What Does “Their Social Skills Are Just Fine” Really Means When it Comes to Children with Language Impairment

As a frequent participant in a variety of speech pathology forums I’ve read through countless “mini scenarios” of SLPs asking for advice regarding various aspects of therapy service provision for children with average IQ and language impairment (characterized by weaknesses in the area of listening comprehension, language processing, vocabulary acquisition, sentence formulation, as well as conversational development.)

When I ask the following question: “What about their social skills difficulties?” I invariably receive the following answer: “Their social skills are just fine!” When I ask: “How was their social competence assessed?” I am invariably told: “The teachers don’t have any complaints, their eye contact is good, and they can keep up with conversations.”

As a result of seeing these and similar statements over and over again from a number of professionals, I decided to write a blog post on this topic due to a certain degree of frustration on my part.

The first concept taught in typical language development classes in undergrad is the fact that language is composed of three areas: Content, Form, and Use. Basically speaking Content refers to conveying coherent and cohesive messages to others, Form refers to grammatically and syntactically correct expression of language, while Use refers to appropriate social pragmatic interactions with the public at large (Bloom & Lahey, 1978). In other words these three areas are interconnected and difficulties will not be exclusively relegated to one area only.

This is further supported by research which indicates that children with language impairment (what many clinicians know as Developmental Language Disorders or DLD, formerly known as Specific Language Impairment or SLI) are actually impaired in numerous aspects of language including phonology, morphology, syntax, etc.

Furthermore, research into language development and disorders has revealed that there is no such category as expressive language disorder alone. In other words, if there are expressive language deficits, you will most certainly find receptive language deficits if you look carefully enough.  In his seminal article entitled: “Is Expressive Language Disorder an Accurate Diagnostic Category?” Laurence Leondard (2009) concluded that “deficits in language expression are typically accompanied by limitations in language knowledge or difficulties processing language input“.

So now that we know that language deficits are diffused and not isolated (e.g., impaired vocabulary/grammar only), let us discuss how social skills/social competence deficits fit into this picture.

One set of researchers who has been studying the construct of social skills in children with DLD for the past several decades are Bonnie Brinton and Martin Fujiki.  In some of their earlier articles in the 90s they found evidence that children with DLD manifested pragmatic difficulties in conversational contexts with partners and were unable to adequately adjust to the needs of others in social interactions (Brinton, & Fujiki, 1993: Brinton & Fujiki,  1995; Brinton, Fujiki,  & Powell, 1997; Fujiki & Brinton, 1994: Fujiki, Brinton  & Todd 1996).

Later, Brinton’s and Fujiki’s work expanded beyond the pragmatic interactions to focus on the concept of social competence of children with language impairments. For those unfamiliar with this term, social competence is a complex, multidimensional concept composed of successful co-interaction of social, emotional, cognitive as well as behavioral factors, resulting in successful social adaptation (Semrud-Clikeman, 2007).

Brinton and Fujiki’s later studies found that children with language impairments were less accepted by peers, had poorer friendships, were perceived by teachers as being more withdrawn (as compared to peers) as well as presented with poor emotional competence and emotional intelligence (Brinton & Fujiki, 2012; Fujiki, Spackman, Brinton, & Illig, 2008; Spackman, Fujiki, Brinton, Nelson, & Allen, 2005).

Studies by other authors found that children with language impairments also present with impaired abstract emotion comprehension (Ford & Milosky, 2003).

In addition, researchers also found that the social competence of language impaired children is affected from a very early age. To illustrate, Longobardi, Spataro, Frigerio & Rescorla, 2015, found that young children (2+ years of age) with delayed language development (who produced fewer than 50 words) exhibited lower social abilities, compared to age-matched peers.

What does this mean? 

Research unequivocally indicates that children with language impairment or DLD, also present with concomitant social communication difficulties, which if left untreated will significantly adversely affect their academic outcomes as well as future life success. It is important to note that due to the varying the nature of social communication deficits (internalizing versus externalizing manifestations) many social communication deficits will be missed without the administration of appropriate social pragmatic language assessments.  It is also important to note that presently social pragmatic assessments ARE NOT routinely administered in numerous school settings as part of comprehensive language assessments.

