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Social Impairment (symbolic dysfunction)
ICD 784.6

Article by:
Sarah Morales, BS
Children's Speech Care Center

Social impairment is a disorder that is only recently being addressed among speech-language pathologists, although pragmatic disorders (social uses of language) have been an area of treatment for years. Researchers in speech-language pathology have yet to investigate this disorder in a large-scale manner. Information on the Internet is lacking also. Thus, a definitive definition of this disorder is, at this time, preliminary at best. Agreement among clinicians and researchers has not yet been reached. Some clinicians and researchers may choose not to use this ICD code for its diagnosis at all.

Social impairments themselves have been widely recognized in many fields. Such deficits range from early social markers, called communicative functions/intents, to more advanced social skills. Newborns and infants show an interest in people, seek eye contact, and cry to get attention. These early precursors are the building blocks to higher social communicative skills. Social impairments may involve the more basic precursors such as establishing joint attention with a communicative partner, turn taking in simple mother-child interactions (vocal play) or demonstrating overall reciprocity in interaction. Basic skills for such acts as requesting objects/actions, giving, calling attention, commenting, and showing may be reduced or absent.

Higher-level skills that may be affected include turn-taking difficulties in play with peers and in conversation; difficulties initiating interactions appropriately; difficulties joining a group of peers; difficulty making/keeping friends; reduced ability to understand or use appropriate body language; difficulty initiating and maintaining conversations or terminating them appropriately; difficulty elaborating in conversation without being tangential or off-topic; difficulty asking and answering questions relevant to the situation; and difficulty following conversations and contributing polite, relevant statements. Such deficits are also seen in autism (see section on AUTISM for more information). However, the presence of perseverative (repetitive, unvarying) or ritualistic behaviors, fixations, narrowed ranges of interests and play, need for sameness, and other behaviors (over reactivity, violent/self-injurious behaviors) make social impairments in autism unique. Cognition (general intelligence) and language abilities (speaking, listening, reading, writing) are highly variable in those with social impairment. For example, a child with mental retardation may exhibit social skills deficits. A child with a language disorder (i.e. developmental language disorder, auditory perceptual processing disorder, expressive language disorder) may also exhibit reduced social skills. Social deficits may also be seen paired with other disorders, such as learning disability and ADHD.

Social skills are taught using the principles of behavioral conditioning. In other words, appropriate social behaviors are taught via the clinician’s demonstrations, the clinician’s rewarding of appropriate behaviors, and practice of appropriate behaviors with peers in a group setting. Parents and classroom teachers are in key positions to identify and reward appropriate social behavior. Generalization of learned social skills to a child’s natural environment (e.g. school, home, community) is essential in success. There are a range of professionals that teach social skills including, but not limited to, speech-language therapists, occupational therapists, psychologists, counselors, and learning specialists.

For more information on this disorder, contact Lynne Alba using the contacting us button, or view the following link for examples of social skills training:


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