Social Language/Pragmatics

While a reciprocal back and forth dialogue may feel natural, there are actually many “social rules” that happen during a successful conversational exchange. 

• Each participant must wait patiently for their turn to speak, initiate and maintain appropriate eye contact, while also maintaining the topic at hand and being able to go with the flow of topic changes. 
• You must be able to respond to questions when asked, and you also must be able to use and interpret nonverbal communication/social cues such as pointing, body language and gestures. 

We have all had conversations with adults that felt awkward, and didn’t flow properly. And we all know adults who have difficulty maintaining a topic, participating in appropriate conversational turn taking or interpret social cues. Oftentimes this is a consequence of social/pragmatic language that was disordered in childhood and not resolved. 

For children with a social communication disorder, using verbal and nonverbal language for social purposes can be a real struggle. This can make holding a conversation difficult, and affect how they form social and maintain social relationships.

While social communication disorders often happen early in a child’s development, the signs are not always obvious. However, as a child gets older and is placed in a variety of more complex social environments, like playing with other children on a playground or working in groups at school, the deficits can become much more apparent.

What is a social communication disorder?

Let’s start with what a social communication disorder is not. People who struggle with social communication do not have a problem with their articulation or speech. They also do not have difficulty understanding language, like grammar or the meaning of words. People with a social communication disorder are not any less intelligent than their peers.

Children and adults with a social communication disorder (also referred to as pragmatic language impairment) struggle to use communication appropriately in social situations. They exhibit difficulty with pragmatic language, which is how meaning is interpreted from verbal and nonverbal interactions. This can make it challenging to follow the unspoken social “rules” of a spoken conversation. 

For example, people with a social communication disorder may:

• Not use greetings
• Not use eye contact 
• Not understand natural turn taking in a conversational exchange and instead may monopolize conversations
• Routinely interrupt the speaker
• Fail to change the style of their communication to match different social contexts--for example, a formal situation versus a casual one

How common are social communication disorders?

There is limited data available on the prevalence of social communication disorders. This is because “social communication disorder” was only recently named an official diagnosis, in 2013, with specific definitions and diagnostic criteria. Before 2013, it was often referred to as a “pragmatic language impairment”.

Some studies suggest that pragmatic language impairment occurred in 7% to 8% of children. Boys were more likely than girls to be diagnosed.

What social communication milestones are expected by age?

According to the American Speech-Language-Hearing Association (ASHA), below are some common social communication milestones your child should be meeting depending on their age. It’s important to note that there are cultural and linguistic factors that can impact the relevance of these milestones.

Milestones for 0-12 months

• Prefers looking at human faces, makes eye contact and follows your gaze, listens when you speak
• Can tell the difference between tones of voice (such as happy, sad, angry)
• Participates in vocal turn-taking (you speak, then they make a sound)
• Demonstrates joint attention (your child focuses their attention on the same person or object as you)
• Uses gestures to make simple requests, like asking for food
• Can play simple games like peek-a-boo

Milestones for 12-18 months

• Makes requests by pointing or vocalizing
• Says ritual words, like “hi” and “bye”
• Is beginning to replace gestures with verbal language
• Responds to speech with eye contact
• Can demonstrate emotions like sympathy or empathy
• Uses inflection in their voice (for example, changes the pitch, volume, or tone of their voice depending on the situation)

Milestones for 18-24 months

• Begins to use single words or short phrases to make a request, show possession, express a problem, or gain attention
• Starts using different pronouns, like "I," "me," "you," "my," and "mine"
• Shows signs that they’re able to stay on topic when communicating
• Participates in verbal turn-taking (you speak, then they speak)

Milestones for 24-36 months

• Engages in short conversations
• Introduces and changes topics when holding a dialogue
• Relates the topic of conversation to their own experiences and provides details
• Asks for clarification if they don’t understand something
• Use polite terms with limited interruptions

Milestones for 3-4 years

• Able to hold a longer conversation, as well as stop a conversation
• Uses filler words, like “yeah” or “okay” to acknowledge the speaker
• Has begun using more imaginative language, like describing a fantasy, telling a joke, playfully teasing, etc.
• Can tell a simple story or narrative from start to finish
• Simplifies their language when talking to a very young child

Milestones for 4-5 years

• Uses deictic terms (such as "this," "that," "here," "there")
• Uses twice as many utterances as when they were 3 years old to discuss their emotions and feelings
• Tells stories that have a sequence of events but no central character or theme
• Able to rapidly shift topics during a conversation

Milestones for school-aged children

• Can read body language and facial expressions to predict someone’s feelings or behaviors
• Can empathize with another person and change their language (example: being comforting when someone is sad)
• Shows improved conversational skills, like staying on topic or increasing the number of back-and-forths during an exchange
• Uses more complex forms of language, such as persuasion or advancing their opinions

What are the symptoms of a social communication disorder?

Social communication skills will vary by age and expected stage of development. However, there are some key themes that caregivers should closely monitor to determine whether their child is on track. These include:

• Using appropriate communication when socializing: Greeting others and smiling, maintaining eye contact, pointing to draw someone’s attention to an object, starting or entering a conversation, responding when asked a question
• Varying communication styles depending on setting and partner: Speaking differently to children and adults, understanding the conventions of formal vs. casual situations, such as a classroom or a birthday party
• Following social rules: Not interrupting, engaging in the normal back-and-forth of a conversation, staying on topic
• Understanding verbal vs. nonverbal cues: Interpreting signals of conversational partners (for example, if someone’s eyes are wandering, they’re bored; if someone’s eyes are welling up, they’re sad)
• Understanding ambiguous or figurative language: Ability to comprehend information when it's not clearly stated stated (inferring); understanding sarcasm or figures of speech

What causes social communication disorder?

There is no definitive cause of social communication disorders. However, studies have shown that a child may be at a higher risk a social communication disorder if there is a family history of autism, learning disabilities, or other types of communication disorders. In addition, social communication disorders often present alongside other types of disorders, such as delayed speech, ADHD, or an intellectual development disorder.

How is a social communication disorder diagnosed?

The first signs of a social communication disorder can show up early in a child’s development. For example, young kids may have delays in reaching age-appropriate milestones for social communication. They may not use sounds or gestures for greetings, and they may have little interest in interacting socially with others, including caregivers.

However, in order to diagnose a social communication disorder, children must be relatively high functioning and have expressive communication. For these reasons, diagnosis often happens around 4 or 5 years of age, when a child is verbal.

Evaluation and diagnosis is performed by a Speech Language Pathologist (SLP), also known as a speech therapist. Speech Pathologists are specialists in all areas of communication use a variety of standardized and informal diagnostic tools and tests to determine if a diagnosis of social communication disorder is appropriate. 

During an evaluation, a speech therapist may:

• Work to better understand your child’s medical and behavioral history
• Perform an assortment of diagnostic tests
• Interact and observe your child in a variety of situations
• Use parent and teacher questionnaires that help measure aspects of your child's language skills

During the evaluation, your speech therapist will work to “rule out” other medical or neurological conditions, such as autism spectrum disorder or other intellectual development disorders.

How is a social communication disorder treated?

Speech language therapy is the main treatment for social communication disorders. Because every child is different, your speech therapist will build a personalized care plan that is tailored to your child’s specific social communication strengths and weaknesses. They’ll use a variety of treatment methods to improve functional communication within a variety of social settings.

Some key skills focused on during therapy include:

• Social pragmatics: Helping children use appropriate greetings and understand the rules of dialogue
• Conversational skills: Practicing back-and-forth exchanges and asking/answering questions
• Nonverbal communication: Interpreting nonverbal social cues to assess someone’s mood or feelings, and learn appropriate social behavior 

How can parents help children improve their social communication?

It’s essential that parents and caregivers play an active role in reinforcing social communication skills at home. After all, no one spends more time with your child than you. Even if you’re working with a speech therapist once or more a week, your child will make much more progress if you’re practicing and using these skills in daily interactions at home. Your speech therapist should be a coach to you as much as they are a teacher to your child. They should be helping you understand not just “what” your child is working on, but “why” it’s important. They should also provide weekly educational tips and techniques that you can use at home.

Below are some ideas that can be adapted to your child’s age to help them use language appropriately in social situations. If you’re working with a speech therapist, make sure to ask them for more suggestions.

• Practice greetings: Practice greeting before starting and ending a conversation. This can include saying “hi” and “bye,” waving, and extending your hand for a handshake.
• Read together regularly: When reading with your child, ask open-ended questions to encourage discussion. Examples can include, “Why is the character sad?” or “What do you think will happen next?”
• Talk about the characters: Similarly, when reading a book or watching a movie, stop to ask how the characters are feeling and why. Discuss what other people in your child’s life, like their friends or classmates, would feel in a similar situation.
• Take turns: Knowing when it’s your turn to speak, and taking turns, is an important part of having a conversation. Practice other turn-taking activities with your child, like rolling a ball back and forth, repeating words, or playing a board game.
• Role-play: Have your child pretend to have the same conversation with different people. For example, how would your child explain their favorite toy to a baby, or a teacher, or their grandparents? Discuss what’s appropriate to say and not say depending on each listener and situation.
• Plan play dates: Have your child participate in a planned, structured activity while socializing with a friend. Start small, with only one friend, and over time add more kiddos to the mix.
• Tell stories: Tell your child a story but leave out important details. See if your child can identify and ask you for more information to increase their understanding. Alternatively, have your child tell you a story. Ask questions throughout for more clarification.
• Try nonverbal cues: Offer your child a series of nonverbal cues, and have them tell you what they mean. For example, you could smile, frown, cross your arms, roll your eyes, or look away.

If you suspect a Social Language Disorder, schedule an assessment today