Comprehensive Social Skills Taxonomy: Development

and Application

Nancy A. Kauffman, Moya Kinnealey

MeSH TERMS OBJECTIVE. We developed a comprehensive social skills taxonomy based on archived children’s social

child skill goal sheets, and we applied the taxonomy to 6,897 goals of children in 6 diagnostic categories to
explore patterns related to diagnosis.

classification

emotional intelligence
METHOD. We used a grounded theory approach to code and analyze social skill goals and develop the
taxonomy. Multivariate analysis of variance and Tukey post hoc honestly significant difference test were used

interpersonal relations
to analyze differences in social skill needs among diagnostic groups.

mental health
RESULTS. We developed a taxonomy of 7 social skill constructs or categories, descriptions, and behav-

social behavior ioral indicators. The 7 social skill categories were reflected across 6 diagnostic groups, and differences in

social skills social skill needs among groups were identified.
CONCLUSION. This comprehensive taxonomy of social skills can be useful in developing research-based
individual, group, or institutional programming to improve social skills.

Kauffman, N. A., & Kinnealey, M. (2015). Comprehensive social skills taxonomy: Development and application. American
Journal of Occupational Therapy, 69, 6902220030. http://dx.doi.org/10.5014/ajot.2015.013151

Nancy A. Kauffman, EdM, OTR/L, is Private Practitioner,

Newtown Square, PA; nancykauffman@verizon.net
Moya Kinnealey, PhD, OTR/L, FAOTA, is Faculty
Emeritus, Occupational Therapy Program, Temple
University, Philadelphia, PA; moya.kinnealey@temple.edu
S ocial interaction and social skills have historically been a domain of concern
for occupational therapy practitioners. These skills were identified initially
in 1985 as a performance subsystem of the Model of Human Occupation
(Kielhofner, 1985) and are included as a client factor in the Occupational
Therapy Practice Framework: Domain and Process (3rd ed.; American Occupa-
tional Therapy Association [AOTA], 2014), which defines and guides occu-
pational therapy practice (Griswold & Townsend, 2012). Social skills may be
a focus of intervention with populations of any age.
Recent educational legislation requires that behavior and social skills that
interfere with educational progress be programmatically addressed and included
in the individualized education program (Individuals With Disabilities Edu-
cation Improvement Act, 2004 [IDEA 2004]; Pub. L. 108–446). Behavior and
social skills are also to be addressed in schoolwide and systemwide programs
within public education (No Child Left Behind Act of 2001 [NCLB]; Pub. L.
107–110). Occupational therapy practitioners may be members of school sys-
tem teams that design and implement social skills programs, and practitioners
experienced in social skills programming can provide useful information in this
endeavor. Four principles that guide current occupational therapy practice are
(1) client-centered practice, (2) occupation-centered practice, (3) evidence-
based practice, and (4) culturally relevant practice (Schell, Scaffa, Gillen, &
Cohn, 2014). The study described in this article sought to provide a client-
centered, research-based taxonomy to guide occupational therapy intervention
to improve social skills.
Social skills include interpersonal, communication, decision-making, and
problem-solving skills and are essential for participation in childhood occupations
(Hilton, Crouch, & Israel, 2008; Griswold & Townsend, 2012). Although specific

