How I structure my Cognition Section in my FCA's

Writing about cognition in a Functional Capacity Assessment can feel overwhelming, especially when you're trying to balance clinical detail, plain language, and functional relevance.

Over time, I’ve landed on a structure that keeps me clear, consistent, and confident that I’ve covered what matters. Here’s the exact breakdown I use when reporting on cognition in an FCA:

Cognitive Presentation

Orientation

Are they consistently oriented to person, place, time, and situation?

Attention

Can they focus, sustain, and shift attention? What supports do they need?

Information Processing

How do they take in and respond to information? Is there overload or delay?

Memory

Where do memory challenges show up in daily life? (Short-term, working, long-term.)

Executive Function

• Insight & Self-Awareness

  The person’s understanding of their own abilities, limitations, and support needs. Do they recognise when something is difficult? Can they identify when they’ve made an error? Do they understand their diagnosis or functional limitations?

• Inhibition

  The ability to stop, delay, or redirect an automatic response — behavioural, verbal, or emotional. Do they interrupt tasks or conversations? Are they impulsive in decision-making? Do they act without considering risks?

• Working Memory

  The ability to hold and use information temporarily for a task (e.g. remembering a phone number while dialling it). Can they follow multi-step instructions? Do they lose track mid-task? Are they reliant on prompts or environmental cues?

Impact on Occupational Performance / Functional Cognition

• Capacity to Make Decisions

  The ability to understand, weigh up, and communicate decisions related to daily life, finances, supports, and safety. Do they understand options and consequences? Can they retain and communicate decisions consistently? Are they vulnerable to persuasion or exploitation?

• Capacity to Problem Solve

  The ability to identify when something isn’t working and generate or implement a solution. Can they identify when something’s gone wrong? Do they try alternative strategies? Do they ask for help when stuck?

• Capacity to Plan

  The ability to initiate, sequence, and structure tasks ahead of time. Can they plan daily tasks or longer-term events? Are they able to organise steps logically? Do they require external structure or support?

• Cognitive Load / Mental Capacity

  How much mental energy a person has available and how they manage or cope with cognitive demands. Are they overwhelmed by too much at once? Do they experience cognitive fatigue? How do they respond to multiple tasks or competing demands?

Recommendations
Add everything relevant to support cognitive barriers here. Supports, strategies, and environmental changes that reduce cognitive load and increase functional engagement.

Here’s what I like about this structure:
It starts by highlighting the barriers; the cognitive processes that are disrupted - but always circles back to the real-world impact.
That’s where the story becomes meaningful.

Rather than just saying “they have poor initiation,” we show what that means:

“Participant required multiple prompts to begin tasks, resulting in incomplete meal prep and reduced safety in the kitchen.”
It’s about turning clinical insight into something practical and understandable - not just for NDIS, but for families, support workers, and the person themselves.

Communication
This sits separately in my reports - often overlooked, but crucial to independence.

• Functional Communication

• Impact on Occupational Performance

• Recommendations

 This format is clear, encourages every aspect to be reviewed and it supports my reasoning, makes it easier for others to follow, and strengthens my recommendations.

If you’re still finding your rhythm with cognition in FCAs, feel free to reply to this email and I can send you the word doc to make it your own.

Until next week,
Imogen