Cognitive-Communication Referral Guidelines for Adults

Most Common Etiologies

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

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 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 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