writing speech therapy

How To: Phonological Treatment for Writing

 5 min read

Back when you were learning to read, you may have been taught that the letter B makes the “buh” sound, like in “boot.” This is known as letter-to-sound correspondence, or more technically, grapheme-to-phoneme correspondence. You then used this information when you sounded out words you were reading, and then in reverse when figuring out how to spell words. But when people develop aphasia after a stroke, they may lose this knowledge. This can make it very difficult to read or write.

The Treatment: Phonological Treatment

Phonological treatment is used to improve sound-to-letter and letter-to-sound correspondence to improve agraphia (difficulty writing) due to aphasia. It targets written expression at the word-level by enhancing phonological processing skills.

Phonological treatment is the middle step in a three-step treatment sequence developed by Dr. Pélagie Beeson’s lab at the University of Arizona. We’ve already covered the first step: Anagram, Copy, and Recall Treatment (ACRT) in another article.

Who Would Benefit from Phonological Treatment for Written Expression?

Phonological treatment has been found to be an effective treatment for individuals with non-fluent aphasia and anomic aphasia with phonological agraphia or surface agraphia. 

Before clients can begin treatment, they must first be able to spell keywords that begin with the initial sounds/phonemes being trained. If the client is unable to complete this task, it is recommended they start with ACRT to train a set of keywords. Once mastered, phonological treatment can begin.

A client may be appropriate for phonological treatment if they demonstrate difficulty with reading and spelling non-words, deleting or replacing phonemes in a written word, or translating phonemes to graphemes. These individuals may frequently demonstrate phonemic paraphasias in speech as well.

What You’ll Need to Do Phonological Treatment

Phonological treatment can be completed with minimal preparation and materials. The clinician will need:

Pen or pencil with paper

A set of keywords that begin with the initial phonemes to be trained.

• The client should be able to write all of the keywords
• Keywords can be individualized and personally relevant, so a family member’s name that begins with a certain sound may make a perfect keyword

Pictures of the keywords

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Get your free PDF on how to do Phonological Treatment with and without apps. Includes a list of keywords used in the Advanced Writing Therapy app.

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How to Start Phonological Treatment

Phonological treatment uses a cueing hierarchy to train targeted graphemes and phonemes. Here’s an example of sound-to-letter training using the phoneme /m/:

Say, “Write the letter that makes the sound /m/.”

• If correct, move on to the next phoneme.
• If incorrect, proceed to step 2.

Say, “Think of your keyword for /m/. Try to write your keyword.”

• If correct, say, “Yes, mug is your keyword. Mug starts with /m/. Underline the /m/ sound in mug.” Repeat step 1 or move to the next phoneme.
• If incorrect, go to step 3.

Show the picture and say, “Your keyword for /m/ is mug. Write mug. Now underline the /m/ sound in mug.”

• If correct, repeat step 1 or move to the next phoneme.
• If incorrect, go to step 4.

Provide a model for the keyword and say, “Your keyword is mug. Copy the word mug. Now underline the /m/ in mug.”

Consonants should be trained using 4 sets of 5 consonants. Criterion is met when the client is able to correctly write and say each set of phonemes with 80% accuracy over 2 sessions. For those with severe apraxia of speech, it’s enough to show mastery of sound-to-letter matching, as letter-to-sound may be too challenging. 

Here’s a home practice video by SLP Christie Shultz from the Aphasia Research Project lab that shows how someone can practice their keywords at home using an unlisted video on YouTube provided by the clinician:

After establishing consonants, vowels are trained in 2 sets of 6. Vowel training will follow the same protocol as consonants with the exception of having two keywords for each vowel. This is because some vowels have more than one typical corresponding grapheme (e.g., ee and ea for /i/). 

Here’s another home practice video all about vowels:

Continuing on with Phonological Treatment

Letter-to-sound training can then be completed using a similar hierarchy, showing the target grapheme to the client, and asking for the keyword for that letter. Get extra practice by creating a matching game by laying out a limited set of the keyword pictures. Ask the client to find the keyword for a sound you say. 

