Communication Challenges and How to Address Them

Some types of cognitive- communication disorders include:

Social Communication Disorders

Social communication disorders refer to difficulties with knowing the right thing to say, in the right (socially acceptable), way at the right time. It refers to the ability to adapt one’s conversational style, non-verbal communication and language according to the context and, relationship with the speaker. For example, being able to speak in a thoughtful, respectful manner with a judge or a police officer as compared to how one would speak to a friend where we can be less formal, make jokes and use different language. Many people with a brain injury also have difficulty understanding jokes, and with emotion recognition. They can’t always tell when another person is being truthful, is angry or teasing. As a result, they are at risk of being exploited and abused. (Byom et al., 2020, Wiseman-Hakes et al., 2019, 2020).

Social communication disorders are also heavily influenced by cognitive-communication disorders and executive functions. For example, difficulties with reasoning and executive functions can result in a person saying the wrong thing at the wrong time and not being able to control explosive emotions and impulsive responses. Social communication disorders can also be exacerbated by the mental health challenges and history of trauma experienced by many people with brain injury who intersect with the criminal justice system.

Among justice-involved persons with brain injury, cognitive-communication impairments are often exacerbated by;

Language and Literacy Impairments 

Many individuals who intersect with the criminal justice system come from socially disadvantaged families and communities (Clark et al., 2010), and are at risk for impoverished early language and emergent literacy experiences (Roy & Chiat, 2013; Spencer, Clegg, & Stackhouse, 2012). As a result, the cognitive-communication and social communication impairments associated with brain injury are superimposed on language and literacy impairments. (Snow et al., 2019, 2016, 2011; Davies et al., 2012).

Specific challenges in justice-involved populations include having a limited vocabulary, difficulty understanding the meaning of complex words and complex sentences, and poor reading and writing abilities. This puts the person at a distinct disadvantage in navigating the justice system and acting in their own interests, and further limits later employment and community integration.

Hearing and Auditory Processing Impairments

Many people with brain injury have auditory processing deficits (Atcherson et al., 2016, Vander Werf 2017), which are deficits in the brain’s ability to make sense of the rapid incoming auditory signals of speech (ASHA, SAC). People with brain injury also may be unable to block out sounds in the environment because of problems focusing auditory attention. Brain injury also can cause a hearing loss (a reduced ability to detect sounds), especially if they have a history of being hit repeatedly in the head and face. Hearing may sometimes be better in one ear than in the other. Complicating the effects of hearing loss is tinnitus, or ringing in the ears, which can be distracting in listening situations and also can negatively affect mental health. These hearing and auditory processing disorders are often undiagnosed.

Communication, Anger and Aggression

Some people with brain injury have significant challenges with anger management. They go from “0 – 100” with little warning and have difficulty controlling these extreme emotions. In addition to heightened emotion and lack of impulse control, this can also be a reflection of lack of emotional vocabulary and lack of the communication skills needed to express themselves in more appropriate ways. It is not uncommon for anger and aggression to be interpreted as anti-social behaviour. However, unidentified communication challenges are often a contributing factor. Research has shown that once other people are informed about the communication difficulties their perception of the ‘issues’ changed, to an understanding of unidentified and overlooked needs rather than previously understood ‘anti-social’ behaviours (Winstanley et al., 2018).

Limitations in language superimposed on brain injury-related cognitive-communication impairments are also exacerbated by the mental health challenges often experienced by those with brain injury. (Wiseman-Hakes et al., 2020).  Not surprisingly, more than one in five people who access mental health and/or addictions services (MHA) have a history of brain injury. (Hwang et al., 2008)

Stress and Self Confidence

Most individuals with brain injury are aware of their challenges in a general sense, even if they do not recognize their specific limitations. They recognize that when they are under stress, their ability to communicate is even more challenged (as is true for everyone). People with brain injury also, however, feel the stigma of labels (Ponsford et al.,2014) and worry that others will perceive them as ‘stupid’. The distinction between specific cognitive and communication challenges and overall intelligence is very important to acknowledge, because having a brain injury does not necessarily mean a person is less intelligent. A brain injury can cause a person to be slower at listening, understanding, thinking and responding; however, with support, rehabilitation, education, environmental modifications, and communication partner training, people with brain injury can live successful and meaningful lives and contribute to their communities and society.