American Speech-Language-Hearing Association

Cognitive-Communication Referral Guidelines for Adults

Most Common Etiologies

  • Alzheimer's disease
  • Brain tumors
  • Stroke
  • Traumatic brain injury (TBI)

Potential Consequences/Impact of Cognitive-Communication Impairment Can Include:

  • 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 (i.e., 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
  • At risk for injury due to inability to communicate in an emergency and/or anticipate the consequences of own actions

Behaviors that should trigger an SLP referral

Difficulty functioning independently due to:

  • unresponsiveness to all external stimuli
  • may open eyes, suck, and/or yawn
  • does not attend to others
  • no purposeful speech
  • extremely impaired attention and memory with impulsivity
  • extremely limited communication:
    • difficulty responding to and/or saying name
    • difficulty expressing basic needs to others using simple words and/or gestures (i.e., yes/no, head nod)
    • difficulty saying greetings (i.e., "hi" and "bye") on own
  • difficulty remembering spouse/caregiver's name
  • difficulty counting to 10
  • becomes agitated when needs are not met
  • limited eye contact
  • limited social behaviors (i.e., expressions of courtesy and facial expressions)
  • very limited communication:
    • difficulty paying attention while speaking (i.e., does not complete sentences or take turns speaking during conversation)
    • 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

Difficulty functioning independently due to:

  • difficulty anticipating consequences of own actions
  • poor organization, with limited problem solving and judgment
  • limited awareness of extent of difficulties; exhibits socially inappropriate behavior
  • difficulty with concepts of time and money
  • difficulty self-disciplining and self-monitoring to follow rules
  • difficulty changing routine or schedule; difficulty learning new rules
  • limited communication:
    • difficulty selecting appropriate words and remembering names
    • limited memory and/or knowledge of current events and/or personal history
    • responses in conversation may be verbose, redundant, or tangential
    • elaborates on information provided from questions, but cannot appropriately change topic, initiate, or end a conversation
    • missing or misunderstanding humor
    • difficulty understanding nonverbal communication (i.e., facial expressions and/or body language)
    • difficulty understanding abstract information

Difficulty managing home or maintaining a job or business due to:

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

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