After training all the phonemes, work begins learning to blend real words and non-words. The client hears a word, repeats it, and then writes the keyword for each sound they hear. They can then combine the target letter in each keyword to write the word or non-word.

Here’s a video of what real word blending looks like for homework:

If you’d like to see non-word blending, follow this link to another video .

This will get the person close to the correct spelling in most cases, or at least to a point that someone can read the word and make sense of it. But because English has so many irregular spellings, this won’t make for perfect writing. That’s where the third step in the writing treatment comes in: interactive treatment. Read more about interactive treatment here .

Phonological Treatment Using Advanced Writing Therapy

Did you know the Match activity in the Advanced Writing Therapy app was based on phonological treatment? That means it is the perfect companion for treatment and homework for clients. 

Open the Advanced Writing Therapy app and select the Match activity

Set up your activity by choosing your levels

Each level is based on the treatment protocol used during development of the phonological treatment. Use the 4 levels of consonants, 2 levels of vowels, and 5 levels of blends to target sound-to-letter training. Work on one at a time, then mix and match.

Begin Phonological Treatment

Begin to follow the protocol. Use the on-screen cues for Hear the Keyword , See the Keyword , and Read the Keyword depending on the client’s success throughout the procedure.

Assign Homework

As with any treatment, intensity and repetition are important. Ensure the client can practice independently at home and email the results of each session to the therapist for monitoring and adjustments.

Selected Resources & References

The University of Arizona provides resources for the phonological treatment protocol, including variations, and ways to implement homework. They also provide picture stimuli for clinician use. https://aphasia.sites.arizona.edu/content/10

For all 3 treatments in this series, along with a free assessment battery for reading and spelling, check out the Aphasia Research Project’s r esources for professionals .

Beeson, P., Bayley, C., Shultz C., & Rising, K. (2018): Maximising recovery from aphasia with central and peripheral agraphia: The benefit of sequential treatments, Neuropsychological Rehabilitation, DOI: 10.1080/09602011.2017.1417873

Beeson, P., Rising, K., Demarco, A. T., Foley, T. H., & Rapcsak, S. Z. (2018). The nature and treatment of phonological text agraphia. Neuropsychological Rehabilitation, 28(4), 568-588. DOI:10.1080/09602011.2016.1199387  Full Text

Beeson, P. M., Rising, K., Kim, E. S., & Rapcsak, S. Z. (2010). A Treatment Sequence for Phonological Alexia/Agraphia. Journal of Speech, Language and Hearing Research, 53(2), 450. DOI:10.1044/1092-4388(2009/08-0229) Full Text

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Katie Brown , MA, CCC-SLP is a speech-language pathologist in Buffalo, NY. She is the owner of Neuro Speech Solutions , a private practice that specializes in treatment for adult speech, cognitive, & swallowing disorders. Katie is passionate about providing person-centered & functional therapy to help her patients meet their life goals.

Megan S. Sutton , MS, CCC-SLP is a speech-language pathologist and co-founder of Tactus Therapy. She is an international speaker, writer, and educator on the use of technology in adult medical speech therapy. Megan believes that technology plays a critical role in improving aphasia outcomes and humanizing clinical services.

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• Literacy Based Therapy

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How to plan a literacy-based speech therapy session

Literacy-based therapy has become quite a buzzy term lately, but what is it, really? In short, it is using books ( or other literature ) as the foundation for your therapeutic interventions. Did you know that almost half of preschool children with language-impairments develop significant literacy learning difficulties ( Aram & Nation, 1980) even if their delays appear to be resolved by age 5 ( Scarborough 1980;2002). Integrating literature into our sessions is a kind of like adding spinach to some chocolate muffins. You are sneaking in some extra goodness and the kids are none the wiser.

