On the playground, Jesse hangs back and does not interact with his peers or participate in games. Classmates avoid Nick because he talks on and on about the same topic. Amanda attempts to communicate, but her peers avert their eyes and exclude her. These examples reveal the dynamic relationship between children's language and social skills and peer consequences. Children's social-communication skills are reflected in the ways that they approach peers, participate in conversations, retell past events, and negotiate conflicts.
The requirements of successful social communication are complex—children must be aware of their own intentions and perspectives as well as those of their peers. If a communication attempt is not successful, flexibility and perseverance are needed to adapt to a peer's response and modify verbal and nonverbal behaviors appropriately. Ultimately, social communication is most successful when children have both the motivation and desire to interact with others as well as the understanding of the explicit and "hidden" social rules for the particular context and culture in which they are communicating.
Successful social communication is supported by a number of skills and processes: language ability, social skills, social-cognitive skills (for example, presupposition and perspective-taking skills, including an awareness of what the listener already knows and listener interest in the conversation), and executive functioning (Adams, 2005; Coggins, Timler, &Olswang, 2007). Speech-language pathologists who serve school-age children with specific language impairment, language-based learning disabilities, mental retardation, traumatic brain injury, hearing impairment, and autism spectrum disorders (ASD) are likely to address these skills and processes in support of children's social communication success (see ASHA's Web site for related policy documents).
Social-communication assessment and intervention protocols should be culturally sensitive and functional. As such, development and support of children's social-communication skills calls for the collaborative effort of parents, classroom teachers, special educators, psychologists, and SLPs. A framework for assessment and intervention of children's social-communication skills includes seven components.
1. Screening of children with speech and language concerns for social-communication skills, particularly those children with specific language impairment.
Challenges in social communication are a defining characteristic of the diagnostic profiles of children with ASD. Social-communication assessment and intervention are an integral part of the comprehensive services provided by interdisciplinary teams of SLPs, psychologists, and special educators. Children with primarily language-based disorders, such as specific language impairment, also experience difficulties in peer interactions (see review by Brinton &Fujiki, 2005) but may receive special education services only from the SLP.
Speech-language evaluations for any child with communication concerns should include a screening of the child's social-communication skills. Norm-referenced parent and teacher report measures such as the Children's Communication Checklist-2 (Bishop, 2003) and the Pragmatic Language Skills Inventory (Gilliam & Miller, 2006) provide a time-efficient option for screening children's social-communication skills. If such screening reveals concerns about a child's skills, a more comprehensive evaluation should be completed. Identification of a social communication concern does not necessarily mean that the SLP will be solely responsible for addressing this concern; instead, the SLP may provide consultation to the classroom teacher regarding strategies to support a particular child's social-communication skills in the classroom.
2. When indicated, completion of a comprehensive social-communication assessment across multiple partners, topics, and settings.
A comprehensive social communication assessment includes observations of children's language skills, social skills, and the processes that support those skills (e.g., social cognition). Although social-communication assessment is an interdisciplinary effort, the SLP is likely the only provider who will assess and treat a child's oral language skills, particularly the conversational skills used during interactions with peers (Paul, 2008). Traditional language-sampling techniques, including conversation and narrative language samples, continue to be useful tools for assessment of children's oral language. Language samples from peer-to-peer interactions are also needed because adults provide supports that peers usually do not. If access to children's peer interactions in classroom and recess settings is limited because of time or other constraints, analogue social situations may be set up during which a group of children is given a specific task to complete (Brinton &Fujiki, 1999); the tasks are designed to elicit conversation and discussion so that children's oral language skills during authentic peer interactions can be observed.
Methods for the analysis of peer interaction language samples include checklists and conversational rubrics (for examples, see Kaczmarek, 2002; Paul, 2008; Prutting& Kirchner, 1987). These checklists do not require transcription of the entire language sample; instead, the clinician makes notations about whether a particular skill or behavior occurred. Most checklists and rubrics include items to observe and document children's discourse management (e.g., turn-taking, conversational repair) and presupposition skills. Although checklists and rubrics do not provide the norm-referenced scores that may be needed to establish children's eligibility for services, the information collected from these assessment tools is particularly useful for treatment planning because it allows for efficient analysis of authentic samples of children's peer interactions.
It is important to note variability in children's skills, if such variability is present. Recent analysis of the conversational samples of high-functioning adolescents with ASD and age-matched typically developing adolescents revealed significant group differences in important conversational skills. For example, the group with ASD had more episodes of limited reciprocity with their communication partners and included more irrelevant and inappropriate details (Paul, Miles Orlovski, ChubaMarcinko, &Volkmar, 2008). However, the adolescents with ASD also had episodes of appropriate use of these important conversational skills.
The study authors suggest that careful analysis of conversational behaviors may help clinicians identify adaptive behaviors that children can be taught to extend to a greater number of topics and partners. They conclude that some children do not need to learn how to converse, but may need additional cues to know when to use their successful conversational behaviors (Paul et al., 2008). In short, multiple samples of children's social-communication skills across different partners, topics, and settings will provide a more accurate picture of those skills. Interventions can be developed to target the specific nature of children's social-communication problems as described in step 4 below.
3. Initiation of social-communication intervention as early as possible.
Young children learn and refine social-communication skills during interactions with their peers. Children who are not successful in peer interactions may be subsequently ignored or actively rejected by their peers and as such lose valuable opportunities to develop social-communication skills. Effective intervention aimed at improving children's peer interactions during the preschool and early elementary school years may help to alleviate or reduce social communication problems (Guralnick, et al. 2006; Paul-Brown &Caperton, 2001).
