What is a word finding difficulty

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.

What causes difficulty finding the right word?

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.

Why do I struggle with my words?

Difficulty with speech can be the result of problems with the brain or nerves that control the facial muscles, larynx, and vocal cords necessary for speech. Likewise, muscular diseases and conditions that affect the jaws, teeth, and mouth can impair speech.

What is difficulty forming words called?

Aphasia is a condition that robs you of the ability to communicate. It can affect your ability to speak, write and understand language, both verbal and written. Aphasia typically occurs suddenly after a stroke or a head injury.

Why do I have difficulty finding the right words?

Word-finding difficulties are a common symptom of early-stage Alzheimer’s, but there are many other possible causes. An assessment by a physician is important if continued difficulties are noted. Word-finding difficulty may also be described as: Tip of the tongue experiences. Difficulty finding the right words.

Why do I have a hard time finding words?

In rare situations, they may be a symptom of a brain disorder. Talk to your healthcare provider if word-finding difficulties are significant and get progressively worse over time, or are accompanied by worsening memory problems. But rest assured that for most of us, word finding difficulties are a shared experience.

Can a person with Alzheimer’s have difficulty finding words?

Word-finding difficulties are a common symptom of early-stage Alzheimer’s, but there are many other possible causes. An assessment by a physician is important if continued difficulties are noted. Word-finding difficulty may also be described as: Tip of the tongue experiences.

What to do when someone is having trouble with a word?

Make an effort to incorporate facial cues, gestures, and visual aids into communication rather than just relying on words. When someone is having trouble with a word, don’t offer guesses of multiple words, as that can further frustrate and overwhelm the person. 5 Ask for verbal and non-verbal clarification.

Summary and Introduction

The patient with word-finding difficulty presents a common and challenging clinical problem. The complaint of ‘word-finding difficulty’ covers a wide range of clinical phenomena and may signify any of a number of distinct pathophysiological processes. Although it occurs in a variety of clinical contexts, word-finding difficulty generally presents a diagnostic conundrum when it occurs as a leading or apparently isolated symptom, most often as the harbinger of degenerative disease: the progressive aphasias. Recent advances in the neurobiology of the focal, language-based dementias have transformed our understanding of these processes and the ways in which they breakdown in different diseases, but translation of this knowledge to the bedside is far from straightforward. Speech and language disturbances in the 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. This has led to a reformulation of our understanding of how language is organized in the brain. In this review we seek to provide the clinical neurologist with a practical and theoretical bridge between the patient presenting with word-finding difficulty in the clinic and the evidence of the brain sciences. We delineate key illustrative speech and language syndromes in the degenerative dementias, compare these syndromes with the syndromes of acute brain damage, and indicate how the clinical syndromes relate to emerging neurolinguistic, neuroanatomical and neurobiological insights. We propose a conceptual framework for the analysis of word-finding difficulty, in order both better to define the patient’s complaint and its differential diagnosis for the clinician and to identify unresolved issues as a stimulus to future work.

‘Word-finding difficulty’ is a common and challenging problem in neurological practice. In many cases, patients will complain of word-finding difficulty or, not uncommonly, the difficulty is identified by the neurologist in the course of the assessment. In both situations, the basis for the word-finding problem needs to be established but this is often not straightforward. Spoken communication depends on a sequence of cognitive processes, and disruption of any of these processes can affect word-finding (Fig. 1). Furthermore, processing occurs in a distributed network of brain areas that is vulnerable to a variety of acute and chronic pathological states (Levelt, 1989; Price et al., 1993; Levelt, 2001; Blank et al., 2002; Gorno-Tempini et al., 2004). The differential diagnosis of word-finding difficulty therefore encompasses a wide spectrum of acute and chronic disorders as diverse as delirium (Geschwind, 1964), aphasic stroke (Kertesz and McCabe, 1977), encephalitis (Okuda et al., 2001), major depression (Georgieff et al., 1998) and psychosis (Critchley, 1964), head injury (Levin et al., 1976), temporal lobectomy (Langfitt and Rausch, 1996) and metabolic and genetic disorders (Spinelli et al., 1995). In particular, however, it is a leading symptom of a number of degenerative conditions: the progressive aphasias (Mesulam, 1982, Hodges et al., 1992; Mesulam, 2003; Gorno-Tempini et al., 2004). In the degenerative diseases, in contrast to many of the other conditions associated with word-finding difficulty, the cause of the word-finding problem may not be obvious or it may be the presenting complaint: accurate diagnosis therefore depends on detailed characterization of the language deficit. It is accordingly in the context of degenerative disease that word-finding difficulty usually presents the greatest diagnostic challenge, yet the classical approach to the clinical assessment of language (which is based largely on the accumulated experience of aphasia in acute stroke: Hillis, 2007) may not be adequate. This reflects the often unique problems posed by speech and language breakdown in the degenerative dementias (Warrington, 1975; Mesulam, 2003).

