Although most people have experienced word-finding difficulty at one time or another, there are no clinical instruments able to reliably distinguish normal age-related effects from pathology in word-finding impairment. Two experiments were conducted to establish a modified version of the Boston Naming Test (BNT) that includes latency times, the Boston Naming Test of Latencies (BNT-L), in order to improve the instrument's sensitivity to mild to moderate word-finding impairment. Experiment 1: Latency times on the 60-item BNT (Goodglass et al., 2001) for 235 healthy adults' ages 18-89 years were collected on a representative sample. Qualitative features of the BNT items, statistical analyses, IRT, and demographic considerations of age, gender, education, vocabulary, race and culture, helped create a reduced BNT-L version with 15 of the most discriminating items. Statistically sound and sophisticated normative tables are provided that adjust for unseen covariates. Response latencies did not indicate earlier age-related decline in an optimally healthy sample. Experiment 2: Twenty-three patients referred for neuropsychological testing were administered the BNT-L. Patients referred for evaluation of mild cognitive impairment or possible dementia produced significantly different response BNT-L latencies from the healthy sample whereas patients referred for mild brain injury evaluation did not. Normal word-finding problems were discussed in terms of serial stage models of lexical access, as well as in terms of automatic and controlled cognitive processes in younger and older adults. Statistical process for creating a psychometric instrument using latencies is illustrated.

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Des avantages et désavantages cognitifs existeraient chez l’enfant bilingue par rapport à son homologue unilingue, dû à l’activation constante des deux langues chez le bilingue et à son traitement langagier plus complexe. Cette surcharge de traitement affecterait d’ailleurs l’accès lexical des bilingues, qui auraient davantage de « mots sur le bout de la langue ». Puisque le discours pourrait être une mesure d’évaluation moins biaisée que les tests de vocabulaire normés et qui permettrait de saisir les compétences fondamentales lexicales des enfants, le Test of Word Finding in Discourse (TWFD ; German, 1991) a été utilisé afin d’évaluer l’incidence des manifestations des difficultés d’accès lexical (DAL ; répétition, révision, mot vide, commentaire métalinguistique ou métacognitif, substitution, pause ou interjection) dans trois situations discursives (2 narratives, 1 explicative) de 30 enfants québécois entre 7;1 et 10;8 ans (15 unilingues francophones et 15 bilingues simultanés français–anglais, dominants en français. L’alternance codique (code-switching), pertinente par la présence de la population bilingue, a aussi été étudiée. Aucune différence n’a été obtenue entre les enfants unilingues et bilingues pour l’incidence des manifestations des DAL. Davantage de mots vides et de révisions ont par ailleurs été obtenus dans le discours explicatif alors que le taux de pauses était plus élevé dans le discours narratif et ce, pour tous les enfants. L’évaluation de la productivité de langage a montré une différence entre les enfants bilingues et unilingues, où ces derniers ont obtenus des moyennes supérieures pour le nombre d’énoncés total, le nombre de mots total et le nombre de mots différents. Aussi, la longueur moyenne de l’énoncé était en moyenne plus longue, pour tous les enfants, dans le discours explicatif que dans la narration. Enfin, les manifestations du MBL en discours seraient une mesure sensible d’évaluation des enfants typiques bilingues, puisque leurs résultats de production ne diffèrent pas de ceux des unilingues typiques, ce qui pourrait éviter de les surdiagnostiquer avec un trouble de langage. / Cognitive advantages and disadvantages seem to exist in the bilingual child compared to his unilingual counterpart, due to the constant activation of the two languages in the bilingual and to his subsequent more complex language processing. This processing overload seems to affect the lexical access of bilinguals, who would have more words on the “tip of their tongue". Since discourse could be a less biased assessment measure than standardized vocabulary tests and would capture children's basic lexical skills, the Test of Word Finding in Discourse (TWFD ; German, 1991) was used to assess the presence of word-finding difficulties (WFD ; repetition, revision, empty word, metalinguistic or metacognitive comment, substitution, pause or interjection) in three discourse situations (2 narrative, 1 expository) of 30 Quebec children between 7;1 and 10;8 years old (15 unilingual francophones and 15 French-English bilinguals (French dominant)). Code-switching, relevant to the presence of the bilingual population, was also studied. No difference was found between monolingual and bilingual children in the WFD measure for the incidence of WFD. More empty words and revisions were obtained in the expository speech for all children, while the rate of pauses was higher in the narrative speech. The assessment of language productivity showed a difference between bilingual and monolingual children, where the latter obtained higher averages for the total number of utterances, the total number of words and the number of different words. Also, the mean length of utterances was longer in the expository discourse than in the narrative, regardless of languages spoken by the children. Finally, WFD manifestations in discourse could be a sensitive measure of assessment for typical bilingual children, since their production scores did not differ from those of typical monolinguals. This could prevent overidentification of language disorders in this population.

