Cognitive Communication Disorder (what is it, presentation, causes, diagnosis, therapy input)

Cognitive communication disorder (CCD) is when a person's communication style changes, affecting their communication effectiveness. The effects of CCD can dramatically vary but, whatever the presentation, the impact is often devastating for the individual and their family and friends. CCD occurs following brain injury.

Presentation of cognitive communication disorder

How CCD presents varies greatly and depends on what cognitive functions are affected by the brain injury. These then affect communication.

Examples of CCD presentations:

  • Reserved talkers can become verbose (saying more than is needed) and unable to stop talking.

  • Social, outgoing people can become withdrawn, answering questions with one or two words and not initiating asking questions to others.

Communicative behaviours can become ‘extreme’. For example:

  • A person may have reduced eye contact as they do not look to you when you speak to them or when they respond to you.

  • A person may make so much eye contact that it feels uncomfortable for the person they are speaking to.

These changes in communication style can be difficult for individuals, their family and friends to come to terms with.

Causes of cognitive communication disorder

CCD can be caused by any type of brain injury, such as:

  • Stroke

  • Traumatic Brain Injury (TBI)

  • Hypoxic brain injury

  • Brain tumours or metastases

Diagnosing cognitive communication disorder In order to establish if someone has CCD, it needs to be understood how the person used to communicated. Were they talkative? Did they swear? How were they with strangers? How were they with their family and friends? This information needs to be gathered from their people who know them well. Only once the individual’s ‘baseline’ (how they normally are) is understood, can it then be considered whether the individual has CCD.

It is also important to consider whether other factors may also be impacting the individuals communication; for example, people with depression may make less eye contact and talk quietly. Once their mood improves then these changes reverse. Thus, this is not CCD. CCD is when the behaviour change is due to a brain injury.

Impacts of cognitive communication disorder Talking to people with CCD can be difficult for others.

For example, if a person is not making eye contact, is talking in a quiet, monotone voice and is responding to you in short answers but is not asking anything back, then it may appear that that person does not want to talk to you.

When I worked with a woman, Barbara, who presented like this she was really upset that other people were not making an effort to talk to her. She found it difficult to change her behaviour (e.g. making more eye contact with her conversation partner), even after weeks of therapy targeting this change.

For Barbara, it was essential that the people around her understood that she enjoyed having conversations, although it did appear that she did.

If a person is very talkative to the extent that you are finding it difficult to have a two-way conversation with them, then it's is not rewarding or enjoyable for you. It can be frustrating to have conversations like this. With these changes in communication, it is not surprising that people with CCD are likely to lose friends and their relationships break down. They may also experience difficulties in their employment. This can make the individual isolated.

Therapy Input

Some people with CCD may respond to feedback to change their communication with others. This is typically achieved by raising the person’s awareness of their behaviour; this can be achieved by them watching a recording of themselves and reflecting upon it and/or being provided with feedback from others (e.g. “When you look down, I think you don’t want to talk”). It is agreed what they will work on (e.g. looking up to others when they speak to you) and then this skill is practised in therapy sessions.

However, many people with CCD have difficulties changing their behaviour. This is due to their cognitive abilities being affected by their brain injury. For example, if they have memory difficulties, they may not be able to remember the strategies that they could use. If they have executive functioning difficulties then they may not be able to regulate themselves, to initiate behaviour and to have insight into their difficulties.

Consequently, intervention for people with CCD often instead works with the person’s family. This will typically involve discussing why the individuals’ communication style has changed and how this impacts them day to day. Therapists and family members should then work together to identify what strategies others can do to support the individual.

For example, Tom had a hypoxic brain injury following a heart attack. As a result, he became verbose and tangential (going off topic). He talked so much and bounced from topic to topic that it was very difficult for others to have a conversation with him. It was hard to understand what he was talking about. He also had memory difficulties so he could not remember that he had CCD which prevented him from using any strategies. When he went out with his family, he would start talking to every person he saw and would talk to them for a long time. This made all trips out very long and exhausting for both Tom and his family. Prior to his hypoxic brain injury, Tom would not make conversation with strangers.

It was found that the best strategy to support Tom was to give him a task to complete. When he went food shopping, he was given a list of items to find. Giving him this task meant that he was focused on this instead and so did not talk to every person in the shop. This meant that Tom was able to keep going out with his family and was involved in the trips.

The strategies that people will benefit from vary from person to person. Because this communication difficulty arises from changes to cognition, therapeutic input may be delivered from a speech and language therapist, neuropsychologist or occupational therapist. Often these individuals will work together.

Further information

If you would like further information on CCD, Headway has a great explanation of the changes that happen:


In summary, cognitive communication disorder is an acquired communication disorder following brain injury. It affects our way of communicating. It’s presentation varies greatly, depending on which cognitive abilities are affected. These changes can be difficult to adjust to for the individual and their family and friends. Communication is a two-way process and so we have to adapt to the individual with CCD.

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