See the treatment section of the Social Communication Disorder Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.
Consistent with the WHO (2001) framework, intervention is designed to
- capitalize on strengths and address weaknesses related to underlying functions that affect social communication;
- facilitate the individual’s activities and participation in social interactions by helping the individual acquire new skills and strategies; and
- modify contextual factors that serve as barriers and enhance facilitators of successful communication and participation.
See ASHA’s resource on the International Classification of Functioning, Disability, and Health (ICF) for examples of handouts featuring goals consistent with ICF.
- recognizes the importance of involving the individual and family;
- considers variations in norms and values;
- focuses on functional outcomes; and
- tailors goals to address the individual’s specific needs in a variety of natural environments.
Treatment typically involves collaboration with a variety of professionals (e.g., classroom teachers, special educators, psychologists, and vocational counselors). See ASHA’s resources on collaboration and teaming and IPP/IPE.
Treatment strategies for social communication disorder focus on increasing active engagement and building independence in natural communication environments.
One-on-one, clinician-directed interventions are useful for teaching new skills. Group interventions are used in conjunction with one-on-one services to practice skills in functional communication settings and to promote generalization.
In school settings, intervention often includes environmental arrangements, teacher-mediated interventions, and peer-mediated interventions (Timler, 2008).
The treatment modalities described below may be used to implement various treatment options.
Augmentative and Alternative Communication (AAC)—supplementing or replacing natural speech with aided symbols (e.g., picture communication symbols, line drawings, and tangible objects) and/or unaided symbols (e.g., manual signs, gestures, and finger spelling). See ASHA’s Practice Portal page on Augmentative and Alternative Communication.
Computer-Based Instruction—use of computer technology (e.g., iPads) and/or computerized programs for teaching language skills, including vocabulary, social skills, social understanding, and social problem solving.
Video-Based Instruction (also called “video modeling”)—an observational mode of teaching that uses video recordings to provide a model of the target behavior or skill. Video recordings of desired behaviors are observed and then imitated by the individual. The learner’s self-modeling can be videotaped for later review.
Below are brief descriptions of both general and specific treatments for addressing social communication disorder. This list is not exhaustive, and the inclusion of any specific treatment approach does not imply endorsement from ASHA.
For additional treatment options that address social communication skills in school-age children, see ASHA’s Practice Portal pages on Autism Spectrum Disorder, Spoken Language Disorders, and Pediatric Traumatic Brain Injury. For treatment options in adult populations, see ASHA’s Practice Portal pages on Traumatic Brain Injury in Adults, Aphasia, and Dementia.
Behavioral interventions and techniques can be used to modify existing behaviors or teach new behaviors. These approaches are based on principles of learning that include identifying desired behaviors (e.g., social skills), gradually shaping these behaviors through selective reinforcement, and fading reinforcement as behaviors are learned.
Behavioral approaches can be used to modify or teach social communication behaviors in one-on-one, discrete trial instruction or in naturalistic settings with peers or other communication partners. Positive Behavior Support (PBS) is one example of a behavioral intervention approach that can be used to foster appropriate and effective social communication (Carr et al., 2002).
Peer-mediated or peer-implemented interventions are those in which typically developing peers are taught strategies to facilitate play and social interactions with children who have social communication disorder.
Social Communication Treatments
The interventions below are designed specifically to increase social communication skills.
Comic Strip Conversations—conversations between two or more people illustrated by simple drawings in a comic strip format. The drawings illustrate what people are saying and doing and what they might be thinking. The process of creating the comic strip slows the conversation down, allowing more time for an individual to understand the information being exchanged. Comic Strip Conversations can be used for conflict resolution, problem solving, communicating feelings and perspectives, and reflecting on something that happened (Gray, 1994).
Score Skills Strategy—a social skills program that takes place in a cooperative small group and focuses on five social skills: (S) share ideas, (C) compliment others, (O) offer help or encouragement, (R) recommend changes nicely, and (E) exercise self-control (Vernon, Schumaker, & Deshler, 1996).
Social Communication Intervention Project (SCIP)—speech and language therapy for school-age children with pragmatic and social communication needs. SCIP intervention focuses on social understanding and social interpretation (e.g., understanding social context cues and emotional cues), pragmatics (e.g., managing conversation, improving turn-taking), and language processing (e.g., improving narrative construction and understanding of nonliteral language; Adams et al., 2012).
Social Scripts—a prompting strategy to teach children how to use varied language during social interactions. Scripted prompts (visual and or verbal) are gradually faded as children use them more spontaneously (Nelson, 1978).
Social Skills Groups—an intervention that uses instruction, role play, and feedback to teach ways of interacting appropriately with peers. Groups typically consist of two to eight individuals with social communication disorder and a teacher or adult facilitator. Social skills groups can be used across a wide range of ages, including school-age children and adults.
Social Stories™—a highly structured intervention that uses stories to explain social situations to children and 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).
