Treatment for word finding problems

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]

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It’s on the tip of my tongue! How many times have you used this expression or heard it from other people. Oftentimes when we think of word-finding deficits we automatically think of it as an adult affliction, however, you would be surprised how many children including even very young children (4+ years of age) are affected by it. Did you know that “up to 7% of children have specific language needs and around 25% of children attending language support services have word-finding difficulties (WFD; Dockrell et al., 1998)?”

If you participate in various speech language and education related forums you may frequently see a variation on this question: “How would you assess and treat a child with word finding difficulties?” Before I provide some recommendations on this matter I’d like to talk a little bit about what word-finding is as well as what impact untreated word finding issues may have in a child.

So how do word-finding deficits manifest in children? In a vast variety of ways actually! For starters they could occur at the word level, conversational level or both. Below are just a few examples of word-level errors from German, 2005:

• Error Pattern 1- Lemma Related Semantic Errors
  • “Slips of the tongue” or semantic word substitutions  such as fox→ wolf;  clown → gnome
• Error Pattern 2 – Form Related Blocked Errors
  • “Tips of the tongue” or responses characterized by word blocks, pauses, fillers (um, ah, etc), repetitions, metalinguistic or metacognitive comments such as “I know”, “I don’t know”, etc.
• Error Pattern 3 – Form & Segment Related Phonologic Errors
  • “Twists of the tongue” which include phoneme omissions, substitutions and additions such as cactus → catus; octopus →opotus, etc.

Further complicating the above may be the speed (some delay or no delay) with which they retrieve words as well as accuracy/inaccuracy of their retrieval once the words are retrieved. Additionally, a number of secondary characteristics may also play a role which include gestures (e.g, miming a word, frustration, etc) as well as extra verbalizations (metalinguistic and metacognitive comments).

At discourse level, students with word-finding deficits typically occupy one of two categories: productive vs. insufficiently productive language users. While their narrative language profile may be marked by frequent pauses, word fillers, as well as word and phrase revisions and repetitions.

Moreover, word-retrieval deficits are not limited to discourse, they are also found in reading tasks.  There word-finding issues  may manifest  as  omitted words or almost stuttering/cluttering like behaviors.  Interestingly German and Newman (2005; 2007) found that  students with word retrieval difficulties are able to successfully correctly identify  the words they missed during oral reading tasks in silent reading recognition tasks.

Difficulty coherently expressing oneself can have significant detrimental effect on the child’s academic performance, social relationships and ultimately self-esteem, which without appropriate intervention may potentially lead to poor school performance as well as mental issues (e.g., anxiety, depression, etc.)

So how can word-finding deficits be assessed for free?  You can assess word-finding at narrative level using the clinical narrative assessment.

At word level you can adapt single word standardazed tests such as the Expressive One Word Picture Vocabulary Test (EOWPVT) in order to test the efficiency of the student’s word retrieval in single word context. Here, the goal is not necessarily to test their expressive vocabulary knowledge but rather to see what type of word finding errors the students are making as they are attempting to correctly recall the visually shown word. Depending on the extent of the child’s word finding deficits you may have some very useful information to derive from the presentation of this test.

To illustrate, I recently informally administered applicable portions of this test to a four-year old Russian speaking preschooler. Based on his performance I was able to determine that his errors are primarily Error Pattern 3 – Form & Segment Related Phonologic Errors or Twists of the tongue”. This was further confirmed when I had the child to participate in the narrative retelling task.

So where can we find reputable evidence-based practice information on effective assessment and treatment strategies for word finding deficits? Start with Dr. Diane German’s website, entitled Word Finding. She has a lot of good information to offer  there for free to both speech language professionals as well as parents. Take a look at her recommended materials and resources, they are very helpful when it comes to assessing and treating children with word finding deficits.   Now have fun and evidence-base practice on!

PS. Calculating percentage of word-finding difficulties in children.

