M OTHER Kayla’s so bright and talented but this is really getting in her way. Her teachers tell me they have never heard her voice.

BUBBY School! Always with the school. The problem is that the school system puts way too much precious — I mean pressure — on the kids!

KAYLA It’s so scary when I can’t remember a regular word or when I mix words up. Is something wrong with my brain? Maybe I have a terrible illness or something…

“This is Kayla” Bubby announces shuffling heavily into my office. She drapes her arm around Kayla’s shoulders. Fifteen-year-old Kayla gives me a wary smile and takes a seat in the waiting area.

Bubby sits down holds her phone at arm’s length and begins swiping. “Kayla’s mother gave me a list of things she wanted me to mention.” She looks at me sharply over her glasses. “Of course I don’t think Kayla needs therapy at all. Maybe if my daughter didn’t have to work so much and spent more time with her kids…” Her voice trails off and she scrolls distractedly through her phone.

“Here it is! Okay Kayla sometimes has trouble remembering words. Sometimes she uses a similar-sounding word instead of the correct word like ‘stream’ instead of ‘street.’ Other times she resorts to describing the word like saying ‘the top of the kugel ’ instead of ‘crust.’ ”

Circumlocution — roundabout speech — is an attempt to compensate for being unable to remember or articulate the precise word.

I step out and call Kayla into the room. “What brings you here Kayla?”

Kayla looks uncertain. “I guess um my mother thinks... I have a hard time saying stuff and like whatdoyoucallit in school…”

Kayla has fallen into the habit of using filler words like um thing and stuff to compensate for her inability to retrieve the precise word.

I hear a tremble in her voice. “I’m afraid to raise my hand in case I get stuck…”

It’s normal to forget details occasionally especially if you’re tired. Word retrieval difficulties also increase with age. But Kayla’s difficulty is more than just exhaustion or distraction — it’s impairing her life so she needs remediation.

Bubby shakes her head. “I don’t see why that’s such a big deal. I do it all the time. Right Rina? I mean Kayla?” She retrieves her phone. “Rina is my other granddaughter. See this is a picture I took of them when we went to — Kayla what was the name of that place we went to on Chol Hamoed?”

Mixing up names is a common and benign form of word retrieval difficulty.

Kayla lifts her hand high and gestures in a roundabout motion. “The roller-coaster place … Keansburg Amusement Park.”

“Right.” Bubby turns to me. “Sometimes she uses gestures to fill in the blanks ” she whispers too loudly.

“It’s like the word gets stuck in my brain ” Kayla tries to explain. “Like I know that I know the word I know it’s just a regular word but I just…” She looks helpless. “I just can’t remember it.” Her voice is laced with anxiety.

“What you’re describing is called ‘word retrieval ’ ” I tell her. “The word is in your brain but you have difficulty retrieving it when you need it. It’s common”—my eyes flicker to Bubby—“and very treatable.”

Kayla looks relieved and Bubby looks curious. It’s hard to tell who’s looking forward more to next session!

Originally featured in Family First Issue 544. D. Himy M.S. CCC-SLP is a speech-language pathologist in private practice for over 15 years.