How Speech Language Therapists Understand Communication: The Evidence-Based Models that Guide Our Work

As SLT’s we draw on several well‑established models to understand how communication works after brain injury. These frameworks highlight that communication is never just about words, it is shaped by cognitive skills, social understanding, emotional and sensory regulation, physical factors, the social context, and the environment around a person.

Cognitive Communication Competence (MacDonald, 2017)
Shows how communication relies on the integration of comprehension, expression, cognition, language, emotion, physical abilities and self‑regulation. It emphasises that successful communication varies across contexts such as home, community, education, work and problem‑solving.

  • The Cup of Competence (Snow & Douglas, 2017)
    Uses a simple analogy to explain pragmatic (social) communication. It illustrates how social‑environmental factors and individual psychological characteristics influence a person’s ability to use communication effectively in real‑world interactions.
  • The Social Communication (SoCom) Model (Wiseman‑Hakes et al., 2020)
    Designed for paediatric brain injury, this model shows how language, cognition and social cognition interact like building blocks. It also highlights how internal factors (such as sex and gender) and external factors (such as culture and environment) shape social communication development.
  • The SoCIAL Framework (Keegan et al., 2025)
    Focuses on the many personal, cognitive, emotional, physical and environmental influences that affect social communication competence. It provides a practical lens for understanding everyday communication challenges.

These models help SLTs look beyond surface‑level speech or language difficulties. They allow us to understand the whole person, their thinking skills, emotions, relationships, environment and daily demands so we can design rehabilitation that truly supports meaningful communication in real life.

CCDs and Social Cognition

Social cognition refers to a set of processes, which enable the perception of social cues from the self and others, the interpretation and understanding of own and others’ emotions, beliefs and behaviours and the generation of responses to these inferences to guide social behaviour.

Impairments of social cognition can contribute to cognitive communication disorders.

CCDs and Neurodiversity

To add to the complexity of acquired cognitive communication disorders, some signs and symptoms can co-occur with, or be attributed to, other diagnoses, most notably neurodevelopmental conditions (such as autism, developmental language disorder) and mental health disorders (such as schizophrenia and depression).

An added complication is that these conditions may themselves be undiagnosed or not formally diagnosed. Making a differential diagnosis between these overlapping, and potentially co-occurring, diagnoses, is important, especially when working with children and young adults.

How to Help People with CCDs

  • Keep information simple and break tasks into steps.
  • Use written reminders, visual supports, or routines to aid memory.
  • Allow thinking time before expecting a response.
  • Stay on one topic at a time and avoid fast‑paced conversation.
  • Check understanding and summarise key points.
  • Support decision‑making by reducing distractions and offering structure.
  • Refer to a Speech Language Therapist (SLT).

Adapting how we interact with people with CCD can ease the flow of conversation.

This PDF describes how to adapt to support a person with CCD

Resources

This tool is easy to use and will help you flag communication difficulties which require an SLT referral: Download CCCABI Checklist.pdf

Acknowledgments:

MacDonald, Sheila (2015) Cognitive Communication Checklist for Acquired Brain Injury (CCCABI) CCD Publishing; Guelph, Ontario, Canada N1H 6J2 , www.ccdpublishing.com

Adapted Communication for Individuals with Brain Injuries – Sheila MacDonald MClSc. SLP(C)

If you would like to discuss a referral, request a quote, or explore how specialist ABI speech and language therapy can support you or your client, please get in touch.

    Resources & Links