What Is the Boston Diagnostic Aphasia Examination?

The Boston Diagnostic Aphasia Examination, now in its third edition (BDAE-3), is a comprehensive clinical battery used to diagnose "aphasia," a language disorder caused by damage to the brain areas that handle language. The exam samples a person's conversational speech, auditory comprehension, oral expression, repetition, reading, and writing, then uses that profile of strengths and weaknesses to classify the impairment into a recognized aphasia syndrome, such as Broca's or Wernicke's aphasia. This article covers where the exam came from, what it measures, how its famous "Cookie Theft" picture works, and how a diagnostic language battery differs from a cognitive ability test.

According to the National Institute on Deafness and Other Communication Disorders, aphasia results from damage, usually from a stroke or traumatic brain injury, to the areas of the brain responsible for language. Stroke is the leading cause, and roughly two million Americans live with aphasia according to figures the institute cites from the National Aphasia Association. About one third of stroke survivors develop some form of the disorder.

The stroke rehabilitation resource Strokengine reports that the Boston Diagnostic Aphasia Examination was first developed in 1972 by researchers Harold Goodglass and Edith Kaplan, two influential figures in aphasia research and neuropsychological assessment. A second edition followed in 1983. The current third edition appeared in 2001 with Barbara Barresi joining as a third author, and it is published by Pro-Ed as a complete kit that includes both a standard (long) form and a short form.

The exam grew out of the "Boston school" approach to aphasia, which holds that patterns of spared and impaired language abilities point to different underlying syndromes. Rather than producing a single global score, the BDAE was designed from the start to map a person's language profile in enough detail to support a syndrome diagnosis.

The publisher describes the BDAE-3 as a tool that helps clinicians identify and distinguish among disorders of language function and neurologically recognized aphasic syndromes. Strokengine summarizes the battery as covering eight areas of language performance.

• Fluency: the examiner rates the flow, effort, and grammatical shape of spontaneous conversational and expository speech, including a formal severity rating of communicative ability.

• Auditory comprehension: tasks such as pointing to named pictures and following spoken commands test how well the person understands language they hear.

• Naming: the person names pictured objects, with scoring that rewards fast, accurate retrieval; Strokengine notes that a response within three seconds earns full credit while slower responses earn less.

• Repetition and automatic speech: the person repeats words and sentences and produces overlearned sequences, which helps separate syndromes that look similar in conversation.

• Reading and writing: oral reading, reading comprehension, and writing tasks establish whether written language is affected along with spoken language.

Administration time depends on the version. Strokengine reports that the standard version takes about 90 to 120 minutes, while the short form takes 30 to 45 minutes and gives quicker access to diagnostic classification when a full workup is impractical. An extended version, which adds testing of visuospatial and quantitative abilities after brain injury, can run up to two and a half hours. The publisher lists the exam for adults, and the long form uses 146 illustrations compared with 27 in the short form.

The best known element of the exam is the "Cookie Theft" picture, a black and white line drawing of a kitchen scene in which children raid a cookie jar, one of them perched on a tipping stool, while a distracted woman washes dishes at the sink. The examiner shows the card and asks the person to describe everything they see happening. The resulting sample of "connected speech," meaning natural flowing language rather than single-word answers, reveals a great deal about fluency, grammar, word retrieval, and how efficiently a person communicates information.

The task has traveled far beyond the exam itself. According to a study by Berube and colleagues in the American Journal of Speech-Language Pathology, descriptions of the Cookie Theft picture are used to rate aphasia severity in both the BDAE and the National Institutes of Health Stroke Scale, which is administered to nearly every acute stroke patient in the United States. The same research team at Johns Hopkins developed a modernized color version of the scene, partly because the original drawing, with its 1950s styling, struck many test takers as dated and offered relatively few objects and actions to describe.

Researchers also use the picture to study language decline in dementia. A study published in the journal Brain by Ahmed and colleagues analyzed connected speech elicited with the Cookie Theft task to track how language changes across the stages of Alzheimer's disease, well before many patients would show obvious aphasia. That is a useful reminder that a single well-designed stimulus can serve both bedside diagnosis and long-term research.

The exam's defining feature is syndrome classification. Clinicians compare the person's profile across fluency, comprehension, repetition, and naming to the patterns associated with classic aphasia syndromes. The medical reference StatPearls describes the major types.

• Broca's aphasia: nonfluent, effortful, telegraphic speech with largely intact comprehension; the person often knows what they want to say but cannot get the words out smoothly.

• Wernicke's aphasia: fluent speech with normal rhythm and melody, but comprehension and naming are severely impaired, and speech contains "paraphasias," meaning substituted or invented words.

• Global aphasia: the most severe form, with both expression and comprehension heavily affected; some patients produce only a few recognizable words.

• Conduction aphasia: relatively preserved fluency and comprehension but marked trouble repeating what was just heard.

