By Pamela T. Boykin, M.Ed., CCC-SLP
Rainbow Rehabilitation Centers

Excellent social skills are a valuable commodity in today’s society. Employers demand employees with strong social skills and offer classes on good customer service and etiquette. Eye contact, a smile and pleasant demeanor are requirements for service jobs- which is a vastly growing sector of business. Use of good social skills can positively change an interaction and make a difference for everyone involved. The good feeling typically spreads and is reinforced. This chain reaction helps in improving self-esteem.

Social skills can be defined as the ability of an individual to facilitate communication and interaction among people. Impairments in social skills are prevalent in the young adult population that have sustained a traumatic brain injury (TBI) and these have a significant impact on their functioning.

After injury, young adults report social isolation. The size of their social network decreases with time, resulting in increased reliance on family for emotional support and leisure. When achievement of independence is a developmental goal for this group, increased reliance on family is defeating to the injured young person. This also affects feelings of self-worth.

If fact, research conducted at the Baylor College of Medicine (Struchen, 2008) showed that decreased productivity in employment settings and social isolation can have a negative impact on quality of life and on emotional functioning of persons with traumatic brain injury. It can be difficult for young adults to recognize their social deficits as a lack of awareness is a common sequelae of injury. Dahlberg et al., 2006 had individuals with TBI rate their own social communication impairments and compared their ratings to the rating made by their significant others and clinicians. Sixty patients who were at least one year post-injury were examined. A summary of results indicated that the significant others and clinicians identified more deficits in social skills than the participants self-reported.

Social Communication

Another challenge for the young adult population falls within the domain of social communication. Social communication involves the sending and receiving of messages to and from others and the ability to comprehend the communication.

Within the framework of social communication skills, verbal (words stated or written) and non-verbal (intonation, voice, volume, use of gestures, facial expressions, body positioning) are identified.

Examples of social communication include:

  • Starting and ending conversations
  • Staying on topic
  • Selecting and changing conversation topics
  • Inhibiting inappropriate communication behavior
  • Taking turns
  • Asking for Clarification
  • Showing feelings with facial expression
  • Using gestures
  • Speaking at an appropriate rate
  • Using tone of voice to express meaning and feelings
  • Eye Contact

Adjusting an Individual’s Communication

Generally, an individual can adjust their communication based on the situation and the person with whom they are talking. This is difficult for the young adult with brain injuries to accomplish and everyday conversations and social skills are affected. Adjustments to verbal context based on the physical setting, the social demands of the situation, and an individual’s relationship to the conversational partner are overlooked.

In addition, young adults often present delays prior to verbalizing a response. Delays can be as minimal as five to 10 seconds; longer delays can be 15 seconds or greater. These disturbances in conversation make it difficult for others to follow the spoken word of an injured young adult. This becomes a barrier for employment, relationships and daily communication. Factors such as premorbid ability, emotional reactions to disability and environmental issues may also contribute to social communication outcomes after injuries.

The question then becomes: How do we help these young people that are tying to become independent? Given that most of the social challenges are prevalent with the population that has had a moderate or severe injury, the question is daunting and the answers multi-faceted.

Therapy Techniques

A review of the research provided approaches that are used clinically with individuals who have a traumatic brain injury. This is not a prescriptive list but techniques used in both neurological and clinical populations. Some of the techniques are as follows:

  • Structured feedback: getting information from someone who is trusted- what aspects of communication went well and what aspects needed work.
  • Videotaped interaction: videotaping conversations and playing them back to increase awareness of communication strengths and weaknesses.
  • Modeling: the speech-language pathologist, family member, or other communication partner demonstrate ways to handle communication situations. There is no better way to teach then to model the behavior that you would like to see.
  • Role-playing and rehearsal: practicing different communication situations. It is best to ask the injured person what they would do in a certain situation rather than assume that they have the information. Have them rehearse the situation. Practicing the desired behavior helps make it real.
  • Positive reinforcement: praise and encouragement for positive communication behaviors matter! A system for material rewards may also be introduced if necessary.
  • Medical management: medication for behavioral disturbances associated with traumatic brain injury. Mood and behavioral stability may be a result of the neurological changes. Medication could assist with controlling these changes.
  • Behavioral modification: working with a mental health therapist or behavioral analysis could aid in reducing personality and behavioral effects of TBI and to retain social skills.

Effective communication is a human right. Speech-language pathologists, families and clinicians working with young adults should use the above statement as a goal in their implementation of social communication strategies that will improve the outcome for functional communication skills, social skills and ultimately increased happiness.


Hahlberg, C., Hawley, Morey, C., Newman, J. Cusick, C.P., Harrison-Felix, C. (2006). Social communication skills in persons with post acute traumatic brain injury: three perspectives. Brain Injury 20 (4), 425-435.

Struchen, M.A., Clark, A.N., Sander, A.M. Mills, M.R., Evans, G., & Kurtz, D. (2008). Relation of executive functioning and social communication measures to functional outcomes following traumatic brain injury. Neurorehabilitation, 23, 185-198.

Struchen, M.A., Pappadis, M.R., D.K., Clark, A.N., Davis, L.E., & Sander, A.M. (2008). Perceptions of communication abilities for persons with traumatic brain injury: validiy of the La Trobe Communication Questionnaire. Brain Injury, 22 (12), 940-951.

Turkstra, L.S. (2008). Conversation-based assessment of social cognition in adults with traumatic brain injury. Brain Injury, 22 (5), 397-409.

Ylvisker, M. (2006). Self-coaching: a context-sensitive, person centered approach to social communication after traumatic brain injury. Brain Impairment, 7 (3), 246-258.

(2010). American Speech-Language-Hearing Association. Communication Facts: Special Population: Traumatic Brain Injury- 2010 Edition. Retrieved from http://www.asha.org/research/reports/tbi.htm

(2010, March 8). Centers for Disease Control and Prevention. Traumatic Brain Injury. Retrieved from http:www.cdc.gov/traumaticbraininjury/.