Understanding of Literal Truth, Ironic Criticism, and Deceptive Praise Following Childhood Head Injury

Children with closed head injury (CHI) have semantic-pragmatic language problems that include difficulty in understanding and producing both literal and nonliteral statements. For example, they are relatively insensitive to some of the social messages in nonstandard communication as well as to words that code distinctions among mental states. This suggests that they may have difficulty with comprehension tasks involving first- and second-order intentionality, such as those involved in understanding irony and deception. We studied how 6- to 15-year-old children, typically developing or with CHI, interpret scenarios involving literal truth, ironic criticism, and deceptive praise. Children with severe CHI had overall poorer mastery of the task. Even mild CHI impaired the ability to understand the intentionality underlying deceptive praise. CHI, especially biologically significant CHI, appears to place children at risk for failure to understand language as externalized thought.