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Social Communication Disorder

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.

What is a Social Communication Disorder?

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.

What is the Difference between Social Communication Disorder and Autism Spectrum Disorder?

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.

How common are social communication disorders?

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.

What social communication milestones are expected by age?

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.

0-12 months

  • Prefers looking at human faces, makes eye contact and follows your gaze, listens when you speak
  • Can tell the difference between tones of voice (i.e. happy, sad, angry)
  • Participates in vocal turn-taking
  • Demonstrates joint attention (your child focuses their attention on the same person or object as you)
  • Uses gestures to make simple requests, like asking for food
  • Can play simple games like peek-a-boo

12-18 months

  • Makes requests by pointing or vocalizing
  • Says ritual words, like “hi” and “bye”
  • Is beginning to replace gestures with verbal language
  • Responds to speech with eye contact
  • Can demonstrate emotions like sympathy or empathy
  • Uses inflection in their voice (i.e. changes the pitch, volume, or tone of their voice depending on the situation)

18-24 months

  • Begins to use single words or short phrases to make a request, indicate possession, express a problem, or gain attention
  • Starts using different pronouns, like I, me, you, my, and mine
  • Shows signs that they’re able to stay on topic when communicating
  • Participates in verbal turn-taking (i.e. you speak, then they speak)

24-36 months

  • Engages in short conversations
  • Introduces and changes topics when holding a dialogue
  • Relates the topic of conversation to their own experiences and provides details
  • Asks for clarification if they don’t understand something
  • Use polite terms with limited interruptions

3-4 years

  • Able to hold a longer conversation, as well as stop a conversation
  • Uses filler words, like “yeah” or “okay” to acknowledge the speaker
  • Has begun using more imaginative language, like describing a fantasy, telling a joke, playfully teasing, etc
  • Can tell a simple story or narrative from start to finish
  • Simplifies language when talking to a very young child

4-5 years

  • Uses deictic terms (i.e., this, that, here, there)
  • Uses twice as many utterances as when they were 3 years old to discuss their emotions and feelings
  • Tells stories that have a sequence of events but no central character or theme
  • Able to rapidly shift topics during a conversation

School-age

  • Can effectively read body language and facial expressions to predict someone’s feelings or behaviors
  • Can empathize with another person’s perspective and modify their language (i.e. being comforting when someone is sad)
  • Demonstrates improved conversational skills, like staying on topic or increasing the number of back-and-forths during an exchange
  • Uses more complex forms of language, such as persuasion or advancing their opinions

What are the symptoms of a social communication disorder?

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:

  • Using appropriate communication when socializing: Greeting others and smiling, maintaining eye contact, pointing to draw someone’s attention to an object; initiating or entering a conversation, responding when asked a question
  • Varying communication styles depending on setting and partner: Speaking differently to children and adults, understanding the conventions of formal vs. casual situations, such as a classroom or a birthday party
  • Following social rules: Not interrupting, engaging in the normal back-and-forth of a conversation, staying on topic
  • Understanding verbal vs. non-verbal cues: Interpreting signals of conversational partners (i.e. if someone’s eyes are wandering, they’re bored; if someone’s eyes are welling up, they’re sad).
  • Understanding ambiguous or figurative language: Ability to comprehend information when not explicitly stated (inferring); understanding sarcasm or figures of speech.

What Causes Social Communication Disorder?

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.

How is a Social Communication Disorder Diagnosed?

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:

  • Work to better understand your child’s medical and behavioral history
  • Perform an assortment of diagnostic tests
  • Interact and observe your child in a variety of situations
  • Use questionnaires that measure aspects of language proficiency

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.

How is a Social Communication Disorder Treated?

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:

  • Video instruction: Recordings of people engaging in conversation that provide a model of desired behaviors
  • Comic book conversations: Similarly, depicting conversations between two or more people in an illustrated form to reinforce behaviors
  • Role playing: Holding mock conversations that focus on different topics, conversational partners, and social settings
  • Scripted responses: Create scripted responses that can help children practice initiating or entering conversations

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).

How can parents help children improve their social communication?

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.

  • Greetings: Practice greeting before starting a conversation and ending a conversation. These can include saying “hi” and “bye,” waving, and extending your hand for a handshake.
  • Reading regularly: When reading with your child, ask open-ended questions to encourage discussion. Examples can include, “Why is the character sad?” or “What do you think will happen next?”
  • Talk about characters: Similarly, when reading a book or watching a movie, stop to ask how characters are feeling and why. Discuss what other people in your child’s life, like their friends or classmates, would feel in a similar situation.
  • Taking turns: Knowing when it’s your turn to speak, and taking turns, is an important part of having a productive conversation. Practice other turn taking activities with your child, like rolling a ball back and forth, repeating words, or playing a board game.
  • Role-play: Have your child pretend to have the same conversation with different people. For example, how would your child explain their favorite toy to a baby, or a teacher, or their grandparents? Discuss what’s appropriate to say and not say depending on each listener and situation.
  • Play dates: Have your child participate in a planned, structured activity while socializing with a friend. Start small, with only one friend, and over time add more kiddos to the mix.
  • Tell stories: Tell your child a story but leave out important details. See if your child can identify and ask you for more information to increase their understanding. Alternatively, have your child tell you a story. Ask questions throughout for more clarification.
  • Non-verbal cues: Offer your child a series of non-verbal cues, and have them tell you what they mean. For example, you could smile, frown, cross your arms, roll your eyes, look away, etc.

How can Expressable help assess and treat social communication disorders

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.

Talk with a certified therapist today.

Therapist on virtual session