Sweden is getting an aging population and with this comes an increase in neurodegenerative diseases such as Alzheimer’s disease (AD). Bilingualism is also on the rise and this may result in an increase of bilingual people suffering from AD. Due to the linguistic deterioration associated with the illness people with AD, bilingual and monolingual, will be an increasing patient group with speech and language pathologists (SLPs). Word retrieval difficulty is an early symptom of the disease and several strategies to compensate for this have been observed (e.g. fillers, circumlocutions and semantic parafasias). The effectiveness of these strategies has not yet been established. With this background this study attempts to investigate which strategies are used by monolingual and bilingual people with AD to compensate for word retrieval difficulties. A case study was performed on four participants with AD, two of which were monolingual and two were bilingual. Spontaneous speech was collected by means of a semi-structured conversation and a short story was produced with picture support. The results showed that there were individual differences in terms of the compensatory strategies. The results indicated that the strategies’ effectiveness depended on the progression of the disease in each individual. No differences between the bilingual participants’ first and second language were observed with exception to the usage of code switching. The picture support seemed to be of some help for the participants to achieve better fluency of speech since word retrieval difficulties seemed to decrease. The conclusion is that SLPs could make their patients aware of several different strategies to compensate for word retrieval difficulties to discover what is the most effective for each individual; furthermore pictures can be used to help clients’ narratives. / Sverige får en allt äldre befolkning. Detta för med sig ökande antal personer med Alzheimers sjukdom (AD). Då sjukdomen innebär stor språklig påverkan kan denna patientgrupp förväntas öka inom den logopediska vården. Även andelen flerspråkiga i samhället växer, vilket gör att logopeder kommer att ta emot allt fler flerspråkiga äldre patienter. Ordmobiliseringssvårigheter har setts vara ett tidigt symtom vid sjukdomen både hos enspråkiga och flerspråkiga personer. Tidigare forskning har visat att ett flertal kompensatoriska strategier (t.ex. utfyllnader, omskrivningar och utbyten) används för att hantera dessa svårigheter men det är inte klarlagt hur väl dessa strategier fungerar. Därför undersöks i denna studie vilka kompensatoriska strategier som förekommer både hos enspråkiga och flerspråkiga personer med AD. En fallstudie genomfördes på fyra deltagare med AD, varav två enspråkiga och två flerspråkiga. Spontantal samlades in genom ett semistrukturerat samtal och en kortare berättelse genomfördes med hjälp av bildstöd. Resultaten visade att effektiviteten i de använda strategierna skiljer sig mellan individer. Hur långt deltagarna kommit i sjukdomsförloppet verkade dock ha betydelse. Ingen större skillnad mellan de flerspråkiga deltagarnas båda språk observerades förutom gällande användning av kodväxling. Deltagarna verkade i viss mån vara hjälpta av bildstöd för att uppnå bättre talflyt eftersom ordmobiliseringsproblematiken tycktes minska. Slutsatser som drogs är att logopeder kan medvetandegöra patienter och närstående om ett flertal olika strategier för att hitta den strategi som fungerar bäst för den individuella patienten samt att bildstöd kan användas för att underlätta berättande.

Word finding difficulties (WFD) and slowing down both in linguistic comprehension and production are standard characteristics of people as they grow older. WFD also commonly occur in aphasia and are considered one of the most pervasive symptoms affecting stroke participants’ everyday communication. Research on older adults’ WFD has traditionally focused on production of single words when completing picture naming tasks, while very little is known about how much these WFD can compromise connected speech. Similarly, while picture naming tasks have typically been used for assessing and treating word finding problems in clinical practice, there is a dearth of studies in the aphasiological literature investigating the relationship between confrontation naming and connected speech tasks. The thesis investigated whether a newly-developed method/treatment targeting both speed and accuracy (‘repeated increasingly speeded presentation’ - RISP) in picture naming was more effective in (a) speeding up participants without compromising accuracy, and (b) improving the use of the trained/treated names in connected speech, compared to a standard method/therapy (‘standard presentation’ - SP) which targeted accuracy alone. English-speaking, elderly participants (n=27 at Chapter 3, n= 21 at Chapter 4) and participants with aphasia of varying severity and subtype (n=5 at Chapter 5 and n=20 at Chapter 6) were asked to carry out picture naming tasks/picture naming treatments and composite picture description tasks where the composite pictures included the trained/treated items. As for the neurotypical participants, words which were retrieved more quickly in picture naming tasks were also those which were more readily available and produced in connected speech tasks. Compared to SP, RISP was found to be significantly more effective in significantly reducing picture naming latencies without inducing a speed-accuracy trade-off and with lasting effects. Finally, SP was as effective in promoting retrieval in connected speech as RISP. As for the clinical population, compared to SP, RISP was significantly more effective in improving picture naming accuracy and in maintaining the reduced RTs in the long term. In comparison to the SP, RISP crucially led to significantly higher carry-over of targeted items to connected speech. The thesis findings underlined the effectiveness of a more demanding single word training method/treatment in improving lexical retrieval in confrontation naming for neurotypical participants and in enhancing connected speech for participants with aphasia.

