Communication Disorders & Youth in the CJS
Communication after TBI
Following a TBI, children and youth often have cognitive-communication disorders. Cognitive-communication disorders refer to challenges with any aspect of communication that result from underlying cognitive (thinking) challenges. They may also have pre-existing challenges with language development and literacy skills, separate from the TBI.
As a result, young people with TBI often have persistent challenges with aspects of communication, including:
- Listening and understanding (for example, hearing, paying attention, and understanding, especially when there is background noise or more than one speaker)
- Speaking (for example, finding the words to use and expressing themselves in a clear and organized way)
- Reading (for example, reading and understanding the information, especially if there are new and/or complex words and ideas and a lot of text)
- Writing (for example, finding the right word and organizing and expressing themselves clearly)
- Thinking (for example, using language to solve problems, organize memories, reason, formulate arguments and think of concepts and ideas)
- Conversation and social interaction
What does this look like? Children and youth with TBI may:
- Have difficulty ‘reading between the lines’ or understanding implied information
- Miss verbal or nonverbal social cues, including facial expressions
- Have trouble understanding new vocabulary, complex sentences, or complex ideas
- Respond to questions slowly or with a delay
- Use simple sentences and basic vocabulary when speaking or writing
- Make inappropriate comments, including comments that are off topic
For example, a young person with a cognitive-communication disorder may have trouble paying attention in conversation, get distracted, and go off on a tangent. They may forget what’s already been discussed, or what it is they are supposed to do. Because they have trouble with organization and planning, their stories and explanations may be mixed up, unclear, and confusing.
Social Communication and Social Cognition after TBI
Another aspect of a cognitive communication disorder is poor social communication.
Social communication refers to the way we use language (including spoken, sign, and body language) in different social situations, to build and maintain relationships. It also involves knowing how to change our communication style depending on the environment and communication partner (for example, speaking to a friend, versus speaking to a police officer).
Children and youth with TBI are often rejected by their peers because of challenges with social communication, such as:
- Talking too much, or too little
- Not understanding ‘inside jokes’
- Saying and doing inappropriate things
- Appearing immature compared to their peers
- Acting aggressively or impulsively
Another related area of difficulty is with social cognition. Social cognition is the term we use to refer to how people ‘read each other.’ It’s how we interpret facial expressions and body language, and try to understand other people’s thoughts, feelings, and behaviour. Children and youth with TBI often have a lot of difficulty with emotion recognition and expression.
The frontal lobes are very vulnerable to injury, and so all cognitive, communication, and social communication abilities related to frontal lobe function are at risk.
Youth and TBI Communication Scenarios
Recognizing how TBI might affect a young person’s behavior and communication–and how a legal actor might interpret that behavior and communication–isn’t easy or intuitive. The example scenarios below illustrate what a “typical” interaction between a youth with TBI and a member of the criminal legal system might look like. These scenarios will show you the “do’s” and “don’ts” of how legal actors might treat a youth with TBI. We’ve highlighted important behaviors or important ideas within each scenario. Keep these keywords in mind as you consider how the legal actor should (and shouldn’t!) act.
Scenario 1 – Approached
by police officer
Robin, 15, suffered a brain injury as a young child after being in a car accident. Although her recovery has progressed, she still struggles with some day-to-day tasks. Communication can be challenging in certain situations, especially casual social interactions. She sometimes doesn’t understand what other people are expressing or says something inappropriate for the situation. Robin is currently staying with her aunt and uncle over her summer holiday. One night, she and her cousin decide to walk down to the corner convenience store to get some snacks.
Robin decides to wait outside because fluorescent lights can be overwhelming and disorienting (common for persons with brain injuries). While she’s waiting by the door, a police officer approaches. “Isn’t it pretty late to be by yourself in front of a gas station?” the police officer asks. Robin thinks for a minute and then says simply, “No.” Without meaning to, Robin has come across as being rude and sullen.