Another reason I am head over heels for literacy-based therapy is the semantic exposure it provides our students. As SLPs we know how critical reading to a child is. Many of our students, for many different reasons, are not read to at home, making their time at school the only chance for reading/exposure to literacy. Did you know if a child is read to for just 20 minutes a day, by the time they are in 6th grade they will have been exposed to 1,800,000 words a year. Where as a student who is read to just one minute a day is exposed to 8,000 words a year. Which student do you think will have a more developed vocabulary? Better critical thinking skills? We can be the opportunity for our students ( at least a few days a weeks ) to give them that boost they may be missing.

It was documented that shared reading activities ( like a literacy-based speech session ) can increase development in multiple areas (Doyle & Bramwell, 2006; Debaryshe, 1993; Burner, 1978) and promote language development in children with typical development (Teale & Sulzby, 1986; Westby, 1985) and with language impairments (Gillam & Ukrainetz, 2006).

Children with oral language impairments are at a greater risk for reading disabilities ( Schuele, 2004 ) By offering exposure during speech therapy, we can help offer instances of practice with reading skills as they relate to their language goals. Proficient reading requires integrated skills across decoding and comprehension that draw on language tenets ( semantics, syntax, and phonology ) ( Schuele, 2004 )

So where do you start? Here is my session break down for using a book to target student goals while giving them and adequate exposure to literacy.

You’ve scoured Pinterest and found the perfect book. Amazon Prime came in, in the clutch and delivered your book the next day! So now what?

On day 1 you’re not even going to read book. I know that sounds a but crazy but stay with me. One of the big things our students lack is background knowledge, in all areas really. Not having adequate background knowledge meanings great difficulty trying to connect to vocabulary, social situations, etc. We need to front load background knowledge for our students to pull from and reference in order for them to learn the skills we are going to be teaching and do so successfully. So your first activity is a book walk . Start by looking at pictures, page by page, and talking about what they see. Who are the characters going to be, what is the setting, look at their facial expressions, how do they characters feel on each page, etc. This is also when you are going to introduce the story grammar vocabulary: character, setting, plot, etc. One thing I always make sure to add in is ‘time’. I ask my kids when they think the story is happening ( year or season ). This is when I will also discuss vocabulary they may not be familiar with it. My word of caution here is NEVER PRESUME KNOWLEDGE. Do not assume your 2nd grade student understands the word ‘travel’ or ‘borrow’. Choose vocabulary in terms of verbs and adjectives that play a large role in the story and/or are repeated in the story. Did you know kids who were read the same book multiple times, remembered the meaning of a new word more than kids who heard different books with the same word ( Horst, Parsons, Bryan, 2011). You can make cards for the book if you want, especially if you plan to use the book again or just use post its if you think this is a one time deal. Write the word and kid generated meaning on card/post it.

Now, while you are doing this introduction you can still incorporate student goals for the session. Use the pictures to draw your inspiration. Have a student working on articulation? Can they find a picture with their sound? If not provide a word but give a tie in to the page. An example could be if you are looking at a pumpkin book and the student has a target for /l/. If there is nothing that can be used and an /l/ target you may want to improvise by tying a word in such as, ” Pumpkins can be heavy to lift, let’s say ‘ Lift the pumpkin’ “. You can follow this same method with language goals.

Today you will get to go a bit more in depth with the book, but you’re still not reading the story yet. In this session you are going to introduce the story elements for the book you are using. I know it sounds crazy that you still aren’t reading the book, but stay with me here. Characters, setting, etc, these are concepts and vocabulary our kids struggle with. If you don’t take the time to introduce and teach them, your students are going to get lost fast, disengage from the session, and miss out targeting their goals. First, I review the story/narrative terminology. To make sure they are engaged I have have them draw for each concept. When talking about character they can draw their favorite movie or book character, for setting I have then draw where the place the would love to travel to. Finding a way for them to make a connection to the word is key. When it comes to more abstract concepts like plot, I have them draw an icon that they feels represents the meaning and we dig into it further from there.

