Cognitive Communication Disorders

A cognitive communication disorder occurs when a person has communication problems caused by issues with a cognitive process, rather than issues with speech or language. Some examples of cognitive processes include attention and concentration, memory, executive functioning, problem-solving, and reasoning.

Cognitive communication disorders can affect many aspects of a person’s life. The person may find it hard to complete activities of daily living, participate in social activities, and achieve success at school or work. 

Whether you or your loved one are experiencing cognitive communication problems, we’ve put together this expert guide to help. Here, we answer your questions about cognitive communication disorders, explain the signs and symptoms, and discuss how cognitive communication challenges can be treated and managed.

1What is a cognitive communication disorder?

2How common are cognitive communication disorders?

3What causes a cognitive communication disorder?

4What are the symptoms of a cognitive communication disorder?

5How are cognitive communication disorders diagnosed?

6How are cognitive communication disorders treated?

7How does Expressable assess and treat cognitive communication disorders?

8Strategies that help with cognitive communication difficulties

What is a cognitive communication disorder?

A cognitive communication disorder occurs when a person experiences any problem with communication caused by deficits in one or more cognitive processes, rather than deficits in speech or language. Cognitive processes include: 

• Attention and concentration

• Memory (including recall of facts and short- and long-term memory)

• Executive functioning (how you plan, complete, and evaluate tasks)

• Perception (how you interpret sensory information)

• Problem-solving (finding solutions)

• Reasoning (logical thoughts)

• Orientation (knowing the who, when, what, and why of where you are)

• Language (words we use to communicate)

• Processing speed (ability to understand and think quickly) 

• Organization (arranging ideas)

• Metacognition (thinking about how you think)

• Insight and judgment (understanding limitations)

Problems with these cognitive functions can affect verbal and non-verbal communication, including speaking, listening, reading, writing, and social skills. As a result, a person may have a hard time safely completing activities of daily living (such as cooking). They may also have challenges with school or work.

How common are cognitive communication disorders?

According to research published in the American Journal of Speech-Language Pathology, cognitive communication disorders are most common in individuals who have experienced an acquired brain injury (ABI). They occur at least 75% of the time after a moderate-to-severe brain injury.

Both children and adults can have a cognitive communication disorder.

What causes a cognitive communication disorder?

As previously mentioned, cognitive communication disorders most commonly occur after an acquired brain injury (ABI). An ABI involves damage from an internal force on the brain. These forces can include: 

• Pressure on the brain from a tumor

• Lack of oxygen to the brain (i.e., anoxia)

• Aneurysm

• Stroke

• Heart attack

Traumatic brain injuries (TBIs) can also cause cognitive communication disorders. TBIs happen when an external force hits the head and makes the brain move inside the skull or damages the skull, which damages the brain. Some examples of a TBI include:

• Falls

• Assaults

• Car accidents

• Sports injuries 

Cognitive communication disorders can also be a result of genetic disorders and dementia, including Alzheimer’s disease.

What are the symptoms of a cognitive communication disorder?

Cognitive communication disorders can vary in severity. According to the American Speech-Language-Hearing Association (ASHA), a person with a cognitive communication disorder may have difficulty with any of the following:

• Paying attention to a conversation

• Staying on topic 

• Remembering information

• Judgment and problem-solving 

• Organization 

• Responding accurately 

• Understanding figurative language, such as jokes or metaphors

• Following directions

• Initiating and effectively communicating their needs

• Completing activities of daily living effectively and/or safely (for example, paying bills, cooking, managing medications) 

Another symptom of a cognitive communication disorder is extreme fatigue. 

How are cognitive communication disorders diagnosed?

Speech-language pathologists, also known as speech therapists, assess and treat the impairments associated with a cognitive communication disorder. The first step to diagnosis is an evaluation. The speech therapist will use a combination of standardized tests, informal measures (such as checklists and patient-reported outcome measures), and client and family/caregiver input during the evaluation.

Information gained in the evaluation will help the speech therapist understand the impact of the cognitive challenges on the person’s daily life. The therapist will identify the person’s strengths and areas of need, design a treatment plan, and determine the need for additional referral(s). Speech therapists will then work with their client and the client’s family to create functional, relevant, and realistic goals that support the person’s needs and wishes.

