ASHA Logo

Social Communication Disorders in School-Age Children

Overview

Social communication can be defined as "the synergistic emergence of social interaction, social cognition, pragmatics (verbal and nonverbal), and receptive and expressive language processing" (Adams, 2005, p. 182). See components of social communication [PDF] and social communication benchmarks [PDF] across the age span.

Social communication disorders may include problems with social interaction, social cognition, and pragmatics. A social communication disorder may be a distinct diagnosis or may occur within the context of other conditions, such as autism spectrum disorder (ASD), specific language impairment (SLI), learning disabilities (LD), language learning disabilities (LLD), intellectual disabilities (ID), developmental disabilities (DD), attention deficit hyperactivity disorder (ADHD), and traumatic brain injury (TBI). Other conditions (e.g., psychological/emotional disorders and hearing loss) may also impact social communication skills. In the case of ASD, social communication problems are a defining feature along with restricted, repetitive patterns of behavior.

Social communication includes interactions with a variety of communication partners, including family, caregivers, child care providers, educators, and peers. Social communication behaviors such as eye contact, facial expressions, and body language, are influenced by sociocultural and individual factors (Curenton & Justice, 2004; Inglebret, Jones, & Pavel, 2008), and there is a wide range of acceptable norms within and across individuals, families, and cultures. For example, preferences for maintaining or averting eye contact, expectations for adult-child interactions, or norms for personal space may vary. The rules of interaction are highly dependent on the situation and condition in which the child is involved (Kayser, 1989; Wolfram, 1986). Clinically and culturally appropriate assessment must examine variations in norms and distinguish these variations from a disorder(s).

Coding for social communication disorders can be complicated. For guidance, refer to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013), ASHA's Billing and Reimbursement, and ASHA's Speech-Language Pathology Billing Codes.

The scope of these pages is limited to social communication disorders in school-age children (5-21 years old); social communication resources for preschool and early adult populations will be developed at a later date. While the four domains of social communication function in an integrated way, this document focuses on disorders of social interaction, social cognition, and pragmatics, because these are unique to social communication. Disorders of receptive and expressive language will be addressed in a separate Practice Portal page.

Incidence and Prevalence

"Incidence" of social communication disorders refers to the number of new cases identified in a specified time period. "Prevalence" of social communication disorders refers to the number of people who are living with social communication disorders in a given time period.

There are no reliable data on incidence and prevalence of social communication disorders, at least partly as a result of inconsistency of definitions across sources. However, data on incidence and prevalence may be available for disorders in which social communication problems co-occur with other defining symptoms and characteristics.

Signs and Symptoms

Signs and symptoms of social communication disorders include problems with social interaction (e.g., speech style and context, rules for linguistic politeness), social cognition (e.g., emotional competence, understanding emotions of self and others), and pragmatics (e.g., communicative intentions, body language, eye contact).

See components of social communication [PDF] and social communication benchmarks [PDF] across the age span.

Causes

A social communication disorder may be a distinct diagnosis or may be associated with other conditions (e.g., ASD, SLI, etc.), some of which have a known etiology and some of which are idiopathic. The causes of social communication disorders are often defined in terms of these specific conditions. Links to disorder- and condition-specific Practice Portal pages will be included as those pages are developed.

Roles and Responsibilities

Speech-language pathologists (SLPs) play a critical role in the screening, assessment, diagnosis, and treatment of school-age children with social communication disorders. Social communication challenges can result in far-reaching problems, including difficulties with shared enjoyment, social reciprocity in verbal and nonverbal interactions, play, peer interactions, comprehension of others' intentions, emotional regulation, spoken and written narratives, and literacy skills. Social communication norms may vary significantly across individuals and cultures. SLPs determine a child's norms within the context of his or her environment to differentiate a language difference from a disorder.

Family members, peers, and other communication partners may encounter barriers in their efforts to communicate and interact with individuals with social communication disorders. Therefore, the SLP's role is critical in supporting the individual, the environment, and the communication partner in order to maximize opportunities for interaction and assist in overcoming barriers that might lead to social isolation if left unmitigated.

SLPs play a central role in the screening, assessment, diagnosis, and treatment of social communication disorders in children. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment), advocacy, education, administration, and research. See ASHA's Scope of Practice in Speech-Language Pathology (ASHA, 2007).

Appropriate roles for speech-language pathologists include

As indicated in the Code of Ethics (ASHA, 2010), SLPs who serve this population should be specifically educated and appropriately trained to do so.

Assessment

See the Assessment section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Screening

Screening of social communication skills is conducted whenever a social communication disorder is suspected or as part of a comprehensive speech and language evaluation for any child with communication concerns.

Screening typically includes

For a list of specific screening instruments, see the ASHA Directory of Speech-Language Pathologist Assessment Instruments.

Expert Opinion

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the Screening section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

ADHD

  • "If screening indicates concerns about a child's speech and/or language-including expressive and receptive language [and] pragmatic language ... a referral should be made to a pediatric speech and language pathologist" (Dobie et al., 2012).
  • "Screen for comorbid conditions that occur commonly with ADHD [such as speech/language and family/psychosocial problems]" (Dobie et al., 2012).

Otitis Media

  • Screen hearing routinely and refer to an audiologist/ear, nose, and throat (ENT) specialist as needed, because "Multiple/chronic ear infections may affect [the] child's ...emotional and social development" (Bernie et al., 2008).

Comprehensive Assessment

Individuals suspected of having a social communication disorder based on screening results are referred to an SLP, and other professionals as needed, for a comprehensive assessment. Assessment of social communication should be culturally sensitive and functional and involve the collaborative efforts of families, caregivers, classroom teachers, SLPs, special educators, and psychologists as needed. Assessment is sensitive to the wide range of acceptable social norms that exist within and across communities.

