This is part of the infant 360 degree appraisal series on social ability. This post follow’s on from last week’s post on basic social ability and will give you information about how to assess higher order social ability in 4 year olds.
Interaction with peers
As described in last week’s post, a child’s interaction with peers is more difficult for them to navigate than interaction with adults. A child that interacts confidently with adults may struggle to interact with peers. This is as 4 year old peers are immature in social skills and are themselves learning to acquire these skills. This is easy to understand if you think about tennis. A child beginning to learn tennis can play with an expert adult as the adult can direct balls at the child and return errant balls. Get two children who are just beginning to learn to play tennis to play with each other and it is much more difficult and frustrating for the children as neither can play properly.
Both Big Sis and Lil Bro went to nursery from a young age and so had much exposure to interacting with other children. From this I was able to get good accounts of their social ability with peers. Most nursery schools will be able to tell you if your child is able to take turns, share toys and join in with other children (for instance joining in with actions to songs such as “The wheels on the bus”, or a game of hide and seek). Most nursery schools will be able to tell you if your child is aggressive in interactions. If your child is constantly victimized (which you will know about as you are required to sign an incident form in a nursery if your child is bumped/ bruised/ bitten/ scratched or harmed in any way), as well as questioning what the nursery is doing about this, you should question what your child is and is not doing to end up in this situation so frequently. Children who are frequently victimised or frequently aggressive are more likely to need extra attention as they may be vulnerable to difficulties.
Most nursery schools will be able to tell you if your child is polite (says “please” and “thank you” – very important social skills that do require to be taught) and caring (what they do in response to another child that has fallen over). They should also be able to give information regarding play. If they don’t, you should ask about it.
The importance of play for children cannot be overstated. Not only as a means of relaxation and enjoyment, but it is in play that children are able to order, understand, rehearse and cement social understanding as well as be creative. Play is often heavily influenced by what the child has experienced in their social environment. It is sad, but no surprise that some children I know in South Africa, following an armed break-in started to play a game of “robbers” involving tying each other up. Back at home, I know children who are more likely to play “I’m mummy, getting ready to go out to a party”. What these children have in common is that they are all learning about their own social environments and about ways to behave in them. It’s no wonder that “play” with a dolls house and family characters is the preferred way that shrinks find out what is really happening at home when we assess children of this age group. If children play about the mummies and daddies shouting at each other, this doesn’t mean a direct call to social services, but does prompt questioning and assessment on the parental relationship and what bearing this may have for the child. Observing what my children play act left to their own devices is one of my favourite pastimes, and if it is about setting up a school and marking a register and reading stories to the assembled stuffed animals (which it is frequently), I can heave a sigh of relief. It’s no wonder that watching children play, and interacting in play with children is one of the main assessment tools in a child psychiatrist’s armoury.
As well as to gain insight into the child’s real social environment, children at this age will be beginning to develop imaginative and interactive play, both precursor skills required for good social ability. Dressing up and pretending to be a princess, a superhero or both is usually a good sign of imaginative play, in particular if they take on the roles, act out stories that they have generated themselves and if they play this with other children, each understanding what the other is pretending. Many adults may see this type of play as “silly” or a “waste of time”, but imagination and role playing is a rehearsal of the ability to think about how someone else is thinking and how this may affect their behaviour, the basis of “mentalization” the new buzz therapy in psychiatry.
Interactive games, such as hide-and-seek, allow observation of practical interaction skills between children. Is your child able to take turns? Will your child cry or get aggressive if they lose? Is your child able to follow and understand the rules? How does your child react if someone else transgresses the rules? Does your child take charge of the game or stand back?
Your child’s nursery can give you this type of information; else you can observe your own child’s play with their sibling (if they are close enough in age to play together) or at a play date.
If you want a real test of social skill, or are just a mean child psychiatrist like me, then you need to work in a few spoilers. Most children will be able to display good social ability when everything is hunky-dory and going their way. But what about compromise and negotiation? What about staying out of trouble? Most children are taught compromise when children are invited over to play and “Guests” are given privileges. “Let your friend go first, because they are the guest”, “Let your friend have the bigger slice of cake, because they are the guest” – this type of thing that happens all the time on play dates. If your children are able to accept this, chances are, they will be able to come to terms with compromise. They understand the social rules and etiquette and are able to conform to them. If they predictably have a tantrum, even when the situation is explained, then problems at school can be anticipated. Getting along with other people, good social ability; includes understanding that getting along with others is sometimes more important than the bigger slice of cake.
Other spoilers can be less easily arranged, but these situations arise all the time naturally and it is often a good idea to stand back and observe how your child deals with situations rather than to wade in and intervene at the onset of trouble. When I took Big Sis to a public sand pit one day, I noticed another child who was more boisterous and disruptive playing there. The boy approached Big Sis, clearly wanting to interact, but he had already disrupted the play of some other children. Big Sis turned subtly away and kept her head down doing what she was doing and saying nothing. The boy got tired of no response and went away to disrupt someone else. Big Sis had clearly clocked this boy was trouble but she managed to deal with the problem in a way that was not rude or confrontational and that achieved its objective with minimal fuss. She was able to see trouble coming and avoid it. It may not be the most obvious social skill, but it is a highly valuable one. We all know some children who are “always” involved in trouble even if they are not necessarily the instigators and I would argue that avoiding trouble is as much a social skill as the ability to make friends. I felt confident that Big Sis could handle herself at school after this.
