treatment section of the Social Communication Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.
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.
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).
- 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.
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).
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.
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.
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.
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 or implemented interventions consist of parents using direct, individualized intervention practices with their child to increase positive learning opportunities and acquisition of skills.
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.
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).
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).
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).
service delivery section of the Social Communication Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.
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.
Format refers to the structure of the treatment session (e.g., group vs. individual) provided.
Provider refers to the person providing the treatment (e.g., SLP, trained volunteer, caregiver).
Dosage refers to the frequency, intensity, and duration of service.
Setting refers to the location of treatment (e.g., home, community-based).