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

Poor Social Skills: Have You Considered Social Cognition Impairments?

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 client knows 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 won’t help if you can’t read the cues that tell you when to use the new 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 caused an explosion 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 clinician’s best option might be an informal assessment:

  1. Ask – Could this client’s “inappropriate behavior” signal impairments 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 “doesn’t 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.