All of us forget the names of things occasionally. But, as with many adults with aphasia, some children have serious problems finding words.
Major word-finding problems can wreak havoc on a child’s academic and social participation. In primary school and junior secondary school, these kids need help to avoid falling further behind their peers – especially if they have a receptive, expressive or mixed receptive-expressive language learning disorder.
In this article, we look at word-finding problems for school-aged kids and some of the key evidence-based treatment options to help them out. I also outline how I use the evidence to deliver therapy to my clients here at Banter Speech & Language, and link to some free resources I’ve developed for use in my clinic.
A. Word-finding symptoms
Children with word-finding problems may:
- hesitate or pause, sometimes in the middle of thoughts or utterances (e.g. “The boy got on…..his bike….and rode away down the…..road”);
- have false starts to what they want to say (e.g. I want to…I mean, I went to, um. Maybe I just want to see the ten- I mean golf.”);
- use an excessive numbers of fillers (e.g. “um”, “er” or “like”) – the key word here is excessive. (This symptom can, like, sometimes be, um, like, hard to pick, with um like, some teenagers);
- resort frequently to using empty words (like “thing”, “you know” or “that one”);
- use “circumlocutions” (literally talking around the point), e.g. “The one with the paws, and the tail and the black-and-white fur that barks and needs a bath.”;
- make semantic errors or substitutions, e.g. calling a “dog” a “cat” or a “spoon” a “fork”;
- make phonological (sound) errors, e.g. “I want to play in the part” or “I don’t speak Fretch”; and
- say “I don’t know” when they can’t think of a name, even if they probably know the answer.
Semantic errors, like the “cat/dog” example above are the most common naming errors, especially for children with language disorders (Lahey & Edwards, 1999) and, in particular, for children with receptive language disorders (e.g. Dockrell and Messer, 2007). We think they are due to:
- not knowing the object, and guessing another item with some similar features;
- knowing exactly what something is but being unable to find and assemble the sounds to name it (the tip-of-the-tongue state);
- sketchy understandings of word meanings with few details to enable the child to distinguish between different items in a category; or
- fewer or weaker links between the target word and other words (e.g. McGregor et al., 2002).
Phonological errors and some “don’t know” errors may be due to difficulties accessing the right sound “model” for the word and/or to sparse or fragile understandings of how to say the words. This leads to sound substitutions or distortions e.g. when kids struggle to say multisyllabic words like “ambulance”, “hospital”, or “helicopter”. Of course, some “I don’t know” errors might simply reflect a child’s shyness, uncertainty, caution, or forgetfulness (McGregor et al., 2005).
B. How can speech-language pathologists help? Evidence-based therapy options
Some treatments for word-finding problems focus on word meanings and relationships between words – also known as “semantics”, which (together with our vocabularies) comprise our language content skills. Semantic therapy focuses on developing:
- knowledge of categories at different levels of specificity (e.g. things that are alive versus inanimate objects, animals versus plants; farm animals versus zoo animals; reptiles versus mammals; crocodiles versus alligators, saltwater crocodiles versus freshwater crocodiles);
- knowledge of attributes (e.g. what different things do, where you find them, colour, size, shape, texture, materials, parts, smell, taste, etc);
- definitions; and
- associations between words.
Phonological treatments for word finding problems tend to focus on:
- identifying and counting syllables (e.g. am-bu-lance, hos-pi-tal, he-li-cop-ter) and sounds (e.g. a-m-b-u-l-a-n-c-e); and
- matching pictures or objects which rhyme (e.g. dog/log, sea/tree, neck/peck) or begin with the same sound (e.g. sun, sea, sip, seal).
Some treatments work on both at once (e.g. Eastern et al., 1997).
C. For general word-finding improvements, evidence currently favours semantic therapy
Studies to date show that both phonological and semantic therapies work. But phonological treatments seem to improve only the words targeted in therapy, e.g. “ambulance”, “hospital” and “helicopter” in our example above, but not other multisyllabic words like rhinoceros (e.g. Wright et al., 1993).