Typically, SLPs assess a child's

See social communication benchmarks [PDF] for age-specific social communication skills. SLPs consider cultural diversity of social communication when they examine eye gaze, orienting to one's name, pointing to or showing objects of interest, pretend play, imitation, nonverbal communication, and language development.

Comprehensive assessment of communication skills typically includes

Standardized Assessment—an empirically developed evaluation tool with established reliability and validity. Coexisting disorders/diagnoses are considered when selecting standardized assessment tools as deficits vary from population to population (e.g., ADHD, TBI, ASD). Formal testing may be useful for assessing the structure and form of language but may not provide an accurate assessment of an individual's use of language (i.e., pragmatics).

Parent/Teacher Child Report Measures—rating scales, checklists, and/or inventories completed by the family member(s)/caregiver(s), teacher(s), and/or child. Findings from multiple sources (e.g., family member, teacher, self-report) may be compared to obtain a comprehensive profile of social communication skills.

Ethnographic Interviewing—an interview technique using open-ended questions, restatement, summarizing for clarification, and avoidance of leading questions and "why" questions in order to develop an understanding of the client's and the family's perceptions, views, desires, and expectations.

Analog Task(s)—observation of the child in simulated social situations that mimic real world events, including peer group activities.

Naturalistic Observation—observation of the child in everyday social settings with other individuals.

For examples of specific assessment instruments, see ASHA's Directory of Speech-Language Pathologist Assessment Instruments.

Assessment may result in

As mandated by the Individuals with Disabilities Education Improvement Act (IDEA; 2004), SLPs should avoid applying a priori criteria (e.g., discrepancies between cognitive abilities and communication functioning, chronological age, or diagnosis) in making decisions on eligibility for services. In the schools, children and adolescents with social communication disorders are eligible for speech-language pathology services, due to the pervasive nature of the social communication impairment, regardless of cognitive abilities or performance on standardized testing of formal language skills.

Expert Opinion

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the Assessment section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

General

  • When the speech and language therapist takes a case history, several areas should be considered, including communication interaction and other social factors (i.e., activities of daily living, current social circumstances, and play skills) (Taylor-Goh, 2005a).
  • "Assessment of the communication ability of school-age children with speech, language, and communication difficulties should include assessment of the use of social rules of communication" (Taylor-Goh, 2005b, p. 26).
  • "Assessment of bilingual children should include observation in a variety of social settings ... and should take a holistic view of the individual's social communication" (Taylor-Goh, 2005a, p.15)

ADHD

  • Because children with ADHD experience significant social and interpersonal problems, their interactions with parents, siblings, and peers are an important aspect of assessment and ongoing treatment (Ministry of Health, 2001).
  • "Information about performance in the school/nursery setting, including details [about] social functioning in relation to other children and staff," should be gathered when parents/caregivers are asked details of the history of the child's current problems, nature of the symptoms, and any associated behaviors (SIGN, 2009, p.7).
  • "Social skills training target skills may include maintaining eye contact, initiating and maintaining conversation, sharing, and cooperating" (Dobie et al., 2012, p.42).

Autism Spectrum Disorders (ASD)

  • Assessment of children with autism spectrum disorders (ASD) should include "an evaluation of the individual's ability to direct and maintain shared attention with another individual" (Taylor-Goh, 2005c).
  • The presence of a social impairment (e.g., lack of interest in other children, inappropriate attempts at joint play) in the primary school-age population should prompt referral for a general developmental assessment. "A systematic approach to direct observation is recommended to examine communication, social interaction, and play skills" (NIASA & Le Couteur, 2003, p. 35).
  • The choice of language assessment should be determined by the individual characteristics of the child and should be used in conjunction with "more informal but semi-structured techniques" to obtain a comprehensive understanding of the child's communication and social understanding of language (NIASA & Le Couteur, 2003, p. 36).
  • Assessment for ASD should include a "formal evaluation of social behavior, language and nonverbal communication, adaptive behavior, motor skills, atypical behaviors, and cognitive status by an experienced multidisciplinary team. Additionally, observations and concerns of parents should be systematically gathered. Diagnosis should be made as early as possible and follow-up diagnostic and educational assessments should be performed within the next one to two years." (National Research Council, 2001, p. 214).
  • "Children with difficulties in the pervasive developmental disorder [PDD]/autism spectrum can sometimes present with symptoms similar to ADHD. Identifying features of PDD/autism from the speech/language standpoint include socially inappropriate behaviors (e.g., screaming, interrupting) and loss of previously acquired language skills…If speech and language problems suggestive of a pervasive developmental disorder are present, referral should be made to developmental or mental health professionals with a speech and language pathologist as a part of the diagnostic team" (Dobie et al., 2012, p. 27).

Fluency

  • Pragmatic language should be assessed as part of the speech and language evaluation of persons who clutter (Taylor-Goh, 2005d).
  • "A case history should include details of the problem, e.g., ... social environment ... and ... psychosocial impact" (Taylor-Goh, 2005d, p. 74).

Hearing Loss

  • With regard to social development/behavior, inquire about the child's interaction with family members and behavior at day care/school, and explore possible causes of behavior problems besides hearing loss (stress, feeling ostracized, family violence) (Bernie et al., 2008).
  • The case history pertaining to otitis media with effusion should include information about social interaction behaviors (SIGN, 2003).

