Saturday, November 23, 2013

Literal Language and Misinterpretations with Kids with Special Needs.... Understanding Language Comprehension/Auditory Processing Difficulties

                                                       "You're in the dog house."

I would tell my daughter she is in the "doghouse". This is what she would think. I did not say that she is in TROUBLE.

For my kids with special needs the English Language and its abstract meanings of words can be confusing.  Think about all the different interpretations that we just understand that "throw" my kids.
That last part of that sentence would cause my kids to stop and look at me with confused expressions. No,  I would not "throw my kids" as they would think I just said.  But we understand it as an expression.

Language Comprehension/Auditory Processing Difficulties

Characteristics: Children with Asperger's Syndrome, FAS, some with Noonan Syndrome and other developmental disabilities generally interpret auditory information literally and concretely. They can have difficulty understanding figurative language, jokes/riddles, multiple meaning words, teasing and implied meanings.

Children are literal thinkers, meaning that they interpret words at face value. ... Children need correct information given in concrete language. For kids/teens/adults with Autism, FASD's and other special needs they remain a literal thinker just like younger children. It will not be apparent until mid childhood when they do not move on to understanding more complex auditory and abstract meanings of speech.

So many things can be a set up for confusion or even disaster. They will follow the instruction to the literal meaning and sometimes that may have repercussions or consequences and it will end in a blown up rage because they did what we said.

The first time I noticed anything with our adopted sib set was I told  them we were going to "RUN ERRANDS". They did what I told them, they ran in the grocery store, they ran in the mall, they ran in the parking lot. I asked them to walk and one of them told me I told them that I told them we were going to RUN ERRANDS make up my mind?  It took me a few minutes to understand that I did say "run errands" and had to correct my instructions.

I knew what I had done because Miss Becca with her Noonan Syndrome can be very literal and I had to teach her the double meanings of many phrases.  I told them to run and they followed my instructions.  From then on it was we are going to the store to buy groceries, to the mall to ....  and we walk in those places.

A mother said to her child, "Stop back-talking to me". The child said, "I'm sorry Mom, I'll talk to your front."  A prime example of literal and concrete interpretation.

If said to a teacher said the same phrase to stop back talking and responded with the talk to your front statement, the teacher would think the teen was a smart A.... and consequence him with a detention. The teen would escalate because they would not understand that they offended a person in authority.

A friend today gave me the topic of the post when I was talking to her on the phone. She was with a little one who has FASD for the day.  They were at a craft fair and the little girl asked my friend when was the "Craft Show"?  They had already been through almost the entire auditorium.  My friend was taken a back and I explained her confusion.  She was thinking she was going to a show, like a play, movie, etc. I told her to explain that "the people who make the crafts are showing their things and selling them".  It now made sense.  Later I talked to my friend and she had explained it to her  adult daughter who couldn't get it, but then she explained that they think differently than we do.  A CRAFT SHOW would be a show about crafts. She figured out that she probably should have said a CRAFT Sale, and I said that she would probably even do better with  " adding an explanation of a place where they sell crafts and things that people make". 

Recently my older daughter S... with Fetal Alcohol was told that she needed to take her meds for 30 days with only missing 3 doses a week and she wouldn't need a guardian.  She made the 30 days and then thought she didn't need to take them anymore.  She understood what they told her but they forgot to add the information that she needed to continue to take her medications and she had to continue to show she could do it in order to have an intervention.  In her way of thinking she did exactly what they told her. Then they went back on their word.

When one of mine was in the teens. I said  she had a stomach bug. She thought there were actually bugs in her stomach and she freaked out. Explaining that only caused further anxiety. I finally just said her stomach was sick and she finally stopped panicking.

When working with kids with FASD's, autism, and other neurocognitive disorders it is very common for some of them to be very CONCRETE in their interpretations of what we say.  Talking simply and thinking about what we say can save confusion and mixed messages.

***I will add that kids who will often present with  delays in processing information auditorilly. Even though they may be able to comprehend the auditory information given, it may take them additional time to process this information prior to responding. They may also have difficulty following multi-step auditory directions.

I often tell Becca or Dee as part of something I said that I was just joking or being facetious, or sarcastic to make sure they connect what I was saying.  They understand that I was not being serious. Eventually they learned many of the double meanings or when we were joking and laughed even when they did not understand. Implied meanings really make them struggle because they are hard to explain because the rules and circumstances are more fluid and not consistant. My kids with FASD got the teasing much better than Becca with her autism and Noonan Syndrome.

So when I see my kids stare at me with those confused eyes, I wait to see if they get the little light bulb look at they just processed the information or they still are confused. I then rethink what I just said and explain it more simply and then I see that they finally figured out what I was meaning.


  • Auditory information/prompting should be kept to a minimum.  It is often too overwhelming for some children/adults. Visual cues should be used to assist the child to more readily comprehend directions, questions, rules, figurative language, etc. 
  • Give the child enough time to respond, in order to allow for possible auditory processing difficulties.  Wait before repeating/rephrasing the question/directive.  Double check for understanding from the child's perspective.
  • The adults in the child's environment should be aware of the child's concrete/literal interpretation of figurative language. We should help by providing concrete explanations.  We need to increase the child's comprehension of figurative language skills, such as idioms, multi-meaning words, jokes, teasing, etc., through the use of simplied explanations. 