How are cognitive communication disorders treated?

Treatment for cognitive communication requires an interdisciplinary approach. This means a variety of healthcare providers will work together to help a person achieve success. Speech therapists are a vital part of this care team. The team can also include physicians, physical therapists, occupational therapists, neuropsychologists, and social workers. 

When treating cognitive communication disorders, speech therapists use two main approaches: 

• Restorative treatments: Direct therapy tasks that aim to improve impaired functions by focusing on symptoms, such as memory, processing speed, and problem-solving. 

• Compensatory strategies: Individualized strategies used to compensate for functions that aren’t able to be restored.

Speech therapy treatment will include both direct therapy tasks and compensatory strategies to support a person’s individual needs. Treatment should focus on:

• Improving the person’s quality of life

• Preserving their ability to participate in life

• Helping them return to daily activities

• Providing support and resources, both for the client and for their family/caregiver

How does Expressable assess and treat cognitive communication disorders?

Expressable matches individuals and families with a certified speech therapist trained to evaluate and treat cognitive communication disorders. All therapy is delivered online via face-to-face video conferencing. Adult clients can choose to attend sessions by themselves, but are welcome to bring caregivers or family members to the sessions as well.

Expressable speech therapists are uniquely qualified to assess, treat, and support people with cognitive communication disorders. Our speech therapists are dedicated to providing the highest quality of care. This includes using current best practices to guide clinical recommendations. Treatment plans are individualized, holistic, functional, and centered on our clients and their families.

Our speech therapists work with people who have cognitive communication disorders to: 

• Identify areas of need

• Modify the person’s home and/or work environment to support those needs

• Restore impaired functions when possible

• Educate, empower, and build self-advocacy skills, for both the person and their family

However, these treatment plans are not created by the therapist alone. Progress in speech therapy is rooted in the person’s motivation and desire to achieve their goals, as well as their commitment to the rehabilitation process. Collaborative decision-making among the client, therapist, and other team members is essential. That’s why we involve our clients in the therapeutic process as much as possible. 

Research suggests that this collaborative approach helps to establish the most functional and appropriate treatment plan. It positively influences the person’s mental health, and it also improves their ability to return to their life.

Speech therapists also play a critical role in providing education about overall brain health. They help improve cognitive-linguistic functioning by teaching strategies to use in everyday life, such as techniques to help with memory problems.

All Expressable clients have access to our client portal, which features educational Learning Paths covering the strategies taught in therapy sessions. You can access examples, tips, demo videos, quizzes, and more. Plus, through the portal, you'll receive weekly home practice activities tailored to your needs. The more you practice speech therapy techniques at home, between sessions, the faster you'll make progress!

Strategies that help with cognitive communication difficulties

Cognitive communication disorders vary in severity. One person may have a hard time following a conversation in a noisy environment. Another person may not be able to communicate in a loud environment at all.

Some individuals find it difficult to remember names or dates of events. Others have difficulty finding the words they want to say. 

Speech therapists teach people how to use compensatory strategies to support these varying issues. A compensatory strategy is a way to compensate for, or work around, a challenge or difficulty. Here are some examples of strategies learned in speech therapy:

Word finding

Describe the word you’re trying to remember by talking “around” the object, person, or place you’re trying to name.

Processing speed

Self-advocate for what you need. Ask your communication partner to give you time to respond or complete a task. 

Memory

Memory strategies can be divided into two main categories: external and internal. Let’s take a look at what each would include.

External memory strategies

• Alarms

• Calendars

• Notes app on a phone or tablet

• Notebook

Internal memory strategies

• Making associations 

• Categorization

• Elaborating 

• Rehearsing/repeating 

• Visualizing 

Attention and concentration 

• Work in a quiet room away from games, TV, and other distractions. 

• Eliminate visual clutter by clearing floors and tables and organizing shelves and drawers. 

• Take quick “microbreaks.” Be aware of how long your attention span can last, and take breaks to compensate.

Executive functioning

Learn to plan the steps and amount of time needed for a specific task. Do the steps, monitor your progress, and analyze any adjustments that are needed until the task is complete.