Today is the day! You actually will start reading the book! Start by reviewing the vocabulary and narrative terms from days 1 and 2. Now that everyone is caught up, go ahead and read first half of book. Be sure to point out the vocabulary you introduced as it comes up. Take a few moments to see how it is being used in the story. After you have read the first half, work with students to identify story characters, setting, the problem. Something else not to be overlooked is character emotion and how it plays into the development of the story. What caused the character to feel like that? What did they do because of it? You will be pleasantly surprised by how much more your kids will participate because you front loaded the information. People sometimes feel like they are ‘giving away too much’ by front loading the information but here is where we need to keep in mind that we want our students to be successful and holding them accountable to for information they don’t know is not a way learn. Integrate student goals into the session as you did before.

Last time you read the first half of the book, so today you will read 2nd half. Kick things off by reviewing of 1st half of the book. Most likely is has been a few days since you last saw your students so a review is good everyone. After you have gone over the events of the 1st half, as well as the vocabulary that has come up thus far, ask for predictions about what may happen next. Be sure to continue to point out the vocabulary you front loaded along the way. You can put the remaining vocabulary cards on the table in front of the students and them use their hands or fly swatters to tap the words that come as they hear them. This is a fun way to make sure everyone is engaged and listening. Once you finish the story discuss ending, how did plot change, did anything surprise them, etc. Be sure to sure their narrative terminology ( character, setting, plot, etc ) and point out an example for each one in the story. Again, you can integrate their goals into the session or simply let it be about the story.

Today is the big day, you read the full story! Review all of the vocabulary you had targeted in the beginning and go over the basic story elements. Read the story in its entirety. During this reading I will just read the story, I won’t stop to point things out or discuss as I read. I do this for two reasons: 1) So they can hear how the story would typically flow and 2) because it is just nice to sit and listen to a story sometimes. When the story is done have the students use the story elements ( aka narrative terminology ) to draw out the story. Have them use the vocabulary you targeted to discuss their artistic creations. Review their predictions. Were they correct? If no, what occurred in the story to make their prediction not come true? Who was their favorite character and why?

This is set up I use for a literacy based approach. I integrate their goals into the sessions for each day while following this framework.

One thing to mention as far as story elements/grammar. There are a few different methods out there. A popular one is Somebody, Wanted, But, So, Then. While this is a nice strategy I have found it to be a bit ‘incomplete’ when it comes to understanding the complete story. Yes, it hits the big things which is great, but over looks the detailed but necessary elements, such as character emotion. This might be a nice introduction strategy that you can then graduate students from as they master story element knowledge. I tend to teach my students this strategy from the beginning, just to avoid hopping around, but everyone is different. The strategy I use is: Time, Character, Setting, Problem, Emotion, Plan, End ( sometimes Ending Emotion ).

If you are trying to figure out what book to use with your first experience with this framework, you can read this post about the best books for your speechie library.

Oh, BTW! I have a One Page Book Target Sheet in the FREE RESOURCES section of my site. I use this to keep track of all the different concepts for a story without using a bunch of post its. Then I just tape this in the back of the book. If you are a part of my email community then you have the password to go in and download this freebie. If you aren’t in our email community of speechie awesomeness, then click HERE to join us.

References:

Aram, D. M., & Nation, J. E. (1980). Preschool language disorders and subsequent language and academic difficulties.  Journal of Communication Disorders, 13 (2), 159-170. http://dx.doi.org/10.1016/0021-9924(80)90033-7

Horst, Jessica & Parsons, Kelly & Bryan, Natasha. (2011). Get the Story Straight: Contextual Repetition Promotes Word Learning from Storybooks . Frontiers in psychology. 2. 17. 10.3389/fpsyg.2011.00017.

Leach, J. M., Scarborough, H. S., & Rescorla, L. (2003). Late-emerging reading disabilities.  Journal of Educational Psychology, 95 (2), 211-224.

Doyle B and Bramwell W (2006) Promoting emergent literacy and social–emotional learning through dialogic reading. The Reading Teacher 59(6): 554–564.

Teale, W. H., & Sulzby, E. (1986).  Emergent Literacy as a Perspective for Examining How Young Children Become Writers and Readers.  Norwood, NJ: Ablex.

