Social Communication and Interaction

Communication is more than just talking. Whenever two people send messages of any kind to each other, even without words, they are communicating. 

Babies communicate long before they start to talk by crying, making sounds, moving their bodies or reaching for something.

They learn to look at faces and give eye contact, focus on the same thing as you are and follow your gaze.

This is interaction. As children grow, they let you know what's on their minds in other ways, such as through gestures and spoken words.

 

Why interaction matters

Interaction is like a see saw at a playground. You need two people to take turns to interact.  

This keeps the see saw going back and forth. If each person isn't taking equal turns, the see saw moves up and down.

Watch this video more information:

Image by Dung phan from Pixabay

Around 1 in every 100 people in the UK have autism.

In Nottinghamshire and Nottingham City autism is diagnosed by a paediatrician. Speech therapists support paediatricians to assess social communication and interaction. All people with autism have differences with:

 

Social communication

Children with autism can present with language difficulties. This means that children often need help to understand how and why to communicate. For example, a child does not greet people, does not get your attention to show you or point to something, does not always make their wants and needs clear to others.

 

Social interaction

This means that a child may not know how to play with adults or children. For example, they don't give eye contact or use gesture and facial expression and do not share interests or enjoyment with a person.

 

Social imagination

This means that they may not play with toys in a pretend way (like pretending a brick is a phone). It may also mean that they have behaviours which they repeat. They may also have interests that they are passionate about. For example, doing one activity over and over, repeating the same routines and fascination with objects rather than toys.

 

Sensory interests

Children with autism can have sensory processing differences, which means they may be motivated by, or adverse to, certain senses.

Speech and language services cannot support with sensory processing differences, but we may use them to support autistic children to communicate and interact.

If your child has sensory processing differences and you would like support for this, please speak to your GP or paediatrician.

Sensory Integrated Therapies are a service based in Nottinghamshire who provide sessions to support children with Sensory Processing Differences. More information is available on the Children's Sensory Therapy. Occupational Therapists in the Midlands website.

 

More information

Some people with autism have very mild difficulties whereas other people need lots of support. See the What is autism? - NHS website for more information.

For more information about getting an assessment for autism from a paediatrician, speak to your nursery, school, GP or healthy families team.

If you have tried the advice above and you would like a Speech and Language Therapy referral, please click here to find out how to refer: How to refer.

Find out more about Autism on the National Autistic Society website.

Between 6 and 12 months, babies begin to coordinate their focus of attention with their parents to objects or events in their environment. For example, they might look at a toy, and then look to their parent and then back to the toy. This suggests that they enjoy know that their parent is looking at the same thing as them. This involves eye contact and switching your gaze and is called 'joint attention' or 'shared attention'. It usually occurs in playful situations with parents, for example, finding hidden objects together or pretending to eat and drink.

Sharing attention is the foundation on which children understand that gestures and words refer to objects and events. If children do not develop joint attention, their ability to interact with others is reduced.  In turn, this impacts on their ability to learn and use language successfully.

 

Joint attention

Joint attention is a really important skill.

By helping your child develop joint attention you are

1. Showing your child it is fun to play together and share interests with others.
2. Sowing the seed for other communication skills to develop.

More information is available on the Before their first words website.

 

Two-way interactions

When two people share the enjoyment, we refer to two-way interaction which is the ability to share focus on and with another person. This video shows a family in a copy-cat game, in which they are having to pay attention and share focus on each other, to imitate each other's actions.

 Games for Kids - The Copycat Game (YouTube)

 

Three-way interactions

Three-way interaction refers to the ability to share focus on another person and a toy. This video shows a child and parent taking part in a three-way interaction.

Son play with Daddy (YouTube)

First few months of life

Eye contact established between the parent and child.

 

3 months

A child's gaze follows adult's, this leads to joint attention of objects.
Takes turns with the parent cooing, making sounds and copying facial expression e.g. sticking tongue out. The baby learns to tell the parent what they needs by sounds, facial expression and body, learns to communication how feeling. When the parent responds to the child's noises this establishes an early back and forth conversation.

 

6 months

Turn taking games like peekaboo have developed - these are important for develop parent child interaction.

 

9 months

A child may give and shake head gestures/body language Learn to also reach, raise arms, hold up and show objects, wiggle hand to wave.
Might like to meet new people but need time to get comfortable.

 

12 months

A child responds to another person's attempt for joint attention - response to shared attention. A child may use an open hand point to show you and tap you to get your attention, learn to wave, clap, and blow a kiss or show 'sh.'

 

18 months

A child initiates with another person. They use gestures (points to the toy, holds up the toy). They look at the parent and then back at the toy as if to say to the parent hey, look at my toy!

 

These are key milestones. If you notice that your child hasn't started doing these things, try some of the activities in the next section called 'Strategies to support your child'.

People games

Games without toys are called 'people games.' They help your child to focus on you and the interaction. Examples include blowing raspberries chasing, tickles, peekaboo and nursery rhymes. People games are:

• Often repetitive so the child can predict what's going to happen.
• Work best when they suit your child's interests. This gives them extra motivation to interact with you because it's using the thing they enjoy doing most. If they like to run, try chasing games.