Psychological/Emotional

  • For children and adolescents with mental health disorders, core speech and language levels should be assessed, including "use of language and pragmatics, and socially unacceptable means of communication" (Taylor-Goh, 2005e, p. 83).

Stroke

  • "The ... social ... needs of the child affected by stroke should be considered early and systematically assessed in a co-ordinated manner when planning their subsequent care" (Paediatric Stroke Working Group, 2004, p. 16).

TBI

  • Closed head injury, which is frequently linked to frontal lobe, anterior temporal lobe, and medial temporal lobe damage, can result in issues such as relatively weak social perception and awkward social behavior. Implications include difficulty assessing impairments, and the disability may be misinterpreted. Schools should monitor the social relationships of students with TBI after an injury and provide counseling and support when indicated (New Zealand Guidelines Group, 2006).

Treatment

The ultimate goal of intervention is to improve social interactions, not to teach specific behaviors or skills. While it is ideal to address all skill areas concurrently, this is not always possible due to a number of factors, including time constraints and the patient's/client's unique needs.

Treatment Strategies

The broad impact of social communication disorders-specifically problems with generalization of skills- necessitates service delivery models and individualized programs that lead to increased active engagement and build independence in natural learning environments. When developing a treatment program, SLPs consider service delivery options that include both direct and indirect ways to mediate social exchanges. Clinician-mediated interventions may be useful for teaching new skills, but are more limited in promoting generalization of those skills. Where appropriate, intervention settings include environmental arrangement, teacher-mediated interventions, and peer-mediated interventions (Timler, 2008).

Treatment typically

Expert Opinion

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the Treatment section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

ADHD

  • Because children with ADHD experience significant social and interpersonal problems, their interactions with parents, siblings, and peers are an important aspect of assessment and ongoing treatment. "Consideration of how to improve social interaction with teachers and peers [may benefit children with ADHD in educational settings]" (Ministry of Health, 2001, p. 25).

ASD

  • It is recommended that primary school-age children with autism be provided "planned additional individual and small group social skills opportunities tailored to the needs of the child (including supported after school and leisure social clubs)" (NIASA & Le Couteur, 2003, p. 45).

Hearing Loss

  • "The [Speech & Language Therapist] SL&T will explain the relationship between hearing and communication, and will be available for discussion and support. Intervention should seek to facilitate the development of early communication skills, particularly appropriate eye contact, initiation, communicative intent and turn-taking skills" (Taylor-Goh, 2005f, p. 58).

Treatment Modes/Modalities

The treatment modes/modalities described below may be used to implement various treatment options.

AUGMENTATIVE AND ALTERNATIVE COMMUNICATION (AAC)—supplementing, or using in the absence of, natural speech and/or writing with aided (e.g., picture communication symbols, line drawings, Blissymbols, and tangible objects) and/or unaided (e.g., manual signs, gestures, and finger spelling) symbols. Aided symbols require some type of transmission device; unaided symbols require only the body to produce.

COMPUTER-BASED INSTRUCTION—the use of computer technology and/or computerized programs to teach social skills and social understanding.

VIDEO-BASED INSTRUCTION—a form of observational learning in which video recordings of desired behaviors are observed and then imitated by the individual (also called video modeling).

Evidence Highlights

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the Treatment section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

General

  • In regard to acquisition of social/communicative skills by secondary-age youth with disabilities, evidence indicates the efficacy of augmentative and alternative communication (Alwell & Cobb, 2009).

ASD

  • Evidence indicates that video modeling is associated with positive gains in social-communicative skills (Bellini & Akullian, 2007; Delano, 2007; Reichow & Volkmar, 2010).
  • Evidence indicates that video modeling is associated with positive gains in functional skills, perspective-taking skills, and problem behavior (Delano, 2007).
  • Evidence indicates that interventions incorporating visual supports (e.g., visual activity schedules) had "positive findings, suggesting they can be an effective method for enhancing social understanding and structuring social interactions or communication for preschool and school-aged children with autism" (Reichow & Volkmar, 2010, p. 161).
  • Evidence indicates that video modeling and video self-modeling "promote skill acquisition" and "are maintained over time and transferred across persons and settings" (Bellini & Akullian, 2007, p. 281).

Intellectual/Developmental

  • Evidence indicates that skill-based and support-based interventions were effective in increasing peer interactions across participants with a range of intellectual disabilities; however, differential effects were noted for several types of interventions by severity. Communication book instruction was most effective for participants with severe intellectual disabilities versus participants with moderate disabilities (Carter & Hughes, 2005).
  • Evidence indicates that clinicians should carefully monitor the effectiveness of AAC interventions with individual clients (with developmental disabilities, including autism) to determine the effects on communicative competence, social interaction, and language skills (Millar, Light, & Schlosser, 2006).

Treatment Options

Treatment for social communication disorders in childhood addresses the areas of need identified during assessment, as well as the specific goals of the child. Treatment involves providing information and guidance to patients/clients, families/caregivers, and other significant persons about the nature of disorders of social communication and the course of treatment. Intervention strategies can be used to supply the communication partner with information about the individual's subtle bids for communication, help them interpret problem behavior, and modify the environment to foster social engagement. Recommended treatment strategies are relevant, specific to the child's communication norms, and in the language(s) used by the child. A bilingual service provider or the assistance of a trained interpreter may be necessary.

Below are brief descriptions of both general and specific treatments for addressing social communication disorders. This list is not exhaustive, and the inclusion of any specific treatment approach does not imply endorsement from ASHA.

Behavioral Interventions/Techniques

Below are examples of interventions and techniques designed to reduce problem behaviors and teach functional alternative behaviors using the basic principles of behavior change.