Schuele, C. M. (2004), The impact of developmental speech and language impairments on the acquisition of literacy skills. Ment. Retard. Dev. Disabil. Res. Rev., 10: 176-183. doi: 10.1002/mrdd.20014

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Meet Maureen

Hey there! I’m Maureen Wilson, a school-base SLP who is data driven and caffeine powered. My passion is supporting other pediatric SLPs by teaching them how to harness the power of literacy and data to help their students achieve their goals…without sacrificing time they don’t have.

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5 responses.

Would you use this same strategy for Pre-school aged kiddos? Thanks for this post! I use books allll the time in therapy. It’s definitely my jam, but I like to see how others use them.

I would, just incorporate movement breaks 🙂

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Reading and Writing Disorders

Reading and writing disorders most likely have a language component. Therefore, a child with difficulties reading and writing most likely needs speech therapy.

It is IMPERATIVE that a child has strong language skills to be a strong reader and writer.

Definition of reading and writing disorders

Reading and writing disorders occur when a child has difficulty with decoding and sight words (actual reading), reading comprehension (understanding), spelling and grammar (mechanics), and composition (structure).

Reading and writing language disorders can involve any of the following 5 categories:

This is the SAME as  language disorders.  

Let’s break it down a little further!

Let's break it down a little further

Semantics and Syntax

Early language skills such as receptive and expressive vocabulary and grammar skills are the building blocks for reading comprehension.

Quick side note: reading comprehension is how one understands what he/she reads (not the actual decoding part).

A child needs to have a strong vocabulary and grammar skills to understand the content of what he/she is reading and be able to write. If a child has a good grasp on vocabulary words and how to relate them together ( solid vocab learning ), he/she has a strong understanding of words and how language can be used to express ideas.

If a child has a delay in receptive or expressive language skills, he/she is at risk for later reading difficulties. That is just another reason WHY  speech therapy  for grammar and vocabulary is so important. 

Articulation, Phonological Awareness, and Learning How To Read

Articulation or  speech sound development  is obviously very important for learning how to read (decoding).

By decoding, I mean learning that letters represent sounds and letters can be put together to make words. I apologize if that is the worst definition of learning how to read, but you get the point.

Moving on...

A child needs a strong representation of speech sounds, be able to make those sounds, and then be able to use those sounds to complete phonological awareness tasks. 

*Side note - Phonological awareness is the ideas that words can be broken down into smaller units such as syllables & sounds

Phonological awareness tasks such as breaking words into syllables, rhyming, and deleting syllables are important pre-literacy skills and can be a reliable indicator for later reading abilities.

Narrative Structure & Reading Comprehension

Ah, my favorite section. I love working on narrative structure because it can make such a huge impact academically and socially.

Narrative structure  is the typical flow or schematic of a story. Most oral language and written stories follow a pattern. This pattern may also be called story grammar or story structure. They all mean the same thing. 

A child with strong narrative structure skills will fill out their mental schema (who, what, where, what happened, feelings and resolution) as he/she reads. He/she will expect the next section to appear as the story goes on. This will aid in recall of the story, comprehension, being able to identify main ideas vs details, being able to retell the story, etc... 

If a child has trouble with narrative structure, their reading comprehension will suffer. They will have a hard time recalling events, answering questions, and/or being able to analyze the story further. 

Therapy Techniques

For how speech-language pathologists can help with reading and writing disorders, click  here. 

How To Help Your Child Today

If you are concerned about your child, please  contact us  for an evaluation or  find a speech-language pathologist near you. 

In the meantime, learn more at:

• How to read to your child
• Narrative Structure Basics
• Oral Language Practice for Story Grammar
• Pre-literacy MUST KNOWS for preschoolers
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This article was a pleasure to read. Your insights are really valuable and thought-provoking. Great job!

You have a gift for writing engaging and informative content. This post was a pleasure to read.