Dr. German recommends the following procedure: “Obtain a language sample of 50 T-units (kernel sentence + subordinate clause)  in length using stimuli of  interest to the learner (or use one you have as long as all utterances in the sample are included). Then asses each T unit for the presence of one or more of the following  7 WF behaviors in discourse: repetitions, revisions (reformulations), substitutions, insertions (comment that reflects on the WF process like I cannot think of it, etc. ), time fillers (um, er, uh),  delays with in the T unit, and empty words (thing, stuff). Learners with WF difficulties manifest one or more WF behaviors in 33% or more of their T units (often 40% – 50%).  Typical language learners display WF behaviors in 19% or less of their T-Units (German, 1991)“ (German, 2015: SIG 16 Topic: Assessing Word-Finding Skills)

Helpful Related Materials:

1. Clinical Assessment of Narratives in Speech Language Pathology
2. Narrative Assessments of Preschool, School-Aged, and Adolescent Children
3. Narrative Assessment Bundle
4. The Checklists Bundle
5. Creating Functional Therapy Plan

References:

1. Dockrell, J.E., Messer, D., George, R. & Wilson, G. (1998). Notes and Discussion  Children with word-finding difficulties-prevalence, presentation and naming problems. International Journal of Language & Communication Disorders, 33 (4), 445-454.
2. German, D.J. (2001) It’s on the Tip of My Tongue, Word Finding Strategies to Remember Names and Words You Often Forget.  Word Finding Materials, Inc.
3. Dr. German’s Word Finding Website: http://www.wordfinding.com/

Disclaimer: The views expressed in this post are the personal opinion of the author. The author is not affiliated with dr. Diane German nor PRO-ED publications in any way and was not provided by them with any complimentary products or compensation for this post. 

Alzheimer’s disease can cause aphasia, which is a decline in language function due to brain disease. Alzheimer’s disease is progressive dementia that causes impaired memory, judgment, and general cognitive functioning.

Aphasia in Alzheimer’s disease often begins with word-finding problems, including difficulty choosing or recalling the right word. It can progress affect someone’s ability to express themselves, and it can involve comprehension too. Brain tumors, infections, and injuries can also cause aphasia, 

This article explains some of the characteristics, symptoms, and causes of aphasia. It also describes how aphasia is diagnosed and treated.

What Is Aphasia?

Aphasia is a language deficit caused by brain disease or brain damage. It ranges in severity, meaning it can be very mild or so severe that communication is nearly impossible. There are several types of aphasia, each caused by damage to a specific region in the brain that controls certain features of language.

Aphasia is usually associated with stroke, head trauma, or dementia. It is rarely associated with other diseases, such as multiple sclerosis or Parkinson’s disease. The condition takes several forms:

• Dementia-associated aphasia is gradual and is associated with other effects of dementia, such as personality changes and memory loss.
• Aphasia from a stroke happens abruptly, when an area of the brain becomes damaged due to insufficient blood supply.
• Aphasia due to head trauma can have fluctuating symptoms.

Symptoms

Aphasia can manifest with difficulty in comprehension and/or expression. Aphasia that’s associated with dementia includes word-finding problems. It may cause a person to hesitate at length, and mentally search for the right word, before speaking.

Alternatively, when they try to speak, they may use an incorrect word that starts with the same letter of the desired word («floor» instead of «flower» or «sack» instead of «sand»). Or they may describe what the word means («You know, the thing on the wall with the numbers and the time»).

Word-finding aphasia may manifest with:

• «Tip of the tongue» experiences
• Difficulty naming objects or people
• Impaired understanding of spoken or written words
• Diminished ability to write or writing the wrong words
• Hesitancy in speaking

Someone with early dementia may have greater difficulty speaking than comprehending. But sometimes, it’s hard to be sure. They may simply appear as if they understand (for example, by nodding their head).

Other early signs of Alzheimer’s dementia can also appear along with aphasia. These signs include forgetfulness, confusion, emotional outbursts, personality changes, and a sudden lack of inhibition.

When to Seek Medical Help

Many adults can relate to the feeling of being unable to retrieve a word. They may call it a «brain jam» or «brain fog.» But if you’ve noticed this happening to a loved one with greater frequency, start taking note of when and how often it occurs. Does it happen when they’re tired, multi-tasking, or extremely stressed? Or does it happen when they’re calm and relaxed?

If you see a pattern that is truly interfering with their ability to communicate effectively, it may be helpful to ask a mutual acquaintance if they’ve noticed any changes in your loved one’s behavior before consulting a healthcare provider.

Types and Causes

Aphasia occurs when areas of the brain that control language are damaged, making it difficult to speak, read, and write. The four main types of aphasia are:

• Anomic aphasia, or when someone has difficulty remembering the correct word for objects, places, or events
• Expressive aphasia, or when someone knows what they want to say but have trouble saying or writing what they mean
• Global aphasia, or when someone lacks the ability to speak, read, write, or understand speech
• Receptive aphasia, or when someone hears someone speaking or reads something in print but cannot make sense of the words

Aphasia due to dementia is caused by the gradual degeneration of cells in the frontal lobe and limbic system of the brain. These areas control memory, judgment, problem-solving, and emotions. It generally does not follow the speech pattern of other types of aphasia.

