Difficulty with word finding

Sometimes a person can understand certain
words but have trouble thinking of and using the word themselves. A
speech pathologist can help diagnose if a child has problems with
this. They can then help a child in several ways, depending on
how old the child is, how severe the problem is and any other
problems the child may
have.                 

What is it?

A ‘word retrieval difficulty’ or ‘word finding
problem’ is when a person knows and understands a particular
word, but has difficulty retrieving it and using it in their
speech. This is similar to when we feel that a word (for example a
name) is on the tip of our tongue. Children may not
be able to find the word at all, they might retrieve a word that
sounds similar to the one they want or they might produce nonsense
words (neologisms) .

In the classroom, a child with a word finding problem may have
difficulty expressing their knowledge. They may appear not to know
the answers when asked questions that need retrieval of specific
facts. For instance, they may have difficulty relating character or
people’s names, locations, dates or other specific facts. Their
conversation may be brief or include word repetitions,
substitutions, empty words, time fillers and delays.

For some people with an acquired brain injury, word retrieval
difficulties can be a significant problem, making it very difficult
to communicate clearly and competently. A child with an acquired
brain injury will also have greater problems with finding the right
word when they are tired or stressed.

Symptoms

A child may:

• have a good understanding of words but a poor
  expressive vocabulary
• talk around the word or explain the word they
  cannot find, for example ‘You know, the thing I brush my hair with’
• use non-specific words such as thing,
  there, that one, him, stuff.  They may over-use general
  words, such as good, big
• over-use words such as um or
  ah
• substitute words with a close meaning, for example they might say spoon instead of
  fork. Or may use words that sound the same, for example
  they might say hair instead of share
• use obvious word searching behaviors such as
  using um a lot, for example ‘ball, book, um, um, um
  bike’
• have lots of pauses in their speech and may
  take a long time to answer a question
• rarely use ‘content’ words. For example, instead of saying ‘I got the book from her’ they may say ‘I got it from her’

Diagnosis

A speech pathologist can assess if a child has
specific word retrieval or other difficulties with their language
development.

Treatment

There are several ways to help a child with
word finding difficulties. These generally depend on:

• how severe the problem is
• how old the child is
• if the child is very aware of the
  problem
• other underlying cognitive and communication
  disorders

A speech pathologist can recommend the best
ways to help each individual child. Some general techniques are
outlined below:

• support the child’s efforts in everyday
  interactions
• provide help online as necessary
• encourage them to search for the specific
  word, rather than talk in a roundabout way and skirt around it
• encourage them to think of the sound the word
  starts with
• if they are unable to think of the sound,
  help their retrieval by offering the first sound in the word, for example ‘b’ for ball. Or offer the initial syllable for the word for example, ‘bir’ for bird
• give the child clues. For example, ‘It looks like’, ‘It’s used to do’
• encourage description of the object. For
  example, ‘What does it look like?’, ‘What do we do
  with it?
• offer a gesture. For example, drinking
  movement for milk
• use a sentence completion strategy, for
  example, ‘Grass is…’

Key points to remember

• A ‘word retrieval difficulty’ or ‘word finding problem’ is when
  a person knows and understands a particular word, but has
  difficulty retrieving it and using it in their speech.
• A speech pathologist can assess if a child has specific word
  retrieval difficulties or is possibly having other difficulties
  with their language development.
• There are several ways to help, depending on the age of the
  child and how severe the problem is.

For more information

• The Royal Children’s Hospital
  Paediatric Rehabilitation Service
  T: (03) 9345 9300
  E: rehab.service@rch.org.au
• The Children’s Hospital at Westmead Brain injury Service
• Kids
  Health Info series of fact sheets listed
  under ‘Brain injury’

Developed by The Royal Children’s
Hospital Paediatric Rehabilitation Service based on information from the Brain
Injury Service at Westmead Children’s Hospital. We acknowledge the input of RCH
consumers and carers.

Reviewed September 2020.

