Social Communication Disorder: Knowing Words and Gestures, But Not How to Use Them

Social communication disorder makes it difficult for preschoolers to chitchat

Social communication disorder (SCD): it’s what we call it when children struggle with subtle nuances of communication. Children with social communication disorder may not be clear about when to respond during conversation, and when it might be better to keep quiet and listen. A child with SCD may not have a good sense of private space: how close or far to stand next to a conversation partner. SCD may also be called pragmatic language impairment or semantic pragmatic disorder. SCD is a relative newcomer to the Diagnostic and Statistical Manual of Mental Disorders (DSM), so some specialists may not even know it as a separate disorder distinct from autism.

Social communication disorder affects a child in three different areas: social interactions, social understanding, and pragmatics. Pragmatics means using language in its proper context. A child with SCD may not understand, for instance, that we use different language and tone when speaking to a baby than when we speak to a teacher or an elderly grandparent. A child with social communication disorder might approach a grandparent and say, “Hello, Cutie-Pie. Does oo want a bottle?”

Child whispers in the ear of shocked seated elderly woman

All children want to make friends and fit in with their peers. Some children find it easy to make friends while others find it difficult. It can take time and practice to learn how to make social conversation and get along with others. If making friends with others is an ongoing challenge, however, it may be a sign of social communication disorder. The symptoms of SCD tend to appear in early childhood, for instance in preschool.

Social Communication Disorder: Symptoms

Symptoms of SCD include:

  • Issues with verbal and nonverbal communication during social interactions
  • Difficulties in adapting to the communication style of a conversation partner
  • Problems in understanding and relating to the context of a partner’s conversation
  • Difficulty in understanding things that are implied rather than explicitly stated
  • Difficulty relating stories
  • An inability to master basic social rules
  • Severe anxiety that causes the child to avoid social situations

Social Communication Disorder: Genetic Factor?

Researchers are still learning about social communication disorder, so don’t as yet have firm answers about what causes the disorder. Some studies suggest that children with social communication disorder tend to have family members with autism spectrum disorder, known communication disorders, or learning disabilities. This would suggest there may be a genetic factor in developing SCD.

Children with social communication disorder can have other disorders at the same time. They may, for example, have other speech disorders or ADHD.

Social Communication Disorder: Diagnosis

A diagnosis of social communications disorder is diagnosed by observing a child’s difficulties in learning verbal and nonverbal communication skills. During an evaluation, a speech and language professional will see if your child can:

  • Answer questions
  • Use gestures such as waving and pointing in appropriate ways
  • Take turns during play and conversations
  • Appropriately express and describe emotions
  • Stay on topic
  • Adapt language and tone to the situation or conversation partner
  • Ask appropriate questions and respond with relevant answers during conversation
  • Use different words and terms for the same thing, for instance hi, hello, hiya, hey.
  • Make friends and keep them

Until recently, many believed that social communication disorder was a facet of autism spectrum disorder (ASD). Ruling out autism is, in fact, part of the process of diagnosing social communication disorder. This is because there is some overlap of symptoms between the two disorders.

Social communication disorder, however, lacks the restrictive and repetitive behaviors (RRBs), interests, and activities of autism. RRBs are different from the repetition you might hear from a child with social communication disorder. Ask a child with SCD if he hung up his hat, and the child may give you a blank look and repeat, “Hat.”

This is because the child doesn’t understand that a question has been asked. The child only understand that s/he is meant to say something, but doesn’t understand what that something might be-only that it’s something about a hat.

Children with autism, on the other hand, may feel a need to eat the same foods each day; to line up their crayons in a specific order; play the same game with the same toy car daily; or engage in the same type of conversation on a specific topic. In social communication disorder, these behaviors are absent.

In the same way that SCD seems similar to autism, it is also sometimes confused with ADHD. Confusing the picture further, children with SCD may also have ADHD. But ADHD comes with attention problems. SCD does not.

If you ask the child with a social communication disorder which he prefers: chocolate or peanut butter, he might say peanut butter, even if he really prefers chocolate. He does so because he is focused on the end. He didn’t process the rest of what you said. But it’s not that the child lost focus as with ADHD. It’s that the child with SCD may think that only the end of a sentence is important.

Chocolate being dipped into peanut butter

Social communication disorder may be suspected when a child has no trouble with words, speech, or gestures but struggles to use and apply them in social situations. If you tell the child to wave, he will do so. But he may not understand that waving is connected to and indicated when greeting and parting from others.

Children with SCD may also be slow to reach language milestones or show little interest in socializing with others. SCD can make it difficult for a child to understand stories and conversations, and to bend to various social situations. These issues are very different from the general issues that come with, for instance, intellectual disabilities. Social communication disorder affects understanding of every type of communication: verbal, nonverbal, spoken, written, gestures, and sign language, too.

Social Communication Disorder: Treatment

While there is no cure for social communication disorder, there are treatments. Speech and language pathologists are trained to recognize and design treatment for communication problems like SCD. Teachers and speech-language pathologists often work together to help children better their communication skills. For those who find speech difficult, there are alternative means of communication. This can mean something as simple as holding up a picture, or as technologically complicated as using a smartphone to type out a sentence.

