The scope of this page is social communication disorder across the life span.
See the Social Communication Disorder Evidence Map for summaries of the available research on this topic.
Social communication is the use of language in social contexts. It encompasses social interaction, social cognition, pragmatics, and language processing.
Social communication skills include the ability to vary speech style, take the perspective of others, understand and appropriately use the rules for verbal and nonverbal communication, and use the structural aspects of language (e.g., vocabulary, syntax, and phonology) to accomplish these goals. For more details, see ASHA's resources on components of social communication [PDF] and social communication benchmarks [PDF].
Social communication, spoken language, and written language have an intricate relationship (see figure below). Social communication skills are needed for language expression and comprehension in both spoken and written modalities. Spoken and written language skills allow for effective communication in a variety of social contexts and for a variety of purposes.
Social communication behaviors such as eye contact, facial expressions, and body language are influenced by sociocultural and individual factors (Curenton & Justice, 2004; Inglebret, Jones, & Pavel, 2008). There is a wide range of acceptable norms within and across individuals, families, and cultures.
Social communication disorder is characterized by difficulties with the use of verbal and nonverbal language for social purposes. Primary difficulties are in social interaction, social cognition, and pragmatics. Specific deficits are evident in the individual's ability to
This definition is consistent with the diagnostic criteria for Social (Pragmatic) Communication Disorder detailed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association [APA], 2013).
Social communication disorder can result in far-reaching problems, including difficulty participating in social settings, developing peer relationships, achieving academic success, and performing successfully on the job.
Social communication disorder may be a distinct diagnosis or may co-occur with other conditions, such as
In the case of autism spectrum disorder (ASD), social communication problems are a defining feature, along with restricted, repetitive patterns of behavior. Therefore, social communication disorder cannot be diagnosed in conjunction with ASD.
Incidence of social communication disorder refers to the number of new cases identified in a specified time period. Prevalence of social communication disorder refers to the number of people who are living with social communication disorder in a given time period.
Precise estimates of the incidence and prevalence of social communication disorder have been difficult to determine because many investigations draw on varied populations and employ inconsistent or ambiguous definitions of the disorder. Moreover, with the relatively recent expansion of the DSM-5 (APA, 2013) to include the new diagnostic category of Social (Pragmatic) Communication Disorder, it will be necessary to examine and evaluate the validity of the criteria for that disorder prior to estimating prevalence (Swineford, Thurm, Baird, Wetherby, & Swedo, 2014).
A population estimate based on a community sample of more than 1,300 kindergarteners suggests that pragmatic language impairment occurs in about 7.5% of children and affects more boys than girls by a ratio of 2.6:1.0 (Ketelaars, Cuperus, van Daal, Jansonius, & Verhoeven, 2009).
Higher prevalence rates (23%–33%) have been noted in individuals with language disorders (Botting, Crutchley, & Conti-Ramsden, 1998; Ketelaars et al., 2009).
Given that social communication problems co-occur with a number of other disorders, additional data on incidence and prevalence may be available for those conditions with other defining symptoms and characteristics.
Signs and symptoms of social communication disorder include deficits in social interaction, social cognition, and pragmatics (see ASHA's resource on components of social communication [PDF]).
Specific behaviors affected by social communication disorder depend on the individual's age, his or her expected stage of development (see ASHA's resource on social communication benchmarks [PDF]), and the communication context. Some examples of behaviors affected by social communication disorder include
Variations across all areas of social communication occur within and across cultures. Differences related to cultural norms are not considered disorders.
The cause of social communication disorder as a distinct diagnosis is not known. It is often defined in terms of the specific condition with which it is associated. See ASHA Practice Portal pages on Intellectual Disability, Spoken Language Disorders, Written Language Disorders, Pediatric Traumatic Brain Injury, Traumatic Brain Injury in Adults, Aphasia, and Dementia for information about social communication skills in these populations.
Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of social communication disorder in children and adults. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment), advocacy, education, administration, and research. See ASHA's Scope of Practice in Speech-Language Pathology (ASHA, 2016b).
Appropriate roles for SLPs include the following:
As indicated in the Code of Ethics (ASHA, 2016a), SLPs who serve this population should be specifically educated and appropriately trained to do so.
See the Assessment section of the Social Communication Disorder Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.
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).
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:
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
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
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 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.
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 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.
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
See ASHA's resource on the International Classification of Functioning, Disability, and Health (ICF) for examples of handouts featuring goals consistent with ICF.
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.
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.
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.
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
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).
This list of resources is not exhaustive and the inclusion of any specific resource does not imply endorsement from ASHA.
Adams, C., Lockton, E., Freed, J., Gaile, J., Earl, G., McBean, K., . . . Law, J. (2012). The Social Communication Intervention Project: A randomized controlled trial of the effectiveness of speech and language therapy for school-age children who have pragmatic and social communication problems with or without autism spectrum disorder. International Journal of Language & Communication Disorders, 47, 233–244.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
American Speech-Language-Hearing Association. (2016a). Code of ethics [Ethics]. Available from www.asha.org/policy/.
