Think about the last time you had a conversation. While this back-and-forth dialogue may have felt natural, there are actually many “social rules” that happen during a successful exchange. You wait patiently for your turn to speak, make eye contact, stay on topic, respond when asked a question, use non-verbal language like pointing and gestures, and so on.
For children with a social communication disorder, using verbal and nonverbal language for social purposes can be a struggle. This can make holding a conversation difficult, and affect how they form social bonds and have healthy social relationships.
While social communication disorders often happen early in a child’s development, the signs are not always obvious. However, they can quickly become more apparent as a child gets older and is placed in a variety of more complex social environments, like playing with peers on a playground or at school. This can cause concern and stress for parents, and lead to many questions around whether their child is simply going through “a phase,” or has a more serious disorder that requires treatment.
When it comes to social communication, educating yourself is the best way to make informed treatment decisions. For that reason, we’ve put together this informational guide to answer common questions about social communication disorders, identify signs and symptoms, explain how a social communication disorder is typically evaluated, diagnosed, and treated, and more.
Let’s start with what a social communication disorder is not.
Individuals that struggle with social communication do not have a problem with their speech, such as pronouncing sounds and words, or constructing sentences. They also do not have difficulty understanding language, like the meaning of individual words, grammar, or developing a vocabulary. People with a social communication disorder are not any less intelligent than their peers.
Instead, children and adults with a social communication disorder (which you may sometimes hear referred to as pragmatic language impairment) struggle to use communication appropriately in social situations. It is primarily characterized by a difficulty with pragmatic language, which is how meaning is interpreted in verbal and non-verbal interactions.
This can make it challenging to follow the social “rules” of a spoken conversation. For example, they may not use greetings; fail to comprehend the natural give-and-take of an exchange and instead monopolize conversations; routinely interrupt the speaker; fail to change the style of their speech to match different social contexts (i.e. a formal for casual setting), etc.
While social communication disorders share some characteristics of autism spectrum disorder (ASD), there are important distinctions.
Both disorders involve difficulties with social communication skills. However, individuals with ASD also have a host of other symptoms that impact social interactions, such as limited interests and/or repetitive or compulsive behaviors.
For example, children and adults with ASD may become upset with interruptions to their daily routines, become hyper-focused on a specific topic while being disinterested in others, exhibit repetitive behaviors like lining toys up or tapping, or being extremely sensitive to certain sounds and textures.
Social communication is a component of ASD. Therefore, these two disorders will never be diagnosed together. In other words, children with social communication disorder only have challenges related to their social skills.
There is limited data available on the prevalence of social communication disorders. This is because social communication disorder was only recently made an official diagnosis in 2013 with specific definitions and diagnostic criteria. Prior to 2013, it was often referred to as a pragmatic language impairment.
One population study in 2009 that sampled 1,400 kindergarteners suggested that pragmatic language impairment occurred in 7-8% of children. Boys were also more likely than girls to be diagnosed.
According to the American Speech-Language-Hearing Association (ASHA), below are some common social communication milestones your child should be exhibiting depending on their age. It’s important to note that there are cultural and linguistic factors that can impact the relevance of these benchmarks.
As mentioned above, social communication skills will vary by age and expected stage of development. However, there are some key themes that parents and caregivers should closely monitor to gauge whether their child is on track. These include:
As of today, there is no definite cause of social communication disorders.
However, studies have shown that a child may be at a higher risk for a social communication disorder if there is a family history of autism spectrum disorder, learning disabilities, or some other types of communication disorders. Research is ongoing to better understand this genetic link and how it is inherited.
Additionally, social communication disorders often present alongside other types of disorders, such as delayed speech, ADHD, or an intellectual development disorder.
The initial signs of a social communication disorder can show up early in a child’s development. For example, young kids may have delays in reaching age-appropriate milestones for social communication, not use sounds or gestures for greetings, have little interest in interacting socially, etc.
However, to diagnose a social communication disorder, children must be relatively high functioning and have started to use spoken language. For these reasons, diagnosis often happens around 4 or 5 years of age when a child is verbal.
Evaluation and diagnosis is performed by a speech-language pathologist (SLP). These communication professionals will use a variety of diagnostic tools and tests to determine if a diagnosis of social communication disorder is appropriate. During an evaluation, a speech therapist may:
During the evaluation, your speech therapist will work to “rule out” other medical or neurological conditions, such as autism spectrum disorder or other intellectual development disorders.
Speech-language therapy is the main treatment for social communication disorders. Because every child is different, your speech therapist will build a personalized care plan tailored to their social communication strengths and weaknesses. They’ll use a variety of treatment methods to improve functional communication within a variety of social settings.
Some common examples include:
The keys skills focused on during therapy include social pragmatics (helping children use appropriate greetings and understand the rules of dialogue); conversational skills (practicing back-and-forth exchanges and asking/answering questions), and non-verbal communication (interpreting non-verbal cues to assess someone’s mood or feelings, such as boredom or discomfort).
It’s essential that parents and caregivers play an active role in reinforcing social communication skills at home. After all, no one spends more time with your child than you. Even if you’re working with a speech therapist once or more a week, your child will make considerably more progress if you’re practicing and incorporating these skills in daily interactions with your child.
Along these same lines, your speech therapist should be a coach to you as much as they are a teacher to your child. They should be helping you understand not just “what” your child is working on, but “why” it’s important, and providing weekly educational tips and techniques that you can integrate at home.
Below are several suggestions that can be adopted to your child’s age to help them use language appropriately in social situations. If you’re working with a speech therapist, make sure to ask them for additional suggestions.
Expressable matches families with a certified speech therapist trained to effectively evaluate and treat social communication disorders. All therapy is delivered online via face-to-face video conferencing.
Your child’s age and development will influence how your speech therapist interacts with them through these video chat capabilities.
Ages 0-3: Parents work directly with their speech therapist to learn cues and at-home strategies so they can confidently practice with their child outside the session and improve their social communication.
Ages 3-6: Parents attend video sessions alongside their child so they both learn valuable skills from their speech therapist. Reinforcing these lessons outside the session will continue to promote at-home skill building.
Ages 7 and Up: Most children attend video sessions independently but parents are kept in the loop with updates and tips during each session.
Adults: Adults attend sessions by themselves, but are welcome to bring loved ones or family members as well.
Expressable is an online speech therapy practice committed to expanding access to quality services for everyone with a communication disorder. Expressable has pioneered a parent-focused care model that uses technology and education to integrate speech therapy techniques into children’s daily lives, improving outcomes and experiences.