Bad (Don't)
The officer (incorrectly) interprets Robin’s behavior as evasive and impolite.
“Don’t take that tone with me, kid,” the officer responds, sounding defensive and confrontational. “There’ve been a couple robberies here recently, and it’s my job to keep an eye out. Why don’t you show me some ID?” he asks, using potentially misleading question forms.
These actions cause Robin to become anxious, scared and confused; the situation is escalated.
Good
The officer (correctly) recognizes that Robin’s behavior doesn’t merit escalation, even if it appears impolite and aloof, it isn’t violent, dangerous, or harmful.
“Just wanted to make sure everything was okay,” the officer says, focusing on his own actions and intentions. Then he walks away.
The officer has avoided escalating the communication context.
Best Practice
Consistent With UNICEF Reimagine Justice For Children Framework
Robin isn’t approached by a police officer at all; Robin’s city had recently passed a transformative budget to shift funding away from the police force and into programs designed to target structural determinants of crime. The money that would have paid the officer went instead to a community initiative designed to improve the walkability of the street where the corner store is.
Scenario 2 – Routine meeting
with a lawyer
Mackenzie, 16, grew up in an abusive household and was often hit on the head and in the face by her father. At times, her father picked her up and slammed her against the wall. In addition to these repeated hits to the head, Mackenzie was so badly injured at one point that she had to be hospitalized for a brain injury. Mackenzie’s mom, together with Mackenzie, was able to escape the abusive relationship. After a lengthy custody battle, Mackenzie’s mom won full custody, and Mackenzie began the process of changing her surname to her mother’s.
The two of them go to a legal clinic for help with the paperwork. As a result of her injuries, Mackenzie has some challenges with understanding conversations, which includes difficulty understanding instructions. Because of her history of abuse, her challenges are exacerbated in stressful situations, particularly those involving adult men. The clinic attorney has a difficult time explaining to Mackenzie that she doesn’t need to write her dad’s name on the form because, even though he is her biological father, he no longer has parental rights. Mackenzie incorrectly fills in the form twice.
Bad (Don't)
The lawyer begins to lose patience.
“Look, it’s not that hard,” the lawyer says, making assumptions about Mackenzie’s cognitive-communicative abilities and being unsympathetic. “Just do it exactly like I told you to.”
The lawyer has adopted a vertical working orientation of non-collaborative authority over Mackenzie. In lay terms, this means a power dynamic has been created whereby the lawyer has authoritative power over her, rather than working collaboratively with her to support her.
These actions cause Mackenzie to feel stressed and withdrawn; the situation is escalated.
Good (Best Practice)
The lawyer recognizes that people with neurodisability (especially young people) can have difficulty following seemingly routine instructions and understanding nuanced information, particularly for novel contexts like a legal procedure.
“Don’t worry, we have a hundred extra copies of this form,” says the lawyer, de-emphasizing the mistake. “I know having to talk to a lawyer can be a stressful thing to do,” the lawyer goes on, showing empathy. “But please know that my job here is to help you as best as I can. Is it okay if we work on this new form together?”
The lawyer has centered Mackenzie’s experiences and goals within the interaction and has adopted a horizontal working orientation to work collaboratively.
Scenario 3 – Courtroom appearance before a judge
Tyler, 15, was raised by a single mother who struggled with substance use disorder. Tyler himself began using drugs in his early teens, eventually establishing a rapport with a classmate-dealer. This relationship eventually soured, and Tyler suffered a head injury after being shoved to the ground by this classmate during an argument. Due to the injury, Tyler became more impulsive with both his emotions and his actions, unable to process and regulate them, which put strain on his household and his schooling.
