The Complete Guide to Speech Therapy for Cognitive Communication Disorders
Abby Barnes, M.S., CCC-SLP
A cognitive communication disorder or deficit 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 executive functioning, attention and concentration, memory, problem-solving, and reasoning.
Speech therapy is an effective treatment for cognitive communication challenges. Here at Expressable, we work with people of all ages to strengthen these skills. Whether you or your loved one are experiencing cognitive communication problems, we’ve put together this expert guide to answer common questions and help you decide on next steps.
What are cognitive communication disorders?
A cognitive communication deficit means that a person has challenges with communication caused by problems in one or more cognitive processes, rather than problems with 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 nonverbal 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 or taking medications independently. They may also have challenges at school or work.
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Get startedWhat causes a cognitive communication disorder?
Cognitive communication disorders most commonly occur after an acquired brain injury (ABI). An ABI involves damage from an internal force on the brain. These internal 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 symptoms of a cognitive communication disorder?
Cognitive communication deficits can vary in severity. According to the American Speech-Language-Hearing Association (ASHA), a person with a cognitive communication disorder may have symptoms that include difficulty with any of the following:
Executive functioning
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
Effectively communicating their needs
Completing activities of daily living correctly or safely (for example, paying bills, cooking, taking care of pets, or managing medications)
Extreme fatigue
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 people 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.
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Start the screenerHow 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. During the evaluation, the speech therapist will use a combination of assessments such as:
Standardized tests, such as the Quick Aphasia Battery (QAB), the Behavior Rating Inventory of Executive Function®2 (BRIEF®2), or the Arizona Battery for Cognitive Communication Disorders, 2nd Edition
Informal measures, such as checklists and patient-reported outcome measures
Client and family/caregiver input
Information from 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). The speech therapist will then work with the 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 the person recover and regain their skills. 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 that help the person make up for, or work around, functions that aren’t able to be restored.
Speech therapy 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/caregivers
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. As you can see, the severity and symptoms will vary among every individual.
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 that may be taught in speech therapy:
Word-finding strategies
Describe the word you’re trying to remember by talking “around” the object, person, or place you’re trying to name.
Processing speed strategies
Self-advocate for what you need. Ask your communication partner to give you time to respond or complete a task.
Memory strategies
Memory strategies can be divided into two main categories: external and internal. Let’s take a look at some examples of each.
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 strategies
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 strategies
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.
How does Expressable online speech therapy work for cognitive communication deficits?
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. Click here to access our full treatment guide to cognitive communication disorders.
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.
Adult clients can choose to attend sessions by themselves, but are encouraged to bring caregivers or family members to the sessions. Online therapy makes it easy for them to attend no matter where they are!
Our speech therapists work with people who have cognitive communication deficits 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 at Expressable, 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.
Support beyond sessions: The Expressable portal
Your speech therapy doesn’t stop when the session ends. At Expressable, you and your loved ones will get access to our client portal, which makes practicing communication strategies easier and more effective. Here’s what you’ll find:
Learning Paths that explain and reinforce what you’re learning in therapy, like memory strategies or ways to improve your attention
Demo videos that show real techniques in action
Home practice activities you can do during your everyday routines
Text messaging support so you can ask questions, get reminders, or receive tips from your therapist between sessions
By using the tools in the portal and practicing regularly, you can make faster progress and build more independence in your communication.
Get started with Expressable today
If you think that you or a loved one might have cognitive communication problems, talk with a speech therapist. We’re here to guide you on the path to better communication and greater independence. Start the process to get matched with a speech therapist here.
