Social Communication Disorder

Social communication disorder is different from autism spectrum disorder. Both disorders have some overlapping characteristics, the most common ones being difficulties with interaction and social communication skills. However, autism has an additional defining and significant characteristic related to restricted and/or repetitive behaviors and interests (ex. repetitive body movements or actions, ritualistic behavior, particular sensory sensitivities). 

Reaching a final diagnosis of Social communication disorder can be tricky, because of the overlapping symptoms and behavior with Autism Disorder. This is why, in case of doubt,  it is recommended to have a thorough multidisciplinary evaluation involving a Psychiatric (MD), a child Neurologist and a Speech language therapist, to be able to rule out Autism, before confirming the diagnosis of social communication disorder. 

Children with social communication disorder have the disorder from early developmental stages. Parents might have difficulties noticing the signs at a younger age but as your child gets older at around 3 to 4 years of age signs become more obvious as he/she has to deal with more complex  social situations and rules in different settings (group activities,  school, daycare, etc.). 

Early signs of a social communication disorder may include: 

As soon as you notice that your child is consistently challenged in his social and communication skills and you start being concerned about it, it is recommended to consult a trusted health professional. You can start by consulting with either your pediatrician, or a child psychiatrist, or a speech therapist in order to rule out potential neurological or medical problems such as hearing loss. The first professional you consult will direct you towards the others that will need to see your child. As a matter of fact, the diagnosis of a social communication disorder is based on your child’s shown symptoms, therefore the opinion of a team of specialists collaborating is necessary to reach a comprehensive diagnosis. 

If you choose to consult first with a Speech language therapist, a formal speech and language therapy assessment will be done. The assessment takes into account your child’s age, expected stage of development and linguistic/cultural background. The speech therapy assessment will be based on interviews, observations, checklists and questionnaires completed by parents, teachers or other caregivers as well as on formal/quantitative assessment tools. 

Following the assessment, the speech and language therapist provides a diagnosis, a description of the condition and its severity, recommendations for interventions, and a tailored treatment plan along with referrals to other specialists if /when necessary.

The cause of social communication disorder is not known. However, many environmental factors can affect the development of a child’s communication and language skills, one of them being excessive screen time. In a natural environment, children usually learn from playing and having social experiences and interactions. The intensive use of video games, computers, tablets, smart phones, and televisions can decrease the amount of social interaction leading to several negative outcomes in the early development of children, such as attention problems, poor academic performance, along with sleep and eating disorders. 

Social communication disorder occurs in about 7.5% of children and affects more boys than girls by a ratio of 2.6/1. 

Like any other skill, acquiring social abilities is done through teaching them but most importantly practicing them.  The child will be taught strategies needed to acquire social skills, however they need to use and re-use those strategies in order to develop them well and maintain their skills. 

As children grow older, the social situations and the rules that run them tend to change and become more complex. So the strategies and skills learned at an earlier and simpler stage are not enough. They need to learn new and different ones. Each development stage is addressed differently by the speech therapist. 

Treating social communication disorder is therefore a lifelong process that will require a regular commitment to the treatment. On average, and for each developmental stage, a period of 3 to 6 months of therapy is needed before being able to see palpable results in the child’s behavior. It is also important to note that children who receive an early therapy intervention will have the best results.

Children with social communication disorder find it more difficult to socialize and make friends, mainly because of the 3 below factors. Fortunately, a well adapted speech therapy can help in all 3 aspects.

They are often more willing to interact with adults because adults can interpret their intentions. This frequent communication with adults leads to the reduction in the children’s opportunities (or ability) to have successful interactions with their peers.  

To have successful interactions with his peers, a child has to acquire the ability to deal with and face conflict in a healthy way. This will allow him to be accepted by his peers and to have successful interactions with them. 

Children with social communication disorder often use inappropriate ways to deal with conflicts such as aggression or avoidance which can lead to rejection from others and can escalate tensions between children. 

Understanding social rules and using appropriate conversational strategies enable your child to make friends. Children with communication disorders have poorly developed conversational skills which makes it difficult for them to make friends. They are unable to interact effectively through conversations. This will hinder them from knowing how to properly approach and interact with their peers in many contexts/situations, such as: initiating a new game, apologizing when needed, asking to join a group, asking for help, understanding jokes and playfulness, etc. 

Children usually express their needs by using what is referred to as “appropriate” social and conversational strategies, such as: holding eye contact, pointing, requesting an object, listening, initiating and maintaining a conversation, etc. 

Children with social communication disorder have poor conversational strategies, therefore they find it difficult to initiate a conversation and deal with intentions. This affects their ability to express their need, to properly seek help, to talk about a conflictual situation and to regulate their behavior. Faced with those communication limitations, children may become frustrated and angry.

For example, young children can often use non appropriate ways to express their needs such as tantrums, crying, shouting, etc. 

Children with Social Communication Disorder need to be explicitly taught the skills required to be able to engage with others in appropriate interactions and in their natural environment. Speech and language therapy focuses on improving verbal and non-verbal communication, as well as social and play skills. 

The therapy sessions will provide your child the opportunity to experiment with different communication settings. It involves a variety of partners, other children with the same disorder, parents, siblings, etc…, and aims to reproduce interactions of real-life  situations.  This will be done through activities such as interactive play, communication games and activities, conversations, interactive book reading, etc. 

Moreover, Speech and language therapists collaborate with teachers and parents to support the child’s social communication skills in the classroom and at home.  

Speech therapists can also develop visual supports as well as augmentative and alternative communication means for individuals who are non-verbal or minimally verbal to help them communicate efficiently. 

Speech and language therapy is more effective when the child’s family is actively engaged in the treatment process. Parents are therefore encouraged to work closely with the child’s speech therapist to reinforce the new skills he/she’s learning in therapy. Your child’s speech therapist might ask you to attend some therapy sessions when needed, however she will certainly ask you or your child’s main caregiver to attend specific coaching sessions or meetings for feedback, guidance and support. 

Attending coaching sessions and observing a therapy session with the speech therapist will provide you with new techniques of communicating with your child. It can also teach you new ways of responding to difficult or problematic behaviors. 

Caregivers play an important role in supporting a child’s communication needs at home and during daily activities. 

It is very important to interact with your child and any time can be a good time.

Below are a few tips to help boosting your child’s communication skills :

Moreover, spontaneous, directed and daily activities will encourage your child’s social communication skills. Below are a few examples of what can be done:

Enrolling your child in group activities such as sports, arts, and scouting can be very helpful to practice acquired social and communication skills with peers, in a group setting. If the group isn’t specifically for children with communication disorders, you could talk to the people in charge of the activity about your child’s needs in order to make the environment more comfortable. Below are some strategies to help your child  integrate with other peers: 

Speech therapy sessions can also progress from one-on-one sessions with the speech therapist to communication and language groups that promote using and generalizing new social skills with other children in a more challenging context. Groups are usually chosen based on your child’s age and needs. These groups can offer children and teenagers an interesting way to learn and practice social skills with peers, in a more naturalistic environment.