, Cornish, and Fombonne (2011) explicitly compared children with ASD and children with SPCD on the ADOS and the SCQ. They found that the groups could be distinguished by the severity of social and communication deficits, but did not differ significantly on measures of RRIB. In contrast, Bishop and Norbury (2002) used similar methods and reported that children with SPCD as a group were less likely to display RRIBs. However, the majority of children with SPCD were rated as having speech abnormalities associated with autism and used stereotyped language. In addition, a significant minority were reported to have unusual sensory interests. Changes to DSM-5 criteria for ASD include the reclassification of stereotyped language as an RRIB, rather than a communication symptom, and include sensory interests. Thus, many of the children studied by Bishop and Norbury (2002) may meet new DSM-5 criteria for ASD.

These studies used the ADOS and the SCQ to quantify RRIB; the reliability of these algorithms is low (Lord et al., 2000) and the scales are perhaps not detailed enough to identify differences between diagnostic groups. A recent study by Gibson, Adams, Lockton, and Green (2013) utilized the Repetitive Behaviour Questionnaire-2 (Leekam et al., 2007) and reported that children with SPCD could be distinguished from peers with ASD on this measure. However, the children included in this study were young, aged between 6 and 11 years. A complication for differential diagnosis is that symptom profiles may change significantly with age (Bishop & Norbury, 2002; Howlin, Mawhood, & Rutter, 2000), with an increase in specialist interests and rigid behaviour becoming more evident over developmental time. Thus, a group difference in the early school years may be less apparent in adolescence. A further complication is that few studies have measured RRIBs in children with SPCD in relation to typically developing peers. It is likely that even if children with SPCD do not exhibit enough RRIBs to meet threshold for ASD, they have elevated levels of RRIB relative to peers. In short, it may not be possible to distinguish ASD and SPCD on the basis of behavioural profiles alone (Reisinger et al., 2011).

Is SPCD a form of Language Disorder?

DSM-5 criteria for Language Disorder stipulate that children will have impairments in any one of three areas: word knowledge, grammar and discourse. Discourse includes narrative and conversational exchange, thus overlapping with SPCD. Children with more ‘specific’ forms of Language Disorder have variable social interaction and social communication difficulties relative to TD peers. These may include difficulties establishing social relationships (Whitehouse, Watt, Line, & Bishop, 2009); poorer quality friendships (Durkin & Conti-Ramsden, 2007); difficulties with peer negotiation and conflict (Brinton, Fujiki, & McKee, 1998; Horowitz, Jansson, Ljungberg, & Hedenbro, 2006) and poorer social cognition (Marton, Abramoff, & Rosenzweig, 2005). In general, it is argued that these social deficits are secondary to the language impairment and strong associations between language test performance and measures of social deficit support this view (Gibson et al., 2013). However, measures do not always correlate, and there is some suggestion that social deficits might be concomitant with language impairment (Marton et al., 2005). It is also typically the case that on measures of social competence, there is a pattern of increasing severity in which children diagnosed with ASD demonstrate the most severe social impairments, children with language disorder the mildest deficits and children with SPCD falling between the two (cf. Gibson et al., 2013). Often performance is continuously distributed with little clear indication of where diagnostic boundaries lie.

Difficulties with pragmatic aspects of language are more consistently vulnerable in children with language disorders. For instance, compared with age-matched peers, children with ‘specific’ language impairment have deficits in narrative (Norbury et al., 2013), inferencing (Katsos, Roqueta, Estevan, & Cummins, 2011), figurative language comprehension (Norbury, 2005) and the use of language context to resolve ambiguities (Brock et al., 2008). Furthermore, distinguishing children with language disorders from those with SPCD on these sorts of pragmatic tasks has met with little success, typically because of the poor performance of children with language impairment. At a group level, differences have been reported in the severity of expressive language disorder (with SPCD experiencing less severe impairments) and in the severity of peer social difficulty (Gibson et al., 2013). However, this is not always the case and the distinction between the two remains one of degree (Norbury et al., 2004).

