Children who survive brain tumour are a growing population, and are increasingly seen in clinical caseloads worldwide. However, cure often comes at a cost, with devastating neurocognitive and communicative sequelae commonly seen in children across the course of development. The impact of tumour and treatment-related variables on the development and acquisition of neurocognitive and communicative skills is considerable, and includes the direct effect of a tumour located in the supratentorial and infratentorial regions, raised intracranial pressure, treatment effects from surgical intervention, radiotherapy, and/or chemotherapy, and other risk factors. Pragmatic abilities and social competence are commonly disrupted in childhood brain tumour (CBT), with devastating effects on quality of life. This chapter addresses the key social skills and constructs of social ability associated with CBT in addition to the primary mechanisms underpinning pragmatic deficits in CBT. Management of pragmatic deficits associated with CBT requires an integrated approach to assessment, treatment, and long-term surveillance. It is also important that these children are not "lost" to services considered essential to ensuring improvements in social functioning and pragmatic competence. These approaches to assessment and intervention are outlined.