Hydrocephalus & Social Skills in the Learning Environment

For most of us, happiness means friends, the move from isolation to inclusion. It means comfort with social interaction so that other people are motivated to actively seek us out. The acquisition of social skills is critical for social inclusion. What can we do to assist a child with Hydrocephalus in developing their social skills?

Social Skills

Positive social interactions are an important part of life. The social skills critical for social inclusion are numerous and for the most part our social learning is done automatically by seeing, copying and conditioning. We learn social skills incidentally, without formal instruction. However, many children with hydrocephalus have learning difficulties that make it difficult, or almost impossible, to pick up the verbal and non-verbal cues necessary for the acquisition of social skills.

Studies have shown that the main concerns for parents of children with Hydrocephalus regarding their social skills are:

• Talking over differences without getting angry • Persistence when facing frustration • Refusing requests politely • Taking turns while talking • Understanding rules • Following directions • Waiting when necessary

Of course, these problems are not limited to children with Hydrocephalus. However, for most of us, learning the social skills necessary to handle these situations is automatic, while for those with Hydrocephalous, often it is not.

Verbal Cues

Most of our social learning is done automatically, by seeing, copying and conditioning. That is, social skills are learned incidentally, without formal instruction. However many children with hydrocephalus have learning difficulties that make it difficult, or nearly impossible, to pick up the verbal and non-verbal cues necessary for the acquisition of social skills.


Children who have a problem with non-verbal cues also often have difficulty perceiving intonation (the way in which the speaking voice emphasizes words). For example, consider the youngster who hears that a party is being planned and goes up to the ‘boss kid’ to ask if they can come. The ‘boss’ responds, “Yeah, sure, I REALLY want YOU at my party.” If the youngster shows up at the party, it is sure to be a heartbreaking experience. The child has heard the WORDS (“I want you”), but not the TONE (“I would rather hang by my thumbs than have you at my party”). Errors such as these can be incredibly painful for kids who are not attuned to such nuances as tone, rhythm or pitch.

Non-Verbal Cues

Spatial Relationships

Difficulty in perceiving non-verbal cues can create serious social problems. Children with hydrocephalus often mis-estimate distance and spatial relationships. They get too close to other people (called “getting in your face”), or they stay back too far. Getting too close will cause others to back off and find an excuse to escape. Staying back too far makes eye contact difficult, puts them out of reach of voice range and is likely to cause others to ignore them.

Visual Cues

Children may also have difficulty picking up other social cues, such as those from clothing for example. Someone dressed in a suit and carrying a briefcase tells us, “I am an authority”. If a child doesn’t pick up such cues, they might not figure out who is the authority, boss, teacher, or even the “boss kid.” And, as a child, if you can’t spot the leaders you may end up imitating the school bully with the high probability that you will then be socially scorned or ignored.

Body Language

Other important non-verbal cues are posture and facial expression. If a child can’t read faces very well, he/she will likely interpret things incorrectly. Often children with hydrocephalus perceive only two kinds of facial expressions, ‘happy’ and ‘mad’, and perhaps ‘sad’. This understanding is not enough to get along in the world. They need to perceive such subtleties as ‘quizzical’, ‘reflective’, and others, and they are expected to learn them incidentally.

Tips for Teachers

It is important to the development of all children that they are given opportunities to succeed, and to grow in self-confidence. It is normal for growing people to experience self-doubt or fears about how well they fit in with their peer group, and it is desirable that children with Hydrocephalus not only socialise with children without disabilities, but that they also have a chance to socialise and talk to other children with disabilities to share their experiences.

• Reduce the amount of information presented at one time and allow extra opportunity for rehearsal;

• Emphasise key points in a logical sequence - information is remembered most effectively when it is processed in an organised and logical way. Extraneous information should be minimised;

• Reinforce conceptual learning through practical activities related to the student's interests and life experience;

• Encourage interaction with other children of similar age as much as possible

• Encourage imaginative play, such as dressing up, drama and make-believe

• It may be helpful to teach ‘what to do’ and how and when to do it’ using informative pictures, mirrors and imitation

• A social skills training program may be of benefit (see an educational psychologist for further information)

• Use a buddy system – link the child with hydrocephalus with a peer who will be able to teach new social skills