Cognitive Communication Disorders

“With a perfect combination of professionalism and humour, Rachel’s approach has proved a great success with my client.”

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We would like to thank Rachel very much for her expertise and commitment to helping John overcome his speech and language problems that were a result of an acquired brain injury.

Since Rachel has been working with us we have been delighted with John’s progress. He is now able to speak with confidence and clarity. He has even delivered speeches at the Headway groups! Something that previously we didn’t think possible!

She is always very helpful and encouraging and she has motivated John to take part in a local discussion group.”

Elaine and John Wellock – Client

The Importance of Communication


Communication is the sharing of experiences, events, ideas and feelings through verbal (sounds, words, sentences) and non-verbal (body movement, tone of voice, touch) channels.

  • Communication permits us to interact as human beings. It serves a number of functions including controlling, sharing of feelings, informing, understanding, imagining and sustaining social relationships
  • Communication serves to meet many individual’s needs including “social interaction, information giving, reassurance, discussion of feelings, advice and counselling”
  • Communication can be impaired following a neurological event including stroke, acquired brain injury (ABI) and traumatic brain injury (TBI).
  • Communication impairments which are mild or severe can have a catastrophic impact on individuals’ day to day interactions and relationships
  • Communication impairments are prevalent in 75% of cases who have suffered an ABI, these often go undiagnosed.

What is a Cognitive Communication Disorder?


Cognitive communication disorders are problems with communication that have an underlying cause in a cognitive deficit rather than a primary language or speech deficit.


A cognitive communication disorder results from impaired functioning of one or more cognitive processes, including the following:

  • Attention
  • Memory
  • Perception
  • Insight and judgment
  • Organization
  • Orientation
  • Language
  • Processing speed
  • Problem-solving
  • Reasoning
  • Executive functioning
  • Metacognition

Cognitive communication disorders vary in severity. Someone with a mild deficit may simply have difficulty concentrating in a loud environment, whereas a person with a more severe impairment may be unable to communicate at all. Whether a mild or severe deficit the impact of these can be very debilitating.

A person with a cognitive communication disorder may have difficulty paying attention to a conversation, staying on topic, remembering information, responding accurately, understanding jokes or metaphors, or following directions.

Cognitive Communication Disorders affect the ability to functioning independently and individuals may have:


  • Difficulty selecting appropriate words and remembering names
  • Limited memory and/or knowledge of current events and/or personal history
  • Responses in conversation which are verbose, redundant, perseverative, inappropriate or tangential
  • Difficulty elaborating on information provided from questions i.e. cannot appropriately change the topic, initiate, or end a conversation
  • Missing or misunderstanding humour
  • Difficulty understanding nonverbal communication (i.e., facial expressions and/or body language)
  • Difficulty understanding abstract information; very concrete responses
  • Difficulty paying attention while speaking (i.e. does not complete sentences or take turns speaking during conversation)

How Cognitive Communication Disorders Are Identified

Anyone who has suffered a brain injury or a stroke should be screened for cognitive and perceptual disorders. Cognitive-communication disorders can be identified using the Cognitive Communication Checklist for Acquired Brain Injury (CCCABI), a free online screening tool. Once cognitive communication disorders are identified, a referral should be made to a Speech and Language Therapist for a full assessment.

What You Might Notice

People with cognitive communication disorders often have trouble participating in conversations. They may have difficulty understanding what is said, or be unable to respond in a timely fashion. They may have trouble speaking clearly or conveying their thoughts efficiently and effectively.

People with cognitive communication disorders often have trouble reasoning and making decisions while communicating. They may have trouble remembering their conversations and experiences. This can affect their ability to make decisions and may require support to make informed decisions.

People with cognitive communication disorders sometimes have trouble responding in an appropriate or socially acceptable manner. They often lack filters, expressing their sexual thoughts and speaking without regard for the feelings of others.

In addition to conversational problems, people with cognitive-communication disorders may find it hard to understand instructions, presentations, movies, television, and radio.

Some have trouble reading and/or writing. This can make it hard for them to complete job tasks and schoolwork, participate in their communities, or simply enjoy books, magazines, newspapers, and online media.

Cognitive communication deficits are challenging to live with and have the potential to have negative consequences on the quality of life and the social participation of an individual and their loved ones. 


If You Have a Cognitive Communication Disorder


There are many things you can do to help yourself if you are a brain injury survivor or find that your mental skills are not as sharp as they used to be. You may need to try a few things before finding the tips and tricks that will work best for you since everyone is different. Try some of these things:

  • If you have memory problems, be sure to write down all your appointments, lists, and important notes in a calendar or digital organizer and always keep it in the same place.
  • If you have attention problems, set yourself up for success by limiting background noise or keep a consistent background noise if you find it helps you to focus.
  • If you have problems with executive functioning, make a detailed plan, use checklists, and check-in along the way to make sure you’re on track with timing.
  • Talk with other people who have similar challenges to learn from their experience. If you have a mild brain injury (the kind that doesn’t feel mild at all, but the doctors keep telling you it is), you may enjoy reading the book Over My Head by Claudia Osborn.

6 Ways to Help Someone with a Cognitive Communication Disorder

A person with a cognitive communication deficit can benefit a great deal from therapy. Meanwhile, you can help the person communicate by taking a few simple actions:

  1. Allow the person extra time to process what you’ve said. Try waiting for up to 90 seconds before repeating yourself.
  2. Provide information in short chunks. If you’re giving directions, break them down into small steps. Instead of saying, “Brush your teeth,” try saying, “Go to the sink . . . Take out your toothbrush . . . Put toothpaste on the toothbrush . . . ” and so on.
  3. If the person has left neglect (i.e., inability to attend to the left side), provide a challenge by standing to the person’s left. For an important conversation, however, sit on the person’s right side.
  4. Write down key instructions and information, or encourage the person to write it down themselves.
  5. Verify any important information the person gives you with a third party, to be sure it’s reliable. People with memory deficits or insight problems may not be accurate communicators, even if their speech sounds good.
  6. Speak simply. Don’t talk too loudly, though, and don’t talk down to the person.

Make a referral to a Speech and Language Therapist who will be able to help you and/or your loved ones.