Here we use ‘word-finding difficulty’ as a shorthand for a class of symptoms which patients and carers commonly volunteer when describing impaired language output. Progressive cognitive syndromes with circumscribed deficits and preserved intellect have been recognized for many years (for example, Pick, 1892; Serieux, 1893, see also Luzzatti and Poeck, 1991; De Bleser, 2006 for other historical cases) and may preferentially affect a variety of cognitive domains, however the comparatively recent renaissance of interest in the language-based dementias (Mesulam, 1982) has transformed our picture both of disease biology in neurodegeneration and the organization of the human language system. The focal dementias pose considerable nosological and neurobiological difficulties. While circumscribed atrophy on structural brain imaging can support the impression of a focal dementia, diagnosis remains essentially clinical. Primary progressive aphasia (PPA) is a clinical syndrome of progressive language impairment with relative sparing of other aspects of cognitive function until late in the course (Mesulam, 1982, 2001, 2003). This broad definition subsumes substantial clinical, anatomical and pathological heterogeneity, and a spectrum of clinical subtypes of PPA has been described. While these subtypes have more or less distinctive profiles of speech and language disturbance, even where clinical characterization is robust (for example, in the distinction between ‘fluent’ and ‘non-fluent’ forms of PPA) understanding of the underlying pathophysiological mechanisms remains limited (Mesulam and Weintraub, 1992; Grossmann, 2002; Mesulam et al., 2003) Moreover, the overlap between clinical subtypes is substantial, incomplete syndromes are frequent (Grossmann, 2002; Mesulam et al., 2003), and none has been shown to have a unique correspondence with either anatomy or tissue pathology. This presents serious and unresolved nosological difficulties, and for the clinician, a substantial diagnostic dilemma. Furthermore, the stimulus of the focal language-based dementias has led to a wider appreciation of speech and language dysfunction in other neurodegenerative conditions, including Alzheimer’s disease (AD) (Emery, 2000; Croot et al., 2000) and the problem of the differential diagnosis of ‘progressive aphasia’ in this broader sense. Accordingly, a conceptual framework is needed to allow the clinician to interpret the patient’s complaint of word-finding difficulty in line with emerging evidence for language network dysfunction in neurodegenerative diseases.

Here we outline such a framework for the clinical analysis of ‘word-finding difficulty’. We propose a clinical scheme that can be used at the bedside to categorize the nature of the problem and to formulate a differential diagnosis, with reference in particular to the degenerative dementias, presented in Fig. 2. This scheme has speech as its focus because word-finding difficulty in spoken language is generally the dominant complaint in the progressive aphasias. Our scheme is informed by evidence emerging from the experimental brain sciences, and contemporary information-processing accounts of language processing (Levelt, 1989; Warren and Warrington, 2007; Hillis, 2007) (Fig. 1). Application of the scheme generates a taxonomy of clinical syndromes arising from different operational stages in the language output pathway and with distinct anatomical substrates. Our approach is based on a series of steps that probe the key stages in language output (Fig. 1). These steps are elaborated in the following sections and in Table 1 , Table 2 , Table 3 , Table 4 . The pattern of performance at each step identifies the cognitive processing stage that is principally affected and builds up a detailed profile of the speech syndrome. Both these levels of analysis are of clinical relevance: the broad cognitive operational level allows the deficit to be localized (Fig. 3), while the detailed syndromic description guides the differential diagnosis of the likely pathological process (Fig. 2). Our intention is to provide the neurologist with a bridge between the dilemmas of the bedside and the theoretical constructs of the brain sciences, rather than a comprehensive neurolinguistic treatise on the progressive aphasias. At the same time, however, we hope to show that understanding of the pathophysiology of these diseases can be advanced by the characterization of clinical phenomena that are difficult to reconcile with theoretical models of language function and dysfunction.

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.

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!