Social Skills

As mentioned earlier, children may experience difficulty with aspects of social interaction and communication. This will impair their ability to relate to peers and form or maintain friendships. They may continue to show pleasure in certain activities but fail to share this pleasure with others through language or other communication modes (for example, eye contact, facial expression). They may make inappropriate remarks or behave in socially unacceptable ways with little awareness of the social implications of these behaviours. For children who have very little language, there may be failure to compensate for this problem by gesturing or miming in order to get their message across. Some children who are able to produce language may have difficulty using their language socially or engaging in a two-way conversation. They may echo language around them, or reproduce set learnt phrases in an inappropriate way. In addition, these children may have problems with abstract thought or generalising from experience. They may have difficulty with imaginative play and some children show obsessional and repetitive behaviour. They may also find unstructured situations, such as the playground, and periods of change or transition very difficult, preferring to stick to familiar routines.

Although these problems are acquired usually around the time of the child’s illness rather than being developmental (that is, present since infancy), they share many similarities to children with autistic spectrum disorders. For some children an additional diagnosis of autism / autistic spectrum disorder may be appropriate whilst in other cases, their behavioural features will not amount to a full diagnosis, but remediation strategies relevant to this population may nevertheless be recommended.

A general emphasis on the use of structure including daily schedules as described in the TEACCH approach (Treatment and Education of Autistic and Related Communication handicapped Children) can be useful in terms of its ability to convey meaning, predictability and order to the child. The use of visual cues can be very useful.

Social skills training may be useful for children who are experiencing problems with social interaction and communication. The evidence (based on children with autism) suggests that there is often a perceived benefit by the child and parents although these skills can be very difficult to teach and transfer to everyday situations. In addition to formal training, many children benefit from support aimed at providing the child with skills to use in social settings (for example, teaching games which can then be re-enacted in the playground) as well as practical help for specific situations as they arise.

There are also some children who do not have autistic spectrum disorder, but who respond negatively and avoid social situations as an understandable reaction to their loss of language.

It is important to recognise these difficulties as they have significant implications for classroom learning, behaviour and the development of social relationships.