Is Social Cognition Impairment Causing Your Patient's Social Problems?

How many times have you worked on social communication skills with a client, only to see little improvement outside of therapy? One possible reason for this lack of generalization is that the clientknows what to do just not when to do it because he or she has trouble reading social cues. The best social skills in the world wont help if you cant read the cues that tell you when to use thenew strategies.

What Is Social Cognition?

The ability to read social cues is part of social cognition the cognitive skills we need to decode the social world. Social cognition includes our capacity to recognize emotions in others and to read their minds (i.e., have a Theory of Mind), as well as to understand our own social thoughts and feelings.

The concept of social cognition has been around for more than 100 years, but recent work in the field of autism has causedanexplosion of interest in this area. Research pioneers, like cognitive psychologist Uta Frith, identified impaired social cognition as a core deficit in individuals with autism, who are described as having impairments in:

• Mind reading

• Belief reasoning

• Mentalizing

• Social thinking

Today, impaired social cognition has been identified in a wide variety of clinical populations, including:

• Specific language impairment

• Schizophrenia

• Traumatic brain injury

• Right hemisphere lesions

• Fronto-temporal dementia

• Developmental disorders, such as Down syndrome

No matter whom you serve, your caseload likely includes people with impaired social cognition, and those impairments are affecting many aspects of treatment.

How Do You Evaluate Social Cognition Impairments?

Clients with social problems should be evaluated for social cognition impairments. However, few standardized tests capture the diversity of human social behaviors across cultures, races, ethnicities, and ages. A clinicians best optionmight be an informal assessment:

1. Ask - Could this clients inappropriate behavior signalimpairments in reading social cues?

2. Observe Watch the clients' social behavior in relevant contexts not just with you in the therapy room. Do you see evidence that they are missing or misinterpreting social cues?

3. Consider Keep the patients' cognitive strengths and limitations in mind. Is their poor social cognition really a reflection of impairments in cognitive functions, such as attention or language, or does the patient show impairments even with minimal cognitive demands?

Next time you hear that a patient has a bad attitude, is egocentric, misses the joke, or doesnt know when to stop, consider that social cognition impairments may be the culprit. As clinicians, our goal is for individuals with social challenges to fully participate in life activities that are important to them. Identifying social cognition impairments can help us develop ways to support that full participation.