American Speech-Language-Hearing Association. (2016b). Scope of practice in speech-language-pathology [Scope of Practice]. Available from www.asha.org/policy/.
Botting, N., Crutchley, A., & Conti-Ramsden, G. (1998). Educational transitions of 7-year old children with SLI in language units: A longitudinal study. International Journal of Language & Communication Disorders, 33, 177–197.
Calderon, R., & Greenberg, M. (2003). Social and emotional development of deaf children. In M. Marschark & P. E. Spencer (Eds.), Oxford handbook of deaf studies, language, and education (pp. 177–189). New York, NY: Oxford University Press.
Carr, E. G., Dunlap, G., Horner, R. H., Koegel, R. L., Turnbull, A. P., Sailor, W., . . . Fox, L. (2002). Positive behavior support: Evolution of an applied science. Journal of Positive Behavior Interventions, 4, 4–16.
Cummings, L. (2007). Pragmatics and adult language disorders: Past achievements and future directions. Seminars in Speech and Language, 28, 96–110.
Curenton, S. M., & Justice, L. M. (2004). African American and Caucasian preschoolers' use of decontextualized language: Literate language features in oral narratives. Language, Speech, and Hearing Services in Schools, 35, 240–253.
Gray, C. (1994). Comic strip conversations: Illustrated interactions that teach conversation skills to students with autism and related disorders. Arlington, TX: Future Horizons.
Gray, C., White, A. L., & McAndrew, S. (2002). My social stories book. London, United Kingdom: Jessica Kingsley Publishers.
Individuals with Disabilities Education Improvement Act (IDEA). (2004). Available from http://idea.ed.gov/.
Inglebret, E., Jones, C., & Pavel, D. M. (2008). Integrating American Indian/Alaska Native culture into shared storybook intervention. Language, Speech, and Hearing Services in Schools, 39, 521–527.
Ketelaars, M. P., Cuperus, J. M., van Daal, J., Jansonius, K. & Verhoeven, L. (2009). Screening for pragmatic language impairment: The potential of the Children's Communication Checklist. Research in Developmental Disabilities, 30, 952–960.
Lemanek, K. L., Williamson, D. A., Gresham, F. M., & Jensen, B. J. (1986). Social skills training with hearing-impaired children and adolescents. Behavior Modification, 10, 55–71.
Luetke-Stahlman, B. (1995). Classrooms, communication, and social competence. Perspectives in Education and Deafness, 13, 12–16.
Nelson, K. (1978). How children represent knowledge of their world in and out of language: A preliminary report. In R. S. Siegler (Ed.), Children's thinking: What develops? (pp. 255–273). Mahwah, NJ: Erlbaum.
Schlesinger, H. S., & Meadow-Orlans, K. P. (1972). Sound and sign: Childhood deafness and mental health. Berkeley, CA: University of California Press.
Schloss, P. J., & Smith, M. A. (1990). Teaching social skills to hearing-impaired students. Washington, DC: Alexander Graham Bell Association for the Deaf.
Seltzer, V. C. (2009). Peer-impact diagnosis and therapy: A handbook for successful practice with adolescents. New York, NY: New York University.
Swineford, L. B., Thurm, A., Baird, G., Wetherby, A. M., & Swedo, S. (2014). Social (pragmatic) communication disorder: A research review of this new DSM-5 diagnostic category. Journal of Neurodevelopmental Disorders, 6, 41.
Timler, G. (2008, November). Social communication: A framework for assessment and intervention. The ASHA Leader, 13, 10–13. Retrieved from http://dx.doi.org/doi:10.1044/leader.FTR1.13152008.10.
Vernon, D. S., Schumaker, J. B., & Deshler, D. D. (1996). The SCORE skills: Social skills for cooperative groups. Lawrence, KS: Edge Enterprises.
Whitehouse, A. J., Watt, H. J., Line, E. A., & Bishop, D. V. (2009a). Adult psychosocial outcomes of children with specific language impairment, pragmatic language impairment and autism. International Journal of Language & Communication Disorders, 44, 511–528.
Whitehouse, A. J., Watt, H. J., Line, E. A., & Bishop, D. V. (2009b). Qualitative aspects of developmental language impairment relate to language and literacy outcome in adulthood. International Journal of Language & Communication Disorders, 44, 489–510.
World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.
Content for ASHA's Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Social Communication Disorder page:
The recommended citation for this Practice Portal page is:
American Speech-Language-Hearing Association (n.d.). Social Communication Disorder. (Practice Portal). Retrieved month, day, year, from www.asha.org/Practice-Portal/Clinical-Topics/Social-Communication-Disorder/.