Spotting Social Communication Difficulties: A Nurse's Guide

A child who struggles to share a glance, a gesture, or a back-and-forth moment is not being difficult — they are telling us where they need support.

In short

Social communication difficulties show up in how a child uses language and non-verbal cues with people — making eye contact, sharing attention, taking turns, reading tone and gesture, and adapting talk to the listener. As a nurse, watch for a child who rarely points to share interest, doesn't respond to their name, struggles to start or sustain back-and-forth interaction, or uses speech mainly to label rather than to connect. These are observations to flag for developmental review, not a diagnosis.

Signs to watch for in clinic

Observe across social interaction, social cognition and pragmatic language — and always in the context of the child's age:

• Joint attention — limited pointing, showing or following another's gaze to share an interest (a key early marker by around 12–18 months).
• Response to name and to social bids — does not consistently turn or respond when addressed, or shows little interest in faces and people.
• Back-and-forth — difficulty taking turns in babble, play or conversation; interactions feel one-sided or stall.
• Non-verbal communication — reduced eye contact, few gestures (waving, reaching, nodding), or facial expression that doesn't match the situation.
• Pragmatic / contextual use of language — in older toddlers and preschoolers: talks at rather than with, struggles to greet, request appropriately, stay on topic, or adjust language to who they are speaking to.
• Understanding social cues — misses tone, humour, or what is implied rather than said.

Remember that social communication develops on a wide normal range, and a single observation in one visit is not conclusive. Note patterns across time, and weigh hearing, the child's home language environment and overall development before concluding concern.

When to refer

Refer for a developmental and speech-language assessment when difficulties are persistent, present across settings, or paired with reduced joint attention and limited gesture. Always rule out or check hearing first — undetected hearing loss mimics social communication difficulty. Significant loss of previously acquired language or social skills (regression) warrants prompt referral.

The Pinnacle way

AbilityScore® is part of Pinnacle’s developmental assessment. Diagnosis, where needed, requires an appropriately qualified healthcare professional — never from a screening observation or an online form. The AbilityScore® is a clinician-administered structured assessment that profiles a child's communication and social development to shape a precise plan. Explore how the AbilityScore® works, our speech and language therapy support, and the Pinnacle network of 70+ centres across 4 states.

Trusted sources

WHO ICD-11 framing of developmental language and pragmatic communication difficulty; American Speech-Language-Hearing Association guidance on social communication; CDC developmental milestone guidance (HealthyChildren.org / cdc.gov) on early social and communication development.

Next step — Spotted patterns worth a closer look? Refer the family to book a developmental assessment with a Pinnacle clinician.