Support for Social Skills in Young Kids with a CHD

Early Intervention (EI) is often the best way for young children with heart defects to get the help they need.  EI is a government program, and is free or affordable to families who have a young child (ages 0, 1, 2) at risk of delay or disability.  Almost all young children with CHDs qualify for EI. Doctors should always refer young children with heart defects to EI.  Families can also refer their own child by calling or writing to their local EI program.

Once a young child qualifies for EI, they can receive many services that support social development. For example, EI can include:

• Developmental specialists who come to the home to teach and play with the child

• Teaching parents activities to use with their child

• Social work

• Occupational Therapy (OT)

• Speech and language therapy

• Playgroup

• Applied Behavior Analysis (ABA)

Families should tell their EI coordinator if they are concerned about how their child understands and interacts with other people.  The EI team can assess the child, and design a treatment program to meet their unique needs.

When young children in the United States are too old for EI, they can often get services from their school district. Public school services are free to qualifying families.   

Before a young child with a heart defect turns 3, doctors should always refer the child for a Special Education evaluation with their school district.  Families can also refer their own preschool-age children for a Special Education evaluation.  School districts can evaluate children starting at age 2 years, 9 months. Families should tell the Special Education evaluator if they are worried about a young child’s social skills. 

Special Education programs can support early social development through a range of services. For example, Special Education for young children can include: 

• Public preschool 

• Counseling with a psychologist or social worker 

• Social skills training 

• Occupational therapy (OT) 

• Speech and language therapy  

• Deaf and hard of hearing services 

• Communication tools 

• Applied behavior analysis (ABA) 

• Home services  

Each child’s Special Education program is written to meet their unique needs. 

In young children, social delays can be connected with language delays.  Children may not understand how to say what they think or feel, and they may not understand what others are saying.   A speech and language pathologist (SLP) can often help young children to communicate more effectively.  Through effective communication, many children can increase their social skills.  Families may find an SLP: 

• At their hospital 

• At their pediatrician’s office 

• In a private clinic 

When finding a new SLP, families may want to ask: 

• What is your experience with children this age? 

• What is your experience with children with these diagnoses? 

• What aspects of speech and language do you focus on? 

• What are your goals for my child? 

• How will your treatment help my child reach their goals? 

• How will you tell if my child is making progress? 

In many cases, medical insurance will pay for speech and language therapy for a child with a heart defect.   

When a young child has significant social challenges, they can often make progress through Applied Behavior Analysis (ABA).  ABA is a therapy that is based on how people learn and act. ABA therapists can work with young children on social skills such as: 

• Having a conversation 

• Behaving in an expected way 

• Following rules and routines 

• Communicating thoughts and needs 

• Daily living skills 

• Playing with other children 

In most states, children with Autism Spectrum Disorder (ASD) can receive free home ABA through their medical insurance company.  When a child has ASD, families may want to talk with their doctor about home ABA. 

ABA can also help children who do not have ASD, but who have social challenges.  Usually, insurance does not pay for children who do not have an ASD diagnosis.  Families can often find provider ABA providers in their community. 

Child therapists can often help young children to learn social skills.   Appropriate therapists could be: 

• Psychologists 

• Social workers 

• Mental health counselors 

• Psychiatrists  

They can work in a hospital, clinic, school, or private practice. Families can find a therapist by asking their doctor or insurance company.  When available, cardiac neurodevelopmental programs can often help. 

Families should feel free to ask a therapist questions, and to find a therapist who is a good match for their goals and values. When finding a new therapist, families may want to ask: 

• What is your experience with children this age? 

• What is your experience with children with these diagnoses? 

• What types of therapy do you use? 

• What are your goals for my child? 

• How will your treatment help my child reach their goals? 

• How will you tell if my child is making progress? 

Some families try several therapists before they find the right one.  Many families find it helpful to ask other parents for the names of therapists who are helpful.  

When a child has a delay in social skills, parents should stay in contact with their doctors, teachers, and other providers. If the child makes good progress, then everyone should know what strategies are effective. If the child does not make good progress, then an expert may need to do a further evaluation. When everyone works together, the whole team can find the best possible treatment for each child.

This content was reviewed by a psychologist at Boston Children's Hospital.

Developmental care is best when it is local. Families local to Boston can receive care from the Cardiac Neurodevelopmental Program (CNP). Families from other regions can use the link below to find their local care team.