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Types of Speech Therapy

Different speech therapy approaches and techniques are used for various issues

• List of Types
• For Late Talkers
• For Apraxia
• For Stuttering
• For Aphasia
• For Swallowing

Frequently Asked Questions

Speech therapy is not one thing. There are different types of speech therapy, each of which involves approaches and techniques that are specific to the issue that needs addressing. That could be related to speech itself—e.g., therapy for people who stutter—or it could relate to problems with memory swallowing, and more.

A speech-language pathologist (SLP), often just called a speech therapist, will perform assessments to determine which type(s) of speech therapy is right for you.

This article reviews the different types of speech therapy and the various disorders each one can be used to treat.

Types of Speech Therapy Used by Speech Therapists

A speech-language pathologist can use different types of speech therapy to help people with problems related to:

• Fluency (e.g., stuttering, and cluttering)
• Speech (e.g., articulation)
• Language (e.g., ability; comprehension of spoken and written language)
• Cognition (e.g., attention, memory, ability to solve problems)
• Voice (e.g., characteristics of vocal tone)
• Swallowing (e.g., stroke, congenital disorders)

In addition to different speech therapy techniques, SLPs may also provide auditory habilitation & auditory rehabilitation for people with hearing problems or disorders.

Some SLPs specialize in other services including professional voice development, accent or dialect modification, transgender voice therapy , business communication modification, and voice hygiene.

Speech Therapy for Late Talkers

A common speech therapy method is used to help children who have reached the expected age for speech development but have not started talking .

If your infant or toddler should be talking by now but isn't, they may be referred to a speech therapist. The therapist will likely try different things to encourage your child to talk, including playing with him. Sometimes, withholding a favorite toy until a child asks for it motivates small children to talk, but this depends on the circumstance.

For some children, other types of communication, such as sign language or picture cards, might be introduced. Speech therapists may also refer your child for further evaluation, such as hearing tests if necessary.

Speech Therapy for Kids With Apraxia

Certain speech therapy techniques are helpful for kids with apraxia.

Children with apraxia of speech have difficulty saying certain syllables or making certain sounds. Your child knows what they want to say, but it doesn't seem to come out right. Speech therapists are qualified to evaluate children for apraxia by using several tests, including:

• Oral-motor assessment to check for muscle weakness in the jaw, lips, or tongue
• Melody of speech assessment during which the therapist listens to see if they can appropriately stress certain syllables and use pitch and pauses at the appropriate place in a sentence
• Speech sound assessment further determines how well the child can pronounce sounds, including vowels, consonants, and sound combinations. This includes determining how well others are able to understand the child's conversational speech

If your child is diagnosed with apraxia , they will probably need speech therapy on a one-on-one basis several times per week. This therapy will likely consist of intensively practicing their speech. The therapist will try to help your child understand auditory feedback as well as visual or tactile cues.

One way a therapist might do this is to have your child look at themselves in a mirror while speaking, or record them speaking and then playing it back. Many children enjoy this.

Since successful treatment for apraxia involves a lot of time and commitment, your therapist may give you assignments to practice with your child at home.

Speech Therapy for Stuttering

Speech therapy techniques can be applied to help treat stuttering.

Stuttering is a problem that typically develops during childhood but can develop during adulthood as well. Stuttering is usually considered a type of behavioral problem. Speech therapists will try to teach your child who stutters behavioral modification techniques that in turn may help control their stuttering.

A common method that may be used on your child is to teach them to control the rate of speech since speaking too quickly can make stuttering worse for some people. Practicing speech in a slower, more fluent manner can be helpful. It can also be helpful to monitor breathing.

Even after treatment, people who stutter may require follow-up sessions with their speech therapist to keep the problem from recurring.

Speech Therapy for Aphasia

Some speech therapy methods help people with aphasia . Speech therapy assessments can also help determine if someone has the condition.

Aphasia is a condition that causes difficulty speaking as a result of some sort of damage to the brain. The condition can also consist of difficulty listening, reading, and writing. Aphasia happens to many adults after they have experienced a stroke .