The clearest evidence for a distinction between language disorder and SPCD comes from detailed analyses of conversational adequacy (Adams & Bishop, 1989; Bishop & Adams, 1989; Bishop, Chan, Adams, Hartley, & Weir, 2000). In these studies, children with SPCD were more likely than language-impaired peers to violate turn-taking expectations, provide no response or pragmatically inappropriate responses to conversational overtures, and made little use of nonverbal communicative devices. Such studies emphasize the importance of measuring social communication in naturalistic conversational exchanges (Adams & Lloyd, 2005). However, the strength of group difference rests with the diagnostic profiles of the children with SPCD. Clearly, DSM-5 criteria were not employed in these studies and it is possible that the more severely impaired children may have met DSM-5 criteria for ASD (Bishop, Whitehouse, Watt, & Line, 2008). Given that the new diagnostic criteria focus so heavily on dyadic conversational exchanges, developing an appropriate analysis measure and honing in on aspects of conversation that yield stable, qualitative differences is an important priority for future research.

SPCD is a feature of other neurodevelopmental disorders

A number of studies have highlighted social and pragmatic deficits in diverse clinical populations, including ADHD (Bishop & Baird, 2001; Cohen et al., 1998; Geurts et al., 2004; Leonard, Milich, & Lorch, 2011); William’s syndrome (John, Rowe, & Mervis, 2009; Laws & Bishop, 2004; Philofsky, Fidler, & Hepburn, 2007), conduct disorder (Donno, Parker, Gilmour, & Skuse, 2010; Gilmour et al., 2004; Oliver, Barker, Mandy, Skuse, & Maughan, 2011), closed head injury (Dennis & Barnes, 2001) and spina bifida/hydrocephalus (Holck, Nettelbladt, & Sandberg, 2009). Where comparisons have been made between ASD and other clinical populations, children with ASD (meeting criteria in both social communication and RRIB domains) have demonstrably more severe social communication and pragmatic language deficits than other clinical groups (ADHD, Geurts et al., 2004; Williams syndrome, Philofsky et al., 2007).

There is intense research and clinical interest in using the CCC/CCC-2 to identify qualitatively different social communicative profiles that align with specific clinical diagnoses, with varying success. For example, Bishop and Baird (2001) reported that the CCC identified pragmatic deficits in children with pervasive developmental disorders, primary pragmatic language impairments and children with ADHD, but that there were no significant differences amongst the clinical groups in pragmatic profile. On the other hand, Geurts et al. (2004) reported that children with ADHD had more severe deficits on items tapping initiation relative to peers with ASD, while those with ASD had more impaired scores on scales tapping structural language and RRIB. Philofsky et al. (2007) reported that children with William’s syndrome had significantly better scores on CCC scales tapping coherence, stereotyped language, nonverbal communication and social relations relative to peers with ASD. However, it is important to bear in mind that most of the differences between clinical groups are a matter of degree and are reported at a group level. There remains much work to be carried out on the sensitivity and specificity of particular pragmatic profiles for differential diagnosis. In addition, clinical groups often differ with regard to structural language, social understanding, cognitive ability and the presence of other developmental concerns such as attention deficits, executive dysfunction and behavioural difficulties, all of which are strongly associated with social and pragmatic deficits (Ketelaars et al., 2009; Mackie & Law, 2010). Individual differences in social communication and pragmatic language are therefore likely to reflect a confluence of risk factors in each of these developmental areas. How these factors interact over time to affect social interaction and contextual processing is an empirical question. It is therefore unlikely that there is a syndrome-specific social pragmatic profile. Instead, there will be individual variation associated with the particular constellation of risk factors that the child experiences. One may hypothesize that ASD represents the extreme end of the distribution in which multiple risk factors are present, creating the least favourable conditions for pragmatic language and social communication to develop.

