American Speech-Language-Hearing Association

Position Statement

Roles of Speech-Language Pathologists in the Identification, Diagnosis, and Treatment of Individuals With Cognitive-Communication Disorders: Position Statement

Working Group on Cognitive-Communication Disorders of ASHA's Special Interest Division I, Language Learning and Education; and Division 2, Neurophysiology and Neurogenic Speech and Language Disorders


About this Document

This position statement is an official policy of the American Speech-Language-Hearing Association (ASHA). The document was prepared by the Working Group on Cognitive-Communication Disorders of ASHA's Special Interest Division 1, Language Learning and Education; and Division 2, Neurophysiology and Neurogenic Speech and Language Disorders. Members of the working group included Leora Cherney, Ron Gillam, Mary Kennedy, Lynn M. Maher (chair), Diane R. Paul (ex officio), Dava Waltzman, Mark Ylvisaker, and ASHA Vice Presidents for Professional Practices in Speech-Language Pathology Alex F. Johnson (2000–2002) and Celia Hooper (2003–2005). The evidence for this position statement was summarized in the 2003 report prepared by Mark Ylvisaker, Robin Hanks, and Doug Johnson-Greene on behalf of the Joint Committee on Interprofessional Relationships between ASHA and Division 40 (Cognitive Neuropsychology) of the American Psychological Association entitled “Rehabilitation of Children and Adults with Cognitive-Communication Disorders After Brain Injury.”


Table of Contents


It is ASHA's position that speech-language pathologists play a primary role in the screening, assessment, diagnosis, and treatment of infants, children, adolescents, and adults with cognitive-communication disorders. This position statement defines the roles of speech-language pathologists in the evaluation and management of individuals with communication disorders associated with cognitive impairments and clarifies the scope and rationale for these services.

Cognitive-communication disorders encompass difficulty with any aspect of communication that is affected by disruption of cognition. Communication may be verbal or nonverbal and includes listening, speaking, gesturing, reading, and writing in all domains of language (phonologic, morphologic, syntactic, semantic, and pragmatic). Cognition includes cognitive processes and systems (e.g., attention, perception, memory, organization, executive function). Areas of function affected by cognitive impairments include behavioral self-regulation, social interaction, activities of daily living, learning and academic performance, and vocational performance.

Cognitive-communication disorders may be congenital or acquired. Congenital etiologies include but are not limited to genetic disorders and pre-, peri-, and postnatal neurologic injuries and diseases. Acquired etiologies include but are not limited to stroke, brain tumor, traumatic brain injury, anoxic or toxic encephalopathy, and nondegenerative and degenerative neurologic diseases (including the dementias).

Given the high incidence and prevalence of cognitive-communication disorders and their potentially serious consequences—including negative impact on social, academic, and vocational success; on quality of life; and on caretakers and personal finances—appropriate preventive efforts, assessment, diagnosis, and management are critical.

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Roles

Speech-language pathologists are knowledgeable about normal and abnormal development, brain-behavior relationships, pathophysiology, and neuropsychological processes as related to the cognitive aspects of communication. Their educational and clinical background prepares speech-language pathologists to assume a variety of roles related to the habilitation and rehabilitation of individuals with cognitive-communication disorders. Appropriate roles for speech-language pathologists include but are not limited to the following:

  1. Identification: Identifying individuals at risk for or presenting with cognitive-communication disorders.

  2. Assessment:

    • Selecting and implementing clinically, culturally, and linguistically appropriate approaches to assessment and diagnosis, using both static and dynamic procedures.

    • Identifying contextual factors that contribute to or can be used to ameliorate cognitive-communication disorders.

  3. Intervention: Selecting and implementing clinically, culturally, and linguistically appropriate and evidence-based approaches to intervention (e.g., training discrete cognitive processes, teaching specific functional skills, developing compensatory strategies and support systems, providing caregiver training, and providing counseling and behavioral support services).

  4. Counseling: Providing culturally and linguistically appropriate counseling for individuals and their significant others about cognitive-communication disorders and their impact.

  5. Collaboration: Collaborating with the individual with a cognitive-communication disorder, family members, teachers and other professional colleagues, care providers, and others in developing and implementing assessment and intervention plans.

  6. Case Management: Serving as case manager, service coordinator, or team leader by coordinating, monitoring, and ensuring the appropriate and timely delivery of a comprehensive management plan.

  7. Education:

    • Developing curricula and educating, supervising, and mentoring future speech-language pathologists in assessment and treatment options and other issues related to cognitive-communication disorders.

    • Educating families, caregivers, and other professionals regarding the needs of individuals with cognitive-communication disorders.

  8. Prevention: Educating the public on the prevention of factors contributing to cognitive-communication disorders.

  9. Advocacy:

    • Advocating for services for individuals with cognitive-communication disorders.

    • Serving as an expert witness.

  10. Research: Advancing the knowledge base on cognitive-communication disorders and their treatment through research activities.

The roles of the speech-language pathologist can be considered within the framework of the World Health Organization International Classification of Functioning, Disability and Health (WHO, 2001). The categories of this classification system can be applied to cognitive-communication disorders as follows:

  • Body structure and function: Neuroanatomic structures and neurophysiological and neuropsychological functions supporting cognitive-communication processes.

  • Activity and participation: Execution of everyday tasks and involvement in social, academic, and vocational situations that may be affected by a cognitive-communication impairment. Activity/participation components are modified by the qualifiers “capacity” (i.e., executing a task in a standardized or uniform environment) and “performance” (i.e., executing a task in a natural context).

  • Contextual factors: Environmental and personal factors that serve as facilitators or barriers to functioning and participation. Environmental factors related to cognitive-communication disorders might include the school curriculum, workplace demands, and interactive and support competencies of everyday communication partners as well as societal attitudes towards disability. Personal factors include such features as age, race/ethnicity, gender, educational background, cultural beliefs, and lifestyle that may contribute to intervention outcomes. Specifically related to outcomes for people with cognitive-communication disorders are awareness of and adjustment to disability, motivation, and acceptance of responsibility for change.

The relative emphasis the speech-language pathologist gives to the various roles described above is determined in collaboration with the individual with the disability. Relevant considerations include etiology, severity of impairments, contextual demands and supports, and the individual's profile of strengths and needs across cognitive and other domains of function.

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Reference

World Health Organization. (2001). International classification of functioning, disability and health. Geneva: Author.

Ylvisaker, M., Hanks, R., & Johnson-Greene, D. (2003). Rehabilitation of children and adults with cognitive-communication disorders after brain injury. ASHA Supplement, 23, 59–72.

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Index terms: assessment, treatment, cognitive-communication, neuropsychology

Reference this material as: American Speech-Language-Hearing Association. (2005). Roles of speech-language pathologists in the identification, diagnosis, and treatment of individuals with cognitive-communication disorders: position statement [Position Statement]. Available from www.asha.org/policy.

© Copyright 2005 American Speech-Language-Hearing Association. All rights reserved.

Disclaimer: The American Speech-Language-Hearing Association disclaims any liability to any party for the accuracy, completeness, or availability of these documents, or for any damages arising out of the use of the documents and any information they contain.

doi:10.1044/policy.PS2005-00110

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