What are retrieval difficulties in children and how do we treat them?

תקציר

We are all familiar with the phenomenon in which we want to say or write a familiar word and are unable to retrieve it. That is, we know the word but have difficulty accessing it (partially or fully) at a certain time. This difficulty can be negligible and not interfere with daily life, but it can also appear as a significant difficulty that is expressed in both the number of errors and the type of errors in retrieving the word. If retrieval difficulties are suspected, it is important to refer the child for evaluation and treatment by a speech therapist. The speech therapist will diagnose the source of the difficulty, characterize it, and tailor treatment to the child. Usually, the treatment will be in two main channels: semantics and/or phonology. This will help the child cope with the difficulty.

Um.... the word escaped me - what does it mean?

You know that… well… when you have a word you want to say and you can’t remember it? For example, I want to talk about the new car I bought and I can’t find the word ‘car’ in my memory and say it. This ability to find a word that you know, that exists in your vocabulary and is stored in your memory (=lexicon), is called retrieval.

That is, I “pull out” the word from storage in mental memory. Another way to describe the phenomenon is through the term naming, meaning that I “give a name” to an item or idea. In the case I presented, there is no doubt that car is a word that I am familiar with, perhaps I even used it a moment ago and suddenly “forgot it”. I can visually identify a car from a number of items or pictures, for example from an apple, a car and a bicycle. I know the meaning of the word car and what it represents. For example, I know that it is a vehicle, that we travel in it from place to place and that it includes various parts such as a steering wheel and wheels. I also know the sounds that make up the word car. For example, I know that car begins with the sound o and ends with to and am also able to produce the word vocally and even write it. However, at a certain point in time when I wanted to say the word ‘car’ I was unable to retrieve it. In other words, the difficulty is not in knowing the word but in the lack of partial or complete accessibility to the word at a certain time.

We all encounter this phenomenon called “on the tip of the tongue” when we feel that the word is on the tip of our tongue and yet we are unable to recall it. An adult produces an average of two to four words per second while speaking, with the number of errors usually being one or two errors per thousand words. In other words, the number of times we experience the phenomenon in which we have difficulty retrieving a word is negligible and does not interfere with our daily lives.

From "the word escaped me" to significant difficulty in retrieving it

Imagine that you are trying to share a significant experience that happened to you today with a close person, and you simply cannot express a large part of the words. You know exactly what you want to say, but you simply cannot find the words from your familiar vocabulary to say what you want. How would you feel? Would you insist on getting the message across or perhaps give up? Maybe you would find strategies (=methods) that would help you express yourself anyway, such as using gestures or using alternative words? For example, when sharing the car buying experience, I could not find any other words besides ‘car’, such as “car lot” or “bank”, to describe the experience.
Such a situation may trigger feelings of frustration, lack of success or thoughts of low self-worth. What do they think of me? Does the other person think I don’t know or don’t understand when I have trouble finding the word I wanted to say?

A difficulty in retrieval may interfere with daily functioning and is manifested both in a greater number of words that the child retrieves inaccurately (for example, instead of the word ‘auto’ he will produce toto or matos) and in a slower word retrieval speed compared to his peers.

A difficulty in retrieval may appear as a single language difficulty, but they often appear together with other language difficulties. Retrieval difficulties can also occur at different levels of severity and can change and develop over time and with language development.

Difficulty retrieving - what does it look like?

Word retrieval errors among children with retrieval difficulties can manifest themselves in various ways. The child may respond to questions with responses such as “I don’t know” or “I don’t remember,” even when it is clear that he knows the answer. For example, to the question “Who did you meet first?” he will answer “I don’t know,” even though the meeting took place a short time earlier.
Another manifestation of the difficulty may be that the child hesitates to answer the question, and will do so only after a period of time that is considered long relative to his age. Another manifestation may be a long pause during speech, for example, “I went to… karate class” or “I saw… Yossi the neighbor.” There is also a high frequency of use of ‘stop’ words (uh…, um…) and the use of general words (something, this). For example, “I went to… um… well… this.” Difficulty in retrieval can also be expressed in talking around the topic or using detours, that is, when the child uses a lot of words to express a particular word without saying the word itself.