Clinical and educational implications: treatment

One advantage of creating a new diagnostic category is that it should indicate a specific course of treatment or educational support. If we identify SPCD as a clinical disorder, treatment is likely to be aimed at improving social communication outcomes, to foster improvements in social relationships and to prevent negative consequences such as disruptive behaviour and social withdrawal. There is a paucity of good quality intervention research, in part hampered by inconsistencies in diagnostic labels, lack of agreement concerning diagnostic criteria and valid instruments for measuring change (Gerber, Brice, Capone, Fujiki, & Timler, 2012). Adams et al. (2012) reported the first randomized controlled trial of a social communication intervention aimed specifically at children with SPCD. The Social Communication Intervention Project (http://www.psych-sci.manchester.ac.uk/scip/) is an individualized intervention approach that targets development in three areas: social understanding and social interaction; verbal and nonverbal pragmatic skills, including conversation; and language processing, including narrative, inferencing, and developing word knowledge. In the trial, 88 children with SPCD were randomly assigned to the intervention or treatment as usual. After 20 sessions of intensive intervention by a highly specialist speech-language therapist, significant treatment effects were reported for ratings of conversational competence (blind ratings), parent ratings of pragmatic skill and social communication (not blind) and teacher ratings of classroom learning (not blind). No significant treatment effects were seen for the primary outcome measure (the Clinical Evaluation of Language Fundamentals -4UK, Semel, Wiig, & Secord, 2003) or a test of narrative expression.

The study is very promising in demonstrating that observable differences in social communication behaviour can be achieved after a period of intensive intervention. However, there are clearly many challenges to overcome. Study participants were extremely heterogeneous, varying from the 3rd to the 95th percentile on all measures of structural language, nonverbal reasoning, and ASD symptomatology. Such extreme within-group differences make it difficult to discern treatment effects. In addition, the outcome measure bore little relationship with the treatment content or treatment aims. Treatment most commonly aims to optimize language and communicative function rather than ‘cure’ disorder. In that regard, it is unlikely that diagnostic instruments themselves are sensitive enough to show change. However, the need for standardized assessment of social communicative function is great and a top priority for future research. Given the complexities of social communication and pragmatic language, it is also perhaps unrealistic to think that we can expect significant change in a relatively brief period of intervention. It is likely that these children will require on-going support as they get older and the complexity of social communication and language context increases in the expectation for more intimate social relationships, and for using language for learning and employment.

Summary and future directions

At present, there is too little research evidence to fully support a new diagnostic category, or to help identify aspects of social communication that distinguish SPCD from other developmental conditions. Social communication disorders and pragmatic language impairments constitute a broad range of phenomena that are likely to be continuous in nature and influenced by a number of developmental achievements. Social communication and pragmatic language skills are not necessarily one and the same; if pragmatics is taken to be the understanding and use of language in context, many children will succeed at pragmatic language tasks such as inferencing and ambiguity resolution and yet be challenged by the nuances of successful social communication.

To establish the validity of SPCD as a diagnostic entity, clinical research must (1) describe a coherent clinical phenomenon; (2) develop culturally and ecologically valid assessment tools with adequate levels of interrater and test–retest reliability to improve consistency of diagnosis; (3) explicitly compare pragmatic profiles across different neurodevelopmental disorders; (4) chart the developmental trajectories of children with SPCD and monitor the stability of diagnosis over time; and (5) conduct family studies to begin to unravel the aetiology of this disorder and its relation with other neurodevelopmental conditions (cf. Robins & Guze, 1970). In addition, intervention studies are urgently needed as they will offer a means to test theories regarding the putative causes and consequences of social (pragmatic) communication disorders.

