Social Communication Disorder

What is a Social Communication Disorder?

Children and adults with a social communication disorder find it difficult to communicate effectively in social situations. It’s characterized by a problem with pragmatic language (another word for social communication), which refers to how meaning is interpreted in verbal and non-verbal interactions. 

This makes it difficult to follow social rules of conversation like greeting people when they enter the house, taking turns correctly during conversation, monopolizing conversations, interrupting speakers, not using formal/casual language appropriately and more. 

People who have social communication difficulties do not necessarily have any issues with speech (sounds in words) or language (comprehension or words, ability to put together sentences, grammar etc), and they have no differences in intelligence in comparison to others. 

Is Social Communication Disorder Different From Autism Spectrum Disorder?

Social communication disorders may be a part of the diagnosis for those with  autism spectrum disorder (ASD), but there are notable differences:

• Autism Characteristics: Difficulties with social communication. Limited interests and/or repetitive or compulsive behaviors. Examples include, being very focused on a specific topic with no interest in others, repetitive behaviors like lining toys up or tapping. Very sensitive to certain conditions like sounds and textures. Rigidity and difficulty transitioning to new tasks. 
• Social Communication Disorder Characteristics: Difficulties with social communication.

Are Social Communication Disorders Common?

Social communication disorder became an official diagnosis in 2013 with specific definitions and diagnostic criteria. Prior to 2013, it was called pragmatic language impairment. Therefore, it is difficult to get accurate data as to its prevalence. 

A population study from 2009 suggested that pragmatic language impairment occurred in 7-8% of children. Boys were also more likely than girls to be diagnosed.

What Are Social Communication Milestones? 

The American Speech-Language-Hearing Association (ASHA) reports some common social communication milestones for children by age. There are many factors that impact these including cultural differences. 

0-12 Months 

• Preference for human faces, makes eye contact, follows caregiver’s gaze, listens to caregiver’s voice
• Can discern between tones of voice (i.e. happy, angry)
• Takes turns vocalizing
• Focuses their attention on the same person or object as caregiver (joint attention)
• Uses simple gestures to requests (e.g., to be picked up)
• Engages in simple games like peek-a-boo

12-18 Months

• Requests by pointing or vocalizing
• Says words like “hi” and “bye”
• Starts to replace gestures with verbal language
• Makes eye contact to respond to speech
• Shows emotions like sympathy or empathy
• Changes the pitch, volume, or tone of their voice depending on the situation

18-24 Months

• Makes a request, indicate possession, express a problem, or gain attention using short phrases
• Begins to use different pronouns (I, me, you, my)
• Stays on topic when communicating
• Takes turns when speaking

24-36 Months

• Engages in short conversations
• Introduces topics and shifts topics
• Adds their own experience to a topic of conversation
• Requests clarification when they don’t understand

3-4 Years

• Can have a longer conversation and stop a conversation
• Uses words like “yeah” or “okay” to acknowledge a speaker
• Uses imaginative language like talking about a fantasy, telling something funny, teasing
• Tells a simple story from beginning to end
• Uses simple language to talk to a younger person

4-5 Years

• Uses words like: this, that, here, there
• Talks about their emotions and feelings
• Tells stories that have a sequence of events (may not be a theme or have a central character)
• Can shift topics of conversation

School-Age

• Can read body language, facial expressions to predict someone’s feelings or behaviors
• Shows empathy with another person’s perspective and changes their language appropriately (e.g., like comforting a sad person)
• Conversational skills improve like staying on topic or increasing the number of back-and-forths during an exchange
• Uses more complex language (persuasion, telling their opinions)

Symptoms of a Social Communication Disorder

Social communication skills differ by age and developmental stage. Yet there are some overarching aspects of social communication that are shared. When these are missing, there may be an issue with social communication:

• Using Social Language: Using greetings (“hi,” “bye”), smiling at others, maintaining appropriate eye contact (not too long/short), pointing to draw someone’s attention to something, initiating a conversation, responding to a question
• Changing Communication Styles Depending on Setting/Situation: Speaking differently to children and adults, understanding the conventions of formal vs. casual situations, such as a classroom or a birthday party
• Adhering to Social Rules: Not interrupting, staying on a topic of conversation, engaging in normal back-and-forth of a conversation
• Understanding Verbal and Non-verbal Cues: Understanding non-verbal cues such as when a person’s eyes wander they may be bored
• Understanding Figurative Language: Can understand the meaning of a message when it is not explicitly stated (making inferences); picking up on sarcasm, understanding jokes

What Causes Social Communication Disorder?