Kids Health Info is supported by
The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.

Word-finding problems increase as we age and we become slower in processing information. Retrieving words is difficult although there is not evidence we lose vocabulary as we age. Semantic structure, or the organization of words in memory, does not change. «Older adults probably have more trouble dealing with large amounts of information» and as they age may develop different strategies to accommodate their decline in processing speed and capacity.^[1]

Words are said to be on the tip-of-the-tongue.

Word-finding problems «covers a wide range of clinical phenomena and may signify any of a number of distinct pathophysiological processes» and speech and language disturbances when dealing with dementias «present unique diagnostic and conceptual problems that are not fully captured by classical models derived from the study of vascular and other acute focal brain lesions.»^[2]

Word-finding problems and ME/CFS[edit | edit source]

Word-finding problems is an often reported symptom of ME/CFS. It is also referred to as language impairment. Etiology for language impairment with ME/CFS or fibromyalgia is undetermined at this time, but may be associated with a speech disorder called dysphasia (or aphasia, if it’s severe).^[3]

Prevalence[edit | edit source]

In a 2001 Belgian study, 75.5% of patients meeting the Fukuda criteria and 80.4% of patients meeting the Holmes criteria, in a cohort of 2073 CFS patients, reported difficulties with words.^[4]Katrina Berne reports a prevalence of 75-80% for ‘aphasia’ (inability to find the right word, saying the wrong word) and/or dyscalculia (difficulty with numbers) — although she notes that this symptom is probably underreported and more prevalent than indicated.^[5]

Presentation[edit | edit source]

Some examples:

• Increasing use of circumlocutions rather than specific terms (e.g., «I wonder where the thing that goes here is»).
• Use of empty phrases, indefinite terms, and pronouns without antecedents (i.e., referring to something or someone as «it» or «him / her» without first identifying them by name).
• Increased frequency of pauses.^[1]

Anomic Aphasia refers to word-finding problems as a type of aphasia. Its typical characteristics are:

• Trouble using correct names for people, places, or things.
• Speaking hesitantly because of difficulty naming words.
• Grammatical skills are unaffected.
• Comprehension is normal.
• Difficulty finding words may be evident in writing as well as speech.
• Reading ability may be impaired.
• Having knowledge of what to do with an object, but still unable to name to the object.
• Severity levels vary from one person to another.^[6]

Symptom recognition[edit | edit source]

The Wisconsin ME/CFS Association lists under the cognitive problem portion of Other Common Symptoms «word-finding difficulties» and then goes on to say about many of the symptoms of ME/CFS, «While these symptoms are also experienced occasionally by healthy people, the frequency and severity of their occurrence in people with CFS/FM/MCS is dramatically increased from their occurrence before they became ill.»^[7]

The ME Association notes under the bullet Brain and Central Nervous System problems including Cognitive dysfunction such as «word finding abilities».^[8]

The Hummingbirds’ Foundation for ME lists word-finding difficulties under Cognitive signs and symptoms.^[9]

The Canadian Consensus Criteria lists difficulties with «word retrieval» under Neurological/Cognitive Manifestations as an optional symptom.

Notable studies[edit | edit source]

Possible causes[edit | edit source]

• Stroke
• Head Trauma
• Dementia
• Tumors
• Aging^[10]

Potential treatments[edit | edit source]

See also[edit | edit source]

• Aphasia
• Cognitive dysfunction
• Dyscalculia
• Dysphasia
• Memory problems
• Speech difficulties

Learn more[edit | edit source]

• Jun 4, 2018, Victory For ME Disability Claim – U.S. Court Upholds Plaintiff’s Lawsuit After Being Denied Disability^[11] — Brian Vastag was able to prove with qEEG and cognitive tests he had «significant problems with visual perception and analysis, scanning speed, attention, visual motor coordination, motor and mental speed, memory, and verbal fluency» winning his long term disability (LTD) claim.^[11]

References[edit | edit source]

Primary word-finding difficulty may occur as an isolated language disturbance or may occur as part of a more extensive cognitive or behavioural syndrome. Secondary word-finding difficulty occurs when a deficit within another cognitive domain interferes with the function of a more or less intact language system.