APPLIED BEHAVIORAL ANALYSIS (ABA)—interventions based on the theory of behaviorism. This approach focuses on the relationship between observable behaviors and the environment; ABA methods are used to make environmental modifications to affect changes in behavior.

FUNCTIONAL COMMUNICATION TRAINING (FCT)—a behavioral intervention program that combines the assessment of the communicative functions of maladaptive behavior with procedures to teach alternative responses. FCT methods are used to reduce problem behaviors by replacing them with more appropriate forms of communicating needs or wants.

INCIDENTAL TEACHING—a teaching technique in which naturally occurring opportunities for learning are maximized, and the child's attempts to behave in a desired way are reinforced the closer they get to the desired behavior.

MILIEU THERAPY—a range of methods integrated into a child's natural environment, including training during activities that take place throughout the day, rather than only at "therapy time."

PIVOTAL RESPONSE TRAINING (PRT)—a treatment based on the belief that development of "pivotal" behavioral skills (e.g., ability to respond to multiple cues, motivation to initiate and respond appropriately to social and environmental stimuli, and self-regulation of behavior) results in collateral behavioral improvements.

POSITIVE BEHAVIOR SUPPORT (PBS)—an approach that uses the functional assessment of problem behaviors to target the relationship between challenging behavior and communication; it integrates the principles of applied behavior analysis with person-centered values to foster skills that replace challenging behaviors through positive response/support. 

Evidence Highlights

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the Behavioral Interventions section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

General

  • Evidence indicates that for social skills outcomes "… there is much support for the use of interventions based on ABA, and these techniques should continue to be used in practice" (Reichow & Volkmar, 2010, p. 159).

ASD

  • Evidence indicates that with regard to contemporary applied behavioral analysis (ABA) interventions, "pivotal response training may be beneficial for communication and social interaction" (Ospina et al., 2008, p. 24).  
  • Evidence indicates "… that long-term, comprehensive ABA intervention leads to (positive) medium to large effects in terms of ... language development and adaptive behavior [e.g., communication, socialization] of individuals with autism" (Virues-Ortega, 2010, p. 397).
  • Evidence indicates that promising behavioral strategies for teaching social skills to children with ASD include modeling and role-play, differential reinforcement, and errorless teaching (White, Keonig, & Scahill, 2007).

Expert Opinion

General

  • "Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains on some measures of social behavior, and their outcomes have been significantly better than those of children in control groups" (Myers & Johnson, 2007, p. 1164).

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is an intervention that combines cognitive and behavioral learning principles to shape and encourage desired behaviors. The underlying assumptions of CBT are that an individual's behavior is mediated by cognitive events and that change in thinking or cognitive patterns can lead to changes in behavior.

Evidence Highlights

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the Cognitive Behavioral Therapy section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

ADHD

  • Evidence indicates that "when using group treatment (cognitive behavioral therapy [CBT]and/or social skills training) for the [school-age] child or young person in conjunction with a parent-training/education programme, particular emphasis should be given to targeting a range of areas, including social skills with peers ... [and] listening skills. Active learning strategies should be used, and rewards given for achieving key elements of learning" (National Collaborating Centre for Mental Health, 2009, p. 205).

Denver Model

The Denver Model is a play-based treatment approach that focuses on the development of social communication skills through intensive one-on-one therapy, peer interactions in the school setting, and home-based teaching (Rogers & Dawson, 2009).

Parent-Mediated/Implemented/Involvement

Parent-mediated or implemented interventions consist of parents using direct, individualized intervention practices with their child to increase positive learning opportunities and acquisition of skills.

Evidence Highlights

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the Parent-Mediated/Implemented Treatment section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

General

  • Evidence indicates support for the practice of parent-implemented language interventions; several specific implications for practices related to parent-implemented language interventions may be drawn, [including the following]: interventions should focus on socially communicative interactions between parents and children" (Roberts & Kaiser, 2011, p. 31).

ADHD

Evidence indicates that

  • "if the [school-age] child or young person with ADHD has moderate levels of impairment, the parents or carers should be offered referral to a group parent training/education programme, either on its own or together with a group treatment programme (CBT [cognitive behavioral therapy] and/or social skills training) for the child or young person";  
  • "for older adolescents with ADHD and moderate impairment, individual psychological interventions (such as [cognitive behavioral therapy] or social skills training) may be considered as they may be more effective and acceptable than group parent training/education programmes or group CBT and/or social skills training."

(National Collaborating Centre for Mental Health, 2009, p. 205).

ASD

  • Evidence indicates that parent-implemented training can improve social communication skills in children with autism (McConachie & Diggle, 2007).
  • Evidence indicates support for the recommendation of parent training "as an effective method for increasing social skills of young children" (Reichow & Volkmar, 2010, pp. 159-160).

Expert Opinion

ASD

  • Promising teaching strategies for social skills training include parent involvement (White, Keonig, & Scahill, 2007).
  • Families should be assisted with ways to foster social-communicative interactions with their children; treatment programs that have proven effective for parents and professionals include offering small-group social opportunities for children an+d their families (NIASA & Le Couteur, 2003).
  • "Support and training should be provided to families (including siblings) to develop social skills interventions in the home" (Ministries of Health and Education, 2008, p. 102).

Peer-Mediated/Implemented/Involvement

Peer-mediated or implemented interventions are those in which typically developing peers are taught strategies to facilitate play and social interactions with children who have social communication disorders.

