Among the vast variety of speech-language deficits that SLPs treat (discussed in this previous post ) are social/pragmatic communication difficulties. Sometimes a child’s challenges with communicating in social situations arise from speech-language deficits such as articulation errors or a stutter which, in turn, may reduce a child’s self-confidence and cause them to refrain from social experiences among other kids for fear of being made fun of. Suddenly these children are adolescents in more socially demanding and peer-scrutinizing scenarios, and struggle to know how to initiate conversation, how to respond and how to end discussions.
Children with autism spectrum disorder (ASD) have particular difficulty with knowing how to communicate with adults and peers. While every child with ASD presents with an individual and unique set of characteristics, social/pragmatic communication difficulties are present in some manner and to some degree. Children may even present with Social (Pragmatic) Communication Disorder (SCD), a deficit that is characterized by communication difficulties that limit their ability to socialize and makes it very hard for them to make friends, but without the presentation of restricted or repetitive behaviors that are seen in children with ASD.
The following are common features of social communication difficulties, particularly for those with SCD or ASD:
- difficulty making and keeping friends
- difficulty initiating conversation
- difficulty with turn-taking
- lack of interest in communicative partners
- making irrelevant and/or inappropriate comments
- not responding in conversation
- dominating conversation
- difficulty understanding abstract/non-literal information (i.e., idioms)
- difficulty ending a conversation
Of course, social skills such as these come more naturally to some individuals than others at any age and in any level of development- it’s obvious in high school cafeterias or cocktail parties alike, where minglers and wallflowers are easy to spot. However, when social language difficulties have a negative impact on a child’s activities of daily living and cause social isolation, apathy and/or depression, skilled intervention may be deemed necessary.
Techniques to Improve Children’s Social Skills
I frequently discuss the importance of the following when targeting social/pragmatic language difficulties with my clients:
- Ask questions
- Make comments
- Show interest
I often reference a see-saw for the child to visualize, using a picture cue of a see-saw and/or making a rocking motion with my hands and body during conversation as a visual for the child to be cued when they may not be employing any of the above strategies. It stresses the importance of taking turns (i.e., asking questions and making comments) and further cues them visually to use their eye contact to pay attention to their communicative partner (i.e., me). When children do not respond to social comments or responses, I may gesture towards a picture and/or written word cue (i.e., a picture of a question mark and/or a label indicating “Ask Questions!”) and prompt them to request additional information in order to keep the conversation going.
I also use a visual of a car driving “off path” when I notice another common trait of social difficulties: getting off topic. This technique often works well in increasing the child’s awareness of topic maintenance by providing the child with a concrete reference that is applicable to their real-world knowledge, especially considering that non-literal information is typically difficult for children with social challenges to understand. It also demonstrates that although everyone can get off topic sometimes, they have the power to redirect themselves and steer back on course.
Role-play scenarios are also an efficient strategy to use. It allows the child to use and practice learned social-language skills while also engaging executive functioning capabilities such as flexible thinking and problem-solving skills. In addition, it provides a reference for the child to recall if they are ever in a situation that mirrors a role-play exchange that they previously had.
The Importance of One-to-One Practice to Ensure Successful Carryover
I believe that it is extremely helpful to teach children social/pragmatic language skills explicitly and in a one-to-one setting before exposing them to other peers to utilize these skills. By then, a clinical goal should be for the child to require faded, minimal verbal and/or visual cues to rely on during conversations with other same-aged children so that their responses and behaviors seem as natural as possible in larger group settings.
One of the main difficulties in working with children with social communication difficulties is in the appropriate carryover of learned skills. Social skills generally come naturally to individuals, so to teach them in such an explicit and structured manner (which is needed for these children!) makes it all the more difficult for these skills to come across as natural when applied in a real-world setting. Children may initially demonstrate awkwardness and uncertainty. As with any therapeutic approach however, with frequency and consistency, social skills CAN be taught and CAN be appropriately carried out by children. It’s disheartening when children can’t make friends- let therapy help make it easier!