Is word finding difficulty aphasia?

Anomic aphasia is the mildest of the aphasias, with relatively preserved speech and comprehension but difficulty in word finding. The persistent inability to find the correct word is known as anomia (literally, ‘without names’).

Is word finding difficulty a symptom of dementia?

Difficulty following storylines may occur due to early dementia. This is a classic early symptom. Just as finding and using the right words becomes difficult, people with dementia sometimes forget the meanings of words they hear or struggle to follow along with conversations or TV programs.

How do you treat word finding difficulties?

The Treatment: Word-Finding Strategies

1. Delay. Just give it a second or two.
2. Describe. Give the listener information about what the thing looks like or does.
3. Association. See if you can think of something related.
4. Synonyms. Think of a word that means the same or something similar.
5. First Letter.
6. Gesture.
7. Draw.
8. Look it Up.

Can anxiety cause word finding difficulty?

Feeling Tired or Stressed Anxiety, especially if it crops up when you’re in front of a lot of people, can lead to dry mouth, stumbling over your words, and more troubles that can get in the way of speaking. It’s OK to be nervous.

How do you fix aphasia?

The recommended treatment for aphasia is usually speech and language therapy. Sometimes aphasia improves on its own without treatment. This treatment is carried out by a speech and language therapist (SLT). If you were admitted to hospital, there should be a speech and language therapy team there.

Will aphasia ever go away?

Aphasia does not go away. Some people accept it better than others, but the important thing to remember is that you can continue to improve every day. It can happen, but there is no set timeline. Each person’s recovery is different.

Why do I stutter sometimes when I talk?

A stroke, traumatic brain injury, or other brain disorders can cause speech that is slow or has pauses or repeated sounds (neurogenic stuttering). Speech fluency can also be disrupted in the context of emotional distress. Speakers who do not stutter may experience dysfluency when they are nervous or feeling pressured.

What is mixing up words a symptom of?

Types of aphasia Symptoms can range widely from getting a few words mixed up to having difficulty with all forms of communication. Some people are unaware that their speech makes no sense and get frustrated when others don’t understand them. Read more about the different types of aphasia.

What is it called when you can’t think of a word?

Aphasia” is a. general term used to refer to deficits in language functions. PPA is caused by degeneration in the parts of the brain that are responsible for speech and language. PPA begins very gradually and initially is experienced as difficulty thinking of common words while speaking or writing.

What can cause temporary aphasia?

Temporary aphasia (also known as transient aphasia) can be caused by a seizure, severe migraine, or transient ischemic attack (TIA), also called a ministroke….Causes of aphasia include:

• Stroke.
• Heady injury (trauma)
• Brain tumor.
• Brain infection.
• Progressive neurological disorder.

What can cause aphasia?

Aphasia is caused by damage to the language-dominant side of the brain, usually the left side, and may be brought on by:

• Stroke.
• Head injury.
• Brain tumor.
• Infection.
• Dementia.

What’s the difference between dysphasia and aphasia?

What is the difference between aphasia and dysphasia? Some people may refer to aphasia as dysphasia. Aphasia is the medical term for full loss of language, while dysphasia stands for partial loss of language.

Can aphasia be caused by anxiety?

Stress doesn’t directly cause anomic aphasic. However, living with chronic stress may increase your risk of having a stroke that can lead to anomic aphasia. However, if you have anomic aphasia, your symptoms may be more noticeable during times of stress.

How can you tell the difference between aphasia?

Aphasia is broken down into two categories:

1. Nonfluent aphasia. Speech is difficult or halting, and some words may be absent. However, a listener can still understand what the speaker is trying to say.
2. Fluent aphasia. Speech flows more easily, but the content of the message lacks meaning.

