Cognitive Communication Disorder

Cognitive Communication Disorder (also called CCD) refers to a difficulty with communication caused by changes to our higher-level thinking skills (cognition). CCD can occur alone or alongside additional communication problems with speech (dysarthria) or language (aphasia). 

CCD can cause difficulty with communication activities of daily living. These include daily activities involving speaking, understanding reading or writing including managing medications, appointments, complex phone calls and planning journeys.

What causes Cognitive Communication Disorder?

CCD is caused by damage to the brain. Problems with social communication are mostly associated with damage to the right or frontal hemispheres of the brain. CCD can be caused by damage as a result of:

  • stroke
  • head injury
  • brain tumour 
  • degenerative neurological diseases e.g. Parkinson's Disease, dementia 

What are cognitive communication skills?

Cognitive communication skills are the skills we use to think, learn, remember, solve problems, and pay attention. These include verbal and non-verbal skills, including: 

  • attention/concentration
  • memory 
  • planning and organisational skills 
  • insight and awareness

What might CCD look like?

CCD affects different people in different ways and varies in severity. Some changes may be more obvious than others and may depend on what a person was like before.
Someone with CCD may have difficulty with: 

  • social skills, for example finding it hard to take turns in conversation, getting stuck on a single topic, or making inappropriate comments
  • understanding facial expressions, body language and tone of voice 
  • taking things people say or do literally e.g. interpreting humor or figures of speech (e.g. 'fly off the handle', or 'butterflies in your stomach')
  • reading and using facial expressions 
  • listening, concentrating, remembering or understanding
  • being aware of cognitive communication changes and using strategies to help

How can family and friends help individuals with CCD?

Different strategies will help different people. You can try:

  • providing support with communication activities of daily living, e.g. allow extra time to complete tasks, proofread, reduce background noise and distractions 
  • acknowledging when a communication breakdown happens. If you are unable to clarify the message at the time, reassure and
  • provide the opportunity to reattempt after a break/rest
  • gently highlighting if the conversation has gone off topic, if you would like to say something, or if you have not understood 
  • providing options if they can't answer your questions straight away e.g. asking a closed question such as: 'Do you want tea or coffee?'
  • using literal language, avoid using metaphors/idioms 
  • providing information in short chunks. If you're giving directions, break them down into short steps.

How can speech and language therapy help?

Speech and language therapists identify and assess patients with CCD. Therapy sessions include:

  • raising insight of the individual's communication difficulties 
  • training patients and family members in the most effective ways to communicate with each other
  • maximising independence in communication activities of daily living and higher level tasks with personalised therapy activities (e.g. planning outings or shopping lists)