The ability to take part in 'normal' social activities can be one of the greatest challenges for a child with a brain injury. While able to demonstrate good verbal and intellectual knowledge of social situations, children with a brain injury may be unable to apply this knowledge in real situations. They may have difficulties with:

• paying attention to all necessary information
• considering another person's point of view (having a tendency to focus only on themselves and lacking in empathy)
• anticipating the consequences of a given act
• adjusting their use of language to suit the audience (friends/teachers/parents)
• self monitoring
• ability to use subtle social cues such as changes in tone of voice, facial expressions and body language. All of which can affect the meaning of a situation
• success in social circumstances, especially in adolescence, which relies heavily on the ability to interpret abstract language such as metaphors, humour and sarcasm

Strategies to help children with social skills and interactions

• Limit the amount of information you give and point out the most important/relevant information that the child needs to consider.
• Making communications clear and direct will help to improve understanding.
• Discuss others people's points of view and interpretations of social situations.
• Express feelings directly in order for the child to understand how you feel or how something affects you.
• Point out the possible short and long term consequences of decisions.
• Give a few specific choices instead of asking for an open ended decision. For example, ask 'Do you want red or blue?' rather than asking 'What colour do you want?'
• Whenever possible, try to avoid the need to make decisions under stressful conditions or time pressures.
• Be clear and specific about:
  • any behaviour or language that is inappropriate and why it is inappropriate
  • how it makes others feel or the message it sends (eg 'You are not looking at me when you are speaking. If you don't look at me, I'm not sure if you are talking to me or to someone else. It makes me feel like you don't really mean what you are saying.')             
• Emphasise that it is the behaviour that is unacceptable, not the person.
• Give examples of more appropriate or desirable behaviours in that particular situation.
• Praise the things that are done well and reassure the child they have the ability to succeed.
• Try to use the same feedback each time so that the child hears the same message and can begin to monitor their own behaviour. Discuss this with everyone who interacts with the child to ensure consistency.
• Be realistic about the child's abilities and the expectations placed on him/her.
• Rehearse and 'role play' the child's possible responses ahead of time.

To help children understand abstract language, humour and sarcasm. Focus on:

• identification of incongruity (something that is absurd or looks out of place). For example, does the person's facial expression match what they are saying? Does what the person is saying make sense in that situation? Why? What else could they mean?
• identifying where the incongruity may be. For example, is there a particular word that has a double meaning? (Such as in the sentence, 'the fans roared'). Does the way the sentence is constructed lead to a double meaning? (Such as in the sentence, 'the duck was ready to eat')
• exploring idioms and metaphors and ask the child to suggest different meanings. Commonly used idioms and metaphors may need to be taught

For more information

• The Royal Children's Hospital
  Paediatric Rehabilitation Service
  T: (03) 9345 9300
  E: rehab.service@rch.org.au
• The Children's Hospital at Westmead Brain injury Service
• Kids Health Info series of fact sheets listed under 'Brain injury'

Developed by The Royal Children's Hospital Paediatric Rehabilitation Service based on information from the Brain Injury Service at Westmead Children’s Hospital. We acknowledge the input of RCH consumers and carers.

Reviewed September 2020.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.