While there is no specific cause of social communication disorder there are studies that have shown that a family history of autism spectrum disorder, learning disabilities and other disorders increase the risk of this diagnosis. 

Some researchers also think that there may be a genetic component. So it might run in families with a history of social or pragmatic language difficulties.

Lastly, social communication disorder may coexist with other disorders like ADHD. Importantly, social communication disorder is not caused by ASD, ADHD, or any other neurological condition.

How Can Speech Therapists Diagnose Social Communication Disorder?

Diagnosis of social communication can only occur around age 4 or 5 when a child is talking and communicating with others. The speech therapist might use the following combination of diagnostic tools to determine if there are any deficiencies in social communication:

• Interviews (with client, parent, caregivers)
• Questionnaires about medical, behavioral history
• Observations of the child/client in various situations
• Standardized evaluations to measure language skills 

It is important for the speech therapist to rule out medical or neurological conditions like ASD or intellectual disorders so an evaluation might be more comprehensive than only testing social communication.

Can Speech Therapy Help Social Communication Disorder?

Yes. Treatment for social communication disorder is speech-language therapy. Since each child is unique, a speech therapist will create a customized treatment plan based on their strengths and deficits in social communication. To increase effective communication in a number of social situations, the SLP will utilize a variety of therapy strategies such as: 

• Videos: Watching other people talking can be used to model proper social behaviors
• Role Playing: Engaging in role playing activities that focus on different topics, conversational partners, and social settings allows the child to practice
• Practice Scripts: Using and practicing with responses that are scripted can help children practice conversation norms
• Explicit Instruction: The SLP can provide explicit explanations around figurative language to help the child understand how to interpret this type of language when it comes their way

What Can Parents Do at Home?

Parents are very important in helping their children work on their social skills. They spend more time with their child than the speech therapist ever could. During speech therapy sessions, the SLP should provide ideas and can coach parents as to how to teach their child how to improve their social communication skills. 

The speech therapists at Therapy Works Together have listed some ideas for what parents can do at home to help their child increase appropriate social communication: 

• Work on Saying Hi: Practice greetings like saying “hello” and “goodbye,” waving, and extending your hand for a handshake. Prompt the child to watch you as you say “hello” to someone.
• Call Attention to Non-Verbal Communication in Books: If there is a character that looks sad, happy or bored, call attention to how you know. What in the character’s facial expressions or body language tell you this? Talk about this explicitly. 
• Taking Turns While Playing: Engage in turn taking play activities like rolling a ball back and forth, stacking blocks or playing a board game. Explicitly talk about the fact that you are taking turns just like you would in conversation. 
• Pretend Play with Dolls: Discuss what is appropriate to say and not say by using a doll. Talk out loud about what the doll might be feeling if your child says something not appropriate. 

How Can Therapy Works Together Evaluate and Treat All Ages Online?

Therapy Works  Together helps families connect online with a licensed and certified speech therapist that is a trained expert in diagnosing and treating a variety of speech, language and communication issues. Speech therapy is delivered online at home with video conferencing applications.

The age of our clients as well as their diagnosis and goals is important in determining how speech therapy online will be delivered. 

Speech therapy for babies and toddlers: For kids aged 0-3, we usually work on early communication skills like joint attention, social communication, or increasing language skills in late talking toddlers.  

Parents work with their assigned speech language pathologist, usually in a parent coaching model, to learn tips and strategies that speech therapists use so they can be adept at practicing teaching their child after the session is over and at home. You can read more here about how important it is for parents to be involved in their child’s speech therapy at home.

Speech therapy for preschoolers: For kids age 3-6, speech therapists target age appropriate articulation, language delays, reading readiness and more. Parents join in for online video sessions with the child so that both learn the speech strategies and skills from the speech therapist. Learning how to use these skills after the session helps kids improve. 

Speech therapy for school age kids: for children age 7 and up, speech therapists might work on academic skills, increasing vocabulary, social skills for kids with autism, stuttering and more. Children this age can come to online video sessions on their own. Our speech therapists keep parents informed by sharing tips and homework. 

Speech therapy for adults: Adults attend speech therapy sessions online after becoming stroke patients, for stuttering, for accent modification and more. They come to sessions on their own from the comfort of their home or office. Often, they bring a caregiver or family members to learn strategies if they will need help communicating with others.