What is a cognitive-communication disorder?
Communication is a highly complex skill which forms part of what we call cognition. Cognitive-communicative disorders affect the ability to communicate by the social rules of language. Cognitive processes involved include the following:
- Orientation e.g. knowing the date, recognising your name, recognising where you are
- Attention e.g. being able to concentrate and not get distracted
- Perception e.g. recognising objects and what they are for
- Memory e.g. remembering recent events
- Organisation / reasoning / problem solving e.g. how to deal with every-day and non-routine problems
- Impulsivity e.g. Not being aware of danger/consequences
- Planning and sequencing e.g. being able to make a cup of tea
- Social behaviour e.g. being able to react appropriately with other people
- Emotional lability e.g. not being able to control laughing/crying
- Reduced insight e.g. having limited insight into any or all of these problems. They may believe they are acting 'normally' and exactly as they would have done before. If the person lacks insight, it makes changing the problematic behaviours extremely difficult because it is hard for them to deal with a problem if they don't know there is one.
- Altered turn-taking skills (e.g. the person either being overly talkative and 'hogging' the conversation or not realising that it is their turn to speak)
- Verbosity e.g. talking too much, interrupting
- Interrupting someone else because they are afraid that otherwise they will forget what they want to say
- Altered ability to talk around a shared topic (e.g. flitting from topic to topic, or having a reduced range of topics)
- Speaking only about themselves and fixating on certain subjects
- Talking in a sexually explicit way or swearing at inappropriate times
- Perseverating (getting stuck) on a favoured topic (e.g. wishing to leave hospital)
- Altered ability to give information in an orderly and organised way (e.g. assuming the other person shares knowledge about the topic when they don't, or vice versa)
- Not using or 'reading' non-verbal cues accurately, such as facial expressions and body language.
Cognitive communication difficulties can often co-occur with language difficulties such as dysphasia. Sometimes it is difficult to tease apart whether someone's communication difficulties are due to dysphasia or a broader cognitive impairment. Speech and Language Therapists and Occupational Therapists work closely together to try prising this apart.
Cognitive-communicative impairments occur primarily with the following conditions:
- Traumatic brain injury
- Hypoxic brain damage
- Viral infection
- Old age
What can I do to help a person with cognitive communication difficulties?
A person with a cognitive communication difficulty needs support and encouragement with their communication. Different techniques will help different people but friends and family can try:
- Minimising distractions. Remove background noise - a television or radio can be very distracting
- Ensuring you talk directly to the person and not talk over them. Try to sit at the same level as the person, and make eye contact
- Establishing a consistent routine and environment where possible
- Gaining the person's attention before speaking to them
- Talking about familiar topics
- Encouraging the person to communicate
- Explaining what is happening as it happens e.g. "your brother has come to visit"
- Only asking one question at a time
- Don't change the topic of conversation suddenly - it's much easier to talk about one topic at a time. Gently remind the person of the topic if they appear to have changed topic unexpectedly
- Taking a break if the conversation is "going round in circles"
- Keeping written reminders of important information e.g. writing key names and dates in a diary
- Use a reassuring, calm and friendly tone of voice at all times
- Use simpler language, as this can be easier to understand
- Repeat key words or phrases to help the person to understand more
- Allow enough time for the person to respond
- Using questions which require a yes/no response can be easier to answer for people with communication difficulties
- Facilitating choice making by giving forced alternatives (e.g. would you like tea or coffee?)
- Use visual references where possible - for example show a cup when asking whether the person requires a drink
- Use gesture to help the person to understand
- Do not expect perfect sentences / vocabulary from the person - it is enough that you have understood what they have said
- Give feedback and confirm that you have understood
- Activities like looking at photos and magazines or playing simple games are often a nice idea, and do not require any real understanding of conversation to be enjoyed.