What are some important friendship skills?

Learning to play with others is both enormously complicated and enormously important. It involves recognizing that you can get clues from other kids about how they are feeling just by listening to how they talk, or by looking at their face and how they hold their bodies. We all understand the importance of taking turns when talking or doing something together. But what about things like knowing to look where your friend is looking? Or realizing what it means when she moves her hand a particular way? And that doesn't even include understanding what your friends are saying and how to respond appropriately.

As kids get older, they learn that other kids may not have the same perspective, and they learn to clarify when others are confused. They recognize that others can suffer and offer sympathy, and they also learn to effectively describe their own feelings and experiences.

This expertise is developed during the natural give and take of play. But what happens to a child who does not seem to be learning these skills?

What is a Social Communication Disorder?

Physicians and professionals use the Diagnostic and Statistical Manual 5th Edition (DSM-5) to guide diagnosis. The latest edition includes Social Communication Disorder (diagnosis code 315.39), which is characterized by challenges in both verbal and nonverbal communication that cannot be explained by otherwise low cognitive abilities. Children may have trouble in the areas of social interaction, pragmatics and social cognition. Teachers and parents may observe children who experience difficulty joining a group, initiating and sustaining a conversation, verbally negotiating with their peers and/or misinterpreting social cues. The impact of this disorder may be seen in social relationships and in school achievement.

Social Communication Disorder can be a distinct diagnosis, or it may occur within the context of another condition (e.g., autism, ADHD, language learning disorder, learning disability, emotional disorder, hearing loss, etc.). While previous editions of the DSM described diagnoses that included the symptoms now listed as Social Communication Disorder, the clinical community felt that the Social Communication Disorder diagnosis was needed to ensure that the unique needs of individuals with only that disorder were met.

When Should I Be Concerned?

Children develop social skills at varying rates. Described below are typical behaviors for English-speaking American children. Some of these behaviors may be influenced by the child's cultural background, which should be considered when defining typical behavior.

Infant/toddler

  • Enjoys games such as peek-a-boo

  • Exhibits good eye contact

  • Uses gestures, vocalizations or words to gain the attention of others

  • Coordinates with another person when attending to an object or event (joint attention)

Preschool

  • Interacts with children at school

  • Participates in circle time and group activities

  • Demonstrates pretend play skills

  • Shares and expresses emotions and thoughts

  • Adjusts approach when not understood

School Age: Elementary

  • Understands jokes, humor, idioms

  • Has conversations with peers where everyone contributes

  • Understands the perspectives of others

  • Accurately interprets body language and facial expressions

  • Speaks differently with peers than with adults

For a comprehensive list of Social Communication Benchmarks see the section on Social Communication Disorders on The American Speech Language Association's website, asha.org.

Who can diagnose a Social Communication Disorder?

The diagnosis of a social communication disorder may be made by physicians, psychologists, developmental pediatricians and/or a mental health professional. Speech Language Pathologists (SLPs) play a central role in both the assessment process and in the treatment of children with social communication disorders. In the public school setting, a child may be referred to a Speech Language Pathologist (SLP) to assess his/her language using standardized testing. Parents may also consult a SLP in private practice and/or at a local hospital to evaluate their child.

Is there a test to determine if my child has this problem?

While formal tests are available to assess a child's social understanding, it's important to remember that children may demonstrate age appropriate skills on standardized measures, but still demonstrate social challenges on the playground and at school. In real life, children are expected to integrate information and respond in seconds. In a formal testing situation the demands are significantly less dynamic. For this reason, an observation of the child in his/her classroom, as well as with peers, will provide additional information regarding the child's ability to interact and respond to both spoken language and the ability to read nonverbal cues, such as body language. Parent and educator input is also critical to the assessment process, which needs to be both culturally and linguistically relevant.

How can I help my child who has social communication challenges at home?

The home is a wonderful place to teach these skills. It's a safe place to practice and learn, and once mastered at home, your child can take these skills into the community to practice with their friends. While there are far too many skills to list here, these are four strategies that can help your child right away.

  1. Slow down . Kids' brains are constantly developing new connections as they learn new skills. When they are first exposed to something, it can take them a long time to figure out what to do. Don't be tempted to solve the problem for them; slow the interaction down so they have time to decide how they want to respond. Practice saying nothing for a full minute to give them time to respond.

  2. Use "I … " statements instead of questions . When kids have a hard time with the typical back and forth of natural conversations, their parents sometimes resort to peppering them with questions. Resist this impulse. Instead, try making an observation about your world ("Boy, I sure am cold!" or "I love taking walks with you"). It's OK if your child doesn't respond at first. This kind of experience-sharing language is fundamental to developing conversational skills.

  3. Communicate without words. Try imagining that your mouth is taped shut, and communicate with your child using exaggerated facial expressions, gestures and vocalizations without words (Hmmmm? Mmmm!). Let your child be a social detective; see if they can figure out what you are trying to communicate.

  4. Use storytime to teach social skills . When looking at picture books or reading with your children, focus on helping them to predict what will happen. Help them to develop empathy by encouraging them to take the perspectives of others and understand the characters' emotional states.

What professionals can help my child?

Children exhibiting social challenges may benefit from participating in social groups led by Speech Language Pathologists and/or therapists (psychologists, social workers, counselors). Evidence-based approaches such as Relationship Development Intervention and Social Thinking ® can help your children learn to navigate the social world.


Susan M. Abrams, M.A., CCC-SLP, founder and director of the Center For Communication & Learning, LLC, has developed innovative programs focused on improving social cognition in children and teens. She has trained with Michelle Garcia Winner and has presented at the Social Thinking Providers Conference in California. Contact her at ccl-md.com.

Sarah Wayland, Ph.D. is a Special Needs Care Navigator and a Certified Relationship Development Intervention (RDI) Consultant at Guiding Exceptional Parents, LLC, which she founded. You can learn more about her at guidingexceptionalparents.com.