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.
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.