A few months later, Tyler was arrested for attempting to rob a liquor store on a dare. Because Tyler had no criminal record, the DA was willing to cut him a good deal–probation only–if he pleaded guilty. Tyler’s attorney encouraged him to take the deal, and Tyler appears as scheduled for his plea hearing with the local criminal judge. As part of the plea, the judge asks Tyler if he has anything he would like to say. “Fuck no, I got nothin’ to say,” Tyler immediately responds, legitimately not wanting to add anything and eager to bring the hearing to a close.
Bad (Don't)
The judges takes offense at Tyler’s apparent lack of decorum and (incorrectly) interprets it as poor character and intentional/volitional misbehavior.
“Young man, I’d think very carefully about my behavior if I were you,” the judge warns, appearing to make an implicit threat. “You don’t appear to grasp the seriousness of your situation,” he continues, assuming a lack of understanding or appreciation. “And I would have expected more remorse from someone who was truly sorry for his actions.” (Again assigning moral shortcomings). “I think we’d better give you an extra month of probation.”
These actions cause Tyler to feel angry, cheated, and disempowered; the situation is escalated.
Good
The judge (correctly) understands that youth with neurodisability can have difficulty regulating and overseeing their own communication and behavior, especially in high-stress contexts like a courtroom appearance. The defense and prosecuting attorneys/solicitors have also made sure the Court Accessibility Coordinator has been contacted to ensure communication accessibility.
“That’s fine,” says the judge, remaining neutral and overlooking the harmless, albeit inappropriate, language. “The most important thing is that you work with your attorney to follow your probation. As long as you do that, I’m satisfied.”
The judge has focused on Tyler’s autonomy and minimized the communication pressure in the courtroom. The judge also made sure to not use complex vocabulary such as ‘remorse’ that Tyler is unlikely to understand, thus accommodating for any language and comprehension difficulties.
Best Practice
Consistent With UNICEF Reimagine Justice For Children Framework
Tyler doesn’t appear in court at all. The jurisdiction has decided to follow best-practice recommendations from international organizations and diverts every single child (with and without neurodisability!) away from the traditional criminal legal system.
Instead, Tyler’s case is assigned to an interdisciplinary group of social workers, therapists, legal workers, education professionals, and community members. This team works together to:
- Assess Tyler’s functional behavioral and communication limitations
- Identify appropriate therapeutic and rehabilitative measures
- Integrate him back into his school with support and accommodations.
Scenario 4 - Meeting with A
probation officer
Dylan, 18, has been precariously unhoused for about a year after his father was laid off from his job. The stress was extremely hard on him, and after a particularly rough day at school he got into a fistfight with another student in which he suffered a major concussion. As a result of the injury, Dylan struggles with impulse control, committing information to longer-term memory, and translating information into appropriate behavior. Dylan and the other student were put on probation, and Dylan manages to stay out of trouble for the remainder of the school year, meeting with his probation officer every couple of weeks.
Over the summer, however, Dylan’s laptop is stolen while he’s at the library. Even though he has just a few weeks left until he moves to a nearby big city for college, Dylan decides that he’s had enough with his hometown and decides to move early. As a result, he inadvertently breaks his bail condition.
Bad (Don't)
Dylan’s probation officer is shocked and incorrectly attributes Dylan’s actions to intentional behavior.
“What on earth were you thinking?” she asks, demanding immediate self-reflection or introspection. “I know you were upset, but you’ve just made things a lot worse for you,” she goes on, emphasizing the negative consequences of Dylan’s behavior.
This behavior causes Dylan to feel ashamed and worried; the situation is escalated.
Best Practice (do!)
Dylan’s probation officer correctly understands the important distinction between “skill” and “will.”
“It’s okay, Dylan, this sort of minor problem happens all the time. I know you didn’t do this on purpose, and I definitely know you’re not a bad person,” she says, reaffirming communal experiences and reaffirming Dylan’s character. “I can understand how someone in your position would do exactly what you did,” she goes on, validating Dylan’s lived experiences and empathizing with his actions.
The probation officer has focused on Dylan’s autonomy and avoided adding additional stress.