Clinical implications

Differential diagnosis of SPCD will be challenging, but the focus on social communication and pragmatic language abilities should be welcomed. Many children presenting for psychological or psychiatric assessment will have some degree of pragmatic language or social communication deficit (Cohen, Farnia, & Im-Bolter, 2013; Cohen et al., 1998) that will require specialist treatment and support. It would therefore seem prudent to obtain parental report of communication skills in everyday contexts, for example using the CCC-2 (Bishop, 2003a, 2003b). Such a measure can inform hypotheses and assessment plans; where there is evidence of a significant social pragmatic deficit, evaluation for ASD will also be essential. On the CCC-2, an index score of zero indicates that both structural and pragmatic language impairments may be evident; thus, an evaluation by a speech-language therapist for language disorder will be necessary. Although standardized measures for exploring pragmatic aspects of language exist, these may not reflect the individual’s ability to apply these skills in less formal settings. Observations of naturalistic interaction, in school or at home, may be most informative. Finally, intervention is likely to be multifaceted, incorporating techniques for improving social understanding and social interaction, structural aspects of language (e.g., vocabulary) and using linguistic context to improve comprehension. Thus, intervention should be centred on the profile of strength and need that emerges from the assessment process, rather than the diagnostic label obtained.

Acknowledgement

The open access fee for this article has been funded by the Economic and Social Research Council (ESRC). This review article was invited by the Editors of JCPP, for which the author has been offered a small honorarium towards personal expenses. The author has declared that she has no competing or potential conflicts of interest.

Neurotypical Psychology / This is what they want

Should any Asperger wish to “neurobastardize” his or her life, this is all there is to it!

 For Aspies everywhere: this is what neurotypicals want us to do:

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10 Psychology Tricks You Can Use To Influence People

February 3, 2013 on LISTVERSE

Gregory Myers:

Before we get started, it’s important to note that none of these methods fall under what we would term the dark arts of influencing people. Anything that might be harmful to someone in any way, especially to their self esteem, is not included here. These are ways to win friends and influence people using psychology without being a jerk or making someone feel bad. (Apparently, intentionally making fools of the people you encounter is not harmful – this crass lie about the “ethical” status of what follows is so neurotypical!)

10. Trick: Get someone to do a favor for you—also known as the Benjamin Franklin effect.

Legend has it that Benjamin Franklin once wanted to win over a man who didn’t like him. He asked the man to lend him a rare book and when the book was received he thanked him graciously. As a result, the man who had never wanted to speak to him before, became good friends with Franklin. To quote Franklin: “He that has once done you a kindness will be more ready to do you another than he whom you yourself have obliged.”

Scientists (the use of this word is offensive and incorrect, meant to deceive the reader into believing that actual people who “do science” have any responsibility for the idiotic ideas contained in this text. It’s a lie; and it is extremely harmful.) I decided to test this theory (stop using this term incorrectly!) and found that those who were asked by the researcher for a personal favor rated the researcher much more favorably than the other groups did. It may seem counter-intuitive, but the theory is pretty sound. If someone does a favor for you, they are likely to rationalize that you must have been worth doing the favor for, and decide that therefore they must like you. Put these and hundreds of other tricks to nefarious use with the help of Mastering Conversational Hypnosis: Psychology Tricks to Influence People Easily and Get Exactly What You Want. (So much for the claim that these “tricks” are not harmful)

9. Trick: Ask for way more than you want at first then scale it back later.

This trick is sometimes known as the “door in the face” approach. You start by throwing a really ridiculous request at someone—a request they will most likely reject. You then come back shortly thereafter and ask for something much less ridiculous—the thing you actually wanted in the first place. This trick may also sound counter-intuitive, but the idea behind it is that the person will feel bad for refusing your first request even though it was unreasonable, so when you ask for something reasonable they will feel obliged to help out this time. (Making someone feel badly is not harmful.)

Scientists (stop using this term incorrectly) tested this principle and found that it worked extremely well as long as the same person asked for both the bigger and smaller favor, because the person feels obliged to help you the second time and not anyone else.

