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Mental health issues and brain injuries can cause various speaking challenges. Speech may become fast-paced or unfocused, or the speaker may struggle with finding the correct words. These disorders can be frustrating for both the speaker and listener, and worse, they may lead to misunderstandings where words are mistaken for insults or challenges. However, individuals with these conditions do have something important to communicate. Identifying the patterns can foster understanding and often pave the way for effective therapy.
10. Clanging
Clanging, also referred to as clang association or association chaining, involves using words that are connected by similar sounds rather than logical meaning. It’s a type of glossomania, where words are immediately associated with one another. People who experience clanging get distracted by the sound or meaning of their words, causing them to veer off-topic. This is commonly seen in individuals with schizophrenia and during the manic phase of bipolar disorder.
Example: “He entered and attempted to speak, but his words turned into a chaotic mix: tying, sighing, dying, ding-dong, dangles, dashing, dancing, ding-a-ling!”
9. Neologisms
Individuals with schizophrenia and neurological disorders often face challenges when trying to express themselves. This can make it hard for them to find the right words. As a result, some people with schizophrenia create entirely new words, known as ‘neologisms.’
Sometimes, a neologism might be based on a word that resembles what the person meant to say. Other times, these made-up words reflect the unique perspective of the individual. For example, a patient in England coined the term “split-kippered” to describe someone who is alive in one place and dead in another. Neologisms are often related to another phenomenon called word approximation, where real words are combined to replace a word that the speaker cannot remember. For instance, “hand shoe” might be used to refer to a glove, or “paper skate” for a ballpoint pen.
Example: “I kind of messed the whole thing up.”
8. Non-Fluent Aphasia
Aphasia is a condition that involves language impairments caused by brain damage, commonly due to stroke or head injuries. It is categorized into two main types based on the speaker’s ability to form grammatically correct sentences. Non-fluent aphasia, also referred to as expressive or motor aphasia, is defined by limited and intentional speech. Those with this type often use fragmented words or phrases, omitting small words, resulting in speech that sounds like a telegram.
People with non-fluent aphasia may also struggle with speech rhythm and inflection, which can make their speech appear as though they have a foreign accent. In its most severe form, known as Broca’s aphasia, sentences usually consist of no more than four words. Helpful communication tips for interacting with someone who has aphasia include allowing them extra time to complete their sentences, minimizing background noise, and using visual aids or gestures instead of spoken words.
Example: “Son... University... Smart... Boy... Good... Good...”
7. Fluent Aphasia
Another major type of aphasia is fluent, also known as Wernicke’s aphasia. This condition is typically caused by neurological damage to Wernicke’s area, located in the temporal lobe of the brain. People with fluent aphasia can produce words with ease, but unfortunately, they often use incorrect or unrelated words. This is why the condition is sometimes called ‘jargon aphasia.’
Sentences produced by individuals with fluent aphasia may include a few incorrect or invented words. In its most extreme form, it can turn into an overwhelming word salad, a chaotic stream of meaningless words. This can lead to long, rambling monologues where the person seems to speak to themselves or imaginary figures.
Example: In response to a question like, “Why do people believe in God?” someone with fluent aphasia might reply “Because spin a circle in life, my box is cracked, help me, blue elephant. Isn’t lettuce courageous? I like electrons, hello.”
6. Paraphasia
Paraphasia is the unintentional production of syllables, words, or phrases during speech. It is most commonly seen in individuals with fluent aphasia. Paraphasia results from damage to the brain's language processing areas.
Paraphasia can be divided into three main types. Literal (also known as phonological or phonemic) paraphasia involves omitting parts of a word or substituting sounds. For example, someone with literal paraphasia might say “pun” instead of “spun” or “tevilision” instead of “television.” This should not be confused with “eggcorns,” which are incorrect but logical changes of a misheard word or phrase, such as “ex-patriot” instead of “expatriate.”
Verbal paraphasia occurs when a person replaces the intended word with another from a similar semantic group. For instance, someone might say 'cat' when they meant 'dog.' They may also use antonyms, like saying 'big' when they actually mean 'small.' The final category is neologistic paraphasia, where a person creates new words due to brain damage. After a stroke, for example, a photographer might not recall the word 'tripod' and refer to it instead as an 'anti-wiggly device.'
5. Pressured Speech
Pressured speech, also known as tachyphasia, is when a person speaks much faster than normal. There are few pauses, making it challenging to interrupt. The individual feels a strong urge to express their thoughts, with a mind overwhelmed by a 'flight of ideas,' which makes it hard to keep up. These thoughts might not always be logically connected. People with pressured speech can become frustrated when asked to slow down, repeat themselves, or calm down.
