CLINICAL TOPICS

Social Communication Disorders in School-Age Children

Overview

Incidence and Prevalence

Signs and Symptoms

Causes

Roles and Responsibilities

Assessment

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

  • recognizes the importance of
    • family involvement,
    • cultural values and norms,
    • collaboration with a variety of professionals and communication partners,
    • facilitation of peer-mediated learning,
    • continuity of services across environments,
    • addressing functional needs,
    • matching service delivery to meaningful outcomes;
  • provides services that are connected with functional and meaningful outcomes, such as
    • the child being included in social settings with greater frequency,
    • the child experiencing less frustration with problem solving, etc.;
  • provides services in natural learning environments to the extent possible
    • using one-on-one or individual services only when repeated opportunities do not occur in natural learning environments,
    • ensuring that any pull-out services are tied to meaningful, functional outcomes and incorporate activities that relate to natural learning environments (Timler, 2008),
    • using one-on-one services in conjunction with group services to teach specific-skills that the child will then use in the group setting;
  • incorporates the collaborative efforts and input from families, classroom teachers, special educators, psychologists, and SLPs.

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

  • 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).

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

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). 

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).

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

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). 

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).

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

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).

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).

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

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).

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).

See the Parent-Mediated/Implemented Treatment section of the social communication evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

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). 

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).

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

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). 

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).

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

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).

ASD

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

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

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).

ASD

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

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

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). 

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).

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

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).

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).

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

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). 

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).

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

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). 

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).

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

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.