Social communication disorder is a developmental disorder that can cause significant social and communication challenges. A person with Social Communication Disorder has a hard time following social rules of verbal and nonverbal communication in everyday situations, changing their language for the listener or situation, and following the rules for having a conversation or storytelling.
People with Social Communication Disorder look “normal” but they may communicate, interact, behave, and learn in ways that are different from most other people. Due to these challenges people with this disorder will often avoid social interactions whenever possible.This disorder lasts the entire lifespan but treatment can help teach many of the skills needed for success.
Social Challenges
Most people who have Social Communication Disorder have a hard time with social interactions. By 8 to 10 months of age, many infants who go on to develop Social Communication Disorder are showing some symptoms such as failure to respond to their names, reduced interest in people and delayed babbling. By toddlerhood, many children with Social Communication Disorder have difficulty playing social games, don’t imitate the actions of others and prefer to play alone. They may fail to seek comfort or respond to parents’ displays of anger or affection in typical ways. Research suggests that children with Social Communication Disorder are attached to their parents. However the way they express this attachment can be unusual. To parents, it may seem as if their child is disconnected.
Both children and adults with Social Communication Disorder also tend to have difficulty interpreting what others are thinking and feeling. Subtle social cues such as a smile, wave or grimace may convey little meaning. To a person who misses these social cues, a statement like “Come here!” may mean the same thing, regardless of whether the speaker is smiling and extending her arms for a hug or frowning and planting her fists on her hips. Without the ability to interpret gestures and facial expressions, the social world can seem bewildering.
Many people with Social Communication Disorder have similar difficulty seeing things from another person’s perspective. Most five year olds understand that other people have different thoughts, feelings and goals than they have. A person with Social Communication Disorder may lack such understanding. This, in turn, can interfere with the ability to predict or understand another person’s actions.
Communication Difficulties
By the first birthday, most typically developing toddlers say a word or two, turn and look when they hear their names, point to objects they want or want to show to someone (not all cultures use pointing in this way). When offered something distasteful, they can make clear – by sound or expression – that the answer is “no.”
By contrast, young children with Social Communication Disorder tend to be delayed in babbling and learning to use gestures. When language begins to develop, the person with Social Communication Disorder may use speech in unusual ways. Some have difficulty combining words into meaningful sentences. They may speak only single words or repeat the same phrase over and over. Some go through a stage where they repeat what they hear verbatim (echolalia).
Some mildly affected children exhibit only slight delays in language or even develop precocious language and unusually large vocabularies – yet have difficulty sustaining a conversation. Some children and adults with Social Communication Disorder tend to carry on monologues on a favorite subject, giving others little chance to comment. In other words, the ordinary “give and take” of conversation proves difficult. Some children with Social Communication Disorder with superior language skills tend to speak like little professors, failing to pick up on the “kid-speak” that’s common among their peers.
Another common difficulty is the inability to understand body language, tone of voice and expressions that aren’t meant to be taken literally. For example, even an adult with Social Communication Disorder might interpret a sarcastic “Oh, that’s just great!” as meaning it really is great. Additionally, someone affected by Social Communication Disorder may not exhibit typical body language. Facial expressions, movements and gestures may not match what they are saying. Their tone of voice may fail to reflect their feelings. Some use a high-pitched sing-song or a flat, robot-like voice. This can make it difficult for others to know what they want and need.
What are the diagnostic criteria
The American Psychiatric Association’s DSM-5 criteria for Social Communication Disorder include:
- Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
- Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context
- Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
- Difficulties following rules for conversation and storytellings, such as taking turns in conversation, rephrasing when misunderstood and knowing how to use verbal and nonverbal signals to regulate interactions.
- Difficulties understanding what is not explicitly stated (e.g. making inferences) and nonliteral or ambiguous meanings of language (e.g. idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
What Causes Social Communication Disorder?
While we are not sure what exactly causes a person to have Social Communication Disorder, a family history of Autism Spectrum Disorder, Communication Disorders or a Specific Learning Disorder appear to increase a person’s chance of developing Social Communication Disorder.
Other Challenges
Many people with Social Communication Disorder also have ADHD, behavioral problems and specific learning disorders which make it harder to overcome their social challenges.
Treatment
Treatment focuses on reducing problematic behaviors and building communication and social skills. This can be done through in-home or outpatient therapy. The main goals of treatment will build on current skill levels and everyone will start at a different point based on their natural abilities.
Typically a person will work on appropriate eye contact and sharing emotional experiences with others. Building off those skills it will be important to work on identifying emotions in others and working on taking another person’s perspective. Once a person can successfully understand how another person would feel in any given situation they can understand why social norms are so important and work on things like having personal space, asking appropriate questions, giving compliments and having back and forth conversations. After a person has a solid understanding of the social “rules” they can work on expressing themselves in socially appropriate ways.