What is the most common cause of aphasia?

The most common cause of aphasia is brain damage resulting from a stroke — the blockage or rupture of a blood vessel in the brain.

What neurological disorders cause aphasia?

There are many causes for aphasia including stroke, brain trauma, brain tumours, and progressive neurological disease. Moreover, there are a variety of disorders of communication that may be due to paralysis, weakness, or incoordination of the speech musculature or to cognitive impairment.

Is Aphasia a symptom of MS?

Multiple sclerosis (MS) primarily affects the white matter of the brain and spinal cord. Aphasia rarely occurs as a clinical manifestation of MS. Since aphasia is usually associated with diseases of the gray matter, it is not an expected presentation of MS.

What is the difference between aphasia and dementia?

Dementia is Latin for “madness.” This implies a state of serious memory loss to a point where normal actions such as eating or drinking are incredibly difficult. The term aphasia means “speechlessness” in Greek. Therefore, a person with aphasia can still operate functionally when it comes to day-to-day activity.

Is Aphasia a sign of dementia?

Symptoms of dementia include: memory loss. confusion. problems with speech and understanding (aphasia).

Many of the children I work with (especially those at junior and secondary age) have word-finding difficulties.  It’s a term you often see written in speech therapy reports.  But what exactly does this mean and how can you help?

What is a word-finding difficulty?

Basically, a word-finding difficulty is exactly what it sounds like – a difficulty with finding the words you want to say.  This is something we all experience from time to time.  The easiest way to explain it is that “tip of the tongue” feeling that you get when you can’t remember someone’s name or a word that you know you should know!  It happens to us all more as we get older and particularly if we are tired or distracted.  This explains why parents of young children often observe that they keep forgetting words!

We all experience word-finding difficulties from time to time, but some people have this all the time. They know what they want to say, but can’t bring the words to the forefront of their mind.  It can be really frustrating!

How will I know that a child is struggling with word-finding?

Word-finding difficulties can present in quite a few different ways.  Here are some of the most common ones.

• Some children “ramble”.  They talk around a topic, but don’t really get to the point because they can’t bring the right words to mind.
• Others start sentences, get a few words in, then stop and start again.
• Some will use a lot of non-specific words or filler words rather than specific vocabulary.  For example, they might say “I saw that thing next to it”.
• A few will use made-up words  or appear to mumble parts of their sentence.

In any of these cases, it can be difficult for a child to get their message across.

How can we help?

If a child is still struggling with word-finding by Junior school age (7+), it is likely that it will always be an area of weakness for them.  However, this doesn’t mean there is nothing we can do to help.  Here are some tips to help a child who has difficulty with word-finding:-

1. Give the child time to think and respond.  This can be hard to do but it really helps.  Try not to interrupt or tell them to hurry up. Wait and give them the time they need to finish what they are saying.
2. Cue them in to the correct word.  This only works if you know what word they are trying to say!  Instead of just telling them, give them a clue to see if that helps them.  Either tell them the first sound (e.g. “you need a fff…”) or give them a clue related to the meaning (e.g. “you don’t need a knife, you need a…”)
3. Point out your own errors.  When you have difficulty thinking of a word, verbalise the difficulty so that the child can see that this happens to everyone.  For example, “what’s your friend’s name?  I’ve forgotten.  I think it starts with l….”
4. Repeat new vocabulary lots of times.  It really helps to make sure that the child learns new words thoroughly, as this means that they are more likely to remember them when they want to use them.  There are some ideas to work on vocabulary in this post and I highly recommend the Word Aware approach to really embed word learning into the curriculum for all children.  Talk about all aspects of a word – it’s sound, it’s meaning, other words it is related to etc.
5. Work on description skills.  What do you do when you can’t remember a word?  My guess is that you get round it by describing the word (e.g. “Today I met…er… I can’t remember his name… the guy who’s married to Sarah, has a beard….”).  Someone supplies you with the name, and the conversation moves on.  Sometimes you may even remember it yourself as you are describing.  This is what we want to teach children to do too.  Play lots of games to help with naming and describing skills to help develop their vocabulary knowledge and their ability to explain when they can’t think of a word.

