Comparison of literal, inferential, and intentional text comprehension in children with mild or severe closed head injury

Background: Children with head injury have impairments in pragmatic language at the level of both single words and texts. Text comprehension deficits are likely to be the more consequential for everyday and academic function, yet the relative magnitudes of literal and nonliteral text comprehension deficits have not been measured. Design: We compared the magnitude of the impairment in three forms of text comprehension for children with mild or severe head injury relative with controls: literal language (understanding literal text information), inferential language (making pragmatic inferences, textual coherence inferences, or enriching inferences), and the language of mental states and intentions (eg, producing speech acts, appreciating irony, and understanding deception). Measures: Effect sizes were used to measure the magnitude of the difference between children with head injury and age-matched controls, Results: Children with severe closed-head injury were significantly impaired on tasks of literal text understanding, inferencing, and intentionality. Children with mild head injury were impaired on some inferencing and all intentionality tasks, although they had no literal text comprehension deficits. Conclusions: For both groups, the greatest deficits (ie, the largest effect sizes) were on tasks requiring understanding of the language of mental states and intentions. The data bear on the long-term effects of childhood closed-head injury on text- and discourse-level language and also on the nature and timing of language rehabilitation in children with head injury.