What happens at the highest levels of social ability – the battle for social dominance? Next week’s post is the conclusion in this series on assessment of social ability and will answer this question. Later on, I will write about what can be done to help support children’s social skills.
 I say “sometimes” as children who always suppress their own needs for others will have other issues that need addressing, and being the class “doormat”, is also not particularly desirable.
This is part of the infant 360 degree appraisal series on social ability. This and the next few posts will give you information about how to assess social ability (from minimal to maximal) in children around the age of 3-5 years old (for short, I will refer to 4 year olds). Later on I will post on how you can help young children to develop their social skills.
Problems with social ability are currently rarely diagnosed in the pre-school period unless problems are severe. This is not because they do not exist but because adults, particularly parents are extremely obliging in making up for their child’s weaknesses, and aren’t aware of their difficulties. Even if a child is gibbering in Alien, you can bet, the parents know exactly what is being communicated and get quite grumpy when you infer that you have not a clue what they are trying to say. Play dates at home supervised by adults will involve parental supervision and intervention to assure that children “play fair”, “don’t leave people out”, “wait their turn”, “be nice”, and critically don’t beat each other into a pulp. If another child is “not nice” to your child, they are not invited back. Not so the school playground where your child will have to communicate with other children who are impatient, do not necessarily care to hear what your child has to say, have little incentive to include your child in games and may beat your child into a pulp if they find them annoying. I don’t care what any school says in their prospectus, teachers cannot be there at all times, and it is much wiser to ensure that your child has the social skills to survive! By educating parents to be more aware of their child’s social skills, weaknesses can be identified earlier, leading to interventions, better support and prevention of more difficult problems developing later on.
When people think about social ability, they tend to first think of the confident thespian, the extrovert lead in the school play. Often these people do have good social skills, but social skills are more than confidence, acting and oration. It is about ability to make lasting friendships, seek help, read emotions, understand social situations, adapt to new social environments and avoid trouble. All the skills required to “get on” with other people, the essence of social ability. If your child was assessed for a private school “assessment” at age 4 years, without a doubt one of the key components that they would have been making a selection on was social ability. A sociable child will get on with other children in the class, be easier to teach, cause less trouble and ultimately, make the school’s life a lot easier! These skills continue to be highly valued throughout life, and there is a reason that even into adulthood, we are asked to demonstrate our “people skills”, “ability to be a team player”, and “communication skills” in any career.
Before talking about how you can improve your child’s social skill, it is a good idea to think about assessing you child’s social skill. It may be that your child is extremely socially able and you have no need to do anything. Lucky you. But how do you judge this? Over the next few posts, I will detail here observations that can be made of social skills from the most basic to the fairly sophisticated levels of social skill.
Basic Social Skills
The most basic social skills are required in an interaction with a familiar adult. Most children aged 4 years should be able to interact easily and readily with a familiar adult. Many children with mild autism (de facto impaired social ability) can pass this level of interaction, as the familiar adult will be primed to be patient, can guess from experience what a child wants, is accepting and willing to invest in understanding the child, and letting them have their own way.
Spending time playing with your child and conversing with them can reveal if there are fundamental difficulties in social interaction. Some readily testable tasks are whether your child turns to face you if you call their name from behind them. Can your child ask you to pass something to them that they need? Can your child look you directly in the face when talking to you/ you are talking to them? Can your child smile at you? Can your child smile at you if you smile at them? Can your child spontaneously wave goodbye to you when you leave, shake their head to mean “no” and nod their head to mean “yes”? Can your child use gestures to show you how to do something (e.g. brush their teeth) without using an actual toothbrush? Can your child recognise facial expressions in picture books and tell you what they mean? Can your child point to show you something and check that you are looking at the right thing? Can your child make up a story? Can your child feed their teddy bears or make their dolls talk to each other? Can your child realise/ understand that other children may have different thoughts and preferences to them? Can your child copy what you do?
Most typically developing children can definitely do all of these things by the age of 4 years. Clinicians are looking for the presence or absence of ability in all the above (and many other things) in a typical autism assessment in 4 year olds with typical development. They may sound like an arbitrary list of things to look out for, but they are amongst the basic building blocks necessary in developing sophisticated social ability.
