Aphasia Subtypes on the Praxis SLP: The Boston Classification Cheat Sheet

Aphasia is one of the highest-yield topics on the Praxis 5331. ETS reliably tests whether you can take a short clinical vignette — fluent vs. non-fluent speech, intact vs. impaired comprehension, intact vs. impaired repetition — and name the subtype, the likely lesion site, and the appropriate intervention. If you can memorize one matrix, you can answer most aphasia questions on the exam. Here it is.

The 2x2 framework that unlocks every question

Classical (Boston) aphasia classification rests on three binary features:

• Fluency — is speech output flowing or halting/effortful?
• Auditory comprehension — can the patient understand spoken language?
• Repetition — can the patient repeat words and phrases?

Map any vignette onto those three axes and the subtype falls out almost automatically.

The eight Boston subtypes you must know

Repetition rule of thumb: all transcortical aphasias have spared repetition. That's the single fastest way to narrow a vignette.

High-yield clinical features the exam loves

• Broca's: agrammatic, telegraphic speech, often with right hemiparesis (because the lesion is right next to motor cortex). Patient is usually aware and frustrated.
• Wernicke's: fluent paraphasic "word salad" with neologisms, poor self-monitoring, often unaware of deficit. No hemiparesis (lesion is posterior).
• Conduction: hallmark is striking inability to repeat (especially long unfamiliar phrases) despite fluent speech and good comprehension. Frequent phonemic paraphasias with self-correction attempts ("conduit d'approche").
• Anomic: word-finding pauses, circumlocution, otherwise normal. Often the residual presentation after other aphasias resolve.

Evidence-based interventions to recognize

• Melodic Intonation Therapy (MIT) — for non-fluent (Broca's-type) aphasia with relatively preserved comprehension. Uses melody and rhythm to recruit right-hemisphere language capacity.
• Constraint-Induced Aphasia Therapy (CIAT) — high-intensity verbal-only practice; restricts compensatory gestures.
• Semantic Feature Analysis (SFA) — for anomia; patient generates features (category, function, location, properties) to cue word retrieval.
• Response Elaboration Training (RET) — clinician expands the patient's spontaneous utterances; good for Broca's-type telegraphic speech.
• Script Training — rehearses functional dialogues for daily life.
• Supported Conversation for Adults with Aphasia (SCA) — partner training; LPAA (Life Participation Approach) framework.

Primary Progressive Aphasia (PPA) — don't miss this

ETS frequently includes one PPA item. It is a neurodegenerative aphasia (frontotemporal spectrum), not stroke-related. Three variants:

• Non-fluent/agrammatic PPA — looks Broca's-like but progressive; apraxia of speech often co-occurs.
• Semantic variant PPA — fluent but loss of word meaning; anterior temporal atrophy.
• Logopenic variant PPA — word-finding pauses, impaired repetition of long phrases; often associated with Alzheimer's pathology.

How aphasia shows up on the exam

Most items are short vignettes that hand you the three diagnostic features and ask either (a) name the subtype, (b) localize the lesion, or (c) pick the best next intervention. A smaller number test recovery patterns, family counseling, or AAC for severe global aphasia. Pair this guide with our cranial nerves guide and the content area breakdown to lock down the adult neuro section.