Word-finding difficulties

Also called Anomia, Word retrieval difficulties, Tip of the tongue, Naming difficulties

Knowing the word and being unable to reach it. It happens to everyone sometimes and to some people all the time, and there are ways round it.

What it is

Word-finding difficulty is the gap between knowing a word and being able to produce it on demand. The person knows what they mean, can often describe it ("the thing you cut with, in the kitchen, not scissors"), may know the first sound, and can usually recognise it instantly when someone else says it. The word is stored; the route to it is blocked.

Everyone has this on a tip-of-the-tongue day. For some people it's constant, and it can look like not knowing, not caring, or not understanding, none of which is true.

Who it can help

Word-finding is the core difficulty in aphasia after stroke, where it's called anomia, and it's common after brain injury, in early dementia, and in children with developmental language disorder. It gets worse with tiredness, stress, and being put on the spot, which is why it's always worst in the GP's office.

Understanding it helps the partner as much as the person: knowing that "the... the... the thing" is retrieval and not confusion changes how you respond.

How it works

Words are stored as a network of meaning, sound and form (semantics). Retrieval means activating the right meaning, then the right sound pattern, then the motor plan to say it. A block can happen at any stage. A semantic block gives a related wrong word ("fork" for "knife"); a sound-level block gives a similar-sounding one ("nice" for "knife"), the first sound alone, or nothing.

Cues work because they add activation. A semantic cue ("you cut with it") helps a meaning-level block. A phonemic cue (the first sound, "n...") helps a sound-level block, and it's the one therapists test first because it tells them where the problem is. Time helps too: the word often arrives thirty seconds later, uninvited, and a partner who has jumped in with ten guesses has made that harder.

Written and symbol support bypasses the block. A person who can't say "knife" can very often point to it, read it, or find it on a board, because recognition is intact when retrieval isn't.

Getting started

Give time first, and say so: "no rush". Then, if wanted, one cue at a time: the first sound, or "is it something you eat with?", or write the first letter. Ask which kind of cue helps and use that kind.

Agree a signal for "I'm stuck, don't fill it in" and another for "please help". Guessing is welcome for some people and infuriating for others.

Have the words within reach. A page of the words that go missing most (names of family, medications, the things needed at the shop) in a communication book or on a phone. The Talk board shows symbol cards with the word written on each, so a person who can't retrieve "toilet" can recognise it and press it, and the device says it.

Where to get help

The NHS page on aphasia and the Stroke Association for adults after stroke; Say Aphasia runs peer groups. Headway for brain injury, and the Alzheimer's Society for word-finding in dementia. For children, RADLD and Afasic. The NHS route is a speech and language therapist.