8. Trick: Use a person’s name, or their title depending on the situation.

Dale Carnegie, the author of How to Win Friends and Influence People, believed that using someone’s name was incredibly important. He said that a person’s name is the sweetest sound in any language for that person. A name is the core part of our identity, and so hearing it validates our existence, which makes us much more inclined to feel positively about the person who validated us. (Humans are like dogs who learn that the sound of their “name” means a cookie reward is coming? How CREEPY!)

But using a title, or form of address can also have strong effects, according to the as if principle. The idea is that if you act like a certain type of person, you will become that person, it’s a bit like a self fulfilling prophecy. (It’s “magical thinking” – words create supernatural reality that eradicates physical reality) To use this to influence others, you can refer to them as what you want them to be, so they will start thinking of themselves this way. This can be as simple as calling an acquaintance you want to be closer to “friend,” or “mate” whenever you see them, or referring to someone you want to work for as “boss.” But be warned: this can come off as very corny. (Really? And creepy, manipulative, and a control freak-sociopath, but then, the sociopath IS the ultimate social human.)

7. Trick: Flattery will actually get you everywhere.

This one may seem obvious at first, but there are some important caveats to it. For starters it’s important to note that if the flattery is not seen as sincere, it’s going to do more harm than good. But researchers have studied the motivations behind peoples reaction’s to flattery, and found some very important things. To put it simply, they found that people tend to look for cognitive balance, trying to always keep their thoughts and feelings organized in a similar way. (And Asperger’s are accused of being inflexible!) So if you flatter someone who has high self esteem, and it is seen as sincere, they will like you more, as you are validating how they feel about themselves. However, if you flatter someone who has low self esteem, there is a chance it could backfire and cause them to like you less, because it interferes with how they perceive themselves. That, of course, does not mean you should demean a person of low self-esteem! (The assumption is that you WILL demean a person having low self-esteem: it’s a great tool for boosting your social status.)

6. Trick: Mirror their behavior.

Mirroring is also known as mimicry, and is something that some people do naturally. (Treatment for Asperger people includes this superficial attempt at making us “invisible” so that we don’t upset social people.) People with this skill are considered to be chameleons; they try to blend into their environment by copying other people’s behaviors, mannerisms and even speech patterns. However, this skill can also be used consciously, and is a great way to make you more likable.

Researchers (stop using this tern incorrectly!) studied mimicry, and found that those who had been mimicked were much more likely to act favorably toward the person who had copied them. Even more interesting was their second find that those who had someone mimic their behavior were actually nicer and more agreeable to others in general—even those not involved in the situation. It is likely that the reason why this works is that mirroring someone’s behavior makes them feel validated. (People who need constant validation from OTHER PEOPLE have very low self-esteem – the perfect behavior for low-rank on the social pyramid) While this validation is likely to be most positively associated with the person who validated them, they will feel greater self-esteem and thus be more confident, happier and well disposed towards others.

It-is-funny

5. Trick: Ask for favors when someone is tired.

When someone is tired they are more susceptible to everything someone may say, whether it is a statement or a request. The reason for this is that when people are tired it isn’t just their physical body, their mental energy levels drop as well. (Mental energy IS physical energy. The brain runs on glucose, not magical power. When you ask a request of someone who is tired, you probably won’t get a definite response, but probably an “I’ll do it tomorrow,” because they don’t want to deal with decisions at the moment. The next day, they are likely to follow through because people tend to keep their word; it’s natural psychologically to want to follow through with something you said you would do.

4. Trick: Start with a request they can’t refuse and work your way up.

This is a reverse of the “door in the face” technique. Instead of starting with a large request, you start with something really small. Once someone has committed to helping you, or agreeing to something, they are now more likely to agree to a bigger request. Scientists tested this phenomenon in regards to marketing. (Stop using this term incorrectly!)

