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JCPSLP
Volume 16, Number 3 2014
Journal of Clinical Practice in Speech-Language Pathology
Mandy withdrew from difficult communication situations
in an effort to reduce communicative failures. She stated
that she was “
not in many conversations at school, [and
says] something when it’s important
”. She appeared
not to value or feel confident about her contributions to
conversations. Hence, she made a conscious decision
to forfeit participation in the interactions: “
I find it hard to
say things, so I just don’t bother, I just sit there
”. Other
researchers (including Bogart et al., 2012; Kelly, McDonald,
& Kellett, 2013; Turkstra, 2000) have referred to the social
isolation that individuals with TBI can face. As these
individuals may lack the ability to take the perspective of
others, they can have problems behaving appropriately
and therefore fitting in. Subsequently, the social interaction
opportunities that would ordinarily foster development of
their communicative competence can be limited.
Bridget took a different approach to handling
communication frustrations involving Mandy. Rather than
ceasing the conversation, Bridget simply chose not to react
to Mandy’s communication impairment.
Interviewer: Do you ever get frustrated with Mandy’s
communication?
Bridget: Sometimes I do but I just get over it.
Interviewer: What about if the topic of conversation
moves on but Mandy brings up an old topic? Do you
react to it or let it go?
Bridget: Just let her go.
While Bridget still felt frustrated about Mandy’s
conversational flaws, she did not react in such a way that
would upset Mandy and make the conversation a negative
experience. Thus, while the communication breakdown still
occurred, it did not intensify into a more unsatisfactory
interaction for Mandy.
A strategy that Mandy used to increase her
communication with people was using online social media.
Interviewer: You seem to use [online] chat a fair bit, is
there any particular reason for that?
Mandy: Just easier, cos I don’t have to verbally say it, I
just type it. I’m pretty quick at typing too so it’s easier,
faster.
Mandy felt more confident to socialise via online chat
because she found it easier to express herself. It was
possible that this form of communication gave Mandy the
advantage of being able to edit her messages before she
sent them. Bridget said that Mandy was “
really quick
” at
responding when using online chat. This communication
experience was optimised for Mandy because she felt that
this modality was a more successful means of
communication for her.
Conclusion
This study investigated and highlighted the effects of social
communication impairment on the life of an adolescent with
TBI, from the perspective of the adolescent, her mother,
and her friend. It was found that a frequent experience
stemming from Mandy’s post-TBI communication
impairment was communication breakdown. This meant
that for various reasons Mandy and her communication
partners could not easily establish shared meaning. Some
of these breakdowns could be attributed to Mandy’s
expressive communication problems, while other ineffective
communication exchanges occurred when Mandy
misunderstood the meaning of others. Mandy, her family,
and friends have implemented strategies to reduce the
Vivienne: I could be looking at something completely
different and [Mandy will say] “What are you looking at
me for?”, “I’m not”.
At times, Mandy perceived adverse facial expressions from
people around her, and mistakenly believed that they were
thinking negatively about her. This misinterpretation was an
example of an impairment of affective communication,
another common consequence of TBI (McDonald, Rushby,
Li, de Sousa, Dimoska, et al., 2011). Babbage and
colleagues (2011) indicated that skill in affective
communication was important for successful interaction
and that inaccurate relation or perception of emotions
within a message resulted in miscommunication. A potential
reason for Mandy’s trouble interpreting other people’s
sentiments was that she may have had an impairment of
theory of mind, the ability to perceive the intention and
perspective of others, such that she could not accurately
perceive the thoughts, feelings, and intentions of her
communication partners (Im-Bolter, Cohen, & Farnia, 2013).
Mandy’s difficulty recognising her communication
partners’ messages was evident when she misinterpreted
jokes and sarcasm. She admitted that, “
when they say a
joke or something, I click to it a couple of days later
.” She
indicated that she spent a lot of time trying to decipher the
meaning of a joke. Vivienne and Bridget confirmed this:
Vivienne: Her father says something to her and she
goes “What did he say that for?” and I go “Mandy it
was a joke”.
Bridget: Sometimes like if I say something [as a joke],
she’ll take it seriously.
The understanding of increasingly sophisticated jokes and
sarcasm is an important social skill to be cultivated during
the adolescent years (Nippold, 2007) and is commonly
impaired following a TBI (Byom & Turkstra, 2012; Im-Bolter
et al., 2013). Mandy misunderstood humour from other
people that her typically developing peers comprehended
appropriately. She had delayed or inappropriate reactions
and this led to the communicative exchange being
compromised in effectiveness and mutual satisfaction
(Marini et al., 2011).
Theme 3: “I can just look in her eyes and
go ‘All right, should we not talk to you
today?’”
Various strategies were used by Mandy or her
communication partners to reduce the likelihood of
communication breakdown. These included withdrawal
from negative communication experiences, deciding not to
react to Mandy’s communication mistakes, and using
Mandy’s preferred modes of communication.
Mandy’s mother chose to withdraw from unpleasant
communication opportunities. Vivienne stated that Mandy
lost her temper easily when she was tired or had a
headache and as a result, Vivienne tried to avoid Mandy
in these situations: “
I can just look in her eyes and go ‘All
right, should we not talk to you today?’ And it’s the look
in her eye and I know she’s tired, she’s had enough
.”
Vivienne knew that when Mandy was fatigued and
irritable, the communicative exchange was less likely to be
effective and fulfilling. Therefore Vivienne discontinued their
interaction and withdrew from the situation. This minimised
the confusion or stress experienced by either party, and
potentially prevented escalation of the situation into a
communication breakdown.