Evidence Highlights

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the Peer Mediated/Implemented section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

ASD

  • Evidence indicates that peer involvement is a promising strategy for teaching social skills to children with ASD (White, Keonig, & Schahill, 2007).
  • Evidence indicates that "peer interactions are a crucial part of intervention programs for children with autism; children with autism of all ages and all levels of disability have been shown to gain from these approaches. Many such approaches use typically developing peers to foster social growth in children with autism. National reviews recommend that children with autism have frequent access to typical peers" (Rogers & Vismara, 2008, p. 33).
  • Within the group of studies of didactic techniques (e.g., peer intervention), evidence indicates "that children described as normally developing have been successfully instructed to teach social communicative skills and social interactive behaviours to children with autism" (Law & Plunkett, 2009, pp. 43-44).

Intellectual/Developmental

  • Evidence indicates that skill-based and support-based interventions were effective in increasing peer interactions across participants with a range of intellectual disabilities; however, differential effects were noted for several types of interventions by severity. Peer support arrangements were most effective for participants with severe intellectual disabilities, whereas assignment of roles to general education peers was most effective for participants with moderate disabilities (Carter & Hughes, 2005).

Expert Opinion

ASD

  • "[Social] interventions using carefully trained and supported typically developing peers should be encouraged" (p. 102). "Peers should be provided with information about ASD and given support and encouragement to foster relationships" (p. 127). "Support and training should be provided to education professionals to develop peer-mediated strategies for social development" (p. 189).

(Ministries of Health and Education, 2008)

  • Emerging research supports the use of a peer-mediated instructional arrangement (i.e., peer tutoring) to increase social communication skills (National Autism Center, 2009).

Social Communication Treatments

Below are examples of interventions designed specifically to increase social communication skills. There continues to be research in the development of similar treatment programs, such as the Social Communication Project (SCIP) for school-age children with pragmatic and social communication problems (Adams et al., 2012). SLPs are encouraged to research additional social communication treatment programs and approaches.

SCERTS—social communication (SC), emotional regulation (ER) and transactional support (TS) is a model of service provision, rather than a specific program, that focuses on how to regulate emotions and communicate with others (Prizant, Wetherby, Rubin, Laurent, & Rydell, 2006).

SOCIAL SCRIPTS—a prompting strategy used to teach children to use a variety of language during social interactions. Scripted prompts (visual and or verbal) are gradually faded out, as children use them more spontaneously (Nelson, 1978).

SOCIAL SKILLS GROUPS—teach ways of interacting appropriately with typically developing peers through instruction, role-playing, and feedback. Groups typically consist of two to eight individuals with social communication disorders and a teacher or adult facilitator.

SOCIAL STORIES™—a highly structured intervention that uses stories to explain social situations to children and to help them learn socially appropriate behaviors and responses. Initially developed for use with children with autism, it is now being used with children with other disorders (Gray, White, & McAndrew, 2002).

SCORE SKILLS STRATEGY—is a social skills program that takes place in a cooperative small group and focuses on five social skills: share ideas (S), compliment others (C), offer help or encouragement (O), recommend changes nicely (R), and exercise self-control (E) (Vernon, Schumaker, & Deshler, 1996).

Evidence Highlights

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the Pragmatics/Social Skills section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

General

  • With regard to acquisition of social/communicative skills by secondary age youth with disabilities, evidence indicates the efficacy of social skills training as well as interventions designed to enhance conversation skills (e.g., conversation books and role play)(Alwell & Cobb, 2009).

ASD

  • Evidence indicates that the bulk of studies of the Social Stories™ intervention had statistically significant results for a variety of outcomes related to social interaction (Ospina et al., 2008).
  • Evidence indiates that "social skills groups for school-aged children with ASD [were] considered an established" evidence-based practice (Reichow & Volkmar, 2010, p. 161).
  • Evidence indicates that "Social Stories ™ may be beneficial in terms of modifying target [social skills] behaviours among high functioning children with ASD" (Karkhaneh et al., 2010, p. 660).

Fetal Alcohol Syndrome (FAS)

Expert Opinion

ADHD

  • "When using group treatment (CBT [cognitive behavioral therapy] and/or social skills training) for the [school-age] child or young person [with ADHD] in conjunction with a parent-training/education programme, particular emphasis should be given to targeting a range of areas, including social skills with peers ... listening skills .... Active learning strategies should be used, and rewards given for achieving key elements of learning" (National Collaborating Centre for Mental Health, 2009, p. 205).
  • "Consider the need for social skills training to improve peer relationships that are often negatively affected by ADHD symptoms (e.g., impulsivity)" (Dobie et al., 2012, p. 41).

ASD

  • Promising strategies for social skills training include teaching social scripts and defining concrete social rules (White, Keonig, & Scahill, 2007).
  • "Appropriate educational objectives for children with autistic spectrum disorders ... should include the development of social skills to enhance the participation in family, school, and community activities" (National Research Council, 2001, p. 218).
  • "All social intervention plans should include generalization and maintenance strategies" (Ministries of Health and Education, 2008, p. 102).

Relationship-Based Interventions

Relationship-based practices in early intervention are aimed at supporting parent-child relationships (Edelman, 2004).

GREENSPAN/DIR/FLOORTIME—is a model that promotes development by encouraging children to interact with parents and others through play. The model focuses on following the child's lead; challenging the child to be creative and spontaneous; and involving the child's senses, motor skills, and emotions (Greenspan, Weider & Simons, 1998).

Expert Opinion

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See theRelationship-Based Interventions section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

ASD

  • Emerging research supports the use of developmental relationship-based treatment for increasing social communication skills (National Autism Center, 2009).