4. Targeting social-communication intervention to the specific nature of the problem.
Within the social skills training literature, three types of social skill deficits have been identified (Gresham, Sugai, & Horner, 2001). Each of these deficits is discussed here, using the social skill of "greetings" as an example.
Children with acquisition deficits do not yet have a particular target skill. Intervention sessions focus on teaching the new skills, including direct instruction on when, how, and why to use that skill. For example, a child may not yet use verbal greetings when someone walks in a room. The SLP could provide direct instruction, modeling, and feedback to help the child learn and deploy this specific social-communication skill.
Children with performance deficits know how to do the skill but do not perform it in one or more settings or do not attempt the skill consistently. Intervention focuses on classroom support strategies for increasing the use of that skill. For example, the SLP could enlist the help of the teacher or develop a visual aid to prompt the child to extend a greeting; moreover, the teacher may provide the child with reinforcement for extending the greeting.
The final type of deficit is a fluency or frequency deficit—a child sometimes performs a particular skill but does not always execute it properly. The child might need a hybrid combination of direct instruction and classroom support strategies to execute the skill. For example, a child may use one particular greeting when someone enters the room, but needs to learn alternative ways to greet (e.g., if the teacher is talking when a peer enters the room, look at the person and nod rather than give a verbal greeting).
Failure to attend to the specific nature of children's deficits may be a primary reason that generalization of social skills training does not occur. Generalization refers to the transfer of social skills learned in one setting, with one partner, and in one activity to other settings, partners, and activities. Intervention plans that take into account the specific nature of a child's social-communication problem are likely to foster greater generalization.
5. Use of clinician-mediated interventions to teach new social-communication skills.
Traditional intervention service delivery models focus on clinician-mediated interventions conducted within individual or small-group sessions. Clinician-mediated interventions are ideal for teaching new skills and providing concentrated practice and feedback to refine those skills. Research has been conducted on some procedures and strategies for supporting the development and refinement of new skills including social stories (Gray, 2000), video modeling (Bellini, Akullian, &Hopf, 2007), social skills instruction followed by a period of play (Goldstein, Kaczmarek, & English 2002), written text and visual checklists (Thiemann & Goldstein, 2004), and social-cognitive curricula for higher-functioning children with ASD that emphasize teaching "why" a particular skill is important (Crooke, Hendrix, &Rachman, 2007; Winner, 2005). ASHA's Committee on Language Use in Social Interactions in School-Based Children is conducting an evidence-based systematic review on interventions in social communication (see sidebar).
6. Social-communication intervention as a collaborative effort supported across settings and partners.
Clinician-mediated interventions may be useful for teaching new skills but are more limited in promoting generalization of those skills. At least three other contexts have been studied to address social-communication problems in preschoolers and school-age children (see review by Timler, Vogler-Elias, & McGill, 2007). These contexts, comprising a continuum from naturalistic and least clinician-directed to contrived and most clinician-directed, include environmental arrangement, teacher-mediated interventions, and peer-meditated interventions.
Environmental arrangement involves systematic arrangement of classrooms to include access to materials that promote cooperative play, projects, and discussion groups. Teacher-mediated interventions are strategies classroom teachers can implement to support peer interactions among children with disabilities and typically developing peers (Girolametto& Weitzman, 2007), including encouraging and prompting children to play and work with one another, rephrasing and restating one child's statement to another when communication breakdowns occur, and praising children who are playing and working together. Peer-mediated interventions involve prompting and reinforcing the efforts of typically developing peers to initiate conversation with and respond to children with communication problems. Peer-mediated interventions may be particularly useful for children with ASD (see review by Goldstein, Schneider, & Thiemann, 2007).
7. Generalization of new social-communication skills for use with authentic partners and settings as early as possible.
The goal of social communication interventions for school-age children is to enhance peer interactions and ultimately to facilitate peer acceptance and authentic friendships. Strategies for supporting children's social-communication skills within peer interactions should be implemented as early as possible. Intervention activities that mimic relevant classroom and recess activities conducted with peers from children's classrooms is an important component of clinician-mediated intervention sessions. Self-monitoring strategies and social-communication assignments are useful for helping children to use their newly refined skills in other settings (Timler, Vogler-Elias, & McGill, 2007). Teachers and parents should be informed of children's social-communication objectives and be encouraged to help monitor children's skills.
One strategy for enlisting concrete support from parents and teachers is daily report cards (Fabiano& Pelham, 2003) that include three to five specific behaviors; teachers and parents circle a "yes" or "no" to identify if a behavior did or did not occur. Children earn a reward for good report cards. Self-monitoring and teacher/parent monitoring systems should be used as soon as children can deploy a particular skill within clinician-mediated settings to facilitate generalization of that skill.
This article presents a comprehensive framework for addressing children's social-communication skills. The three children described at the beginning of this article underscore the importance of a comprehensive approach. Jesse, the bystander on the playground, may need to learn specific verbal and nonverbal behaviors for joining a group of peers if further assessment reveals that he has similar difficulties during class and lunch activities. A social-cognitive approach may help Nick to understand why and when talking about the same topic becomes frustrating for his peers, particularly if he is able to discuss a variety of topics with adult partners. The most effective support for Amanda, who is trying to communicate, may be for her peers to participate in an intervention so that they recognize and respond to her attempts.
Collaborative efforts among parents and educators; assessment across settings; intervention and support mediated by SLPs, teachers, and peers; and strategies for promoting generalization are important to supporting children's social-communication success.