Social norms are an intrinsic part of culture and communication. These norms may vary across and within cultures. It is essential that clinicians acquire knowledge of their client’s individual cultural norms to determine what is typical for that client. Once the clinician is able to determine the rules of communication for that client, the clinician can determine if variations in patterns reflect communication differences or a disorder. See ASHA’s Practice Portal page on Cultural Competence.
Treatment is conducted in the language(s) used by the individual. A bilingual service provider or the assistance of a trained interpreter may be necessary to provide treatment. See ASHA’s Practice Portal pages on Bilingual Service Delivery and Collaborating With Interpreters, Transliterators, and Translators. See also ASHA’s resource on person- and family-centered care.
Transitioning Youth and Adults
Social communication skills are crucial for adolescents as they explore peer relationships and learn about friendship, loyalty, and individual differences (Seltzer, 2009). Social communication skills are equally important beyond the high school years—in postsecondary school, on the job, and in social settings.
Social communication problems tend to persist as adolescents transition to these new roles (Whitehouse, Watt, Line, & Bishop, 2009b). Individuals diagnosed with social (pragmatic) language impairment as children may have difficulty establishing close friendships and romantic relationships as adults (Whitehouse, Watt, Line, & Bishop, 2009a).
School-based SLPs are often involved in transition planning to help mitigate the impact of social communication difficulties and to ease the transition to adulthood. See ASHA’s resource on transitioning youth. Intervention and supports for adults with social communication needs may be available in various forms (e.g., social skills groups, conversation groups, life skills groups, and workshops) and from a variety of providers (e.g., SLPs, psychologists, college counselors, and vocational counselors).
In adulthood, social communication disorder can arise secondary to traumatic brain injury, right-hemisphere damage, aphasia, and neurodegenerative disorders such as Alzheimer’s disease (Cummings, 2007). Intervention for these populations often focuses on improving conversational skills, navigating social situations, and encouraging participation in daily activities to the fullest extent possible. See ASHA’s Practice Portal pages on Traumatic Brain Injury in Adults, Aphasia, and Dementia.
Individuals Who Are Deaf or Hard of Hearing
Many social language skills are learned through exposure to events that are witnessed or overheard (i.e., incidental learning). Some of these avenues for learning are not readily available to individuals who are deaf or hard of hearing, and this can have a negative impact on the development of social competencies (Calderon & Greenberg, 2003).
Programs to help children overcome these challenges begin early by promoting parent–child communication. Parents can help “fill in the gaps” by helping children understand and interpret what they have not directly heard (Calderon & Greenberg, 2003). Parents can also help by modeling healthy ways to interact and by teaching acceptable social behaviors (Schlesinger & Meadow-Orlans, 1972).
It is important for adolescents who are deaf or hard of hearing to feel a part of their social network and be able to interact effectively within this network (Calderon & Greenberg, 2003).
Interventions during the adolescent years include
- social skills training aimed at improving interpersonal skills (e.g., Lemanek, Williamson, Gresham, & Jensen, 1986; Schloss & Smith, 1990) and
- curriculum-based interventions that promote the development of social skills through teacher modeling and cooperative learning and by incorporating social skills lessons into other class lessons and activities (Luetke-Stahlman, 1995).
See the Service Delivery section of the Social Communication Disorder Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspectives.
In addition to determining the type of speech and language treatment that is optimal for individuals with social communication disorder, SLPs consider other service delivery variables—including format, provider, dosage, and setting—that may affect treatment outcomes.
Format refers to the structure of the treatment session (e.g., group and/or individual). The appropriateness of the treatment format often depends on the relevant communication setting and goal of therapy. For example, one-on-one treatment sessions are often used to teach specific social communication skills. Group sessions (e.g., group conversation therapy, classroom-wide interventions, and integrated social interaction groups) provide opportunities to practice these skills with a variety of communication partners in natural communication settings.
Provider refers to the person providing treatment. Treatment for individuals with social communication disorder often involves collaborative efforts that include families and other communication partners, classroom teachers, special educators, psychologists, vocational counselors, and SLPs. It can also include family- or peer-meditated learning.
Treatment is conducted in the language(s) used by the individual. A bilingual service provider or the assistance of a trained interpreter may be necessary when there is not a client–clinician language match. See ASHA’s Practice Portal pages on Bilingual Service Delivery and Collaborating With Interpreters, Transliterators, and Translators.
Dosage refers to the frequency, intensity, and duration of service. Dosage depends on factors such as the age of the individual, his or her communication needs, and the presence of comorbid disorders or conditions. Regardless of the specific dosage parameters, social skills intervention addresses the functional communication needs of the individual and provides continuity of services across settings.
Setting refers to the location of treatment (e.g., SLP’s office, classroom, community, inpatient rehabilitation facility). To the extent possible, treatment is provided in naturalistic environments and incorporates activities that typically relate to those environments (e.g., group projects in the classroom setting).