TEACCH (Treatment and Education of Autistic and related Communication Handicapped Children)

TEACCH is a university-based system of community regional centers that provides clinical services, such as diagnostic evaluations, parent training and parent support groups, social play and recreation groups, individual counseling, and supported employment (Mesibov, Shea, & Schopler, 2007).

Evidence Highlight

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the TEACCH section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

ASD

  • Evidence indicates that integrative programs, such as TEACCH, resulted in improvements in social skills and social adaptive functioning (Ospina et al., 2008).

Service Delivery

In addition to determining the type of speech and language treatment that is optimal for children with social communication disorders, SLPs consider other service delivery variables—including format, provider, dosage and timing—that may impact treatment outcomes.

See the Service Delivery section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Format

Format refers to the structure of the treatment session (e.g., group vs. individual) provided.

Evidence Highlights

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the Format section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

ADHD

Evidence indicates that

  • "when using group treatment ([cognitive behavioral therary] and/or social skills training) for the [school-age] child or young person [with ADHD] in conjunction with a parent-training/education programme, particular emphasis should be given to targeting a range of areas, including social skills with peers … listening skills and dealing …. Active learning strategies should be used, and rewards given for achieving key elements of learning";
  • "for older adolescents with ADHD and moderate impairment, individual interventions [such as cognitive behavioral therapy or social skills training] may be considered as they may be more effective and acceptable than group parent training/education programmes or group cognitive behavioral therapy and/or social skills training"

(National Collaborating Centre for Mental Health, 2009, p. 205).

ASD

Expert Opinion

ASD

  • Families should be assisted with ways to foster social-communicative interactions with their children; treatment programs that have proven effective for parents and professionals include offering small-group social opportunities for children and their families (NIASA & Le Couteur, 2003).
  • It is recommended that primary school age children with autism be provided "planned additional individual and small group social skills opportunities tailored to the needs of the child (including supported after school and leisure social clubs)" (NIASA & Le Couteur, 2003, p. 45).

Provider

Provider refers to the person providing the treatment (e.g., SLP, trained volunteer, caregiver).

Expert Opinion

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the Provider section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

General

  • "Screening [of areas such as language and social skills] by a community speech/language pathologist helps to identify the extent of the problem" (Ho & Smith, 2001, Community Assessment section).  
  • "Children with language impairments have difficulties interpreting non-verbal communication and verbal language in social contexts. The Speech & Language Therapist should provide strategies to facilitate the child's understanding of social aspects of language" (Taylor-Goh, 2005b, p. 30).

ASD

  • "School staff should receive professional learning and development in modifying the learning, physical and social environments to support the child" (Ministries of Health and Education, 2008, p. 187).

Hearing Loss

  • "The [Speech & Language Therapist] SL&T will explain the relationship between hearing and communication, and will be available for discussion and support. Intervention should seek to facilitate the development of early communication skills, particularly appropriate eye contact, initiation, communicative intent and turn-taking skills" (Taylor-Goh, 2005f, p. 58).

Neurological

  • In regard to patients exposed to chemotherapy-antimetabolites and/or radiation (potential impact to brain/cranium), or who have undergone neurosurgery, "refer patients with neurocognitive deficits to [a] school liaison in [the] community or cancer center (psychologist, social worker, school counselor) to facilitate acquisition of educational resources and/or social skills training" (Children's Oncology Group, 2008, p. 22).

Dosage

Dosage refers to the frequency, intensity, and duration of service.

Expert Opinion

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the Dosage section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

ASD

  • "Social [skills] instruction should be delivered throughout the day in various settings, using specific activities and interventions planned to meet age-appropriate, individualized social goals" (National Research Council, 2001, p. 221).

Setting

Setting refers to the location of treatment (e.g., home, community-based).

Evidence Highlights

Highlights of general and disorder-specific evidence and/or expert opinion for specific populations are included where available; all populations may not be represented in these statements. Most evidence and/or expert opinion statements address individual aspects of social communication (e.g., social skills). See the Setting section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Psychological/Emotional

  • Within the group of studies pertaining to hybrid interventions, evidence indicates that positive effects on language and social skills were associated with a classroom-wide implemented intervention (Law & Plunkett, 2009).

Expert Opinion

ADHD

  • "Information about performance in the school/nursery setting, including details [about]social functioning in relation to other children and staff" should be gathered when parents/carers are asked details of the history of the child's current problems, nature of the symptoms, and any associated behaviors (SIGN, 2009, p. 7).

ASD

  • Promising teaching strategies for social skills training include practice in natural environments (White, Keonig, & Scahill, 2007).
  • "It is essential to make a qualitative assessment of the [child with ASD's] social interaction skills. This should be carried out in a variety of social settings such as a school, nursery or day centre" (Taylor-Goh, 2005c, p. 36).
  • "Social [skills] instruction should be delivered throughout the day in various settings, using specific activities and interventions planned to meet age-appropriate, individualized social goals" (National Research Council, 2001, p. 221).
  • "Social interventions should take place in natural settings and within natural activities as much as possible" (Ministries of Health and Education, 2008, p. 102).
  • "Social assessment should be carried out in a variety of natural settings with both adults and peers as social partners" (Ministries of Health and Education, 2008, p. 102).
  • "Structured observation periods in ... the classroom and [on] the playground are needed to evaluate ... spontaneous social communication, and behaviour and social interaction [on the] playground" (NIASA & Le Couteur, 2003, p. 31).

Resources

ASHA Resources

Components of Social Communication [PDF]

Consumer Information Page: Social Language Use

Directory of Speech-Language Pathologist Assessment Instruments

Self-Assessment for Cultural Competence

Social Communication Benchmarks [PDF]

Brinton, B., Robinson, L., & Fujiki, M. (2004). Description of a program for social language intervention: If you can have a conversation, you can have a relationship. Language, Speech, and Hearing Services in Schools, e35(3), 283-290.

