The study of the cognitive substrates of pragmatic disorders is a relatively recent development in clinical pragmatics. This development has been ushered in by calls from researchers and clinicians on two fronts. First, it has been urged that the field of pragmatics should undergo a cognitive turn, such that a cognitive examination of pragmatic concepts is afforded equal significance to societal, philosophical and linguistic approaches to the discipline. Second, clinicians have increasingly acknowledged that it is not possible to assess and treat clients with pragmatic disorders in isolation from cognitive concerns. The chapter begins with an examination of the various cognitive processes that play a role in a standard communicative exchange. From this examination the two main components of any cognitive treatment of pragmatic disorders – executive functions and theory of mind – are established. The findings of clinical studies of clients with pragmatic disorders are discussed. These studies suggest an association between cognitive processes such as theory of mind on the one hand and a range of pragmatic impairments on the other hand. Conversational data from clients with pragmatic disorders are used to illustrate these cognitive-based pragmatic impairments. Finally, three theoretical frameworks with the potential to explain the cognitive basis of pragmatic disorders are examined.