Pressured speech may accompany other speech disorders, especially during the manic phase of bipolar disorder. At times, the speaker might use rhyming words or similar sounding words ('clanging'), or engage in wordplay, like puns.
4. Distractible Speech
Distractible speech is marked by abrupt and illogical shifts in topics during conversation. This is often seen in conditions like ADHD, schizophrenia, bipolar disorder, or fetal alcohol syndrome, and tends to be more evident when the speaker is feeling anxious.
Distractible speech manifests in several ways. One form is 'derailment,' where the conversation starts logically but veers off course. For instance, 'The next day, when I’d be going out, you know, I took control, like, uh, I put bleach on my hair in California.' Another variant is 'tangential speech,' where the speaker gives responses loosely tied to the original question. For example, in answering 'What city are you from?' the response might be 'I really don’t know where my relatives came from, so I don’t know if I’m Irish or French.' Finally, there’s 'loss of goal,' where the person drifts away from the main subject and fails to return, often leading to lengthy, meandering speech filled with irrelevant details.
3. Coprolalia
Coprolalia refers to the involuntary and often inappropriate utterance of offensive words or phrases. The term is derived from the Greek 'kopros' meaning 'dung' and 'lalia' meaning 'chatter.' It was first coined in 1885 by Georges Gilles de la Tourette, after whom Tourette syndrome is named. While coprolalia is most commonly linked to Tourette syndrome, only about 10% of individuals with the disorder actually produce obscene language. It can also be seen in individuals with other neurological disorders, obsessive-compulsive disorder, or brain injuries.
People with coprolalia are sometimes able to sense an impending outburst and may manage to delay it for a short time, but eventually the urge to speak the offensive word or phrase becomes overwhelming and cannot be suppressed. Coprolalia can also be accompanied by copropraxia, which involves motor tics that resemble offensive gestures, like extending the middle finger or touching one’s genitals.
It is important to distinguish coprolalia from mere frequent swearing. Unlike regular swearing, coprolalia is involuntary, meaning it interrupts normal speech patterns and may also alter the speaker's tone. Additionally, the utterances are often socially inappropriate, including racial slurs or comments on someone's physical appearance, but these are not meant as insults. Instead, they are triggered by something in the environment that prompts the individual to say the inappropriate word or phrase.
2. Echolalia
Echolalia resembles palilalia, but instead of repeating one's own words, the utterances involve mimicking what others have said or something heard on television or read in books. The repetitions may happen immediately or be delayed, sometimes for minutes or even years. This phenomenon is especially common among children with autism and individuals with Tourette syndrome. In some cases, echolalia is used to convey a thought that relates to the current situation, while in others, it may simply reflect anxiety, regardless of the context.
For children with autism, echolalia may serve as a temporary phase in the process of developing fluent speech. While some individuals may never progress beyond this stage, others may resort to echolalia during times of stress or anxiety, even if they normally speak fluently. Delayed echolalia can be hard to recognize because the listener may not have heard the original speaker or may have forgotten that they themselves said the words.
1. Palilalia
Palilalia refers to the involuntary repetition of words or phrases that a speaker has previously spoken. It is frequently observed in individuals with autism, developmental disabilities, and Parkinson’s disease.
The repeated words are often muttered or whispered. For instance, a child who experiences palilalia might say, “I want to go to the store,” then quickly whisper, “go to the store.” This behavior is commonly associated with anxiety or an atypical process of acquiring verbal communication.
Many children eventually grow out of palilalia. Adults who recall exhibiting this behavior as children sometimes mention that they were double-checking to ensure they had spoken the words correctly. Others confess that they still mentally repeat phrases, driven by a perfectionist tendency.
+ Anomia
Anomia is a condition where a person struggles to recall specific names and terms for objects. This is sometimes called nominal or anomic aphasia. Individuals with anomia can speak fluently and maintain proper grammar, but they may have difficulty retrieving the right word, often substituting one that is similar, like saying 'telephone' when they mean 'television.'
Anomia results from damage to the brain's parietal or temporal lobes. It is commonly seen in patients with fluent aphasia and contributes to the phenomenon of 'word salad.' There are specific types of anomia, such as 'averbia,' where the individual has difficulty recalling verbs, and 'color anomia,' where the person can distinguish colors but cannot name them.
Jackie, a former journalist and Huffington Post blogger, has a passion for word origins and medieval history. Her blog, Nothing Too Trivial (Interesting Things for Interested People), can be accessed at jackiefox1976.wordpress.com.