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 constructs underlying social skills are elusive and past
studies have frequently focused on a particular skill or skill
set, a general consensus on what social skills encompass was
offered by the Council for Exceptional Children (2003):
Social skills are skills that make it possible for children
and adolescents to get along with others, to gain ac-
ceptance as learning and play partners, and to develop
and keep friendship. Social skills include 1) social
behaviors, such as maintaining eye contact, taking turns,
and asking before taking another child’s play materials;
2) emotional and behavior regulation skills that make
it possible for children to inhibit disruptive behavior;
3) social-cognitive processes that children utilize to
solve social problems, such as attending to and inter-
preting social cues to understand others’ intentions; and
4) social knowledge, for example, understanding what it
means to be a friend. (p. 1)
Social competence is the ability to use and generalize
social skills across settings and is the desired outcome of
social skills training. Research has demonstrated that social
skills training has positive effects on social–emotional de-
velopment and behavior in young children with disabilities,
and a strong relationship has been shown among social
competence, behavior, and achievement in randomized
controlled trials (What Works Clearinghouse, 2013). A
meta-analysis of the effectiveness of school-based social–
emotional behavioral programs found broad benefits,
including an increase in social skills and a decrease in
antisocial behavior, as well as overall benefits in social
skills, antisocial behavior, substance abuse, positive self-
image, academic achievement, mental health, and pro-
social behavior (Sklad, Diekstra, DeRitter, Ben, &
Gravesteijn, 2012). Multiple studies have linked early
social skill deficits to psychosocial problems in adult-
hood, including loneliness, depression, alcoholism, so-
cial anxiety, and marital distress (Segrin & Flora, 2000).
Children with disabilities show more deficits in social
skills than do their nondisabled peers (Fussell, Macias, &
Saylor, 2005; Howlin & Goode, 2000). Specific social
patterns are depicted as characteristic of some diagnoses.
For instance, social reciprocity deficits are considered a
core feature of autism spectrum disorder (ASD; White,
Keonig, & Scahill, 2007). Difficulty with social skills
has been well documented in diagnostic groups of chil-
dren with disabilities including autism, learning dis-
abilities, attention deficit disorder (ADD), language
impairment, and negative social–emotional behavior
(Aro, Eklund, Nurmi, & Poikkeus, 2012; Gutstein &
Whitney, 2002; Smith, 2000; Smith & Wallace, 2011).
Social skill deficits are also widely recognized throughout
the school population at large. Griswold and Townsend
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(2012) reported significant differences in the quality of
social interaction between children with and without
disabilities in the natural context of school, child care,
and play situations. Hilton et al. (2008) compared chil-
dren with high-functioning autism with nondisabled
peers and concluded that difficulty with social skills was
related to some aspects of out-of-school participation
patterns.
Educational legislation has evolved to reflect research
on social skills and academic participation (e.g., Ameri-
cans With Disabilities Act of 1990, Pub. L. 101–336;
IDEA Amendments of 1997, Pub. L. 105–117; IDEA
2004; NCLB). NCLB identified behavioral management,
social skills development, and transition to adult life as
legitimate educational outcomes. The IDEA Amend-
ments of 1997 noted that behavioral issues interfere with
student learning and that neither punitive measures nor
removal from the academic setting is a constructive so-
lution. Positive intervention strategies and related services
that focus on students’ strengths and needs have been
recommended (Smith, 2000). NCLB emphasized quality
education for all students, including those with disabilities,
and recognized the need to address social, emotional, and
behavioral needs to enable students to learn. Whole-school
initiatives and dynamic models to improve student out-
comes have also been supported (Smith, 2000).
IDEA 2004 strengthened school-based mental health
initiatives and provided opportunities for timely in-
tervention and preventive approaches. Early Intervening
Services and Response to Intervention can be instituted,
increased, or adapted when a child is showing signs of
difficulty. School failure or diagnosis is no longer the sole
criteria for receiving services.
Addressing mental health issues in public education
has shifted from an individual deficit model to a public
health and preventive model (AOTA, 2014; Koller &
Bertel, 2006). Under this model, occupational therapy
practitioners can participate with other team members in
designing and establishing programs targeted to whole
schools, at-risk groups, or individual students, thereby pro-
moting mental health through preventive programming
(AOTA, 2009). Intervention and prevention activities
may include conducting workshops, adapting the envi-
ronment, and facilitating supports for students at risk
(AOTA, 2008, 2009).
Occupational therapy is a primary public education
service for children ages birth to 3 yr and a related service
for children ages 3–21 yr. The focus of school-based
occupational therapy is to enable children to participate
in the learning, play, and social participation inherent
in the educational experience (AOTA, 2011). Through
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 participation, children learn skills and competencies, build
relationships, and establish social networks, all of which
contribute to health and well-being (Law, 2002; Law et al.,
2004).
Social skill strengths and weaknesses have been iden-
tified through various methods, including peer report, parent
report, and teacher observation (Griswold & Townsend,
2012). Although parental participation is recognized as
important in acquiring, generalizing, and maintaining
social skills, few studies have sought information from
parents on what skills should be addressed in social skills
programs (Kolb & Hanley-Maxwell, 2003). Also missing
from the literature is child-centered identification of so-
cial difficulties by the children themselves, corroborated
and expanded on by parents or caregivers. A child-centered
method of eliciting social skill goals would ground in-
tervention in personal experience and foster children’s
awareness of and investment in the process. Including the
family in the discussion and decision making adds per-
spective, clarifies priorities, and ensures that the program,
child, and family are working together.
Study Purpose
The purpose of this research was twofold:
1. To develop a social skills taxonomy to provide a frame-
work for social skill categories and constructs and re-
lated behavioral descriptors based on a child-generated
and parent-corroborated needs assessment
2. To apply the social skills taxonomy to school-age chil-
dren in six diagnostic categories and compare social
skill patterns across diagnoses.
Method
Research Design
A mixed-method research design was used for this study.
First, we used the qualitative approach of grounded theory
to analyze 6,897 child- and family-generated social skill
goals. The goal of this approach is to expose concepts and
relationships within field-based data for the purpose of
generating a theory or model (in this case, a taxonomy)
that allows for further empirical testing (Creswell, 1998).
Second, using the taxonomy structure, we used the
quantitative analysis methods of multivariate analysis of
variance (MANOVA) and Tukey post hoc honest sig-
nificant difference (HSD; Portney & Watkins, 1993) test
to explore the social skill patterns of 450 children in six
diagnostic categories. The study was deemed exempt
from institutional review board approval.
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Setting
The study took place in the context of a private nonprofit
social skills intervention program in a suburb of a large
metropolitan city. The occupational therapy–based pro-
gram offered up to 25 after-school groups in 4 counties in
2 states. The program operated from 1987 to 2013, and
the study was conducted from 2001 to 2006. The chil-
dren who enrolled were ages 3–18 yr and were from
suburban, middle-class families. Payment for the pro-
gram included self-pay, insurance, or scholarship. Chil-
dren were referred for social skills intervention because of
difficulty with peer interaction identified by school per-
sonnel, community professionals, and parents.
All groups were led by experienced, licensed occu-
pational therapists with several years of clinical work
experience in pediatrics or mental health and specific
experience or training in working with social skills. The
program consisted of 8 weekly 1.5-hr sessions in a com-
munity location; most children reenrolled in successive
programs. The intervention was organized around the
collaborative planning, creation, and completion of co-
operative projects. Social skills were taught using modeling,
coaching, problem solving, and positive reinforcement
involving common social scenarios including meeting
and greeting, engaging in discussion, eating, playing, and
working collaboratively on a project.
Procedure for Question 1
The study used anonymous, archived, social skills goal
sheets developed from intake interviews with program
enrollees. The therapists who conducted the interviews
and guided the development of the social skills goals were
experienced social skills group leaders working in the
program. They prepared to conduct intake interviews in
three ways: (1) by studying the written procedure or
watching a training video and observing as the lead
therapist (Nancy Kauffman, the first author of this article)
conducted interviews; (2) by practicing conducting
interviews under the observation of the lead therapist; and
(3) by being judged competent in conducting interviews
by the lead therapist.
The intake interview followed a standard procedure
for all children entering the program. The occupational
therapist, child, and parent or caretaker met, and the
therapist addressed six scripted interview questions to the
child and recorded the child’s responses. The therapist
then directed the questions to the family member or
caregiver and recorded his or her responses. The therapist
encouraged children to express their opinions throughout
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 the process. If a child did not respond to a question, this
was recorded. The six questions were as follows:
1. Tell me about some good things that happen [or go
on] at your school.
2. Now tell me about some not-so-good things at school.
3. Tell me about your friends.
4. And now tell me about any kids who are not so
friendly.
5. What activities do you like to participate in?
6. What do you think your parent [or other caregiver] is
wishing we could be helping with or working on with
you?
Therapists placed particular emphasis on using positive
techniques to elicit spontaneous information and descrip-
tions from children that indicated their awareness of the
situation. The questions were designed to elicit information
on the following social areas:
• Positive and negative aspects of the school community
• Current success level in attempts to make friends with
peers
• Personal goals for the program
• Whether the social needs were in acquiring or per-
forming social skills
• The family’s view of the enrollee’s social skill needs.
Children were assigned to a group deemed thera-
peutically suitable for them on the basis of the array of
social skills needs and goals of group members and not by
a specific skill level. The interviewer framed social concerns
into goals that all participants agreed with, and the family
signed the goal sheet. These goals provided the focus of
intervention, and the archived goal sheets provided the data
for the development of the social skills taxonomy.
Development of the Social Skills Taxonomy
The first purpose of the research was to develop a com-
prehensive taxonomy of social skills using grounded
theory methodology, which is designed to explore con-
cepts underlying field-based data for the purpose of theory
building (Creswell, 1998). This process required the de-
velopment of a reliable method for coding the data
contained in the goal sheets.
An expert panel comprising four interdisciplinary
university faculty with qualitative research expertise was
convened. The panel members had professional certifi-
cation, a doctoral degree, research experience, and more
than 20 yr of professional teaching experience. Their
professional affiliations were physical therapy, speech–
language therapy, occupational therapy (Moya Kinnealey,
the second author of this article), and health information
management. The physical therapist, an accomplished
national expert on qualitative research procedures, led the
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panel. In addition, two occupational therapy social skills
practitioners participated in the expert panel as content
experts. One (Kauffman) was a clinician with a master of
education degree and more than 15 yr experience in pe-
diatric occupational therapy and social skills intervention.
The other had 4 yr experience in pediatric occupational
therapy and social skills intervention and was completing
a master of science degree in occupational therapy.
The expert panel used open coding category de-
velopment and axial thematic coding to analyze the data
contained in the goal sheets. In open coding, data are
analyzed by first breaking the data into small compo-
nents; then exploring the properties, dimensions, and
continuum of the components; and finally grouping
them into categories. Axial coding is then used to re-
assemble the data on the basis of logic and identification
of the central phenomena, causal conditions, context,
interactions, and consequences (Creswell, 1998). The
panel grouped the data into categories and then named
and defined the categories, thereby creating a conceptu-
alization or construct.
The expert panel started by analyzing the goal sheets
of children diagnosed with ADD. (In this article, we use
ADD as a category that includes attention deficit hy-
peractivity disorder [ADHD].) They collectively open
coded the social skill goals of 10 children, identifying all
behavioral descriptors and then grouping the descriptors.
For example, bragging, overtalking, and no verbal volley
were included in the category Verbal Presentation, and
meet new people, take social risks, and make friendly over-
tures were included in the category Interpersonal Rela-
tionships. The process continued until saturation—that
is, until no new information was being generated from
the data and all goal sheets meeting the criteria for in-
clusion had been coded. The process resulted in identi-
fication of seven social skill categories:
1. Verbal Presentation includes goals addressing the need
to modify use of words (content) that interfere with
acceptance by others.
2. Nonverbal Presentation includes goals addressing the
need to modify behaviors that interfere with accep-
tance by others.
3. Emotional Response includes goals addressing the need
to modify emotional reactions to frustrating, new,
accidental, or unexpected occurrences or when transit-
ing from one situation to another.
4. Play includes goals addressing the need to modify
behaviors related to playing and working with others.
5. Awareness of Self and Others includes goals addressing
the need to improve conscious consideration and val-
uing of oneself and other people.
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 6. Interpersonal Relationships includes goals addressing
the need to initiate and maintain effective relation-
ships with other people.
7. Feelings About Self includes goals addressing the need
to modify level of self-esteem.
Reliability and trustworthiness of the coding process
were established by calculating the percentage of agree-
ment among the expert panel members’ categorizations of
the goals. Percentage of agreement was established using
the coefficient of agreement measure (Portney & Watkins,
1993). Panel members individually scored each goal on
a goal sheet. The total number of items on which they
were in agreement divided by the number of possible
agreements provided the coefficient of agreement.
To establish ongoing coding reliability, expert panel
members first independently coded the goals for 10%
of the goals sheets for children diagnosed with ADD.
Interrater reliability for co-coding was .82 using the
coefficient of agreement calculation. Next, a four-member
coding team was established, consisting of two expert
panel members, an occupational therapist social skills
practitioner, and a graduate student. (The team included
both authors of this article.) Following training and
practice coding, interrater reliability of 80% was achieved
for the coding team before individual coding was per-
mitted. This process was repeated in coding all goals for
each diagnostic group. Throughout the process, the
coding team analyzed and discussed any social skill that
was difficult to code within the categories and behavioral
indicators to ensure that the model was inclusive.
Trustworthiness was ensured by establishing and main-
taining coding reliability of 80% and saturation of social
skill characteristics. Table 1 outlines the resulting social
skills taxonomy, including the seven constructs, their goal
descriptions, and behavioral indicators.
Procedure for Question 2
The second purpose of the study was to apply the tax-
onomy to children in six diagnostic categories to examine
social skill patterns among the diagnostic groups. We
examined the goal sheets of 456 enrollees representing six
diagnostic categories identified in the Diagnostic and
Statistical Manual of Mental Disorders (4th ed.; DSM–IV;
American Psychiatric Association [APA], 1994): (1) au-
tism, (2) pervasive developmental disorder–not otherwise
specified (PDD–NOS), (3) Asperger syndrome, (4)
ADD, (5) learning disabilities–verbal, and (6) nonverbal
learning disabilities. The total number of goals for the
entire sample was 6,897, with an average of 15 goals per
child. Table 2 provides the diagnosis, gender, and age of
the children whose goal sheets were included in this part
of the study.

Table 1. Social Skills Taxonomy: Social Skill Category, Goal Description, and Behavioral Indicators
Category
Verbal Presentation
Nonverbal Presentation
Emotional Response
Play
Awareness of Self and Others
Interpersonal Relationships
Feelings About Self
Goal Description
Modify use of words (content) that interfere with acceptance
by others
Modify use of behaviors (psychomotor) that interfere with
acceptance by others
Modify emotional reactions to frustrating, new, accidental,
or unexpected occurrences or when transitioning from
one situation to another
Modify behaviors related to playing and working with others
Improve conscious consideration and valuing of oneself and
other people
Initiate and maintain effective relationships with other people
Modify level of self-esteem
Behavioral Indicators
Avoid bragging, outtalking others, teasing, interrupting
others, lying, and rambling, inappropriate greetings.
Express self accurately, clearly, and succinctly; engage in
verbal reciprocity
Listen, pay attention, make eye contact, respect others’
personal space, use well-modulated voice, and refrain
from hitting and pushing
Refrain from temper tantrums, crying, screaming,
overreacting to accidents, acting out, arguing, withdrawing,
threatening self, and defiance; use problem solving
Have fun, share, lose gracefully, play with same-age children
rather than younger children, take turns, follow directions,
laugh, cooperate, compromise, play age-expected activities,
and avoid inappropriate competition
Follow situational norms, sense and interpret both verbal and
nonverbal behaviors of others accurately, be aware of
social cues, value others, and be responsive to others;
interpret humor
Meet new people, take social risks, make friendly overtures or
responses even in new settings, treat people with respect,
accept responsibility for own behavior, use good
manners, interact without having to be in control, follow
instructions, and accept help
Feel appreciated, exhibit self-confidence and self-esteem, be
comfortable with self, feel less shy, and be less distressed
by teasing