Hadley, P., & Schuele, M. (1998). Facilitating peer interaction: Socially relevant objectives for preschool language intervention. American Journal of Speech-Language Pathology, 7, 25-36.

Westby, C. , Burda, A., & Mehta, Z. (2003, April 29). Asking the right questions in the right ways: Strategies for ethnographic interviewing. The ASHA Leader. Retrieved from www.asha.org/Publications/leader/2003/030429/f030429b/.

Organizations and Related Content

speechBITE

References

Adams, C. (2005). Social communication intervention for school-age children: Rationale and description. Seminars in Speech and Language, 26(3), 181-188.

Adams, C., Lockton, E., Freed, J., Gaile, J., Earl, G., McBean, K., ... & Law, J. (2012). The Social Communication Intervention Project: A randomized controlled trial of the effectiveness of speech and language therapy for school-age children who have pragmatic and social communication problems with or without autism spectrum disorder. International Journal of Language & Communication Disorders, 47(3), 233-244.

Alwell, M., & Cobb, B. (2009). Social/Communicative interventions and transition outcomes for youth with disabilities: A systematic review. Career Development for Exceptional Individuals, 32(2), 94-107.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC: Author.

American Speech-Language-Hearing Association. (2007). Scope of practice in speech-language-pathology [Scope of Practice]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2010). Code of ethics [Ethics]. Available from www.asha.org/policy.

Bellini, S., & Akullian, J. (2007). A meta-analysis of video modeling and video self-modeling interventions for children and adolescents with autism spectrum disorders. Exceptional Children, 73(3), 264-287.

Bernie, K., Creaven , B. K., Brodie, L., Joseph, S. P., O'Dea, K., Schulz, B., & Post, P. (2008). Adapting your practice: Treatment and recommendations for homeless children with otitis media. Nashville, TN: Health

Care for the Homeless Clinicians' Network, National Health Care for the Homeless Council, Inc.

Carter, E. W., & Hughes, C. (2005). Increasing social interaction among adolescents with intellectual disabilities and their general education peers: Effective interventions. Research and Practice for Persons with Severe Disabilities, 30(4), 179-193.

Children's Oncology Group. (2008). Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers. Arcadia, CA: Author.

Curenton, S. M., & Justice, L. M. (2004). African American and Caucasian preschoolers' use of decontextualized language: Literate language features in oral narratives. Language, Speech, and Hearing Services in Schools, 35, 240-253.

Delano, M. E. (2007). Video modeling interventions for individuals with autism. Remedial and Special Education, 28(1), 33-42.

Dobie, C., Donald, W. B., & Hanson, M. (2012). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school-age children and adolescents. Institute for Clinical Systems Improvement [homepage on the Internet]. c2012. Available from: https://www.icsi.org/.

Edelman, L. (2004). A relationship-based approach to early intervention. Resources and Connections, 3(2). Retrieved from www.eicolorado.org/files/relationship_based_approach.pdf.

Gard, A., Gorman, J., & Gilman, L. (1993). Speech and language development chart. Austin, TX: PRO-ED.

Gray, C., White, A. L., & McAndrew, S. (2002). My social stories book. London, UK: Jessica Kingsley Publishers.

Greenspan S. I., Weider, S., & Simons, R. (1998). The child with special needs. Reading, MA: Perseus Books.

Grice, P. (1975). Logic and conversation. In P. Cole & J. Morgan (Eds.), Syntax and semantics. Vol. 3, Speech acts (pp. 41-58). New York: Academic Press.

Ho, H. H., & Smith, D. H. (2001). Autistic disorders: What can a physician do? British Columbia Medical Journal, 43(5), 272-276.

Individuals with Disabilities Education Improvement Act (IDEA). (2004). Available from http://idea.ed.gov/.

Inglebret, E., Jones, C., & Pavel, D. M. (2008). Integrating American Indian/Alaska Native culture into shared storybook intervention. Language, Speech, and Hearing Services in Schools, 39, 521-527.

Karkhaneh, M., Clark, B., Ospina, M.B., Seida, J. C., Smith, V., & Hartling, L. (2010). Social stories to improve social skills in children with autism spectrum disorder: A systematic review. Autism, 14(6), 641-662.

Kayser, H. (1989). Speech and language assessment of Spanish-English speaking children. Language, Speech, and Hearing Services in Schools, 20(3), 226-244.

Law, J., & Plunkett, C. (2009). The interaction between behaviour and speech and language difficulties: Does intervention for one affect outcomes in the other? London, UK: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.

McConachie, H., & Diggle, T. (2007). Parent implemented early intervention for young children with autism spectrum disorder: A systematic review. Journal of Evaluation in Clinical Practice, 13(1), 120-129.

Mesibov, G. B., Shea, V., & Schopler, E. (2007). The TEACCH approach to autism spectrum disorders. New York, NY: Springer-Verglag.

Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49, 248-264.

Ministries of Health and Education. (2008). New Zealand autism spectrum guideline. Wellington, New Zealand: Ministry of Health.

Ministry of Health. (2001). New Zealand guidelines for the assessment and treatment of attention deficit hyperactivity disorder. Wellington, New Zealand: Ministry of Health.

Myers, S. M., & Johnson, C. P. (2007). Management of children with autism spectrum disorders. Pediatrics, 120(5), 1162-1182.

National Autism Center. (2009). The National Standards Report: Addressing the need for evidence-based practice guidelines for autism spectrum disorders. Randolph, MA: Author.