If they like songs and music, try nursery rhymes. If they like swinging or rocking, try swinging them in a blanket.

We can use SPARK to help us to remember how to play People Games:

S - Start the same way each time - Name your game and use an action or gesture when you say the name of the game (e.g., put your hands in the tickling position)

P - Plan your child's turn - Think about a moment in the game when your child can participate in some way. Maybe he can show you he wants more of the game once it ends by moving his body, looking at you, or reaching.

A - Adjust the routine so your child can take a turn - You can pause and wait, or encourage your child to participate further by giving a cue (or hint), like leaning in close, opening your eyes wide with anticipation, using a gesture or action to remind your child what to do.

R - Repeat the same actions, sounds and words - This repetition helps your child learn what's coming next, and the words that go along with each part of the game.

K - Keep the end the same - Let your child know that the game has ended by saying and doing the same thing each time you play.

A Speech and Language Therapist will give advice on more games to try.

We use strategies from The Hanen Centre and Autism Corner.

Here is an advice sheet about People Play from the Hanen Centre.

 

Creating opportunities for your child to communicate

• Get your face in the right place (appropriate physical level).
• Put favourite things in view but out of reach.
• Use hard-to-operate toys or people toys . E.g. wind-up toys, bubbles, balloon, spinning tops.
• Be the keeper of what they want or need.
• Offer what they want bit by bit. e.g. juice, biscuits, puzzle pieces.
• Offer choices. Do the unexpected (creative stupidity). E.g. make mistakes accidentally , pretend you don't know where things are.
• Remember to pause and wait for your child to communicate. This can be verbal (for example a word), or non-verbal (for example a look towards you, a vocalisation, a gesture). 

See this link from Speech and Language UK to get ideas on how to to create more opportunities for communication: Create opportunities for your child to communicate - Speech and Language UK: Changing young lives

 

Observe, wait and listen

Observe - Notice what your child is interested in. This gives your child the lead in the play.

Wait - To see what your child does in their play.

Listen - To any sounds or actions your child makes.

By using OWL we can see what your child is interested in in that very moment.

Get on your child's level and sit near your child. Now join in and play! If your child is pushing a train, find a similar toy and do the same action.

Make comments on your child's play - if they push the train on the track, you can say choo choo goes the train and then wait to see what they do next. 

Make it into a game - Sometimes following their lead naturally turns into a game, such as peek-a-boo or crashing the trains into each other. Watch and see what your child enjoys most.

Once you join in by doing the same thing, making a comment, or making a game together, you must then wait for your child to respond. Are they laughing, smiling, or trying to tell you something? When you play together, what part is most fun for them?

Play like a child and have fun together. Remember, this is their turn to be the leader in the play and for you to follow where their curiosity leads them.

See these links from Tiny Happy People to get more ideas on how to follow your child's lead in play:

What to do when your child prefers to play differently - BBC Tiny Happy People

Follow your child's lead - Tiny Happy People

 

Useful links

Ready steady go with bubbles

Anticipating with ready steady go

Copycat game

Alternative and Augmentative Communication

Some autistic children may prefer to communicate using symbols, also known as Alternative Augmentative Communication (AAC). These can be low-tech (for example, an aided language board) or high-tech (for example, a tablet).

A speech and language therapist can provide more advice and support the introduction of AAC for a child who prefers to use symbols as a means of communication.

Please click this link to see more information about the type of AAC support our service provides: Find out more about augmented and alternative communication.

  

Signing

Some autistic children may also benefit from the use of Makaton signs, alongside spoken language, to help them communicate their wants and needs.

A speech and language therapist can provide more advice and support the introduction of Makaton signs for a child who prefers to use signs as a means of communication.

Our service runs regular Signs and Symbols trainings that can be accessed by families and settings of children who are known to our speech and language therapy service.

For more information about getting an assessment for autism from a paediatrician, speak to your nursery, school, GP or healthy families team.

Find out how to refer if you have tried the advice above and you would like a Speech and Language Therapy referral.

 

Older children

We do not offer any assessment or therapy appointments to children who have the following communication skills:

• Using good functional language skills and can use spoken language for a wider range of reasons.
• Can hold simple conversations (although may struggle to follow the rules of conversation.)
• Can interact/talk/play with some children.
• Prefers to talk about their own interests.
• Starting to talk about things outside the 'here and now'.
• May repeat or echo words if they do not understand.
• They understand many words and can follow simple instructions.
• They may take things literally and misunderstand what people say to them. 

However, if your child is presenting with any of these communication difficulties and you would like some advice, please contact our advice line on 0300 123 3387 (option 1), available Tuesdays and Thursdays 9am-12.30pm.

 

Additional support

You can also receive support for children with Special Educational Needs via local services throughout Nottinghamshire.

ASK LiON

Early Years Foundation Stage Special, Educational Needs and Disabilities Team (EYFS SEND Team) - Ask Lion

Autism Team (SEND Inclusion Support Services) - Ask Lion

Neurodevelopmental Pathway and Support Team (NPST) - Ask Lion

Nottshelpyourself

Nottshelpyourself SEND Local Offer - Early years support

Nottshelpyourself Neurodevelopmental Support Team - The Family Service

Nottshelpyourself - SEND Inclusion Service