Pragmatics includes a wide range of abilities related to how we communicate with one another in various ways, depending on who we are speaking to and on the specifics of the situation. For example, we use different words, prosody and body language when we speak to our boss than we do with a co-worker, or when communicating with a store clerk as compared to a close friend. Similarly, the words we use, our body language and our communication style vary when we are in public versus when we are at home with our family. We learn all of these subtle variations over time and rarely need to think about them to choose the appropriate style and words to fit a situation.

All of that can change when a person has RHD. Some people may talk too much, monopolizing conversations and not picking up on others’ cues that they want to take a turn. These lengthy responses may also seem highly disorganized, jumping from topic to topic. Or, the opposite may be the case: they may answer with only short responses and/or rarely ask another person for their thoughts or opinions. For example, when asked, “How are you?” they may reply, “Fine,” but not ask “How are you?” in return. In addition, they may have difficulty “filtering” their responses according to usual social conventions. For example, they may say, “That’s an ugly dress,” not realizing that may hurt the other person’s feelings.

Pragmatic impairments can be very challenging to cope with as they make the usual “give and take” of conversation difficult. It is important to remember that these problems are a direct result of the person’s RHD.

What you can do

You may not be able to wait for a natural break in their speech in order to say what you want to say; rather, you may need to gently interrupt them so that you can take a turn. You may want to use a gesture of some sort (e.g., raise your hand) to help them know that you want to take a turn. Or, they may need to be reminded of what the original question or topic was. On the other hand, if the person does not say much, they may benefit from direct requests to say more or to ask a follow-up question. It can be challenging to provide this sort of help without seeming to be patronizing or “talking down to them,” so it is important to maintain an adult-like, supportive and kind manner when providing any of these types of cues or guidance.