Social skill difficulties in autism

As previously discussed, autism is primarily a social communicative condition, and so all people with autism will have some delay or differences in developing social skills.

The spectrum of social skills is broad, and individuals will present with a range of differences. Some children may not yet be ready to socially interact with others, while other children and young people with autism may interact freely with peers but still experience social anxiety at times or lack specific skills, such as understanding sarcasm.

DSM 5 (American Psychiatric Association, 2013) lists the following social communication differences as diagnostic criteria for autism:

Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviours used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behaviour to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Some children with autism may still be developing social skills and have ongoing difficulties in basic social skills, for example:

• Awareness of other people around them
• Approaching other people to request basic needs
• Initiating interaction e.g. looking at the person, taking someone by the hand to request an object, pointing/showing, basic verbal greetings
• Responding to name, questions, instructions
• Taking turns in games
• Taking turns in reciprocal conversation
• Sharing toys, games and other materials
• Tolerating the close proximity of others

Other children and young people with autism may be very competent in basic social interactions but have difficulty with more complex skills, for example:

• Using gesture and facial expression
• Understanding body language and facial expression
• Using and understanding sarcasm and humour
• Understanding idioms, slang and dialect differences
• Adjusting communication style to different listeners i.e. being able to differentiate between formal and informal social skills
• Giving others an opportunity to share an opinion and understanding the viewpoint of others
• Taking an interest in the other person’s preferences e.g. asking them about their hobbies etc.

These lists are not exhaustive but provide an idea of the huge spectrum of social skill acquisition and the complexity of social skill development.