Functional communication has been a clinical theme since Martha Taylor Sarno first used the term as a label for her Functional Communication Profile (1968). Since then, the concept of functional communication has broadened in scope, with the result that there are now within this field two pertinent connotations for the word functional. Both are applicable to functional approaches to assessment and treatment of communication disorders in adults. Elman and Bernstein-Ellis (1995) suggest that the first connotation invokes a sense of the basics: for example, having the language necessary for signaling survival needs or rudimentary wants, for getting help, or for using “yes” and “no” reliably and accurately. Functional in the second sense connotes smooth running, getting through the worst of one's communication problem, or learning satisfactory compensatory skills that permit individuals only occasionally to have to remind themselves that they still have residual problems in communicating.

The term communication as used in the assessment and treatment of adult language disorders also has two connotations. For some clinicians, communication is almost synonymous with language, and their work emphasizes recovery or restitution of language skills. But clinicians whose interest is on functional communication utilize a more comprehensive definition. For them, communication typically encompasses not only language, but also other behaviors that permit individuals to exchange information and socialize even when they speak different languages. Most pertinent to adult language disorders are gesturing, drawing, and other ways of getting messages across, or learning how to guide others to provide the support and scaffolding that facilitates interpersonal interchange.

These expanded definitions are crucial to understanding the differences between functional and more traditional approaches to assessment and treatment of the language disorders that are acquired in adulthood, typically the result of insults to the brain and occurring to individuals who previously had normal language and communication. For such individuals, understanding the way that language functions in communication remains relatively spared, in contrast to their deficits of impaired lexicon, grammar, and phonology. As a result, functional approaches tend to stress communication strengths rather than linguistic deficits.

Because they emphasize everyday language and communication use, functional approaches rely heavily on the context in which such activities occur. They focus on authentic interpersonal exchange and interaction across a variety of settings, as well as communicative activities that occur in everyday life. Functional approaches also include usual conversational partners and emphasize their new role in facilitating as normal communication as is possible. With this background in mind, the following summarizes functional approaches to assessment and treatment of aphasia. Although functional approaches can be applied to disorders such as traumatic brain injury and dementia, the bulk of the literature concerns aphasia, and it will be featured here.