Lexical retrieval deficits in anomic aphasia

and specific language impairment (SLI)

More similar than different? Grammatical class
and context effects

Maria Kambanaros & Willem van Steenbrugge

Cyprus University of Technology & Cyprus Acquisition Team /
Flinders University

Lexical retrieval of verbs and nouns was compared in two groups of impaired
language users, children diagnosed with SLI and adults with acquired anomic
aphasia, on two production tasks: picture confrontation naming and connected
speech. Both children with SLI and adults with anomic aphasia showed a more
substantial lexical or naming deficit for verbs than for nouns. However, no
specific verb retrieval deficit was observed in connected speech in either group.
Furthermore, partial correlations between verb and noun naming and their type-
token ratios in connected speech failed to find an association between verb/ noun
retrieval in naming and in connected speech. The results suggest (1) that children
with SLI and adults with anomic aphasia show a specific verb deficit in naming,
and (2) that the ability to predict lexical retrieval abilities for verbs (and nouns) in
connected speech from naming performance is weak for both groups.

1.  Introduction

Lexical retrieval is an everyday matter of activating and retrieving any given con-
cept speedily and successfully within the human language faculty for communica-
tion. Recent research (Friedmann et al. 2012) suggests that lexical retrieval deficits
(aka word finding difficulties) that are prominent in language-impaired children,
can serve as a sub-clinical marker of SLI.1 Moreover, the observed lexical difficul-
ties, i.e. (developmental) anomia in children with SLI, follow similar patterns of

.  Children diagnosed with pragmatic SLI did not show symptoms of lexical anomia
(­­­­Friedmann & Novogrodsky 2008).

Linguistic Variation 13:2 (2013), –. doi 10.1075/lv.13.2.05kam

issn 2211–6834 / e-issn 2211–6842 © John Benjamins Publishing Company
 Maria Kambanaros & Willem van Steenbrugge

naming breakdown to those of adults with anomic aphasia (Friedmann et al. 2012;
Kambanaros 2013). This raises the interesting proposition on theoretical grounds
that a common linguistic impairment or clinical marker is common in both con-
ditions, SLI and anomic aphasia, despite the obvious etiological differences at the
neuronal level between the two. Furthermore, grammatical class membership
appears to influence the lexical retrieval process with verbs significantly more dif-
ficult to retrieve than nouns on naming tasks in children with SLI (see Sheng &
McGregor 2010 for English, and Kambanaros et al. 2013a for Greek) and adults
with anomic aphasia (see Kambanaros 2008 for Greek; Kambanaros 2009: 10 and
references for other languages).
This paper summarizes the findings of two published studies investigating the
effect of context, (i.e. naming vs. connected speech), on lexical breakdown of verbs
and nouns in children diagnosed with SLI (Kambanaros 2014) and adults with
acquired anomic aphasia (Kambanaros 2010). The language of investigation is
Standard Modern Greek (SMG), the dominant language of all participants in both
language-impaired groups and will be referred to in the rest of the paper as Greek.2
Greek is a morphologically complex, highly inflected language where verbs
and nouns are differentiated by different suffixes which encode grammatical infor-
mation such as phi-features for verbs (person, number, and, with nouns, gender);
nouns are also obligatorily case-marked. These subsets of information are highly
prominent (e.g. [lexical stem + affix]), as Greek words being stem-based must be
accurately projected, marked, and expressed for production. Verbs and nouns
are considered of similar morphological complexity, given that each word class
has several conjugational patterns. However, a fundamental distinction is made
between the verbal and nominal domains, with verbs exhibiting more complex
morpho-phonological operations (see Ralli 2003 on all points).
The purpose of comparing the two studies is to tease apart potential simi-
larities and/or differences between the two impaired groups on word retrieval
abilities for verbs and nouns and the effect of context, i.e. naming abilities versus
verb/noun use in connected speech, in a highly inflected language. The common
denominator being that anomia or lexical retrieval difficulty is a hallmark of both
anomic aphasia and certain types of SLI.
The present review will attempt to reconcile the findings from both impaired
groups to a disruption in the lexical system based on the lemma-lexeme framework