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 Table 2. Diagnosis, Gender, and Age of Dataset Children (N 5 450)
Gender, n (%) Age
Diagnosis n (% of Total) Male Female Mean Range
Asperger syndrome 81 (18.0) 74 (91) 7 (9) 9.7 3–18
PDD–NOS 74 (16.4) 63 (85) 11 (15) 5.1 2–17
Autism 33 (7.3) 25 (76) 8 (24) 7.3 4–15
ADD 176 (39.1) 138 (78) 38 (22) 9.1 3–17
Learning disabilities–verbal 70 (15.6) 49 (70) 21 (30) 10.7 6–18
Nonverbal learning disabilities 16 (3.6) 16 (100) 0 (0) 9.3 6–15
Total 450 (100) 365 (81) 85 (19) 8.9 2–18
Note. ADD 5 attention deficit disorder; PDD–NOS 5 pervasive developmental disorder–not otherwise specified.

Results 3. Emotional Response: Children with Asperger syndrome

We calculated a MANOVA among the diagnostic groups and
social skill categories to determine whether significant dif-
ferences existed among diagnostic groups in the social skill
categories represented by selected goals. Results indicated
significant F values (p 5 .001) for all social skill categories,
indicating that the means were not equal and that differences
existed among the diagnostic groups, as depicted in Table 3.
The Tukey post hoc HSD test is a multiple com-
parison procedure used to determine which mean com-
parisons in the MANOVA are significant. The following
results were obtained, by social skill category and significance
of the mean difference (Mdif ) between diagnostic groups:
1. Verbal Presentation: Children with PDD (M 5 3.72)
had a higher percentage (p 5 .000) of goals in this
category than children in the other diagnostic groups.
Children with Asperger syndrome (M 5 2.42, Mdif 5
1.170, p 5 .001) and ADD (M 5 2.61, Mdif 5
0.998, p 5 .001) had a significantly higher percentage
of goals in this category than children with learning
disabilities–verbal.
2. Awareness of Self and Others: Children with Asperger
syndrome (M 5 2.59) had a higher percentage of goals
in this category than those with PDD (Mdif 5 1.438,
p 5 .000) and ADD (Mdif 5 727, p 5 .014), who had
a significantly lower percentage of goals in this category.
(M 5 2.57) had a significantly higher percentage of
goals in this category than those with autism (M 5
1.42; Mdif 5 1.248, p 5 .000) and PDD (M 5 1.23;
Mdif 5 1.106, p 5 .03). Children with PDD had the
lowest percentage of goals in this category of any
diagnosis.
4. Play: Children with PDD had a significantly higher
percentage of goals in this category than those with
Asperger syndrome, ADD, or learning disabilities–
verbal (p 5 .000).
5. Interpersonal Relationships: Children with learning dis-
abilities–verbal (M 5 3.00) and nonverbal learning
disabilities (M 5 3.00) had a higher percentage of
goals in this category than those with other diagnoses.
Children with PDD had the lowest percentage of
goals in this area (M 5 0.39, Mdif 5 1.785, p 5
.000).
6. Nonverbal Presentation: This goal was reflected in all
diagnostic groups, and there were no significant differ-
ences among diagnostic groups.
7. Feelings About Self: Few goals were established in this
category for children of any diagnosis.
To determine the relationship between social skill
categories and the intervening variable of age, a correlation
was calculated between age and social skill categories.
Inversely correlated with age were Verbal Presentation