Another characteristic of retrieval difficulties are errors in replacing the target word (= the word the child wants to retrieve) with another word. Sometimes the child will notice the mistake and try to correct himself, and sometimes not. There may be several types of errors: a random word that is not related to the target word – for example, he wants to say ‘table’ but retrieves the word ‘strawberry’.
Semantic substitution – using a word that is related in meaning to the target word he intended. For example, replacing the word ‘bird’ with another animal, ‘cow’.
Phonological substitution – Replacing or omitting one or more sounds from the target word (for example, זעתת/צלטל instead of צלאש). It is also possible to add a sound to create a new word that does not exist (for example, צלרחת instead of צלאש). Another form of phonological substitution is adding a sound or replacing a sound to create another word that exists in the language (for example, סלון instead of קנון). Phonological substitution can also be expressed in attempts to reach the target word (מח… בח… חבר… מחבר… מחבר… instead of קברט).

Another option is to use a gesture. For example, instead of saying the word ‘bird’, the child will make a flying movement. Sometimes the child will use a strategy of partial or complete definition in place of the word that he has difficulty retrieving (for example, instead of ‘bird’ he will say ‘חיא שאבר’).

Assessment and treatment

Retrieval difficulties do not arise from a lack of world knowledge, a poor vocabulary, low cognitive abilities or memory problems. The awareness of parents and educational teams of this fact is of great importance. Understanding the difficulties is important both for referring to appropriate treatment and for appropriately addressing the child experiencing the difficulties.
If retrieval difficulties are suspected, it is important to refer the child for evaluation and treatment by a speech therapist. Speech therapists have in-depth knowledge of the areas of language, speech and communication, along with other areas. The speech therapist will conduct a comprehensive evaluation of all areas and examine the child’s abilities and difficulties. If a difficulty in retrieval is found, the clinician will diagnose the source of the difficulty and characterize it. Based on the findings of the evaluation, the clinician will determine therapeutic goals and a work plan for their implementation. Depending on the source of the difficulty in retrieval, the clinician will usually treat through two main channels: semantics and/or phonology.
The clinician will help the patient learn and use compensation strategies for retrieval difficulties – methods that he can use when he encounters difficulty in retrieving words. At the same time, the semantic and/or phonological systems can be strengthened in order to reduce retrieval difficulties. Semantic treatment will focus on strengthening meaning connections. For example, identifying and naming a category (which category does the word belong to?), how it is used (what is done with it?), and an external feature (a prominent external characteristic – such as: what color, size, shape, parts, what is special about it?). For example, if we return to the story of the car, the clinician will help the patient characterize the category to which the word belongs (a means of transportation), the use (something that is driven), an external feature (four wheels and a steering wheel) and bring up additional associations (other means of transportation, types of cars, automotive professionals, experiences related to traveling by car), and so on.
All of this helps to strengthen the accessibility of the word car for retrieval. Teaching the child a strategy for defining the word will allow him to overcome the difficulty and be able to express himself better. Phonological therapy will focus on strengthening knowledge of the sounds of the word such as: division into syllables, identification of the opening syllable of a word, rhyme.

It should be noted that in addition to the verbal difficulties, children with retrieval difficulties may experience associated difficulties in the academic and social aspects. Thus, a child with retrieval difficulties may have difficulty answering an open-ended question in class due to difficulty retrieving the answer (for example, in answering the question of what the name of the main character in the story was).
There are several ways in which a child can be helped to express his learning abilities in the best possible way, such as: providing several options for choosing an answer orally (Is his name Danny or Roy?), choosing the correct answer from pictures (pictures of Danny and Roy), or circling an answer in a question with several answer options. Similarly, a child with retrieval difficulties may have difficulty in the social sphere due to difficulty expressing himself in front of his peers. Understanding the source of the difficulty, addressing the child’s behavior accordingly, and receiving appropriate mediation will help the child cope. For example, for a child with retrieval difficulties who has difficulty expressing himself during a conflict with another child (for example, another child stole his toy), it is possible to strengthen the retrieval of vocabulary relevant to coping during the conflict (for example, “give it back to me,” “leave me alone”).

In conclusion, children with retrieval difficulties may experience daily difficulties in speaking and writing and associated difficulties such as difficulties in the academic and social areas. Understanding the difficulties is important both for referring them to a speech therapist for appropriate treatment and for providing appropriate treatment to the child experiencing the difficulties and providing coping strategies. If your child is experiencing these types of difficulties, there are ways to help them and make them feel better.

Key terms

Retrieval/ Naming:  The process of moving from an idea to producing a spoken or written word.

Semantics: The field of semantics deals with the study of the meanings represented by words in language.

Phonology: The field of phonology deals with the study of the relationships between the various sounds, their function, and their combination in language.

Gesture: A gesture, sign, or movement of a body part to express an idea, word, or emotion that supports speech.