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:: but what do you really mean? ::

March 24, 2011

I have fallen off the face of the earth.

But don’t worry, I have climbed back on.

School had essentially swallowed me up whole for a brief moment in time there.  During this time we also travelled to Saskatoon and stayed with my parents for a week while Ava had a re-assessment at ABC, journeyed to Edmonton for a boat motor (even though it was -30 Celsius) and read a lot.  I also wrote a couple of term papers in the midst of the chaos, which is what I wanted to share today.

No, wait!  Come back!  It’s interesting, I promise!

One of the term papers I wrote dealt with communication and language difficulties of children with ADHD, TS (Tourette’s) and ASD (Autism spectrum disorder).  I find it’s interesting to see how these three disorders or so interwoven and complex, many of the social features crossing barriers and interacting.  The features that stuck out most to me were the difficulties that children with ADHD and TS experience with pragmatic language and non-literal (figurative) language.

Pragmatic language is, essentially, the rules that govern our social interactions.  Pragmatics contain knowledge about turn-taing, participating in conversations, eye contact, tone of voice and prosody.It is the essential language skills and social knowledge that enable us to understand a conversation partner’s intended meaning, and to respond in an appropriate manner. Thomas Brown is one of the leading researchers and speakers on ADHD.  He notes (2009) that, “children with ADHD speak louder, fail to modulate their voice volume and speak for much longer at a stretch with many short pauses during their talk, but they take much longer to respond to their conversational partner” (206).  ADHD also effects individuals relationally as many children with ADHD do not seek relevant cues from social interactions that would allow them to monitor their behavior in accordance with social expectations and may, therefore, display poor pragmatic behaviour.

Figurative language is another area of communication that is compromised.  More specifically, the researchers I will cite investigated something called Theory of the Mind (ToM) which is the ability to understand that others have beliefs which can be different from your own.  How does this relate to sarcasm, idioms, simile and metaphor?  Understanding figurative language can be compromised by inhibition.  The listener’s mind impulsively retrieves the literal meaning for all figurative expressions (Eddy et al, 2010).

Some examples of figurative language we’ve had to explain to Ava include:

“It’s raining cats and dogs” ~ Ava ran to the window to check (at five years old) and was hugely disappointed that the puddles contained water instead of poodles.

“Nose to the grindstone”

“Between a rock and a hard place”

Anything related to sarcasm or simile also need to be explicitly explained several times for her to understand.

The impact of difficulty with figurative language is quite significant, socially.  Figurative language is woven throughout our interactions on a daily basis.  It’s featured in TV shows, novels, picture books, radio programs, classroom conversations and interactions with peers.  Difficulty understanding the complete meaning behind someone’s words leaves the child vulnerable to social exclusion or avoidance.  Those tested in the study had TS and/or ADHD with co-morbid TS.  The researchers noted that those with TS judged what was considered socially appropriate differently than those without TS.  Often, they were unable to discriminate when inappropriate statements or actions had been performed (also known as a faux-pas test).  Eddy et al. (2010) created a parallel between this deficiency and common communication difficulties seen with individuals who have ASD.

These studies have me fascinated due to the implications they have for Ava.  Initially, her PDD-NOS diagnosis was due to the difficulties she experienced with social interactions (failing the figurative language component of the ADOS, ignoring social boundaries, interrupting, etc), but she didn’t fit they ‘typical’ ASD model in that her symptoms were of late onset.  The late onset of symptoms is more common for ADHD with co-morbid TS.  Not that it matters what diagnosis we end up with, it is rather frustrating to experience this ‘diagnosis soup’ where symptoms from this disease and that disorder are plucked out and applied to my daughter.  The more I research, the more it appears to me that these conditions are related and present with similar features.  Knowing this makes it easier for me to ignore the distinctions the doctors want to make and to just work on what is causing difficulty at that time.  It doesn’t matter if this characteristic is common for ADHD or that one for TS, in my mind it’s a continuum of similar factors.


Brown, Thomas (2009).  ADHD comorbidities: handbook for ADHD complications in children and adults. Arlington, Virginia; American Psychiatric Publishing Inc.

Eddy, Clare et. al (2010).  Impaired comprehension of nonliteral language in Tourette syndrome.  Cognitive Behavioural Neurology. Volume 23, Number 3, September 2010 (p 178 – 184)

doi: 10.1097/WNN.0b013e3181e61cb7

Heyer, Judith (1995).  The responsibilities of speech-language pathologists toward children with ADHD.  Seminars in Speech and Language.  Volume 16, Number 4, November 1995 (p 275 – 288).

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