One fall afternoon in 1994, clinical psychologist Jeffrey Jones, PhD had a particularly frustrating group therapy session with four pre-adolescent boys. The Atlanta-based therapist was trying to get a group discussion going.

But one 11-year-old boy in the group, "Billy," just didn't seem to "get it." He tended to blurt out inappropriate and silly comments. Later, as Jones walked the children outside to play an active therapy game, he remembers Billy saying something like "OK guys, now we're going to go out and have a great time," in the exaggerated, cartoonish voice he liked to use.

In response, some of the other group participants sighed in exasperation or rolled their eyes dismissively, and someone muttered under his breath, "What a dork." Jones remembers feeling frustrated because while he could stop the other children from overtly mocking Billy, he couldn't make them accept him--preventing the youngster from reaping the benefits of a group therapy session.

"I remember feeling like there was just too big of a gap between Billy's issues and what these guys were capable of accepting," Jones said.

Billy needed to learn how to talk to people--how to negotiate the give-and-take of what's said in words, and what's communicated through gesture, posture, tone of voice and facial expression, Jones says.

But he also needed to be with a group of kids dealing with the same issues, so he could work on these basic communication skills, while still enjoying the feeling of being part of a group, he says.

That experience inspired Jones to found the Beyond Words Center for Social Skills Training in 1996 to teach social skills and nonverbal communication to children and adolescents. His wife, fellow psychologist Lisa Heimann, PhD, joined the center two years later. Local schools, child psychologists and pediatricians refer about 300 children a year: Youngsters who just don't seem to fit in, who are friendless and teased by other children, Jones says.

Beyond Words gives them a chance to learn how to relate to peers in a positive, supportive atmosphere. "For some of our kids, these are the closest friends they have," Jones says.

Missing the cues

Jones and Heimann studied nonverbal communication with Stephen Nowicki Jr., PhD, and Marshall Duke, PhD, at Emory University, and the approach they use at Beyond Words expands upon Nowicki and Duke's concept of "dyssemia:" difficulty in sending or receiving nonverbal cues.

Psychology professors who have devoted their careers to studying nonverbal communication and developing ways to help children understand its subtleties, Nowicki and Duke published the books "Helping The Child Who Doesn't Fit In" (Peachtree Publishers, 1992) and "Teaching Your Child the Language of Social Success" (Peachtree Publishers, 1996). They also developed a test to assess dyssemia, called the Diagnostic Analysis of Nonverbal Accuracy (DANVA), which gauges a child's ability to read the facial, postural and paralinguistic expressions for anger, fear, sadness and happiness. They estimate that one of every 10 children has significant problems with nonverbal communication.

According to Nowicki, children with dyssemia fail to recognize the wide eyes of someone beset by fear, or the pursed lips of a person who is angry. They can also fail to interpret the other nonverbal cues, including posture and gestures, tone of voice and the correct use of personal space during interactions with other people.

Dyssemic children, says Nowicki, also have trouble employing nonverbal cues in their own communications and can benefit from specific instruction in how to receive and send nonverbal messages--as outlined in an article he co-authored for the Journal of Genetic Psychology (Vol. 164, No. 1, pages 88-100).

While Nowicki and Duke study how to help children struggling with nonverbal communication skills, Byron Rourke, PhD, a Canadian psychology professor at the University of Windsor in Windsor, Ontario, researches the root causes of those difficulties. Rourke ties those difficulties to what he characterizes as the syndrome of nonverbal learning disabilities (NLD) in children.

Children with NLD show a broad pattern of cognitive impairment, which encompasses visual, spatial and organizational skills in addition to understanding nonverbal cues. Rourke theorizes that the condition is caused by dysfunction in the "white matter" nerve fibers in the brain, with the dysfunction particularly detrimental to systems within the brain's right hemisphere. For a skill such as reading, Rourke says the right side of the brain recognizes individual words, but it's the left side of the brain that "automatizes" the process, stringing the words together and allowing for the meaning of the text to emerge.

For children with NLD, the damage to white matter means the two sides of the brain are not integrated, says Rourke, leading to challenges with important dimensions of language, fine motor skills, dealing adaptively with novel experiences and nonverbal communication.

And while children with NLD are often described as hyperlexic and hyperverbal, talking a lot isn't the same as understanding what's being expressed through all the nuances of gesture, tone, and even silence, Rourke says.

"The principal problem of kids with NLD is that everyone seems to think they're smart because they talk well," says Rourke. "But in terms of social communication, talk is really cheap."

For children with NLD, the earlier an intervention the better, because early communication difficulties, and continued failures to get close to someone, can snowball into depression during adolescence, he says.

"They really try, and they fail; they fall flat on their faces," he says.

Learning communication skills

At Beyond Words, such children are identified through a comprehensive screening and assessment process. Using a battery of tests and interviews, including the DANVA, Beyond Words staff break down the children's communication deficits into two main parts.

  • Identifying. How well a child can recognize happiness, anger, sadness and fear on faces, understand those emotions in taped tone of voice samples, and interpret posture and gestures.

  • Expressing. How effectively a child can communicate those four emotions through facial expressions and tone of voice, and use personal space appropriately when talking to people.

After assessment, some children join a social skills training group of four to six students led by a master's-level counselor. The three counselors develop relationships with the children by constantly engaging with them and leading them through different communication-strengthening exercises. The goal is building their communication skills in the context of the relationship between the individual child and the counselor, and interaction between the children in the group.

"Our general approach is really kind of a coaching model; we work hard just to engage kids in social communication," Heimann says.

Counselors like Alexis Davis practice everyday social skills with the children--skills such as how to join in with others, listening, playing a game; the importance of eye contact and give-and-take in conversation; and how to signal friendliness with posture and gesture.

The skills training pays off, according to one parent, who didn't want to be identified by name. Her family moved to Atlanta in 2004, and the transition to a new school and the third grade was difficult for her son "Alex."

In his previous school, Alex had known many of his fellow students since preschool and stayed with the same group of kids throughout the day.

In his new school, he stayed with the same teacher, but with different children in each class. It turned out that Alex wasn't up to the challenge of making new friends, perhaps because he lacked the skills to initiate conversation. And without the buffer of a social group, Alex began to attract the attention of bullies, says his mother.

Since enrolling in the program, his teachers say her son is now doing much better at school, his mother says. He greets people now, is able to hold a conversation, and has even made a friend.

"He talks about other kids more. We'll see children from his school, and they seem happy to see him," says his mother.