JCPSLP Vol 16 no 3 2014_FINAL_WEB

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 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 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 their communicative competence can be limited. Bridget took a different approach to handling react to it or let it go? Bridget: Just let her go. While Bridget still felt frustrated about Mandy’s

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.

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JCPSLP Volume 16, Number 3 2014

Journal of Clinical Practice in Speech-Language Pathology