They started by getting people to express support for the rain forests and the environment—which is a fairly simple request. Then they found that once they had gotten them to express their agreement to supporting the environment, they were much easier to convince when it came to buying products that supported rain forests and other such things. (Like products that actually destroy the environment – NTs fall for it every time) However, don’t start with one request and immediately assail them with another. Psychologists found it much more effective if you wait a day or two to make the second request.

3. Trick: Don’t correct people when they are wrong.

Carnegie also pointed out in his famous book that telling someone they are wrong is usually unnecessary and does the opposite of endearing them to you. There is actually a way to show disagreement and turn it into a polite conversation without telling someone they are wrong, which strikes to the core of their ego. This is called the Ransberger Pivot, invented by Ray Ransberger and Marshall Fritz. The idea behind it is pretty simple: instead of arguing, listen to what they have to say, and then seek to understand how they feel and why. Then you explain the common ground that you share with them, and use that as a starting point to explain your position. This makes them much more likely to listen to what you have to say, and allows you to correct them without them losing face. (Oh sure! We see this “enlightened conversion” all the time – NTs change their opinions when introduced to facts, especially when presented as reasonable explanations. Try this on religious people – or any NT! ) 

2. Trick: Paraphrase people and repeat back to them what they just said.

One of the most positive ways to influence others is to show them that you really understand how they feel, that you have real empathy for them. (A sociopath does this very effectively – it’s a con job) One of the most effective ways to do this is by paraphrasing what they say and repeating it back to them, also known as reflective listening. Studies have shown that when therapists used reflective listening, people were likely to disclose more emotion and have a much better therapeutic relationship with the therapist. (Go ahead and PRETEND to have empathy; it’s what psychologists do with their clients.)

This easily transfers over to talking to your friends. If you listen to what they say, and rephrase it as a question to confirm that you understood it, they are going to be more comfortable talking with you. They are also going to have a better friendship with you and be more likely to listen to what you have to say, because you showed that you care about them. (OMG!)

1. Trick: Nod a lot while you talk, especially when leading up to asking for a favor.

Scientists (just stop!) have found that when people nod while listening to something, they are more likely to be in agreement with it. They also have discovered that when someone is nodding a lot in front of them, it is natural for them to do the same. This is understandable because humans are well known at mimicking behaviors, especially those that they consider to have positive connotations. So if you want to be extra convincing, nod regularly throughout the conversation. The person you are talking to will find it hard not to nod themselves, and they will start to feel agreeable toward what you are saying, without even knowing it. (Yes! Be a sociopath and you’ll get what you want. Not harmful at all.)

 

“Bleach” Cure / Abuse of Autistic Children

Parents Give Autistic Children Bleach Enemas (Chlorine Dioxide)

A product sold on the internet claims to cure autism: called Miracle Mineral Solution (MMS) it sounds like any other quack remedy, but MMS can harm living things in serious ways. That’s because it’s a solution of 28 percent sodium chlorite which, when mixed with citric acid as instructed, forms chlorine dioxide (ClO2), a potent form of bleach used in the paper and fabric industries; a dangerous chemical concoction, and yet some parents are giving this to their children, both orally and through enemas, in the belief that it will cure their child of autism.

What is the FDA doing to protect children from toxic chemicals and criminal abuse?

The FDA is aware of this abuse: in 2010 it issued a warning that the product turns into “a potent bleach” that “can cause nausea, vomiting, diarrhea, and symptoms of severe dehydration” if ingested. There are has been one possible death and children were taken from a home in Arkansas because the parents were suspected of using the solution on them, but a number of people are convinced that MMS will provide cures. The underlying belief is that it will clear the body of parasites known as “rope worms” and other pathogens that they believe cause autism: this is dangerous quackery.

Funny how religious people are behind so much child abuse.

If this belief sounds religious in nature, it is. MMS was “discovered” by Jim Humble, a former Scientologist who started Genesis II ( a new religion) for which he is the Archbishop. The church is a marketing tool for “the cure” but the church site doesn’t sell MMS directly. It offers supplementary materials like a $199 “MMS HOME VIDEO COURSE” and information on expensive MMS seminars.

