Although the Adult population is referenced here, Speech Therapy Enterprises LLC also services the pediatric population for cognitive/communication disorders.

ADULTS: Cognitive-Communication Guidelines for Referral to Speech-Language Pathologists (SLPs)

REFERENCE: Adult Cognitive Communication Referral Guidelines BY ASHA

Most Common Etiologies:
• Alzheimer’s disease
• Brain tumors
• Stroke
• Traumatic brain injury (TBI)

Related Terms:
Abstract information, anosognosia, attention, cognitive rehabilitation, community reentry, concrete information, emotional lability, executive functioning, external stimuli, eye contact, impulsivity, memory, perseveration, pragmatics, redundant responses, social communication, tangential responses, verbose responses

Potential Consequences:
• Reduced awareness and ability to initiate and effectively communicate needs
• Reduced awareness of impairment and its degree (i.e., loss of ability to assess one’s own communication effectiveness)
• Reduced memory, judgment, and ability to initiate and effectively exchange routine information
• Difficulty performing personal lifestyle management activities effectively (e.g., pay bills)
• Reduced ability to anticipate potential consequences, with reasonable judgment and problem solving
• Reduced social communication skills and/or ability to manage emotions, often causing loss of relationships
• Disruption of ability to fulfill educational or vocational roles, including potential loss of employment
• Risk for injury because of inability to communicate in an emergency and/or anticipate the consequences of own actions


Difficulty functioning independently due to
• lack of or atypical responsiveness to all external stimuli
– may open eyes, suck, and/or yawn
• inability to attend to others
• extremely impaired attention and memory with impulsivity
• severely limited communication
– lack of purposeful speech
– difficulty responding to and/or saying name
– difficulty expressing basic needs to others using simple words and/or gestures (such as yes or no, or head nod)
– difficulty saying greetings (such as “hi” and “bye”)
• difficulty remembering spouse/caregiver’s name
• difficulty counting to 10
• agitation when needs are not met

• limited eye contact
• limited social behaviors (such as expressions of courtesy and common facial expressions)
• moderately limited communication
– difficulty paying attention while speaking (i.e., does not complete sentences or loses train of thought)
– difficulty responding appropriately to message of other individual (i.e., delayed, perseverative, or off-topic responses, including inappropriate words)
– limited ability to provide biographical information
– difficulty understanding abstract information; very concrete responses
• problems anticipating consequences of own actions
• poor organization, with limited problem solving and judgment

Difficulty managing home or maintaining job or business due to problems
• making, following, and modifying plans as needed
• planning and completing necessary daily activities
• following directions
• comprehending or applying abstract written information
• analyzing personal and/or business problems, identifying and applying solutions
• assessing own strengths and weaknesses, developing effective plans to improve weaknesses
• managing multiple responsibilities simultaneously
• managing emotions (especially anxiety, frustration, or anger) related to performance difficulties
• making, following, and modifying plans as needed
• understanding and managing personal legal or financial matters (i.e., taxes, buying or refinancing a home, etc.)
• effectively communicating with colleagues and/or customers, especially initiating effective responses, interpreting combined verbal and nonverbal responses during conversations to determine strategic communication action, and modifying response when feedback indicates it has not been successful