Difficulties in Social Communication and Interaction

In this chapter, we'll cover the first main area of the autism diagnostic criteria, difficulties in social communication and interaction, with concrete examples. This area breaks down into three subdimensions: reciprocal social-emotional interaction, nonverbal communicative behaviors, and developing and maintaining relationships.

Reciprocal Social-Emotional Interaction

In typical development, from the first months of life babies engage in an exchange called "social reciprocity": a baby smiles, the parent smiles back, the baby smiles again. This loop forms the basis of increasingly complex social interaction. In children with autism this reciprocity may follow a different pattern: the child may initiate socially less often, may respond less to, or differently to, other people's emotional reactions, or may show shared attention (pointing something out, looking to share an accomplishment) less often.

The idea of "joint attention" is especially important here: in typical development, when a baby sees something interesting, they look first at the object, then at the parent, then back at the object, sending the message "let's look at this together." In many children with autism this three-way gaze pattern is seen less often; the child takes an interest in the object, but the urge to share that interest with someone else may be weaker.

Nonverbal Communicative Behaviors

Eye contact, facial expressions, gestures, and body language are the nonverbal but extremely important parts of social communication. In children with autism, the following differences may be seen:

• Eye contact — may appear as complete avoidance, very brief contact, or eye contact that seems "odd" (too intense or aimless). A lack of eye contact doesn't mean a lack of interest or love; some autistic people describe eye contact as uncomfortable, even overstimulating.
• Facial expressions — the expressions that convey emotion may appear less often, in a more limited range, or in ways that seem "mismatched" to the situation.
• Gestures — the use of conventional gestures such as pointing, waving, or nodding may be delayed or remain limited.
• The integration of body language — the coordination of verbal and nonverbal communication (making eye contact or gesturing while speaking) may differ from typical development.

A simple comparison

You can think of social communication as an orchestra: the words of speech are the melody, and eye contact and gestures are the accompanying instruments. In typical development these instruments play in sync on their own, mostly without conscious effort. In autism this synchronization is set up differently; some instruments may stay quieter while others come out stronger. The music is still there, but the arrangement is different.

Developing, Maintaining, and Understanding Relationships

Developing and maintaining age-appropriate relationships, making friends, joining in peer play, reading the social context, is often one of the most challenging areas for children with autism. In young children, this may show up as taking part less in imaginative/symbolic play or not showing interest in peers. At school age, even when there is a desire to make friends, it may show up as not knowing how to do it, or as approaching social rules (waiting your turn, noticing a change of subject, understanding humor and irony) not as something learned naturally but as "rules" that need to be taught explicitly.

Caution / When to Seek Advice

While the observation "he has no friends, he always plays alone" is concerning on its own, some children consciously prefer to play alone, and this isn't always a sign of a problem. What matters is whether the child shows a desire for social interaction and how much support they need to act on that desire; this distinction must be evaluated by a specialist.

How Do Social Communication Difficulties Change with Age?

The way social communication difficulties look changes with age. In infancy they may show up as not turning to look at one's name or a delay in the social smile; in the preschool years they may show up as a preference for parallel play and limited interest in peers; at school age, difficulty keeping up a back-and-forth conversation, joining in group games, and reading social cues (facial expressions, tone of voice) may come to the fore. In adolescence, as social expectations grow more complex (friendship dynamics, romantic interest, social media), the difficulties may take on a new shape again; this topic will be covered in Chapter 12.

Tip / Practical Suggestion

When you observe your child's social communication, pay attention not only to the "deficits" but also to their own unique ways of communicating: maybe they connect with you through a particular toy, a particular song, or a particular routine. Sharing these strengths with your therapists helps tailor the treatment plan to your child.