Social skills development in children with hydrocephalus

I. Overview

As I read the information about social skills development, I suddenly realized that social skills are an area I had never considered my hydrocephalus affecting because I have always been very out-going and made friends easily. That being said, the Hydrocephalus Association (HA) brings up an interesting point "As the first generation of children shunted for hydrocephalus mature into adulthood, it has become apparent that some of them will have difficulty developing their social skills. Lets look at why this is an issue and what can be done to correct it.

For most of us, happiness means friends, meaning we are able to move from isolation to inclusion. Additionally, it means becoming comfortable with social interaction which causes other people to actively seek us out or, at the very least, not ignore us. In order to be involved in social interaction, the acquisition of social skills is a must. In teaching a child (with hydrocephalus) about social skills, we must remember that they can be broken down into component parts and taught in much the same fashion as other skills. According to a study conducted by the National Institutes of Health (NIH), the greatest area(s) of concern for parent's of special needs children - including those with hydrocephalus - are: 1) Talking over differences without getting angry; 2) Persistence when faced with frustration; 3) Learning to politely refuse requests; 4) Learning to take turns when speaking with their peers or other people; 5) Understanding rules; 6) Following directions; and 7) Learning to wait when necessary.

It should be said, however, that these problems are not just limited to children with special needs. For most of us, learning the social skills to handle these situations is automatic. But, for children with learning special needs, often this is not the case.

II. What happens

For the most part our social learning is done automatically through a combination of seeing, copying, and conditioning. By that, I mean that social skills are learned incidentally and without formal instruction. Research has shown that children born with hydrocephalus often have associated learning disabilities which makes it difficult - if not impossible in certain cases - for them to pick up on both verbal and non-verbal clues necessary to learn proper social skills.

Difficulty in picking up on these non-verbal cues can result in serious (emphasis added) social problems for children with hydrocephalus. One example of this is seen in how they often mis-estimate distance and spatial relationships. As such, they tend to either get too close to other people OR stay too far back. When this occurs, the person whose space they have "invaded" normally has the tendency to back off and find a reason to remove themselves from the situation. On the other hand, if they stay too far back, eye contact is difficult and other children are more likely to ignore them.

Research has shown that children may also have difficulty with non-verbal cues might also have difficulties perceiving intonation (the way in which the speaking voice emphasizes words). As an example, consider the child that hears that a party is being planned and then goes up to the "boss kid" inquiring if they can come. The 'boss' responds "Yeah, sure, I REALLY want YOU at my party" Sadly, when the child arrives at the party, it is most likely going to be a heart-breaking experience because the child heard the WORDS ("I want you") but not the TONE ("I would rather hang by my thumbs than have you at my party"). Instances such as this can be excruciatingly painful for children not attuned to such nuances as tone, rhythm, or pitch.

Other important non-verbal cues can be found in posture and facial expression. If a child isn't proficient in reading the facial expressions of others, he/she will likely misinterpret the other person's non-verbal cues. As a general rule, children with hydrocephalus are able to perceive only two types of facial expressions: 'happy' and 'mad' (and, occasionally, 'sad'). Unfortunately, this is not enough to for them to get along in today's world. In addition to those noted above, they need to be able to perceive (and understand) such subtleties as 'quizzical' and 'reflective' and are expected to learn them incidentally.

III. What can be done

It is a known fact that children with hydrocephalus tend to be slower in acquiring skills such as walking, talking, and hand-eye coordination. With a combination of time, remediation, and early intervention, these skills can be obtained, however, is the same true with social skills? Many neuropsychologist (particularly those who have done extensive work with hydrocephalic children) believe that intervention is vital. The reason behind this is, even if the child does manage to catch up on their own, some necessary skills will be missing.  In those rare cases where undeveloped skills do come later in life, the child may have become exhausted, reclusive, or self-defeating in their interaction with each other.

Parents need not wait for this self-defeating behavior to begin if they realize that many of these social skills being discussed can by taught. The first step in this process is to have the child evaluated by a neuropsychologist which can pinpoint areas of deficiency allowing the most effective way to teach the child the necessary social skills to be undertaken. It is worthy to note that, even though schools are now under mandate to provide many types of evaluations, often the in-depth testing and remediation plan(s) necessary to pinpoint areas of deficiency are best carried out by an experienced professional. 

For additional information: Social skill development in children with hydrocephalus