A woman named Kerri Rivera is a bishop in Humble’s church; she has authored a book titled Healing the Symptoms Known as Autism, which recommends “hourly doses” of chlorine dioxide and enemas to kill pathogens in the brain.”

If you fed your child rat poison or antifreeze you’d be prosecuted for attempted murder. Hell, if you tried this “cure” on your dog, you’d be arrested for animal cruelty.

Why aren’t the “bleach cure” propagandists and parents charged with crimes against children? Why? Because Americans still hold to the religious notion that children are the property of their parents and have no right to protection from violent and “insane” adults. 

 

UPDATE: https://www.consumeraffairs.com

Consumer affairs posts articles on dangerous and fraudulent products, lists recall notices, and divulges scams!

“Miracle Mineral Solution” promoter convicted of selling bleach as a miracle cure

Seven-day federal trial ends in conviction for Louis Daniel Smith

05/29/2015 | ConsumerAffairs |  Scams

 

Western Desire to Control the World / Oswald Spengler

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Excerpts from: Oswald Spengler, Decline of the West, 1914

“Western mankind, without exception, is under the influence of an immense optical illusion.”

Aspergers: pay attention! Spengler got it right.

Everyone demands something of the rest. We say “you will do it” in the conviction that the person in fact will, can, and must be changed or fashioned or arranged conformably to the social order, and our belief both in the efficacy of, and in our entitlement to give such orders, is un-shakable. That, and nothing short of it, for us, morality. In the ethics of the West everything is direction, claim to power, will to affect the distant. The beginning of morality is a claim to general and permanent validity. It is a necessity of the Faustian (Western) soul that this should be so. He who thinks or teaches “otherwise” is sinful, a backslider, a foe, and he is fought down without mercy.

You “shall,” the state “shall,” society “shall” – this form of morality is to us self-evident; it represents the only real meaning that we can attach to the word. But it was not so either in the Classical world or in India, or China. Buddha, for instance, gives a pattern one may take or leave; Epicurus offered counsel. Both undeniably are forms of high morality, and neither contains the will-element. The West is concerned exclusively with the conscious, religio-philosophical morality that can be taught and followed, and not with the unconscious rhythm of life and habit. The morality with which we are dealing turns upon intellectual concepts of virtue and vice, good and bad.

What we have entirely failed to observe is the peculiarity of moral dynamic. If we allow that Socialism in the ethical sense (not the economic) is that world-feeling which seeks to carry out its own views on behalf of all, then we are all (westerners) without exception, willingly or not, wittingly or not, socialists. Even Nietzsche, that most passionate opponent of “herd morale,” was perfectly incapable of limiting his zeal to himself in the Classical way. He thought only of “mankind,” and he attacked everyone who differed from himself.

Epicurus, on the contrary, was heartily indifferent to both other’s opinions and acts, and never wasted one thought on the “transformation” of mankind. He and his friends were content that they were as they were and not otherwise. The ideal Classical behavior was indifference to the course of the world, which is the very thing that the The West desires to control.  

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An important element both of Stoic and of Epicurean philosophy was the recognition of a category of things neither preferred nor rejected. (The scientific “zero point” that modern psychology refuses to accept; it’s the Asperger default reaction.) In Ancient Greece there was a pantheon of moralities just as there was a pantheon of deities, as the peaceful coexistence of Epicureans, Cynics and Stoics shows, but the Nietzschean Zara-thustra, although professedly standing beyond good and evil, breathes from end to end the pain of seeing men to be other than as he would have them be, and the deep and utterly un-Classical desire to devote a life to their reformation. It is just this that makes ethical monotheism, in a deep sense, socialism. All world-improvers are Socialists. Consequently there were no Classical world-improvers.

“The moral imperative to reform humanity is the sole form of Western morality and it is solely Western.”