Speech therapists play a crucial role in diagnosing aphasia by evaluating an individual's ability to understand others, express themselves, and even swallow. There are many different things a speech therapist might do to help a person with aphasia, including:

• Drills to improve specific language skills
• Group therapy to improve conversational skills
• Gestures and writing to augment their communication skills

Speech Therapy for Swallowing Difficulty

Speech therapy techniques can also be used to help people who are not able to swallow when they eat or drink.

Your child may experience difficulty swallowing for a variety of reasons. A speech therapist may help your child with swallowing difficulty by assisting them with exercises to make her mouth strong, increase tongue movement, and improve chewing.

A speech therapist may also make recommendations about the consistency of food. For infants, a speech therapist may assist in coordinating her suck-swallow-breath pattern. As previously mentioned these are only some of the things that a speech therapist might do. There are many other conditions and methods used to evaluate those in need.

There are different types of speech therapy that can be used to treat various disorders affecting speech, hearing, and swallowing. Children and adults with speech delays, apraxia, swallowing problems, and certain medical conditions may benefit from working with a speech therapist.

A speech therapist evaluates, diagnoses, and treats speech issues and communication problems, as well as swallowing disorders. They provide various services, from teaching articulation and clear speaking to helping strengthen muscles used to talk and swallow.

The four types of articulation disorders are substitution, omission, distortion, and addition. Speech-language pathologists use the acronym SODA to remember them.

Childhood Apraxia of Speech: Treatment . Asha.org.

Chang S, Synnestvedt A, Ostuni J, Ludlow C. Similarities in speech and white matter characteristics in idiopathic developmental stuttering and adult-onset stuttering .  J Neurolinguistics . 2010;23(5):455-469. doi:10.1016/j.jneuroling.2008.11.004

Stuttering . Asha.org.

American Psychological Association. APA Dictionary of Psychology - Definition of Articulation Disorder .

Scope of Practice in Speech-Language Pathology . American Speech-Language-Hearing Association website.

Childhood Apraxia of Speech . American Speech-Language-Hearing Association website.

Feeding and Swallowing Disorders (Dysphagia) in Children . American Speech-Language-Hearing Association website.

By Kristin Hayes, RN Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.

How Speech Therapy Can Help with Word-Finding Problems

It’s a frustrating feeling when you can’t think of the word you want to say. While not uncommon, word retrieval problems can feel embarrassing and confusing. They can also affect a person’s daily communication–the ability to find and use the right word at the right time.

When a person has trouble finding words, it can lead to misunderstandings, social withdrawal, and a decline in confidence. Fortunately, speech therapy can improve word retrieval skills, helping people regain their ability to communicate clearly.

What is word-finding difficulty? 

First, some quick background. Word-finding difficulty, also called anomia or word retrieval difficulty, refers to challenges saying a known word while you’re speaking or writing. 

What causes frequent word-finding difficulty? 

Occasional anomia is a universal phenomenon. People of all ages experience trouble finding words. That said, it’s important to note how often it happens, since anomia is more common among people with neurological disorders. When word-retrieval problems in adults become persistent or severe, it’s a good idea to check in with your doctor.

Word-retrieval problems for adults can have several causes, such as:

Typical age-related changes to the brain

Neurological conditions, such as aphasia , dementia , traumatic brain injury , Parkinson’s , long COVID , or multiple sclerosis

Mental health conditions, such as depression or anxiety

Not getting enough sleep

Alcohol or drug use 

How speech therapy addresses word-finding problems

Speech therapy helps people overcome communication challenges, including trouble with recalling words. A speech-language pathologist, also known as a speech therapist, works closely with the person to assess their word-retrieval difficulties, then create a treatment plan to address those challenges.

Speech therapy for word retrieval typically includes two approaches:

Compensatory word-finding strategies , which serve as a sort of “safety parachute” when a person has a tough time recalling words 

Language tasks, which focus on retrieving various types of words to promote mental connections and improve word-finding skills

Language tasks used in speech therapy for word retrieval

Let’s take a look at some language tasks that are commonly used in speech therapy sessions for word-finding.

