Language is one of our most important and complex skills and is often affected by a brain injury in ways that may be subtle but nevertheless important. We start to hear, respond to and learn language from the time we are born. By about five years of age, most of the basic language structures are in place, but the process of extending and refining these structures, building vocabulary and thinking skills, learning to read and write, goes on throughout childhood and adolescence.
A brain injury can interrupt this process. The younger the child when the brain injury occurs, the smaller the ‘store’ of vocabulary and language structures he/she has built up, and can call on after the injury. In general, the more severe the brain injury, the more severely the language is impacted, although there are exceptions to the rule.
A speech pathologist is the person to help with language problems, ideally one who is experienced in working with young people with a brain injury.
Language involves both ‘comprehension’ – understanding what others say, and ‘expression’ – saying things ourselves. And it also involves the thinking that links these two together, enabling us to respond appropriately to what someone else says. There are many skills and resources involved such as a large vocabulary, the rules of grammar, stringing ideas into a narrative and organising the mouth, throat and lungs in complex sequences to talk.
Using and understanding language
Children who are very young when they sustain a brain injury may have difficulty learning the building blocks of language. These are words, grammar, and skills such as how to talk about something that happened yesterday.
Most often, children with a brain injury can talk quite well. The problems are often less obvious, involving the processing of language – that is, the way we understand and organize things in language. Children with a brain injury may, for example, have difficulty with:
understanding similarities and differences between things, and putting things in categories – the differences and similarities, for example, between a car and a truck
being able to link ideas and build associations between different things
sequencing and organising information logically
knowing how much to say, or being able to think of what to say
Children who have challenges in these areas may fail to understand humour, metaphor, innuendo and the ‘social rules’ in each situation. If the young person has difficulties with memory or with focusing attention, it can be more difficult to understand what is being said and to follow a conversation.
A young person with a brain injury may have difficulties in developing grammar and sorting out the order of words within a sentence.
Getting ideas in sequence can also be difficult, such as telling a story. Without strong oral language, it’s very hard to develop good reading and writing skills. Sometimes children can read but find it hard to understand what they have read, put it into their own words, or write down their own thinking.
A speech pathologist can often help substantially to develop these skills. If a child is unable to communicate verbally then a speech pathologist can also help by providing the child with an alternative way of communicating. This may include using pictures, words and/or hands.
Slurred and jerky speech – ‘dysarthria’ – can be a problem after a brain injury. Usually this clears over the first few days or weeks, but sometimes, with more severe injuries, speech is more affected. A child with weak or tight muscles of the face, tongue, jaw may have slurred or imprecise speech. You will have to pay good attention to your child’s efforts to speak.
Helping your child to listen and understand
Use language that is concrete and straightforward. If you are giving instructions, use short, simple sentences and limit yourself to one or two at a time.
Model or demonstrate what you want, while you say it as well. Ask your child to restate the information you’ve just given: “Now tell me, how are you getting home from school today?” Allow time for your child to take in what you have said.
Say the same thing twice, in different ways (allowing your child time to take in each): “We’re going to the beach soon. Are you ready to go to the beach?”
Allow your child time to think of what he/she wants to say. Talk with your child a lot-just ordinary, everyday conversation. Listen, don’t correct and interrupt, but hear what is said and respond in a way that shows your interest. Make talking enjoyable and rewarding.
Help your child to listen as well as talk-for example, explain that everyone has a turn in conversations, and it’s your turn now (or the turn of another member of the family, etc.). Then encourage your child to respond e.g. “what do you think about it?”
Organise things so that your child has to ask for things at the shops such as buying the milk. Make opportunities for talking in all sorts of everyday situations.
Do things together and talk through the steps together. For example, packing a bag to go away for a weekend – ask your child what he/she is going to take, help to write a list and fill it out, e.g. “What’s going to happen if it rains?”
Find out what games are ‘in’ at school or in the playground and rehearse them at home. Or play other games; cards, checkers, etc. Take it slowly, talk through the rules step by step, practice each step, and help your child learn to take turns. Use the communication aids you and your therapist might make.
A Parents Guide
Building social skills
Children and young people with a brain injury may have difficulty with the social skills that most of us take for granted.