Table 3. Means, Standard Deviations, and Multivariate Analysis of Variance Results for Effects of Diagnosis on Social Skill Needs
Asperger PDD–NOS Autism ADD LDV NVLD
Social Skill Goal Category M SD M SD M SD M SD M SD M SD F p
Verbal Presentation 2.42 1.63 3.72 0.84 1.67 1.51 2.61 1.80 1.16 1.37 1.31 1.49 21.590 .001
Nonverbal Presentation 2.01 1.63 2.15 1.44 1.64 1.47 2.03 1.48 1.49 1.24 1.38 1.31 3.659 .001
Awareness of Self and Others 2.59 1.98 1.12 1.12 2.15 1.67 1.81 1.36 1.65 1.53 1.63 1.82 5.317 .001
Emotional Response 2.57 1.85 1.23 1.08 1.42 1.37 2.24 1.62 2.35 1.80 2.06 1.34 5.190 .001
Play 1.95 1.80 3.22 1.71 2.36 2.20 1.45 1.20 1.75 1.73 1.94 1.38 6.856 .001
Interpersonal Relationships 2.47 2.05 0.39 0.75 1.94 1.80 1.72 1.43 3.00 1.76 3.00 1.82 18.644 .001
Feelings About Self 0.51 0.98 0.16 0.50 0.36 0.60 0.43 0.83 0.42 0.86 0.25 0.57 4.336 .001
Note. ADD 5 attention deficit disorder; LDV 5 learning disabilities–verbal; M 5 mean; NVLD 5 nonverbal learning disabilities; PDD–NOS 5 pervasive de-
velopmental disorder–not otherwise specified; SD 5 standard deviation.