Consequently, if a student presents with language impairment and the prevailing teacher/parental belief is that his/her social skills are “just fine”, it is important to support this with relevant data based on comprehensive formal and informal battery of social communication assessments in order to justify the above statement with all due veracity.

References:

• Bloom, L & Lahey, M. (1978) Language development and language disorders.New York, Wiley.
• Brinton, B., & Fujiki, M. (1993).  Language, social skills, and socioemotional behavior.  Language, Speech, and Hearing Services in Schools, 24, 194-198.
• Brinton, B. & Fujiki, M. (1995). Intervention with conversational skills.  In M. E. Fey, J. Windsor, & S. Warren, (Eds.) Communication intervention for school-age children (pp. 183-212).  Baltimore: Paul H. Brookes.
• Brinton, B., Fujiki, M., & Powell, J. M. (1997).  The ability of children with language impairment to manipulate topic in a structured task.  Language, Speech, and Hearing Services in Schools, 28, 3-11.
• Brinton B., & Fujiki, M. (2012). Social and affective factors in children with language impairment. Implications for literacy learning. In C. A. Stone, E. R. Silliman, B. J. Ehren, & K. Apel (Eds.), Handbook of language and literacy: Development and disorders (2nd Ed.). New York, NY: Guilford.
• Ford, J., & Milosky, L. (2003). Inferring emotional reactions in social situations: Differences in children with language impairment. Journal of Speech, Language, and Hearing Research, 46(1), 21-30.
• Fujiki, M. & Brinton, B. (1994).  The social competence of children with specific language impairment.  In M. L. Rice & R. Watkins (Eds.) Language intervention with children with specific language impairment (pp. 123-143). Baltimore: Paul H. Brookes.
• Fujiki, M., Brinton, B., & Todd, C.M. (1996).  Social skills of children with specific language impairment.  Language, Speech, and Hearing Services in Schools, 27, 195-202.
• Fujiki, M., Spackman, M. P., Brinton, B., & Illig, T. (2008). Ability of children with language impairment to understand emotion conveyed by prosody in a narrative passage. International Journal of Language & Communication Disorders, 43(3), 330-345
• Longobardi, E, Spataro, P, Frigerio A & Rescorla, L (2015) Language and social competence in typically developing children and late talkers between 18 and 35 months of age. Early Child Development and Care.
• Semrud-Clikeman, M. (2007). Social competence in children. New York, NY: Springer.

Helpful Smart Speech Resources Related to Assessment and Treatment of Social Pragmatic Disorders 

• Gauging Moods and Interpreting Emotional States 
• Social Pragmatic Language Activity Pack
• Social Pragmatic Language: Multiple Interpretations Therapy Activity
• Social Pragmatic Photo Bundle for Early Elementary Aged Children
• Introduction to Social Pragmatic Language Disorders
• Recognizing the Warning Signs of Social Emotional Difficulties in Language Impaired Toddlers and Preschoolers
• Social Pragmatic Deficits Checklist for Preschool Children
• Social Pragmatic Deficits Checklist for School Aged Children
• Social Pragmatic Assessment and Treatment Bundle
• Narrative Assessment Bundle
• Psychiatric Disorders Bundle
• Fetal Alcohol Spectrum Disorders Assessment and Treatment Bundle
• Assessing Social Pragmatic Skills of School Aged Children
• Behavior Management Strategies for Speech Language Pathologists
• Effective Behavior Management Techniques for Parents and Professionals
• Assessment and Treatment of Non-Verbal Language Disorder (NVLD) in Speech Language Pathology
• Treatment of Social Pragmatic Deficits in School Aged Children
• The Role of Frontal Lobe in Speech and Language Functions
• Executive Function Impairments in At-Risk Pediatric Populations 
• Differential Diagnosis of ADHD in Speech Language Pathology
• Speech Language Assessment of Older Internationally Adopted Children