Preschooler with smartphone

Therapy for children with social communication disorder may be given in the child’s school setting, or at a local clinic. Schools employ speech-language pathologists who can offer therapy and coordinate these efforts with the child’s teacher. Some clinics offer therapy to children with SCD as part of early intervention programs or special education initiatives. Hospitals and medical centers may also have therapists on hand to help you find and implement a strategy that works for your child. The idea is to figure out a treatment plan that gives such children a plan: a reliable method to get them through challenges and difficult social situations.

Therapy for social communication disorder is a must, as SCD doesn’t improve without professional assistance.

A therapeutic plan for a child with SCD may include:

  • Social skills training that helps children acquire the skills to interact with others in social settings
  • Cognitive behavioral therapy (CBT) to minimize anxiety and deal with strong emotions
  • Medication for coexisting conditions that may worsen the child’s social communication disorder, for instance ADHD.
  • Speech and language therapy
  • Support and training for parents

SCD Action Plan

If you suspect your child is having difficulty with social skills, you’ll want to get to the bottom of things. Here are three simple steps for getting started:

  1. Watch your child and note his or her behavior. Write your observations in a notebook.
  2. Share your observations with your child’s teacher and compare notes. The teacher can help by making sure that classroom instructions are clear and by pairing your child with children who share similar interests.
  3. Ask the teacher about having your child undergo an educational evaluation. If the school agrees this is indicated, the evaluation will be free. The results of the evaluation may mean your child receives supports and services, all absolutely free.

SCD: Specialists and What They Can Do

Social communication disorder can only be diagnosed by a speech therapist. But it’s possible other specialists can rule out SCD. It helps to know what the various specialists can and cannot do for your child. It’s important to note that if you go the private route, using private specialists, you’ll have to pay for any tests administered. Here’s the breakdown of the specialists you might visit for a child who may have SCD, keeping in mind that only you know your financial and community resources and what you are able to afford:

Pediatrician: A pediatrician can help rule out medical issues as cause for your child’s behavior and advise you on your next step. Some pediatricians are also able to test for ADHD. A pediatrician can sometimes offer a referral for further testing or therapy with a speech therapist.

Learning specialist: A learning specialist can test for learning and attention issues. These are the same tests your child would receive in an evaluation provided by the school. The difference is that you would have to pay. In the case where the school decides not to test and you still feel there is a problem, you might want to go this route and hire a learning specialist to administer tests. If you don’t feel that what the school offers is adequate, and you can afford to go private, a learning specialist may be a good option.

Psychologist: A psychologist is trained in both learning disabilities and attention issues and can rule out or diagnose a variety of learning and attention difficulties. The psychologist can also check for nonverbal learning disorder and for ADHD. While the learning specialist’s focus is specific to learning disabilities, a psychologist has a broader framework. Your child may not need that broader framework.

Speech therapist: The speech therapist is the specialist who is most qualified to diagnose social communication disorder. This is also the professional best equipped to prepare a treatment plan for your child with SCD.

SCD: What You Can Do At Home

Parents can do a lot to help children develop their social skills, feel better about themselves, and can also offer the support children need to keep trying. Here are some practical ways you can help your child:

Read and learn all you can: Read articles online, take books out of your local library, or buy books on children and social communication issues. Knowledge is power. So is understanding your child’s plight.

Watch for and note patterns: Keep a notebook handy and jot down your observations. Does your child always have difficulties in the same social situations? Do you see a pattern in your child’s behavior? What you observe can help the professionals help your child.

Practice social situations at home: Role-playing can go a long way toward training your child in appropriate behavior at parties, playdates, or just plain holiday gatherings with the family. Take turns starting and ending conversations, or greeting friends, neighbors, and relatives. Home is a safe place to try these behaviors out. It’s also fun to play-act, a great way for parent and child to bond!

Play matchmaker between your child and other possible friends: Your child has the best chance of effective communication with kids who share his or her interests. Does your child enjoy dance, art, or sports? Enroll your child in an afterschool class in whatever it is your child likes to do. There your child will be sure to meet other children who like the same things. It’s a good basis for friendship.

Try social skills building classes: Some schools offer free classes in social skills. You might be able to find a private class offered by those with training in learning difficulties who also run programs for children with social challenges.

Experiment with strategies: Don’t be afraid to try out new ways of helping your child. Seek out role-playing and other games on Pinterest, websites, and blogs.

Talk to other parents: Though every child with SCD will have unique challenges, it can help just to speak with other parents going through similar difficulties with their children. It’s comforting to network and share strategies. It’s great to have a support system and get advice on specialists or new strategies to try.

While social communication skills don’t ever go away for good, children with SCD can learn strategies to help them socialize and get along with others. As your child improves his social skills, this will give him the impetus to keep on aiming for better. And as long as your child is encouraged to keep on keeping on, things can only look up!

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Author: Varda Epstein

Varda Meyers Epstein is a mother of 12, communications writer, and education blogger at the Kars4Kids blog.

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