.  The children with SLI were native speakers of the Cypriot Greek dialect and the adults
with anomic aphasia were speaker-hearers of English as L2. When the distinction between
SMG and CG does not play a role, the authors simply refer to the varieties and their proper-
ties as Greek.
 Lexical retrieval deficits in anomic aphasia and specific language impairment (SLI) 

(Levelt 1989; Levelt et al. 1999; Levelt 2001). Within this perspective, evidence for
dissociations between nouns and verbs should be found in isolation (naming) and
in sentence contexts (connected speech) to classify as a “true” grammatical class
specific category deficit. In this way, a preliminary investigation may contribute
new insights into the unresolved issue at hand: the manner in which grammatical
class information is organized in the brain and represented in the mental lexicon
of children and adults with language impairment.

2.  Lexical retrieval deficits

Lexical or word retrieval deficits for children with SLI and adults with anomic
aphasia are frequently identified on the basis of their (single word) naming
performance on picture confrontation tasks (e.g. “What is this?”). The naming
impairment is not related to processing difficulties in the visual system (e.g. object
agnosia) in both conditions, but arises at any or combination of stages and/or in
the connections between these stages in the process of lexical retrieval itself. This
could be when accessing/retrieving the conceptual or semantic information for
the target word, when accessing the morphological and/or syntactical compo-
nents of grammar, or when accessing/retrieving the phonological representation
or the word form within the phonological output lexicon (see Levelt 1989). In
most cases, naming is significantly compromised in light of intact comprehen-
sion for the same set of pictured stimuli (see Kambanaros 2010 for aphasia and
Kambanaros et al. 2013 for SLI) when the deficit excludes conceptual or semantic
impairments.
Furthermore, different characteristics of the target words can affect picture
naming accuracy; high-frequency words are commonly named faster and more
accurately than low-frequency words, and if not, the lexical retrieval impairment
is assumed to be at the word form stage. Likewise, age of acquisition reflects the
impact of experience with a word and subsequent lexical selection, with words
acquired earlier in life typically easier to retrieve than those acquired later. Fea-
tures intrinsic to the visual stimuli, such as picture (or visual) complexity and
(concept) imageability, can also influence the success in naming (see Kambanaros
2009: 17–19, 56–57 for relevant references).
Spoken errors produced by children with SLI and adults with anomic aphasia
during picture confrontation tasks are indicative of the stage breakdown occurs
during naming. Yet, errors may arise as a result of a deficit at a number of dif-
ferent levels. For example, semantic errors (i.e. words related in meaning to the
target) often reveal a problem at the semantic level. Phonological errors, that is,
errors that are phonologically related to the target, suggest a deficit in accessing the
 Maria Kambanaros & Willem van Steenbrugge

­ honological form of the word or subsequent processes, such as phoneme selec-

p
tion. Unrelated errors, for example when the output does not resemble the target
word are often the result of a breakdown at more than one level.