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 (r 5 2.12, p < .006), Nonverbal Presentation (r 5 2.11,
p < .00), and Play (r 5 2.20, p < .001). Positively cor-
related with age were Awareness of Self and Others (r 5
.17, p < .000), Interpersonal Relationships (r 5 .28, p <
.000), and Feelings About Self (r 5 .30, p < .000). In
contrast, Emotional Response was not correlated with
age. Six of the seven social skill categories had significant
but not strong correlations with age.
Discussion
The first purpose of the research was to develop a com-
prehensive model of social skills and behavioral indicators.
The resulting child-centered taxonomy of social skill
constructs and behavioral indicators contains social skills
nomenclature that is widely used, readily recognized, and
therefore suitable for school and other community
applications. The 6,897 behavioral goals of 456 enrollees
within six diagnostic categories informed the taxonomy
and are reflected within its parameters. This taxonomy
provides a useful framework to facilitate the development
of prosocial behavior and social competence programs that
support mental health and enable students to benefit from
the educational experience and successfully transition to
adult life.
Self-Esteem
The taxonomy category Feelings About Self may be a by-
product of ineffective social interaction rather than a social
skill per se. However, the expert panel identified goals
related to how children felt about themselves that could
not conceptually be included in other social skill cate-
gories. Examples of such goals are to feel less shy when
approaching a play situation or to not withdraw when
approached by other children. Such goals indicate that
self-esteem was a concern related to social skills and needed
to be included in the taxonomy. Self-esteem is a self-
evaluation of how one feels about oneself and one’s
personal worth. It forms throughout childhood based on
everyday interactions, experiences, and self-comparisons
and continues through adolescence and young adulthood
(Erol & Orth, 2011). Children with low self-esteem
avoid activities, refrain from offering their opinion, do
not initiate interaction, or remain in destructive rela-
tionships (Sorenson, 2014). Feelings About Self re-
flected the fewest number of goals (4%) of all categories,
and no significant difference in frequency among di-
agnostic groups was found. However, this category was
moderately positively correlated with age (r 5 .30, p <
.000) and with Interpersonal Relationships (r 5 .14,
p 5 .001).
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Age
Age was correlated with six of the seven social skill cat-
egories. A low negative correlation was found with Verbal
Presentation, Nonverbal Presentation, and Play, and
a moderate positive correlation was found with Awareness
of Self, Interpersonal Relationships, and Feelings About
Self. These findings suggest that whereas younger children
tend to demonstrate social skill difficulty in verbal and
nonverbal interaction and play issues, older children tend
to demonstrate difficulty in awareness of self and others
and interpersonal relationships.
Children’s social skills begin developing in very early
childhood through social referencing—that is, reading
emotional cues and regulating their own responses to
their parents and others in their social situation (Thompson
& Lagattuta, 2006). With age and experience with other
children, increasingly complex interactions develop.
Positive interaction, communication skills, and an in-
crease in vocabulary contribute to the child’s ability to
communicate, regulate feelings and behaviors, and de-
velop empathy (McClelland & Tominey, 2009). Friend-
ships become increasingly important from preschool to
middle school, and by adolescence social skills are nec-
essary to form and maintain friendships. The inability to
form these relationships has been found to result in
negative outcomes such as delinquency and psycholog-
ical problems (Hair, Jager, & Garrett, 2002). Social
skills that facilitate adjustment in adolescence include
interpersonal skills, conflict resolution, intimacy and
prosocial behavior, and the attributes of self-control,
behavior regulation, social confidence, and empathy
(Hair et al., 2002).
Emotional Regulation
Emotional Response is the social skill category accounting
for the largest percentage of goals (18% for the total
group). Emotional Response is not correlated with age,
suggesting that emotional response is a priority skill at any
age. The Council for Exceptional Children’s (2003) de-
scription of social skills in children includes emotional
and behavioral regulatory skills. Behavioral regulation in
response to sensory stimuli, referred to as sensory modu-
lation, has been studied in children with ADHD and
Asperger syndrome (Kinnealey, Koenig, & Smith, 2011;
Mangeot et al., 2001; Pfeiffer, Kinnealey, Reed, &
Herzberg, 2005). Although sensory modulation difficul-
ties are related to emotional and behavioral regulatory
difficulties, this area warrants further investigation be-
cause other precipitating factors may also contribute to
challenges in this area.
6902220030p7
 Social Skill Needs and Diagnostic Categories
The second purpose of the research was to explore the
incidence of social skill goals by diagnostic category. The
incidence of social skill need by diagnosis was determined
by analyzing the goals of 456 program enrollees in six
diagnostic categories. A significantly higher percentage of
goals in a given social skill category indicates that a di-
agnostic group experiences a greater need in that skill
category. This incidence provides insight into social skill
needs related to diagnosis and may help in prioritizing
intervention or prevention efforts. Using this interpre-
tation method, several patterns and insights emerged from
the data.
Autism, Asperger Syndrome, and PDD–NOS Diagnostic
Changes. The diagnostic categories used in the study
reflect the DSM–IV diagnostic criteria, which were in
use from 1994 to 2013, when the DSM–5 (APA,
2013) was published. The diagnosis of PDD in the
DSM–IV was based on three areas of impact—(1) social
interaction, (2) communication, and (3) behavior—and
included PDD–NOS, autism, Asperger syndrome, dis-
integrative disorder, and Rett syndrome. This study in-
cluded three of these categories: Asperger syndrome,
PDD–NOS, and autism. The DSM–5 provides an up-
dated diagnosis of ASD based on two areas of impact: (1)
social communications and interaction and (2) restricted,