What you can do at home
Learning about Social Communication Disorder and getting involved in treatment can go a long way toward helping your child. Additionally, the following tips will make daily home life easier for both you and your child:
- Be understanding. Connecting with a child with Social Communication Disorder can be challenging, but once you understand why they are acting the way they do you can adjust how you think about them. They are not a “bad” “rude” “cold” or “mean” person. They are loving, caring and intelligent. They need some support and understanding to compensate for their social skills at times and that’s okay. Make sure that you never shame or name call a person who has Social Communication Disorder because it may discourage them from wanting to learn new social skills.
- Be consistent. It’s important to be consistent in the way you interact with your child and deal with challenging behaviors and uncomfortable social situations. Try to stay positive and use it as a “teaching moment”.
- Reward good behavior. Positive reinforcement can go a long way with children with Social Communication Disorder, so make an effort to “catch them doing something good.” Praise them when they act appropriately or learn a new skill, being very specific about what behavior they’re being praised for. Also look for other ways to reward them for good behavior, such as giving them a sticker or letting them play with a favorite toy.
- Be a good example. As your child learns to read new social cues they are going to need a role model to practice with. Be aware of how you look at your child, the way you touch him or her, and by the tone of your voice and your body language. Talk about when you feel confused by their communication e.g. “I feel confused because you say you are happy but you are not smiling”.
- Be a detective. It’s only natural to feel upset when you are misunderstood or ignored, and it’s no different for children with Social Communication Disorder. When children with Social Communication Disorder act out, it’s often because you’re not picking up on their (often vague) nonverbal cues. Throwing a tantrum is their way of communicating their frustration and getting your attention.
Being an Advocate
One of the biggest jobs for a family is to be an advocate for the person with Social Communication Disorder. To accomplish this ask yourself:
- What are my child’s strengths?
- What are my child’s weaknesses?
- What behaviors are causing the most problems?
- What important skills is my child lacking?
- How does my child learn best (through seeing, listening, or doing)?
- What does my child enjoy and how can those activities be used in treatment?
Once you have answered these questions determine if your child is getting enough help at school, through therapy and with social interactions. If you feel something is lacking, advocate for a change!
How is Social Communication Disorder Different than Autism?
Autism Spectrum Disorder and Social Communication Disorder are similar developmental disorders that impact social and communication skills. Autism has additional symptoms that relate to repetitive or restrictive behaviors. You can think of Social Communication Disorder as being half the symptoms of Autism.
If a person also has the following symptoms they may need to be tested for Autism:
Repetitive behaviors:
- Hand-flapping, rocking, jumping and twirling, arranging and rearranging objects, and repeating sounds, words, or phrases
- Lining up toys in a specific way instead of using them for pretend play or having household or other objects in a fixed order or place.
- Needing extreme consistency in their environment and daily routine. Slight changes can be extremely stressful and lead to outbursts
Routined behaviors:
- Insistence on sameness
- Inflexible adherence to routines
- Ritualized behaviors ((e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day)
Restrictive interests:
- Extreme interest in unusual things (e.g. fans, vacuum cleaners or toilets)
- Intense knowledge on a topic (e.g. knowing and repeating astonishingly detailed information about Thomas the Tank Engine or astronomy).
- Tremendous interest in numbers, symbols, dates or science topics
Sensory processing difficulties:
- Sensory Processing refers to the way our nervous system receives messages from the senses and responds to those messages. People who have a difficult time processing this sensory information essentially have a neurological traffic jam that prevents certain parts of the brain from receiving the information they need to interpret sensory information correctly. These difficulties lie on a spectrum with some people having severe difficulties while others are more mild.
- These sensory processing problems can impact any of the senses: vision, hearing, smelling, tasting, touch, pressure, vestibular (the sense that tells us when we feel dizzy). Some people have one or two senses impacted, others have difficulties with all of the senses.
- For each sense that is impacted, a person may be under sensitive and seek extra input to interpret the information or they may be overly sensitive and avoid a sense so they are not overwhelmed. For instance, a person may be overly sensitive to sounds and avoid loud noises and under sensitive to touch and seek out rough textures. A third group have motor problems that make holding a pencil or riding a bike seem impossible. Whatever the difficulty, such people are often described as “out-of-sync,”
Autism is most frequently diagnosed by a developmental pediatrician, neurologist, psychiatrist or psychologist. The diagnostic process usually consists of getting a detailed developmental history, some standardized tests and behavioral observations. The results are usually written up into a report and shared with the family.
*Some people who have Social Communication Disorder may be better described as having Autism even if their repetitive or restrictive behaviors only existed when they were younger.*