Speech and Language Therapy
A Guide to Social Communication
Difficulties and Autism
www.talkaboutnorfolk.co.uk
Looking after you locally
Norfolk Community Health and Care NHS Trust A Guide to Social Communication Difficulties and Autism2
The Communication Pyramid...
Communication is more than just talking;
early development of social interaction,
play, listening and attention skills form the
foundations of language. Children usually
develop these skills from the bottom to
the top of the Communication Pyramid,
though all of them continue to develop over
many years. Social interaction is an essential
foundation for all other learning, helping us
make and maintain relationships, give our
attention to other people and what they
may be telling or showing us and engage
meaningfully with others.
If children struggle with social interaction,
one of the foundational skills in the
communication pyramid, then it is likely that
they will struggle with skills further up the
pyramid. See our other guides for how to
support children with their attention and
listening, their understanding of language
and their talking.
Speech sounds
Talking
Understanding
Play
Attention, looking, listening
Social interaction
Norfolk Community Health and Care NHS Trust A Guide to Social Communication Difficulties and Autism3
Social communication skills...
How social communication skills
normally develop
Babies
5 weeks: Are most interested in faces and
‘coo’ in response to their parent
8 weeks: Smile and copy faces
3 months: Take part in simple turn taking
6 months: Recognise facial expressions and
tones of voice; anticipate what will happen
next in familiar games
9 months: Use their gaze to direct parents’
attention; play peek-a-boo; clap their hands
10 months: Point and look to a parent;
follow the gaze of an adult
12 months: Enjoy playing with adults;
wave ‘bye bye’
15 months: Explore how things work and
have some functional play
Toddlers
18 months: Echo adult words and have some
simple pretend play
2 years: Listen with interest to conversation;
join in songs; begin to take turns, with
support; engage in parallel play
2 ½ years: Talk about things they’re
interested in to an adult; are more flexible
in their pretend play
Children
3 years: Understand turn-taking; take part in
make-believe play with peers
4 years: Enjoy jokes; use language to argue;
seek the companionship of other children;
show empathy
5 years: Play cooperatively; show a sense of
humour; understand rules and fair play
Norfolk Community Health and Care NHS Trust A Guide to Social Communication Difficulties and Autism4
Social communication diff iculties...
Why do some children have
these difficulties?
Children may struggle with their social
interaction for any of the following reasons:
When looking at a child with social
communication difficulties, it is tempting to
assume that they have autism. It is essential
to remember that there is a lot of overlap
with autism and other communication
difficulties. When we work with a child we
must not jump to conclusions and try to
‘diagnose’ them. Observation, liaising with
parents and working closely with other
professionals are all essential when working
out a child’s difficulties.
• Autism
• Environmental factors, such as few
opportunities to build relationships
with a responsive adult
• Lack of experience with others
• ADHD (attention deficit hyperactivity disorder)
• Attachment disorder, where the child has
been unable to make a secure attachment
with a caregiver early on in life
• Global developmental delay, where all
of the child’s development is delayed.
These children may be delayed in their
development of social communication
Norfolk Community Health and Care NHS Trust A Guide to Social Communication Difficulties and Autism5
Identifying diff iculties...
Children with social communication
difficulties may struggle with a range
of different skills which would normally
develop naturally through interactions with
other people. For children who have social
communication difficulties without autism,
they may struggle with just a few aspects
of their interaction skills. For children with
autism there is a ‘triad of impairment’, which
means that the child has difficulties with their
social communication, their social interaction
and their social imagination. As well as these
difficulties, children with autism are likely to
have sensory difficulties. These can be quite
mild or very severe.
Sensory difficulties can affect all of the
child’s senses. They may be oversensitive
or undersensitive to:
• sight
• sound
• touch
• taste
• smell
• balance (‘vestibular’)
• body awareness (‘proprioception’)
Over the page you will see some of
the things which any child with social
communication difficulties might find hard.
For a child with autism they will find things
difficult in each area.
Norfolk Community Health and Care NHS Trust A Guide to Social Communication Difficulties and Autism6
Identifying diff iculties...
Social communication difficulties
A child may…
A child may struggle to…
• Consistently interrupt
• Use pedantic or overly formal language
• Understand sarcasm, metaphor, idiom and
double meaning
• Use a different accent
• Make inferences
• Treat peers and adults in the same way
• Follow instructions
• Repeat other’s speech (echolalia)
• Use creative language
• Use pronouns (me, you)
• Understand and use social greetings
Social interaction difficulties
• Be passive or invasive
A child may struggle to…
• Be withdrawn and solitary
• See things from another’s point of view
• Interact on own terms only
• Empathise
• Interact only to have needs met
• Use eye contact
• Point to things to request them, but not to
share interest
• Respond to, but not initiate interactions
Social imagination difficulties
A child may…
A child may struggle to…
• Line things up
• Play ‘let’s pretend’ games
• Show good attention to detail
• Have repetitive play which lacks imagination
• Separate pretence from reality (eg, thinks
Sponge Bob is a real friend)
• Have obsessive behaviours or routines
• Play a role (eg, in drama or PE)
• Have a limited range of interests
• Write or tell creative stories
• Prefer activities with adults rather than playing
• Manage change to his/her usual routine
• Struggle to show creativity with
construction, may follow the manual
• Prefer factual books to fiction
Norfolk Community Health and Care NHS Trust A Guide to Social Communication Difficulties and Autism7
How you can help...