1 Word association and categorization tasks

One of the foundational approaches in speech therapy for word retrieval is the use of word association and categorization tasks. These exercises help the brain create stronger connections between related words and concepts.

For example, the speech therapist may ask the person to name items in a category (such as fruits or animals), or to come up with words associated with a particular word (e.g., "apple" might lead to "red," "fruit," and "pie"). These tasks encourage the person to think of related words, which strengthens the neural pathways involved in word retrieval.

2 Semantic feature analysis (SFA)

Semantic feature analysis is a technique that involves breaking down a word into its semantic components, such as its category, function, and characteristics. For example, when working on the word "dog," the person might be guided to think about the category (animal), its characteristics (furry, four-legged), and its function (pet, barks). 

The SFA technique helps the person retrieve the word by activating related concepts, making it easier to recall the target word.

3 Verbal network strengthening treatment (VNeST)

VNeST is based on the idea that verbs are central to sentence structure, and when you’re better able to retrieve and use verbs, your overall language skills can improve. This is a highly effective and evidence-based therapy technique used in speech therapy, particularly for people with aphasia or other language disorders that affect word retrieval and sentence formulation.

VNeST focuses on activating the neural networks associated with verbs and their related subjects and objects. Here’s an example using the verb “write.”

The person might be encouraged to generate subjects who write, such as ”author,” “teacher,” or “doctor.”

Then they’re asked to think of objects that might be written, like a ”book,” “lesson,” or “prescription.”

Additional questions such as “Why did they write?” or “Where did they write?” are then answered to extend the length of the sentence. 

4 Cueing hierarchies

Cueing hierarchies involve providing prompts to help a person retrieve a word. The speech therapist might start with a minimal cue, such as the first sound or letter of the word, and gradually increase the level of assistance if needed.

For instance, if the target word is "book," the speech therapist might first provide the sound /b/ as a cue. If the person still can’t retrieve the word, the therapist can give more cues, such as describing the word's function or providing a sentence with a blank (e.g., "You read a _____"). Over time, this method helps the person improve at finding words on their own, without help.

5 Phonological and orthographic cueing

Phonological (sound-related) and orthographic (spelling-related) cues can also be highly effective. These cues help activate the brain's word retrieval processes by focusing on the word's sound or structure.

Phonological cueing might involve asking the person to think of words that rhyme with the target word, or identifying the word’s initial sound.

Orthographic cueing might involve writing the first letter of the word or showing a written word with some letters missing.

6 Script training

Script training involves practicing set phrases or sentences that the person can use in specific situations. For example, if someone struggles to order food at a restaurant, their speech therapist might help them practice a script like, "I would like to order a cheeseburger, please." While this approach doesn’t focus on spontaneous word retrieval, it can build confidence, reduce the cognitive load, and make it easier to retrieve words in all kinds of situations.

7 Functional communication practice

Finally, functional communication practice is an essential part of speech therapy for word-retrieval problems. This involves practicing communication in real-life scenarios, such as making phone calls, participating in conversations, or giving a presentation at work. The speech therapist might simulate these scenarios in therapy sessions in order to provide support and feedback. This practice helps the person use their new word retrieval strategies in everyday life.

The benefits of speech therapy for word retrieval

Speech therapy offers several benefits for people with word-finding problems:

Improved communication: By strengthening word retrieval skills, individuals can communicate more effectively, reducing frustration and misunderstandings.

Increased confidence: As word retrieval improves, people often have a boost in confidence, which leads them to participate more at work and socially.

Better quality of life: Effective communication is a cornerstone of social interaction. Improving word retrieval can enhance relationships and overall quality of life.

The “last word” on speech therapy for word retrieval

Problems with word finding can be a major barrier to effective communication. Fortunately, speech therapy provides a range of strategies and exercises to help people overcome these challenges. By working closely with a speech therapist, you or your loved one can improve the ability to find and articulate words, leading to more confident and effective communication.

If you or someone you know is struggling with word retrieval, Expressable speech therapy offers a path to a better quality of life. Schedule a free consultation call to talk with one of our licensed speech therapists and get your questions answered.

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