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Social Communication Disorder

by Callie Swayze, M.S., CCC-SLP


For most people, social thinking comes naturally. We have an innate ability to take notice and understand subtle social cues in order to respond appropriately. These basic social skills help us make, build, and keep relationships with others. However, for some people, these skills do not come naturally. Children with prenatal drug and alcohol exposure, for example, often do not innately understand these social cues and how to respond. Many will be diagnosed with “social communication disorder”, requiring the support of a trained speech-language pathologist to learn how to interact with those around them.

What is social communication?

According to the American Speech, Language and Hearing Association, “Social communication is the use of language in social contexts. It encompasses social interaction, social cognition, pragmatics, and language processing.” This includes a host of skills, including greeting or saying goodbye, transitioning in a conversation, taking turns, following social rules, understanding nonverbal cues, and so much more.

What is social communication disorder?

In the simplest terms, social communication disorder is a deficit in the use of communication for social purposes. Children with social communication disorder have difficulty with any or all of the skills listed above, among other skills. Social communication disorder may co-occur with a range of other deficits.

Why is social communication disorder prevalent in this prenatal substance exposure population? 

Children with prenatal exposure may be more likely impacted in social settings for a multitude of reasons.

  • Sensory: children with sensory processing differences may be unable to discriminate subtle facial expressions, body language, gestures, or how close to stand to someone. They may try to control play due to sensory differences. They may not understand what is communicated to them, causing inappropriate responses. 
  • Anxiety: anxiety may cause children to worry about social situations (social anxiety), get “tongue-tied”. Anxiety impacts processing and regulation and may trigger a fight, flight, or freeze response which significantly impacts social participation.
  • Trauma: similar to anxiety, children with trauma have an impaired fight, flight, or freeze stress response. Every part of the brain is impacted by trauma and toxic stress responses. Children with trauma have more difficulty with social communication than peers due to difficulties with pragmatics and social cognition.
  • Executive dysfunction: children with executive dysfunction, common in the prenatal substance exposure (PSE) population, have more difficulty with situational awareness, inhibition, attention, memory, cognitive flexibility, self-monitoring, and problem-solving, among many other things. These skills are imperative to successful social communication. These children also exhibit difficulty with theory of mind – understanding that others have thoughts and feelings.

What is the role of an SLP in working with children with social communication disorder? 

SLPs are the primary specialists when it comes to social communication (although mental health therapists and occupational therapists discuss these skills as well). SLPs help children with social communication disorder learn the skills to appropriately navigate the social world. We practice understanding how to greet, transition, and say goodbye. We discuss turn-taking and sharing the conversation. We discuss asking others questions and how to respond appropriately. SLPs teach about expected vs unexpected behaviors and what the consequences might be, that others have thoughts and feelings, and the ways we can assess what those may be. There is a range of evidence-based treatment techniques for these children, and they can learn to be successful in social situations given the right tools!

I think my child might have social communication disorder, where should I start?

To start, you can read more about this disorder on the American Speech-Language and Hearing Association’s website. 

The most well-renowned social skills curriculum is the Social Thinking curriculum by Michelle Garcia Winner, MA, CCC-SLP. This website has lots of resources for parents and providers.

Finally, reach out to your doctor or contact Hope RISING Clinic to set up an evaluation with a trained speech-language pathologist.

About the author: Callie Swayze, M.S., CCC-SLP, is a speech-language pathologist at Hope RISING Clinic for Prenatal Substance Exposure. She attended the University of Texas at Austin for her undergraduate degree and received a master’s degree in speech-language pathology from the University of Washington. While having a wide range of interests within speech pathology, Callie found her passion in helping children and their families. She has worked with children with autism, selective mutism, speech and language delays, oppositional defiant disorder, ADHD, and many more populations. Callie loves living in Seattle and spends her weekends trying new restaurants, hiking, skiing, and hanging out with her wonderful friends.


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