National Collaborating Centre for Mental Health. (2009). Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults. London, UK: The British Psychological Society and The Royal College of Psychiatrists.

National Initiative for Autism: Screening and Assessment (NIASA) & Le Couteur, A. (2003). National autism plan for children (NAPC). London, UK: The National Autistic Society for NIASA, The Royal College of Psychiatrists, The Royal College of Paediatrics and Child Health, and All Party Parliamentary Group on Autism.

National Research Council, Division of Behavioral and Social Sciences and Education. (2001). Educating children with autism. Washington, DC: National Academy Press.

Nelson, K. (1978). How children represent knowledge of their world in and out of language: A preliminary report. In Siegler, Robert S. (Eds.), Children's thinking: What develops? (pp. 255-273). Mahwah, NJ: Erlbaum.

New Zealand Guidelines Group. (2006). Traumatic brain injury: Diagnosis, acute management and rehabilitation. Wellington, New Zealand: Author.

Ospina, M. B., Seida, J. K., Clark, B., Karhaneh, M., Hartling, L., Tjosvold, L., … Smith, V. (2008). Behavioral and developmental interventions for autism spectrum disorder: A clinical systematic review. PLoS ONE, 3(11), 1-32.

Paediatric Stroke Working Group. (2004). Stroke in childhood: Clinical guidelines for diagnosis, management and rehabilitation. London, UK: Royal College Physicians of London.

Peadon, E., Rhys-Jones, B., Bower, C., & Elliott, E. J. (2009). Systematic review of interventions for children with fetal alcohol spectrum disorders. BioMed Central Pediatrics, 9(1), 35.

Prizant, B. M., Wetherby, A. M., Rubin, E., Laurent, A. C., & Rydell, P. J. (2006). The SCERTS™ Model: Comprehensive educational approach for children with autism spectrum disorders (Vols. I & II). Baltimore, MD: Brookes.

Reichow, B., & Volkmar, F. R. (2010). Social skills interventions for individuals with autism: Evaluation for evidence-based practices with a best evidence synthesis framework. Journal of Autism and Developmental Disorders, 40, 149-166.

Roberts, M. Y., & Kaiser, A. P. (2011). The effectiveness of parent-implemented language interventions: A meta-analysis. American Journal of Speech-Language Pathology, 20, 180-199.

Rogers S. J., & Dawson G. (2009). Play and engagement in early autism: The Early Start Denver Model. Volume I: The treatment. New York, NY: Guilford Press.

Rogers, S. J., & Vismara, L. A. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child & Adolescent Psychology, 37(1), 8-38.

Russell, R. L. (2007). Social communication impairments: Pragmatics. Pediatric Clinics of North America, 54(3), 483-506.

Scottish Intercollegiate Guidelines Network (SIGN). (2003). Diagnosis and management of childhood otitis media primary care: A national clinical guideline. Edinburgh, Scotland: Author.

Scottish Intercollegiate Guidelines Network (SIGN). (2009). Management of attention deficit and hyperkinetic disorders in children and young people. A national clinical guideline. Edinburgh, Scotland: Author.

Taylor-Goh, S. (Ed.). (2005a). Royal College of Speech and Language Therapists clinical guidelines: 5.1 Core clinical guideline. Bicester, UK: Speechmark Publishing.

Taylor-Goh, S. (Ed.). (2005b). Royal College of Speech and Language Therapists clinical guidelines: 5.3 School-aged children with speech, language and communication difficulties. Bicester, UK: Speechmark Publishing.

Taylor-Goh, S. (Ed.). (2005c). Royal College of Speech and Language Therapists clinical guidelines: 5.4 Autistic spectrum disorders. Bicester, UK: Speechmark Publishing.

Taylor-Goh, S. (Ed.). (2005d). Royal College of Speech and Language Therapists clinical guidelines: 5.9 Disorders of fluency. Bicester, UK: Speechmark Publishing.

Taylor-Goh, S. (Ed.). (2005e). Royal College of Speech and Language Therapists clinical guidelines: 5.10 Disorders of mental health and dementia. Bicester, UK: Speechmark Publishing.

Taylor-Goh, S. (Ed.). (2005f). Royal College of Speech and Language Therapists clinical guidelines: 5.7 Deafness/Hearing loss. Bicester, UK: Speechmark Publishing.

Timler, G. (2008, November 4). Social communication : A framework for assessment and intervention. The ASHA Leader. Retrieved from www.asha.org/Publications/leader/2008/081104/f081104a.htm.

Timler, G. R., Olswang, L. B., & Coggins, T. E. (2005). Social communication interventions for preschoolers: Targeting peer interactions during peer group entry and cooperative play. Seminars in Speech and Language, 26(3), 170-180.

Vernon, D. S., Schumaker, J. B., & Deshler, D. D. (1996). The SCORE skills: Social skills for cooperative groups. Lawrence, KS: Edge Enterprises.

Virues-Ortega, J. (2010). Applied behavior analytic intervention for autism in early childhood: Meta-analysis, meta-regression and dose-response meta-analysis of multiple outcomes. Clinical Psychology Review, 30, 387-399.

White, S. W., Keonig, K., & Scahill, L. (2007). Social skills development in children with autism spectrum disorders: A review of the intervention research. Journal of Autism and Developmental Disorders, 37(10), 1858-1868.

Wolfram, W. (1986). Grammatical, phonological, and language use differences. In L. Cole & V. Deal (Eds.), Communication disorders in multicultural populations manual (pp. 1-33). Rockville, MD: American Speech-Language-Hearing Association.