Social Communication Disorder

See the Assessment section of the Social Communication Disorder Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Screening

Speech and Language

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

Screening typically includes the use of competency-based tools such as interviews and observations, self-report questionnaires, and norm-referenced report measures completed by parents, teachers, or significant others. 

Hearing

Hearing screening is conducted to rule out hearing loss as a contributing factor to social communication difficulties. Hearing screening is within the Scope of Practice in Speech-Language Pathology (ASHA, 2016b) . Referral for a full audiologic evaluation is necessary if the individual fails the hearing screening.

If the individual wears hearing aids, the hearing aids need to be inspected by an audiologist to ensure that they are in working order, and the aids should be worn by the individual during screening (and during comprehensive assessment, when recommended).

See ASHA’s Practice Portal pages on  Childhood Hearing Screening, Adult Hearing Screening, Permanent Childhood Hearing Loss, and  Hearing Loss - Beyond Early Childhood.

Comprehensive Assessment

Individuals suspected of having social communication disorder based on screening results are referred for a comprehensive speech and language assessment or to other professionals as needed. When the individual has a diagnosed co-occurring condition, it is the role of the SLP to be aware of overlapping or similar signs and symptoms and to assess specifically for social communication components.

Assessment of social communication should be culturally sensitive and functional and involve the collaborative efforts of families, caregivers, classroom teachers, SLPs, special educators, psychologists, and other professionals as needed (e.g., vocational counselor). Assessment is sensitive to the wide range of acceptable social norms that exist within and across communities.

Consistent with the World Health Organization’s (WHO)  International Classification of Functioning, Disability and Health  (ICF) framework (ASHA, 2016a; WHO, 2001), comprehensive assessment is conducted to identify and describe the following:

  • Impairments in body structure and function, including underlying strengths and weaknesses in communication and communication-related areas.
  • Co-morbid deficits or health conditions, such as spoken or written language disorders, ADHD, or developmental disabilities.
  • Limitations in activity and participation, including functional communication and interpersonal interactions.
  • Contextual (environmental and personal) factors that serve as barriers to or facilitators of successful communication and life participation.
  • The impact of communication impairments on the individual’s quality of life.

See ASHA’s resource on the  International Classification of Functioning, Disability, and Health (ICF) for examples of handouts featuring assessment data consistent with ICF.

Typically, SLPs assess the individual’s ability to

  • use verbal and nonverbal means of communication, including natural gestures, speech, signs, pictures, and written words, as well as other augmentative and alternative communication (AAC) systems (See ASHA’s Practice Portal page on Augmentative and Alternative Communication);
  • understand and interpret the verbal and nonverbal communication of others, including gestures and intonation;  
  • initiate spontaneous communication;
  • initiate and maintain conversation;
  • manipulate conversational topics and repair communication breakdowns;
  • take turns in functional activities across communication partners and settings;
  • comprehend verbal and nonverbal discourse in social, academic, vocational, and community settings;
  • understand figurative and ambiguous language and make inferences when information is not explicitly stated;
  • attribute mental and emotional states (e.g., thoughts, beliefs, and feelings) to oneself and others (Theory of Mind [ToM]);
  • communicate for a range of social functions that are reciprocal and that promote the development of friendships and social networks; and
  • access literacy and academic instruction as well as curricular, extracurricular, and vocational activities.

Both formal and informal assessments are used to assess social communication skills. There are a few standardized tests specifically designed to assess social (pragmatic) language skills, and some comprehensive language tests include subtests that target these skills.

As with screening, competency-based tools, self-report questionnaires, and norm-referenced report measures (e.g., parent, teacher, and significant other) are frequently used. Analog tasks that mimic real-world situations and naturalistic observations can be used to gather information about an individual’s communication skills in simulated social situations or in everyday social settings. See ASHA’s resource on assessment tools, techniques, and data sources for general information about assessment options.

Assessment may result in

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

Differential Diagnosis

SLPs play an important role in the differential diagnosis of social communication disorder and ASD. Many times, older children no longer exhibit overt repetitive behaviors, interests, or activities. However, subtle repetitive patterns may still be present (e.g., patterns of speech or compulsive retracing over letters while writing). Accurate diagnosis is essential for planning effective intervention.

Assessment Considerations

Assessment of social communication skills takes into consideration the individual’s age, cultural norms and values, and expected stage of development. See ASHA’s resource on social communication benchmarks  [PDF] for age-specific social communication skills. See also ASHA’s Practice Portal page on Cultural Competence.

When assessing social communication skills in individuals who are deaf or hard of hearing, it is important to consider the age of onset and the duration of hearing loss, as these factors play a role in the development of language and communication skills. 

Eligibility for Services in Schools

As mandated by the Individuals with Disabilities Education Improvement Act (IDEA, 2004), SLPs should avoid applying a priori (theory-based) criteria (e.g., discrepancies between cognitive abilities and communication functioning, chronological age, or diagnosis) in making decisions on eligibility for services in the schools.

Due to the pervasive nature of social communication impairments, children and adolescents with social communication disorder are eligible for speech-language pathology services, regardless of cognitive abilities or performance on standardized testing of formal language skills. See ASHA’s resources on cognitive referencing.

Coding and Reimbursement

Coding for social communication disorder can be complicated. For guidance, refer to the DSM-5 (APA, 2013) as well as ASHA’s resources on billing and reimbursement and speech-language pathology billing codes

Content Disclaimer: The Practice Portal, 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.