ConditionMental health & sleep
Social Difficulties
Social difficulties are ongoing problems with making or keeping friends, understanding social cues, joining conversations, or feeling comfortable around others. They are common and have many causes: shyness and social anxiety, autism, ADHD, language or learning disorders, depression, hearing problems and difficult life experiences. They are a sign to explore rather than a diagnosis. Understanding the reason guides help, from social skills groups and speech therapy to treatment of anxiety or depression.
Also called: Social challenges, social skills difficulties, social communication problems, trouble making friends
At a glance
- What it is
- Persistent trouble with social interaction, communication or relationships.
- Common causes
- Social anxiety, autism, ADHD, language disorders, depression, hearing loss, trauma.
- Signs in children
- Few friends, playing alone, missing cues, being left out or bullied.
- Signs in adults
- Avoiding social situations, difficulty at work, loneliness.
- Help
- Assessment to find the cause, social skills training, therapy, speech and language support.
When to get help
Call 911 or go to the ER
- Thoughts of suicide or self-harm: call or text 988 (US), or call 911 or your local emergency number
See a doctor within a day or two
- A child or teen being seriously bullied, threatened or excluded, especially with changes in mood, sleep or school refusal
- Sudden loss of social or language skills in a young child (regression)
- Sudden withdrawal, personality change, or unusual beliefs or behavior in a teen or adult
Book a routine appointment
- A toddler who does not respond to their name by 12 months, point by 14 months, or use phrases by 2 years
- A child who consistently plays alone, has no friends, or struggles with conversation and turn-taking
- Fear of social situations that leads to avoidance and affects school, work or relationships
- Loneliness or isolation that is lasting and affects your wellbeing
What social difficulties look like
In children
- trouble joining play or taking turns
- preferring to play alone most of the time
- difficulty understanding jokes, sarcasm, facial expressions or tone of voice
- talking at length about one topic without noticing others' interest
- interrupting, acting impulsively, or struggling to wait
- being very quiet or not speaking in certain settings
- conflicts with peers, being excluded or bullied
- intense distress in groups
In adults
- avoiding parties, meetings or calls because of fear or discomfort
- difficulty starting or maintaining conversations
- feeling misunderstood or misreading others' intentions
- trouble with teamwork or workplace relationships
- few close relationships and loneliness
Common causes
| Cause | Typical clues |
|---|---|
| Shyness | Slow to warm up but comfortable once familiar, little distress |
| Social anxiety disorder | Intense fear of being judged or embarrassed, avoidance, blushing, shaking |
| Autism spectrum disorder | Differences in social communication from early childhood, with repetitive behaviors, intense interests and sensory differences |
| ADHD | Interrupting, impulsivity, missing cues because of inattention, difficulty following conversations |
| Social (pragmatic) communication disorder | Difficulty using language socially without the repetitive behaviors of autism |
| Developmental language disorder | Trouble understanding or expressing language |
| Selective mutism | Speaks normally at home but not at school or with strangers |
| Depression | Withdrawal, low mood, loss of interest in friends |
| Hearing loss | Misses parts of conversations, especially in groups |
| Learning disabilities and nonverbal learning disability | Difficulty reading body language and processing social information |
| Trauma, neglect or attachment difficulties | Distrust, difficulty with closeness, emotional reactivity |
| Brain injury or neurological illness | New change after injury or illness |
Several causes often overlap, such as autism with anxiety or ADHD.
When to seek help
Consider an assessment if social difficulties:
- are persistent, lasting months rather than days
- affect learning, work, safety or wellbeing
- come with developmental delays, unusual behaviors, or loss of skills
- cause significant distress or isolation
- lead to bullying or school refusal
Early support makes a big difference, especially in young children.
How social difficulties are assessed
- Pediatrician or primary care doctor: developmental history, screening questionnaires (such as the M-CHAT for autism in toddlers), and hearing and vision checks
- Psychologist or psychiatrist: assessment for anxiety, depression, ADHD and autism, using interviews, observation and standardized tools
- Speech-language pathologist: language and social communication skills
- School input: teacher observations and educational assessments
Support and treatment
- Social skills training: structured groups teaching conversation, reading cues, problem-solving and friendship skills. Programs such as PEERS have evidence for teens and young adults.
- Cognitive behavioral therapy: effective for social anxiety and depression, using gradual exposure to feared situations.
- Speech and language therapy: for language and pragmatic communication difficulties.
- Treatment of ADHD: behavioral strategies and medicines can improve impulsivity and attention in social situations.
- Autism support: early intervention, communication support, and adjustments at school and work.
- Parent coaching: helping parents create social opportunities and model skills.
- School supports: an individualized education program (IEP) or 504 plan, structured recess activities, and anti-bullying measures.
- Medicines: SSRIs can help social anxiety disorder and depression.
Practical tips
- practice in small, low-pressure settings, such as one friend at a time
- build on shared interests: clubs, sports, hobbies or online communities
- role-play common situations
- notice and praise efforts, not just outcomes
- for adults, start with brief, structured social contact, such as a class or volunteering
Frequently asked questions
What causes social difficulties?
Common causes include shyness, social anxiety, autism, ADHD, language disorders, depression, hearing loss, and difficult early experiences. Often more than one factor is involved. An assessment helps identify the cause and the right support.
Are social difficulties a sign of autism?
They can be, but not always. Autism involves social communication differences from early childhood, along with repetitive behaviors or intense interests. Social difficulties can also come from anxiety, ADHD, language problems or depression.
How can I help my child make friends?
Arrange short, structured playdates, encourage activities built around your child's interests, practice social situations through role-play, and coach turn-taking and conversation. If difficulties persist, ask your pediatrician about an assessment and social skills programs.
Can adults improve their social skills?
Yes. Social skills can be learned at any age. Therapy, especially cognitive behavioral therapy for social anxiety, social skills programs, and gradual practice in comfortable settings all help adults build confidence and connection.
When should I worry about my child's social development?
Talk to your pediatrician if your child does not respond to their name by 12 months, does not point or share interest by about 14 months, loses skills, plays alone almost always, or is persistently excluded or bullied.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Pediatrics (HealthyChildren.org): Social development and autism screening
- National Institute of Mental Health (NIMH): Social anxiety disorder; Autism spectrum disorder
- American Speech-Language-Hearing Association (ASHA): Social communication disorder
- CDC: Developmental milestones; ADHD
- American Psychological Association: Social skills and loneliness