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When Conversation is Challenging for Children


When we engage in conversation, we follow many unspoken rules, such as turn-taking, personal space and appropriate tone and volume. Most children learn these rules fairly naturally or with a bit of prompting. But for some, understanding and following the rules of social communication is extremely challenging.

Social communication disorder1 is a recently defined condition in which a child has difficulty understanding how to interact and communicate with others.

Social communication disorder involves:

  • Trouble using spoken language in socially appropriate ways.
  • Trouble with the give-and-take of conversation, monopolizing conversations, frequently interrupting or hesitating to talk at all.
  • Difficulty changing communication style to match the setting (for example, a classroom versus a playground) or the listener (a child versus an adult).
  • Trouble understanding and using non-verbal signals.
  • Difficulty understanding humor, figures of speech, inferred meanings, or words that have different meanings in different circumstances.

Children with social communication disorder may say inappropriate or unrelated things during conversation and their challenges may lead to problems making and keeping friends. However, they generally don’t have trouble with the mechanics of speaking—they can pronounce and understand words and create sentences.

Communications problems may be noticeable in some children by age 4 or 5, but for others problems may not become obvious until later when communication becomes more complex. Many of the characteristics of social communication disorder are also seen in people with autism, however, autism also involves repetitive behaviors and fixed interests.2

Getting Help

A variety of health professionals can be involved in the diagnosis and treatment of social communication disorders, including psychiatrists, psychologists, developmental pediatricians, e and speech language pathologists (speech therapists). Evaluation will typically involve structured assessment, gathering input from parents, teachers and caregivers (such as rating scales, checklists) and observing the child in different situations (classroom, at home, on a playground).

Evaluation should also take into account cultural and language issues relating to communication. Expectations and acceptable communication practices can vary greatly in families and cultures. For example, appropriate eye contact, personal space, children’s roles with adults may vary.

When a child needs help with social communication, speech therapists and others use a variety of therapies and interventions, including one-on-one therapies and parent training. Treatment may also include use of strategies and tools, such as social stories (using stories to help children understand social situations) and social skills groups.

Parents play an important role in helping their child overcome social communication difficulties. Some strategies that can be used at home to help children with communication include:

  • Make reading interactive. As you read with your child, talk about ideas and reactions, ask open-ended questions.
  • Model good communication and encourage your child to practice (e.g., how to greet someone, making requests).
  • Take turns in speaking or other activities, such as throwing a ball.
  • Predict – help your child think about what might happen next in a story.
  • Slow down the interaction allowing the child more time to respond.

If you’re concerned about your child, start by getting an evaluation for your child. Children under 3 can receive free evaluation through each state’s early intervention system and parents can request an evaluation through a child’s school.

Resources and References

  1. Social Communication Disorder is included in the 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM, the manual used by clinicians to diagnose mental disorders).
  2. A diagnosis of social communication disorders requires that autism spectrum disorder be ruled out.


AutismPatients and Families


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