repetitive patterns of behavior, interest, and activity.
These impact areas may occur with or without in-
tellectual impairment and with or without language im-
pairment (Autism Speaks, 2014). Under DSM–5
diagnostic criteria, people formerly diagnosed with As-
perger syndrome would be included in the diagnosis of
ASD without language impairment. Children diagnosed
with PDD–NOS would be considered for the diagnosis
of social (pragmatic) communication disorder, which
reflects impairment in the ability to change communi-
cation to match the context, follow rules, or understand
what is not explicitly stated, resulting in functional lim-
itations. The Centers for Disease Control and Prevention
(2014) recommended that
individuals with a well-established DSM–IV diagnosis
of autistic disorder, Asperger disorder, or pervasive
developmental disorder not otherwise specified should
be given the diagnosis of autism spectrum disorder.
Individuals who have marked deficits in social com-
munication, but who do not otherwise meet the criteria
for autism spectrum disorder, should be evaluated for
social (pragmatic) communication disorder. (p. 1)
Social Skill Differences Among Diagnostic Categories. In
this study, children with Asperger syndrome demonstrated
6902220030p8
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significantly more deficits related to Awareness of Self and
Others and Emotional Response. In contrast, children
with PDD–NOS demonstrated more difficulty with Play
and Verbal Presentation. Children with autism and As-
perger syndrome had social skill needs in initiation and
maintenance of Interpersonal Relationships.
Children with learning disabilities, both verbal and
nonverbal, had more goals (i.e., greater needs) in the
category of Interpersonal Relationships than children with
other diagnoses. Kavale and Forness (1996) completed
a meta-analysis of the social skills and learning disabilities
literature over a 15-yr period. They found that across 152
studies that included 6,353 children with learning dis-
abilities, 75% of the children had social skill deficits. The
authors concluded that social skill deficits should continue
to be viewed as one of the elements of learning disability.
They described the major categories of deficit as skill
deficit, performance deficit, and self-control deficit.
In this study, children with ADD did not demonstrate
a significantly greater need in any of the social skill cat-
egories compared with other diagnostic groups. The
largest numbers of goals were in Verbal Presentation,
Nonverbal Presentation, and Emotional Response. Ma-
dan-Swain and Zentall (1990) reported that social re-
jection of children with ADHD is correlated more with
negative physical and verbal behavior than with high
activity level and off-task behavior. In adolescence, os-
tracism by peers may result from behaviors such as run-
ning, talking, interrupting, and disruptive or unsafe
behavior, as well as inability to perform tasks that require
attention (Cunningham, 2002). A recent study by Sciberras
and colleagues (2014) of 179 children with ADHD ages
6–8 yr found that 40% had language problems that af-
fected their social and academic functioning.
Limitations and Future Research
This study has several limitations. First, we used a single
source of data: goal sheets developed for a social skills
occupational therapy program with enrollees who were
predominantly suburban, middle-class children attending
community schools with little social or economic diversity.
Second, the program participants were not divided equally
among diagnostic categories; however, the numbers ac-
curately reflect the program participants over the time
studied. Consideration of comorbidities and dual di-
agnoses was not within the scope of this study.
Finally, the DSM–5 was published in 2013, replacing
the DSM–IV. Two conditions used in this study were
recategorized: PDD–NOS and Asperger syndrome.
PDD–NOS was replaced with ASD, and many children
March/April 2015, Volume 69, Number 2
 previously diagnosed as PDD–NOS may now meet the
DSM–5 criteria for social (pragmatic) communication
disorder. In addition, the diagnosis of Asperger syndrome
has been replaced with ASD without language im-
pairment. Further research investigating the use of the
new taxonomy with the new diagnostic categories is
warranted.
Implications for Occupational
Therapy Practice
The findings of this study have several implications for
occupational therapy practice:
• The comprehensive social skills taxonomy described in
this article includes seven social skill constructs and
behavioral indicators that can be useful for broad-
based planning in educational settings.
• The strengths of the taxonomy include its basis in
child-centered social skill goals generated by the chil-
dren and their families and its education-friendly
nomenclature.
• The taxonomy provides a research-based framework
for addressing social skills that is derived from grounded
theory as well as application to children in varied di-
agnostic categories based on multivariate analysis. Re-
sults are discussed in light of current literature.
• This taxonomy can inform broad-based or focused
intervention and prevention programs to address so-
cial, emotional, behavioral, and mental health issues
within school and community settings and to prepare
students for life beyond school.
Conclusion
Occupational therapy practitioners in school settings are
expected to address behavioral and social–emotional issues
that interfere with learning. Social skills training has pos-
itive effects on social–emotional development, behavior,
and achievement. This article describes a research-based,
child-centered, comprehensive taxonomy of social skills to
facilitate identification of children with social skill con-
cerns, intervention to address those concerns, and tracking
of outcomes in school and community settings. s
Acknowledgments
We thank Katherine Shepherd, Barbara Mastriano, and
Laurinda Harman for their research expertise in designing and
piloting the typology. We also thank Sandra Snopkowski,
Michael Yuha, Elizabeth Graalman, Sarah Bliss, and our
master of occupational therapy students for their contri-
butions to the application of the typology to specific diagnostic
The American Journal of Occupational Therapy
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populations. Finally, we thank the wonderful families, chil-
dren, and therapists of the Collage Social Skills Program.
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