Les difficultés d’accès lexical, aussi appelées trouble d’accès lexical, se manifestent par une incapacité fréquente à retrouver le mot voulu pour s’exprimer. Bien que les difficultés d’accès lexical soient couramment rapportées chez les enfants vus en orthophonie, celles-ci bénéficient de peu de recherches en orthophonie. Les recherches auprès des enfants francophones ou ayant recours à des tâches discursives, comme la narration, sont encore plus rares. Cette thèse visait, dans un premier temps, à mettre à l’essai l’analyse de l’accès lexical en discours du Test of Word Finding in Discourse (German, 1991) auprès des enfants francophones d’âge scolaire. Dans un deuxième temps, cette thèse avait pour objectif 1) de mieux comprendre à quelle étape de la production de la parole se situent les difficultés d’accès lexical et 2) de déterminer quelles tâches, parmi celles les plus fréquemment utilisées pour évaluer l’accès lexical, permettent de distinguer des enfants avec et sans difficultés d’accès lexical. Pour répondre à ces objectifs, trois études distinctes ont été développées. Deux études auprès d’enfants francophones participant à des tâches de narration suggéraient que nos participant·e·s produisaient plus de manifestations pouvant être associées à des difficultés d’accès lexical, appelées caractéristiques d’accès lexical (répétitions, révisions, etc.), que celleux de l’échantillon de normalisation du Test of Word Finding in Discourse (German, 1991). Nos résultats suggèrent que la fréquence des caractéristiques d’accès lexical peut être associée au genre de l’enfant, à la langue parlée et au type de tâche (narration vs description d’images). Les résultats de la troisième étude, réalisée auprès d’enfants avec et sans difficultés d’accès lexical, suggèrent qu’en général, les difficultés d’AL impliquent un déficit sémantique, soit à développer des représentations sémantiques précises sur les mots appris. Cela rendrait ensuite ardu l’accès à ces mots. Lorsque les enfants avec difficultés d’accès lexical sont catégorisés en profils de difficultés, un profil de difficultés sémantiques et phonologiques émerge, de même que des profils intermédiaires, sans être spécifiques à des difficultés sémantiques ou phonologiques. Ces résultats concordent avec une autre étude faisant usage des analyses par profils, mais ne concordent pas avec la majorité de la littérature qui propose de catégoriser les enfants avec difficultés d’accès lexical en profils sémantiques et phonologiques. Concernant l’identification de difficultés d’accès lexical, nos résultats suggèrent qu’un questionnaire de dépistage des difficultés d’accès lexical, une tâche de définitions de mots et une tâche de dénomination sont prometteurs. Bien qu’il existe des différences significatives entre les enfants avec et sans difficultés d’accès lexical en discours, nous recommandons d’utiliser le discours pour permettre de décrire les impacts des difficultés d’accès lexical plutôt que de statuer sur leur présence. D’autres études sont nécessaires, surtout impliquant le discours, étant donnés les défis de l’évaluation en discours. / Word-finding difficulties are best described as a frequent inability to find the target words to express oneself. Although word-finding difficulties are commonly reported in children receiving speech and language services, research on these difficulties is sparse. Research with French-speaking children or including narrative tasks is even rarer. French-speaking children and for narration. This thesis aimed to test the use of the Test of Word Finding in Discourse’s analysis of word-finding behaviours with French-speaking school-aged children. This thesis also aimed 1) to better understand at which stage of speech production word-finding difficulties may arise and 2) to determine which task, among the ones frequently used to assess word-finding difficulties, can best distinguish children with and without word-finding difficulties. To this end, three distinct studies were developed. Two studies of French-speaking children participating in a narrative task suggest that our participants produce more word-finding behaviours (repetitions, word reformulations, etc.) than those from the Test of Word Finding in Discourse’s (German, 1991) normalization sample. Our results suggest that the frequency of word-finding behaviours could be associated with a child’s gender or language spoken as well as the type of task (narration vs picture description). The third study, conducted with children with and without word-finding difficulties, suggests that, in general, word-finding difficulties involve a semantic deficit, that is, difficulties developing precise semantic representations when learning new words. This would then make it hard for the child to retrieve these words. When children with word-finding difficulties were categorized into word-finding difficulties profiles, one with both semantic and phonological difficulties emerged, as well as intermediary profiles that were not specific to semantic or phonological difficulties. These results agree with another study of word-finding profiles, but not with the majority of the literature that proposes that children with word-finding difficulties can be categorized into semantic and phonological profiles. Regarding the identification of word-finding difficulties, our results indicate that a screening questionnaire for word-finding difficulties, a word definition task and a naming task are all promising tools. Although there were significant differences between children with and without word-finding difficulties in discourse, we recommend using discourse measures to describe the impacts of word-finding difficulties rather than to identify word-finding difficulties. Further studies are needed, especially ones involving discourse measures, given the challenges in using discourse in speech-language pathology.