    When working with children/adults with FASD, autism and other processing issues. Speak slower giving them time to process, simply and concretely.  Watch for looks of confusion and misunderstanding and check for understanding with asking a question. Then explain again using more literal/concrete terms.
Use visual supports which helps them have the ability to independently complete tasks/activities and as always we need to show more and talk less with our kids/adults with auditory processing disorders.

One thing I have found highly effective with working with my teens and adults with auditory processing difficulties is to use their always present cell phone as a tool to help them be more independent. I talk less, I text more and thus they are highly successful and Mom is not nagging from prompting, prompting or explaning. They see it, they can do it, they can reference it if they forget and they can ask questions that simplify my responses.  It also cuts the processing time way down and it is done much faster.


I found this book, inspired by a boy with autism,  "Unintentional Humor is a laugh-out-loud book that highlights the ambiguity of the English language when experienced by a literal mind. Literal interpretations of common expressions such as Surfing the web, You're in the dog house."

"The twenty-three pages of definitions make Unintentional Humor an effective teaching tool for both home and school. Unintentional Humor is being developed into school curriculum, learning materials, and a series of additional books."

Friday, November 15, 2013

Broken Adoptions: Another Story in the Headlines

Another story of a desperate family with an adopted child who gave up. I do not condone the method of how they gave up their son, but I understand their desperate measures to keep their family safe.

In October when the Reuters story broke about the rehoming of children hit the headlines, I wrote a piece on

Adoption: Where  The Systems Have Failed Both Children and Families

The Ohio story is spreading like wildfire across the internet. How come the real story is not ever heard?   When will it end... if we don't start addressing the problems with the lack of help, diagnosis, post adoption support, families will keep making the headlines by giving up, or in some severe cases find themselves in unthinkable circumstances.  Families are not equipped to be residential treatment centers without any guidance or support or understanding.

Here is my attempt at educating the media. As a long time adoptive parent and advocate of some very challenging children I have seen adoptive and biological families struggling to find services in a broken system. There is much written about the failure of the children's mental health system and the lack of qualified board certified child psychiatrists, plus the lack of parity with insurance companies, lack of evidence based practice and the lack of research into the effects of psychotropic medications and the off label use on our children.

Many of these children also have been prenatally exposed to alcohol and drugs in utero and the kids from the foster care system also have challenges and brain structure changes from the effects of abuse and neglect. Normal parenting strategies for these children do not work and the advice given by the children's mental health system often is opposite from what actually works with children with prenatal alcohol exposures.

A recent study written in Canada says 55% off the children in foster care have Fetal Alcohol Spectrum disorders.

The lack of research, diagnosis, and awareness and evidence based practice is really hard to find. And there is little post adoption support, foster parents move these children from place to place and some of these children due to their histories have a hard time fitting in home leaving families desperate, grieving and broken from trying everything and faulted for not loving them enough.

Post adoptive support services need to be funded to help families when they find themselves with a child who needs help. Love alone will not heal the children when they are genetically challenged by their parents genetics which are often loaded with mental health issues, prenatal alcohol and drug exposures, for children from institutional settings and the foster care system abuse, neglect and trauma.

From the Bazelon Center for Mental Health Law  Child Welfare

There is much written about the failures of the well kept secret of broken systems of care and the Custody Relinquishment to garner Mental Health Systems not just from biological families, adoptive parents, kinship parents have all faced the awful decision that after exhausting options to gain a very expensive out of home placement. All children belong in homes and parents sometimes are sleeping under threat of harm, fear not only for their child, themselves, the siblings and everyone suffers from secondary trauma.
More on the issue of Custody Relinquishment

Policy Documents on finding alternatives to Custody Relinquishment

We need help and I have been helping parents find services for now 15 years after I adopted a set of 5 from foster care. I had little help, I had to fight, I had to learn the ins and outs of Medicaid law and fought for the right for my adopted daughter who while on medications which were making her worse nearly killed me. The black box warnings were too late. But she was not mentally ill only, she had Fetal Alcohol syndrome and I had to fight for two years for her right to family and a residential placement as a young teen. Today she is an adult, she knows that this mom never gave up.

We have not come very far since 2003 when the United States General Office of Accounting wrote a report on this tragic practice.

Nami's information on that report: 

But few families can fight a broken system. Until we look at the underlying problems and find help these stories will continue to happen and families crucified by society and the media for the lack of support and understanding of some very complex issues and the underlying cause of most of these stories. Fetal Alcohol Spectrum Disorders compounded by no support for families and often times inadequate histories when parents adopt. Kinship parents, foster parents, biological parents also struggle with our FASD, mentally ill and all become traumatized and every one loses.

Why do I know so much:  I had no choice but learn it all to fight for my adoptive daughter's right to family and not be relinquished to the vary system she came from.

I wrote our adoption and fight story in the second half of our families story.
Tiny Titan, Journey of Hope by Ann Yurcek

I have spent the last 10 years helping families keep custody and find support and diagnosis for their complex adoptive children.