CLINICAL TOPICS

Social Communication Disorders in School-Age Children

Overview

Incidence and Prevalence

Signs and Symptoms

Causes

Roles and Responsibilities

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

  • norm-referenced parent and teacher report measures,
  • competency-based tools such as interviews and observations,
  • hearing screening to rule out hearing loss as a possible contributing factor to social communication difficulties.

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). 

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).

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

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

  • initiation of spontaneous communication and reciprocal turn-taking in functional activities across communication partners and settings;
  • willingness to initiate and maintain conversation;
  • ability to manipulate conversational topics and repair communication breakdowns;
  • comprehension of verbal and nonverbal discourse in social, academic, and community settings;
  • communication for a range of social functions that are reciprocal and promote the development of friendships and social networks, including differentiation of one's own feeling from the feelings of others (Theory of Mind [ToM]);
  • verbal and nonverbal means of communication, including natural gestures, speech, signs, pictures, and written words, as well as other AAC systems;
  • ability to access literacy and academic instruction, as well as curricular, extracurricular, and vocational activities.

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.

Assessment may result in

  • diagnosis of social communication disorder,
  • description of the characteristics and severity of the disorder,
  • recommendations for intervention and support,
  • referral to other professionals as needed.

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). 

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).

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

Treatment

Resources

References

Content Disclaimer: The Practice Resource Project, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.