There is some evidence from a small, one-site randomised controlled trial study published by Susan Ebbels and colleagues in 2012 that semantic therapies can be effective at improving general word-finding skills – and not just for the treated words (see citation below). In this study, semantic (language) therapy was trialled on a group of 15 older primary and younger secondary school students (the age range was 9;11-15;11). The group was randomised into a treatment and delayed treatment group. The treatment group received two 15-minute semantic therapy sessions per week for eight weeks targeting words from one of three categories (animals, food and clothes) – a total of four hours of therapy. The treatment group’s word-finding skills were then assessed and compared with those of the other group. The other group then received the semantic language treatment.
After treatment, both groups made statistically significant gains on a test of word-finding, and these gains were maintained for five months after treatment finished. However, the treatment gains did not appear to generalise to the discourse level (story telling/conversation) or improve the children’s ability to name items in categories under time pressure. In other words, the treatment worked to improve word-finding in naming tasks, but these gains did not cross-over into more natural tasks like conversation.
D. Why does semantic therapy work?
We don’t know for sure. Semantic therapy may increase and strengthen the links between words and increase the amount of detail the children associate with the targeted words. But Ebbels’ study had more general effects than just the words being targeted, and it’s possible that the prompts used in therapy helped the children to start to think in more detail about words and meanings generally. Some of the older children may have been able to adapt the strategies used to recall the target words and applied them to other words, a so-called “meta-cognitive approach” where the children are able to monitor and describe their “thinking about thinking”.
E. Now, let’s get practical: What does semantic therapy look like? What sort of activities does it involve?
So here’s what I do when treating school-age kids with word finding problems in my clinic.
Following the Ebbels’ study – which very helpfully includes enough details to replicate her therapy – my semantic therapy includes tasks to:
- categorise pictures (first in broad categories, then narrower, more detailed categories);
- discuss the attributes of pictures (e.g. What group is it in? What shape is it? What noise does it make? Where do you find it? How does it feel? What does it do?);
- compare pictures to find similarities and differences using attributes;
- play the 20 questions game where the child gives semantic cues and the speech pathologist tries to guess the picture; and
- do strategy games using cards and different strategies, e.g. to move a place in a board game, or win a token (e.g. a play coin).
In addition, I use semantic mapping scaffolds like this one to have the child:
- generate definitions of target words;
- ask questions to guess the identify of mystery objects kept in a bag (either physically or via a simple app like the wonderful and cheap Bag Game); and
- describe objects to others in barrier tasks (where the guesser can’t see the picture being described).
Final point: choose age-appropriate, interesting and/or curriculum-based topics
With older school-aged children, I generally steer away from “babyish” categories like animals and fruits and look for categories more likely to interest or help the child in their real life. For example, for a client obsessed with sport, I might contrast soccer and rugby codes, teams and players. For a disorganised school-aged client who is always forgetting to bring things to/from school, I might choose items you find at school and contrast them with items found at home. I’ve even worked with one very reluctant client to contrast Pokemon and Yu-Gi-Oh! trading cards to teach him the nuts and bolts of semantic strategies, before moving onto more academic targets.
F. Clinical bottom line
School-aged children – including high school kids – can improve their word-finding naming skills with as little as four hours of therapy. But we need more research to figure out how best to get these gains to transfer across to real life tasks, like conversation. The 2012 Ebbels study is yet further evidence that language therapy for older children and teenagers with language disorders can be effective. Although early intervention is often trumpeted as the best option, it’s never too late to improve your language, reading or learning skills for school, social media participation, or life.
- How to help your school-age child learn new words – the nuts and bolts of how I do it in therapy
- How to help our secondary school teachers support teenagers with language disorders at school
- Helping older students with their reading comprehension. What should we teach and how?
Principal source: Ebbels, S.H., Nicoll, H., Clark, B., Eachus, B., Gallagher, A.L., Horniman, K., Jennings, M., McEvoy, K., Nimmo, L., & Turner, G. (2012). Effectiveness of semantic therapy for word-finding difficulties in pupils with persistent language impairments: a randomised controlled trial. International Journal of Communication Disorders, 47(1), 35-51.
Hi there, I’m David Kinnane.
Principal Speech Pathologist, Banter Speech & Language
Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.