If you do not have a preference for looking at people’s faces, particularly their eyes, which are usually the most expressive, you will fail to pick up all the social nuances in expression that a person is communicating (see part 1). “You idiot” said with angry eyes will mean something different to “You idiot” accompanied by a glint in the eye. If you are not looking at a person’s face/ eyes, you cannot infer intention and you are liable to misunderstanding. If your child does not naturally pick up common social conventions (smiling at people, nodding and shaking the head, waving) they will have more difficulty understanding what is going on as social conventions are so frequently used in communicating with others instead of speech. Think how awkward you feel when travelling to a foreign country where all the social conventions are different (bowing in the Far East, not using your left hand in India). Your actions may be misinterpreted by others and it will affect how you get on socially. If your child has difficulty understanding that others may have different thoughts, they may not act in consideration of other people. If they cannot understand facial expression, they cannot infer how someone else is feeling and act accordingly. If they cannot ask for something to be passed to them, they may have difficulty communicating their other needs in an appropriate way. If they do not naturally copy you and what you are doing, they are missing out on the most frequent method children naturally have to acquire social skill, by emulating their parents and other adults around them.
If your 4 year old child is struggling with all/ most of the above, it would be worth considering the 4 main possible reasons that a child psychiatrist would consider: hearing impairment, speech and language problems, learning difficulty and autistic spectrum disorder.
Intermediate social skill
Interacting with an unfamiliar adult takes more social skill than interacting with a familiar adult as an unfamiliar/ less familiar adult will not know or understand the idiosyncrasies of a child’s communication. For instance, when Big Sis was two, she loved to watch a music DVD called “Fun song factory” (which incidentally starred a pre-fame member of JLS). She was at the time unable to enunciate “Fun song factory”, but called it “Bun song Bactery”, or just “Bactery”. One time, when my mother was looking after her, she repeatedly stated that she wanted “Bactery”. My mother was at a loss at what she was talking about and it led to a lot of frustration on both sides. Indeed, my mother strangely concluded that she was talking about the “lavatory” (rather advanced vocabulary for this age group) and whisked her nappy off and plonked her on the lav. Needless to say, Big Sis was not amused. Eventually, my mother called me and I immediately knew what she wanted. Thus interaction with an unfamiliar/ less familiar adult pushes the need for better communication skills to avoid frustration.
In clinical practice, we often see parents that are so good at compensating for their children’s weaknesses that they cannot see that their children have pretty severe impairment. They get very upset when teachers report difficulties at school and blame the teachers, but the reality is that the level of ability required to interact with an unfamiliar adult is more challenging than interacting with a familiar one. If your child has consistent difficulties interacting with a kind and supportive teacher, the chances are, they will have difficulties interacting with many other people and are likely to have weaknesses in social ability.
Interaction with unfamiliar adults can be observed easily. Leave your children with a trustworthy friend whom they do not know well and see how they behave. How well your child is able to communicate what they want can be observed (child psychiatrists and psychologists would do this crammed behind the one-way mirror in our clinics, but you can do this by poking your head quietly into the room or hiding behind a door left slightly ajar) and you can extrapolate their behaviour in this situation to their likely interaction with their new teacher (an unfamiliar adult). If you want to challenge your child’s social skill a bit more, you can ask the adult to occasionally disagree with the child, or to deliberately thwart them (e.g. accidentally knock down the tower they were building), or try to contribute a different idea to the game they are playing and see how your child responds. If this is all a bit too Cold War, just ask your new babysitter how they got on and garner as much intel from this as you can.
In addition to communicating needs and wants, in this scenario, a socially able child would understand that they will need to behave better than they do with a parent or a familiar adult, this is called “social inhibition”. Even if your children are naturally boisterous and cheeky to you or their grandparents, they should be inhibited by someone they know less well. This natural recognition of social context, the awareness that something is different about this social environment and the appropriate way to respond is part of a child’s natural social ability (whether they are able to sustain behaviour is a different matter). Most children are able to behave well and interact with an unfamiliar adult even at age 4 years for a short time at least, which is why even hyperactive children can behave well when they visit the doctor’s clinic much to the chagrin of their parents who have spent the entire time talking about the child’s inability to sit still. More worrying is the child that is over-familiar with strangers, and goes straight up to cuddle and sit on the lap of a stranger, not only as this has implications for vulnerability to abuse, but as here it is clear that they are unable to pick up the difference in social environment and expectation naturally.
The types of difficulties in social interaction which we professionals would be looking out for fall broadly into the following categories:
1) Aloof – a child with no interest in social interaction. They neither initiate social interaction nor engage in interaction when it is initiated by others.
2) Passive – a child who will engage in some social interaction, but will not initiate it.
3) Active but odd – a child who both initiates and engages in social interaction but does it in an odd or inappropriate way (such as the disinhibited, over-familiar manner described above).
A caveat to this interaction as a means of assessing social skill is the confounding factor of anxiety and security. I will discuss these issues at greater length in another post, but needless to say that if your child has difficulty separating from you or is anxious in new situations and with new people, you will not be able to get a clear picture of their social ability using this type of observation.
Brownie points if your children are well behaved, appropriate, polite and obliging with an unfamiliar adult. Extra, extra brownie points if they are also engaging, interactive and interested. They will have no problems with interacting and communicating with their teachers and in the structured environment of the classroom. However, it is easier for children to interact with adults. Many children with autism are able to interact with adults. This is as adults are generally nice to children and will make allowances for children, will have the ability to guess what a child wants, give in to what a child wants and are generally predictable and sensible. Higher levels of social ability are required in interacting with other children; the basis of next week’s post.