Here are a few ideas of activities to do with your child, which can help with word-finding.  There are lots more too that we will share another day.

• Get a set of picture cards of objects or animals.  Take turns to take a picture and describe it for the other person to guess what it is.  Talk about what makes a good clue.  e.g. “it’s black” is not necessarily a helpful clue for a cat, but “it says miaow” might help you guess it more quickly!
• Think of a category, such as farm animals, or clothes.  Roll a dice and see if the child can think of that many things which fit the category.  For older children, make the categories harder (e.g. things which are red, or things that are round).
• You can also do this the other way round.  List a few items and see if your child can work out the category.  e.g. carrots, potatoes and peas are all….
• Talk about similarities and differences between different things.  You could find two different things around the house and see if you can think together of what is the same about them and what is different.  For example, a glove and a sock are both clothes, they both come in pairs, they are both soft.  However, a glove goes on your hand and a sock goes on your foot.

What do you find helps your child or the child you work with?  Do add your ideas and experiences here too to help us all!

Do your students struggle with word finding?

It’s a chronic concern with many students on my caseload — and research backs it up. According to Dockrell, Messer, George, and Wilson (1998) 23% of children on a speech-language pathologist’s caseload will have difficulty with word finding.

My students usually shrug their shoulders when they don’t know an answer to a question. I spend a lot of time vocabulary building with my students, but that’s a different discussion. Word finding means that the student can’t think of words they already know or have exposure to.

What are the 3 Main Types of Word Finding Errors?

When researchers look more closely at word finding errors, they find three main types of errors (McGregor 1997):

1. Semantic substitutions (Saying “horse” for “burro”)
2. Phonological errors (Saying “manza” for “manzana” — ‘apple’ in Spanish) — This type of error is less common.
3. “Don’t know” errors (My students’ errors are often in this group)

10 Word Finding Strategies

While I love learning about research (I geek out on it just a bit), I really need specific therapy techniques to help my students. So how do we help students with word finding difficulties in therapy? I’ve compiled a list of ten strategies to use in therapy:

1. Priming — Start out a therapy task with a review of all of the relevant vocabulary words in a lesson. This activates the student’s categorical vocabulary knowledge and gets their brains ready for the task ahead.
2. Vocabulary drill — Throw it back to traditional speech therapy and get out those picture cards in categories and have a student name, name, name. Pair it with a game!
3. Narrative intervention — Bring out the books, preferably related to grade-level curriculum, and focus on story retell. Recalling the parts of the story and the key vocabulary with help the student learn and retain important words. Must be done consistently and story grammar visuals are beneficial, too.
4. Visualization — When a student is stuck, ask the student to close their eyes and imagine the object. Then ask him/her to say what they see in their mind.
5. Providing phonemic cues — If you know the word the student is search for, provide the first sound. For example, if they are looking for the word “mug,” say, “It starts with ‘m.’”
6. Providing semantic cues — Again, if you know the word that the student can’t find, ask the student questions about the category, “Is it a tool?” or the function “It is used to hit nails.”
7. Reverse engineer their error — If the student says “tiger” for “lion,” consider offering other associated words, like “It’s an animal that lives in Africa like a zebra, gazelle, or a cheetah.”
8. Providing the opposite word or a similar word — Telling the student the antonym of the target word or a synonym is another way to have the student think creatively to locate the missing word.
9. Gesture — So many of my students use gesture naturally when they struggle to name a word. But pantomine or gesturing can really work to recall that missing word.
10. Word vomit (aka Circumlocution) — Ask the student to just say as much as they can about the word and sometimes then they land on it.

I hope that this blog post helps you by offering you new ideas that you can use during your next therapy session. Make sure to join my email list (see very top bar to opt-in) for more interesting and helpful information.