The following advice is useful
for all children with social
communication difficulties.
Use concrete language
Be clear with the words you are using, say
what you mean and mean what you say. Try
to avoid idioms (eg, “pull your socks up”,
“let’s get cracking”).
Use positive directive language
Rather than telling a child what not to do,
tell them what you would like them to do,
remembering to be specific. For example,
rather than saying “stop fidgeting and
annoying Harry”, say “hands still, bottom
on the floor”.
Simplify language, make it specific
Be aware that children may well struggle
with indirect requests – you need to tell
them exactly what you want them to do. For
example, rather than “Can you help me tidy
up?”, say “Put the bricks away”. Rather than
saying “It’s got very cold in here”, say “Leah,
please close the door”.
Extra time for processing
When you give an instruction or ask a
question, be aware that the child may take a
while to process what they have been asked.
Some children need 10 seconds or more – try
pausing and seeing if they can answer with
enough time. By jumping in and repeating
or rephrasing the question, you will find
they have to start processing the question or
instruction all over again.
Get their attention first
This is good practice for all children, but
for children with social communication
difficulties they may not realise that a whole
class instruction applies to them. Try saying
“Everybody listen, Michael I want you to
listen too…”.
Use visual information / gesture as well
as language
Children may have difficulties processing
language. Using visual support (through
pictures, gesture, showing them what
you want them to do) can support their
understanding. Using a visual schedule for
everyday activities can help children learn
how to do them.
Norfolk Community Health and Care NHS Trust A Guide to Social Communication Difficulties and Autism8
How you can help...
Visual resources
Choice boards
Visual Timetables
These are particularly useful for children
who struggle to settle to an activity. You may
need to start with just two choices initially.
These help children understand what is
happening next and that the activity they are
doing has an end.
Visual timetables can be made using real
objects, photos or symbols, depending on
the child’s level of ability. You may need to
simplify them, so that the child is told what
is happening for half the day, rather than
the full day.
Once an activity is finished, the child can be
supported to take the symbol off the timetable
and put it in the ‘finished’ box or pocket.
‘First and Then’ cards
For children who struggle with moving from
one activity to another, these cards can help
them realise that what they are doing will end.
First and then cards are helpful when children
don’t want to do an activity – they can see that
it will finish and what will happen next.
During ‘free time’, choice boards can help
focus a child who would struggle to make a
decision otherwise.
Timers
These are a lovely visual way of showing
a child that an activity has to end soon.
Children who have favourite activities and
struggle to leave them can more easily see
when their time is ‘up’ and that it’s time to
let someone else have a turn or move onto
another activity.
Norfolk Community Health and Care NHS Trust A Guide to Social Communication Difficulties and Autism9
How you can help...
Intensive interaction
For children who are pre-verbal, or have very
little intentional communication, intensive
interaction can be useful. It is easy to set up
- the only equipment needed is a sensitive
person to interact with the child.
The approach works by slowly developing
enjoyable and relaxed interaction sequences
between the interaction partner and the
child. These interaction sequences are
repeated frequently and gradually grow in
duration and complexity.
As this happens, the fundamentals of
communication are gradually rehearsed
and learnt in a free-flowing manner. The
style of the adult is relaxed, non-directive
and responsive. The adult basically allows
the child to lead and direct, with the adult
responding and joining in. The child sets the
content and flow of the activity.
The sessions are frequent, quite intense,
but also fun-filled, playful and enjoyable.
The adult and child should both be at
ease, with enjoyment of the activity as
the main motivation.
A session could be highly dynamic, with
a great deal of vocalisation, sometimes
with fun-filled physical contacts.
A session could also be peaceful, slow
and quiet.
The key points to remember are that the
adult should:
• Create an atmosphere of equality, without
controlling or leading
• Tune in and observe the child’s behaviour
• Consistently respond to the child by joining
in with or mirroring key behaviours
• Use pauses to allow the child to lead
the session
• Give the child their full attention
• Respond to any vocalisations the child makes
Please see the resources list for how to access
further information about this approach.
Norfolk Community Health and Care NHS Trust A Guide to Social Communication Difficulties and Autism10
Resources...
I CAN: www.ican.org.uk
Afasic: www.afasic.org.uk
Intensive interaction:
www.intensiveinteraction.co.uk
The National Autistic Society
www.autism.org.uk
‘Toddler Talk’, ‘Chatting with Children’
from I CAN:
https://shop.ican.org.uk/earlyyears
For further information or advice
For further information, such as how to
refer a child to our Speech and Language
Therapy Service, contact your local office
on 01603 508959.
You can receive help with queries about NHS
services from NCH&C Patient Advice and
Liaison Service (PALS)
If you would like this publication in
large print, Braille, alternative format
or in a different language, please
contact us on 01603 697300 and
we will do our best to help.
Tel: 0800 088 4449
Email: [email protected]
Produced by Norfolk Community Health and Care NHS Trust, September 2014. Review date, September 2015.
www.talkaboutnorfolk.co.uk
Looking after you locally