With dementia, impairment of semantic memory (the memory for understanding and recognizing words) is a significant contributor to word-finding difficulties.

Primary progressive aphasia is a specific type of aphasia caused by dementia that results from degeneration of the frontal and temporal regions. It typically occurs in frontotemporal dementia (FTD), and also in Alzheimer’s disease. It starts gradually, usually with word-finding difficulty and problems with naming and pronunciation. As it progresses, people develop problems with comprehension, reading, and writing. They may also lose their ability to speak. 

Diagnosis

Word-finding aphasia is a common symptom of early-stage Alzheimer’s disease, but there are others. Your doctor will ask about your loved one’s symptoms and may want to speak with family members. Interestingly, aphasia affects a person’s second language before it begins to affect their first language.

The doctor will also consider your loved one’s baseline language ability during the assessment. For example, your loved one would be expected to demonstrate familiarity with words in their field of work. Forgetting words that they’ve presumably used often and easily could be a warning sign of dementia or aphasia. The evaluation might also include;

• A physical examination, including a comprehensive neurological examination, to help distinguish different causes of aphasia
• The Verbal Fluency Test or the Boston Naming Test
• An online dementia test called the Self-Administered Gerocognitive Exam SAGE test. It evaluates thinking abilities.
• Diagnostic tests, such as brain imaging tests, if there is a concern that your loved one might have had a stroke.

Prevention

The best ways to try to prevent aphasia mirror prevention tips for many other diseases. And they all boil down to one point: Live a healthy lifestyle. In this case, your loved one should focus on reducing the risk of stroke. By now, you may know the drill:

• Eat a healthy, balanced diet.
• Maintain a healthy weight.
• Exercise regularly.
• Quit smoking and drinking (if applicable).
• Be proactive about keeping blood sugar, cholesterol, blood sugar, and blood pressure levels low.
• Stay mentally active with activities like puzzles and word games.
• Prevent falls and head injuries.

Treatment

If your loved one is at risk for stroke, lifestyle factors and medication can reduce the risk. Even if aphasia is caused solely by dementia, having a stroke can substantially worsen the symptoms.

Treatment for aphasia involves a multidisciplinary approach that might call for medication and therapy. A doctor can prescribe medication for the treatment of dementia, which may help slow the progression of the disease.

Otherwise, aphasia is treated by working with a speech and language therapist to improve your loved one’s ability to communicate with others. This should be an ongoing process, especially if the underlying cause of the aphasia continues to progress.

Coping

No one ever said that it’s easy to care for or even be in the presence of someone whose communication skills are faltering. Being patient and supportive is your best coping strategy. For example:

• Maintain eye contact and adopt a calm tone of voice.
• Use short, simple words.
• Don’t offer guesses, rattle off word choices, or finish sentences. It’s easier than you think to frustrate and overwhelm someone with aphasia. Give your loved one time to speak.
• Don’t rolls your eyes, snicker, or show any other signs of impatience when you know your loved one is doing their best to communicate.
• Incorporate facial cues, gestures, and visual aids into communication rather than relying only on words.
• Ask for verbal and non-verbal clarification. For example, if your loved one says that their «fig» hurts, ask if their finger hurts and point to it.
• Don’t argue, even if your loved one baits you. Try to appreciate just being together, even when you aren’t talking.

Summary

Aphasia occurs when areas of the brain that control language are damaged. This impairs the ability to speak and understand. The symptoms often include an inability to understand spoken or written words and difficulty speaking or writing, The four main types of aphasia include expressive aphasia (someone knows what they want to say but have trouble saying or writing it); receptive aphasia (when someone hears a voice or sees the print but can’t make sense of the words); anomic aphasia (difficulty using the correct word for objects, places, or events); and global aphasia (when someone cannot speak, understand speech, read, or write). Prevention and treatment for aphasia involve a multidisciplinary approach that might call for medication and therapy.

A Word From Verywell

Aphasia can keep loved ones guessing, but you can eliminate one of the mysteries by taking your loved one to get their hearing and vision checked. If these senses are deteriorating, your loved one may feel more confused, agitated, or withdrawn than necessary. Faltering hearing or eyesight may also explain some behaviors that you’ve been attributing to aphasia. Plus, hearing and vision problems are usually simple to improve.