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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, and stay on topic. You respond when asked a question, and you may use nonverbal language like pointing and gestures.

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 and maintain 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 other children on a playground or working in groups at school. This can cause concern and stress for parents, who may wonder if their child is simply going through “a phase” or has a disorder that needs 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, and explain how a social communication disorder is evaluated, diagnosed, and treated.

1What is a social communication disorder?

2What is the difference between social communication disorder and autism spectrum disorder?

3How common are social communication disorders?

4What social communication milestones are expected by age?

5What are the symptoms of a social communication disorder?

6What causes social communication disorder?

7How is a social communication disorder diagnosed?

8How is a social communication disorder treated?

9How can parents help children improve their social communication?

10How does Expressable assess and treat social communication disorders?

What is a social communication disorder?

Let’s start with what a social communication disorder is not.

People who struggle with social communication do not have a problem with their speech, such as pronouncing words or constructing sentences. They also do not have difficulty understanding language, like grammar or the meaning of words. 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. The main symptom is difficulty with pragmatic language, which is how meaning is interpreted in verbal and nonverbal interactions.

This can make it challenging to follow the social “rules” of a spoken conversation. For example, people with a social communication disorder may

  • Not use greetings

  • Not understand 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--for example, a formal situation versus a casual one

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, autistic people have other symptoms that impact social interactions, such as limited interests and/or repetitive or compulsive behaviors.

For example, children and adults with autism may become upset with interruptions to their daily routines. They may become hyper-focused on a specific topic while being uninterested in others. They may have repetitive behaviors like lining toys up or tapping, or be extremely sensitive to certain sounds and textures.

Social communication is a component of autism. 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. Before 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% to 8% of children. In another study, the preliminary estimates of social communication disorder in eighth graders ranged from 7% to 11%. Boys were 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 meeting depending on their age. It’s important to note that there are cultural and linguistic factors that can impact the relevance of these milestones.

Milestones for 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 (such as happy, sad, angry)

  • Participates in vocal turn-taking (you speak, then they make a sound)

  • 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

Milestones for 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 (for example, changes the pitch, volume, or tone of their voice depending on the situation)

Milestones for 18-24 months

  • Begins to use single words or short phrases to make a request, show 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 (you speak, then they speak)

Milestones for 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

Milestones for 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 their language when talking to a very young child

Milestones for 4-5 years

  • Uses deictic terms (such as "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

Milestones for school-age

  • Can read body language and facial expressions to predict someone’s feelings or behaviors

  • Can empathize with another person and change their language (example: being comforting when someone is sad)

  • Shows 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?

Social communication skills will vary by age and expected stage of development. However, there are some key themes that caregivers should closely monitor to tell 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, starting 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. nonverbal cues: Interpreting signals of conversational partners (for example, 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 it's not clearly stated 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 a social communication disorder if there is a family history of autism, learning disabilities, or some other types of communication disorders. Research is ongoing to better understand this genetic link and how it is inherited.

In addition, 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 first 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. They may not use sounds or gestures for greetings, and they may have little interest in interacting socially.

However, in order to diagnose a social communication disorder, children must be relatively high functioning and have started to talk. 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, also known as a speech therapist. These communication professionals 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 your child's language skills

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 of treatment methods include:

  • Video instruction: Watching recordings of people in conversation that provide a model of desired behaviors

  • Comic book conversations: Showing 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 starting 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

  • Nonverbal communication: Interpreting nonverbal 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 much more progress if you’re practicing and using these skills in daily interactions at home.

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. They should also provide weekly educational tips and techniques that you can use at home.

Below are some ideas that can be adapted 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 more suggestions.

  • Practice greetings: Practice greeting before starting and ending a conversation. This can include saying “hi” and “bye,” waving, and extending your hand for a handshake.

  • Read together 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 the characters: Similarly, when reading a book or watching a movie, stop to ask how the 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.

  • Take turns: Knowing when it’s your turn to speak, and taking turns, is an important part of having a 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.

  • Plan 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.

  • Try nonverbal cues: Offer your child a series of nonverbal cues, and have them tell you what they mean. For example, you could smile, frown, cross your arms, roll your eyes, or look away.

How does Expressable assess and treat social communication disorders?

Expressable matches families with a certified speech therapist trained to 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: Caregivers work directly with their child's speech therapist to learn cues and at-home strategies. That way they can confidently practice with their child outside the session and improve their child's social communication.

Ages 3-6: Caregivers 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 caregivers are kept in the loop with updates and tips during each session.

Adults: Adults attend sessions by themselves, but they are welcome to bring loved ones or family members as well.

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