• Anomic aphasia: a milder pattern in which word-finding difficulty is the main complaint.

• Transcortical aphasias: less common patterns in which repetition is spared despite nonfluent speech (transcortical motor) or impaired comprehension (transcortical sensory).

Alongside classification, StatPearls notes that the Boston Diagnostic Aphasia Examination offers a severity rating ranging from slight to severe, which helps teams track recovery over time. In practice, many patients do not fit any textbook syndrome neatly, and careful clinicians treat these labels as descriptions of a score profile at one point in time rather than fixed categories.

The BDAE-3 has a close companion. The publisher's kit includes the 60-item Boston Naming Test, Second Edition, a picture-naming measure, along with a 15-item short form and a multiple-choice version for retesting. Because word-finding problems appear in nearly every aphasia syndrome, and in many dementias, confrontation naming deserves its own dedicated instrument. You can read a full breakdown of that measure in our article on the Boston Naming Test.

Both tools typically appear inside a larger evaluation. When a neuropsychologist assembles a battery after a stroke or head injury, language measures like the BDAE sit alongside tests of memory, attention, and problem solving. Our overview of neuropsychological testing explains how these pieces fit together.

The Boston Diagnostic Aphasia Examination is a diagnostic language battery. It asks whether specific language systems are damaged and, if so, in what pattern, rather than estimating general intelligence. An IQ test asks a different question: how strong is a person's overall reasoning ability compared with other adults? Language-based reasoning is one part of that picture, and our article on verbal reasoning explains how it is measured in cognitive tests.

For healthy adults who simply want a rigorous picture of their cognitive abilities, a normed online instrument is a practical option. The RIOT IQ test (the Reasoning and Intelligence Online Test), developed by RIOT IQ with psychometrician Dr. Russell T. Warne, is designed for adults 18 and older and includes 15 subtests across six cognitive indices: verbal reasoning, fluid reasoning, spatial ability, working memory, processing speed, and reaction time. It takes about 52 minutes and reports scores on the familiar mean-100, standard-deviation-15 IQ scale. It is not a medical instrument, and no online test replaces an individually administered diagnostic evaluation for someone with a suspected brain injury or language disorder. If you want a trustworthy measure of your reasoning ability, you can take the RIOT IQ test.

Strokengine reports about 90 to 120 minutes for the standard version, 30 to 45 minutes for the short form, and up to two and a half hours for the extended version.

It is a line drawing of a kitchen mishap from the BDAE. The person describes everything happening in the scene, and the resulting speech sample is scored for fluency, content, and efficiency. It is also used in the NIH Stroke Scale.

It is a clinical instrument used by speech-language pathologists, neuropsychologists, and other trained professionals, most often after a stroke or brain injury.

No. It profiles language abilities and rates aphasia severity from slight to severe. It does not measure general intelligence, although an extended version samples visuospatial and quantitative abilities.

Yes. The 2001 third edition includes a short form with 27 illustrations that takes 30 to 45 minutes and still supports diagnostic classification.

The Boston Naming Test is a separate 60-item picture-naming measure included in the BDAE-3 kit. It provides a deeper look at word-finding ability than the naming items inside the main exam.

1. Goodglass, H., Kaplan, E., & Barresi, B. (2001). Boston Diagnostic Aphasia Examination, Third Edition (BDAE-3). Pro-Ed. proedinc.com

2. Strokengine. (n.d.). Boston Diagnostic Aphasia Examination (BDAE). strokengine.ca

3. Berube, S., Nonnemacher, J., Demsky, C., Glenn, S., Saxena, S., Wright, A., Tippett, D. C., & Hillis, A. E. (2019). Stealing cookies in the twenty-first century: Measures of spoken narrative in healthy versus speakers with aphasia. American Journal of Speech-Language Pathology, 28(1S), 321-329. talkbank.org

4. Ahmed, S., Haigh, A.-M. F., de Jager, C. A., & Garrard, P. (2013). Connected speech as a marker of disease progression in autopsy-proven Alzheimer's disease. Brain, 136(12), 3727-3737. pmc.ncbi.nlm.nih.gov

5. Le, H., Lui, F., & Lui, M. Y. (2024). Aphasia. In StatPearls. StatPearls Publishing. ncbi.nlm.nih.gov

6. National Institute on Deafness and Other Communication Disorders. (n.d.). Aphasia. U.S. Department of Health and Human Services. nidcd.nih.gov

Hero image: color plate of a boy feeding a white rabbit, by G. A. Harker, from The Brooks Primer (1906), public domain, via Internet Archive Book Images / Wikimedia Commons; composed as a picture card on a weathered wooden table (photo by W.carter, CC0, via Wikimedia Commons) with a fountain pen (photo by Enrique Íñiguez Rodríguez (Qoan), CC BY-SA 4.0, https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons).