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