3.  C
 linical syndromes: Specific language impairment
(SLI) vs. anomic aphasia

SLI and anomic aphasia share a number of characteristics in relation to their lin-
guistic profiles (e.g. word-finding problems, fluent speech) but differ significantly
in other areas (e.g. aetiology). These commonalities and differences are presented
in Table 1. SLI is considered to be a neurodevelopmental disorder with inherited
genetic components in which the language performance of afflicted children is
low (i.e. below one standard deviation or more) relative to age expectations on
formal language assessment. The exclusion criteria used to identify children with
SLI are hearing loss, general intellectual impairment (children with a non-verbal
IQ of 85 or lower), obvious neurological impairment (e.g. cerebral palsy or epi-
lepsy), autism spectrum disorder (ASD) and severe speech impairment (see Rice
2013 for an update). A general description of SLI posits deficits in structural lan-
guage, in the grammar, and in the lexicon (Tomblin 2011). Evidence is accumu-
lating to suggest different children with SLI can present with different patterns of
linguistic impairment (i.e. a different type of SLI) dependent on which aspects of
the language system are impaired and/or spared (see work by van der Lely 2005;
­Friedmann & Novogrodsky 2008; Leonard 2010). In fact, lexical SLI has been
proposed as a separate sub-type of SLI by Friedmann and Novogrodsky (2008)
based on their description of ten Hebrew-speaking children (mean age 11 years),
who after rigorous testing met the criteria for lexical SLI, e.g. they failed a naming
test, a word-to-definition task, and two verbal fluency tasks, but showed preserved
abilities on grammatical (e.g. relative clause comprehension and production) and
phonological testing (e.g. repetition of words and non-words).
Aphasia, on the other hand, is an acquired language impairment due to
brain injury, most commonly stroke. More than likely, comprehension and
production of language are affected, with spoken and written output processes
compromised. Problems may arise at all linguistic levels such as semantics,
syntax, morphology, and phonology. Aphasia may range from mild to severe,
but it almost universally affects the ability to find words, a condition known
as anomia (Kohn & Goodglass 1985). Patients diagnosed with anomic aphasia
often struggle in structured confrontation naming tasks and in conversational
speech when retrieving the target word. In their attempt to produce the correct
response they often produce a wide range of errors including semantically or
 Lexical retrieval deficits in anomic aphasia and specific language impairment (SLI) 

phonetically related words, descriptions of the word, unrelated or jargon words

or no response at all (Goodglass 1993).

Table 1.  Similarities and differences between SLI and anomic aphasia
SLI Anomic aphasia

Characteristics

Onset developmental acquired

Aetiology unknown brain injury/stroke
? candidate genes
Brain Pathology largely intact brain but abnormalities focal lesion in the parietal
of brain structures in left frontal BA or temporal lobes
44, premotor, basal ganglia (caudate)
circuits, cerebellum, inferior parietal
cortex, superior temporal cortex
I.Q normal normal
Receptive Language/ (usually) preserved preserved
Word Comprehension
Expressive Language deficits within the grammar and the anomia
lexicon + lexical retrieval deficits
Language Impairment modular modular
Speech Output fluent fluent
Communication Intent poor communicators good communicators
Group Description heterogeneous homogenous

4.  Grammatical class: Verbs vs. nouns

Verbs and nouns are near-universal categories across languages but differ in basic
morpho-syntactic properties, conceptual-semantic features, and neural underpin-
nings. Specifically, verbs and nouns often refer to prototypical actions and objects
respectively. Furthermore, there are differences in (concept) imageability as action
representations are usually less imageable given the fewer sensory attributes while
being temporarily transient and object representations are highly imageable and
concrete given the abundance of visual attributes while static. In the past, func-
tional neuroimaging studies proposed that verb processing relied exclusively on
frontal brain regions while noun processing relied on temporal brain regions but
this claim has since been refuted. More sophisticated analyses of past neuroimag-
ing evidence suggest that verb and noun processing in the brain is not spatially seg-
regated in different areas, but involves areas that are overlapping and ­intertwined,
 Maria Kambanaros & Willem van Steenbrugge

situated mainly in a left fronto-temporal-parietal network (see Crepaldi et al. 2013

for an update).
Verb processing requires an understanding of diverse relational concepts
(encoding information about the path, manner, or instrument associated with
(some) verbs), whereas nouns are usually non-relational and only need one sin-
gle object reference. Moreover, verbs core meanings are also linked to two kinds
of semantic information: thematic role assignment and argument structure (e.g.
agent, patient, beneficiary). In addition, because of their often polysemous nature
(i.e. multiple meanings, such as ‘reading a book’ vs. ‘reading a person’), verbs are
considered more non-transparent whereas nouns, especially concrete nouns (e.g.
‘book’) are more transparent (Gentner 2006). Overall, verb processing compared
to noun processing appears to require access to – and manipulation of – larger
intricate sets of semantic and linguistic information.
For lexical retrieval in response to the picture of an object (e.g. ‘book’), or dur-
ing picture recognition, a noun lemma is activated providing the lexical-­syntactic
(i.e. noun, singular) and lexical-semantic (i.e. held in the hands for reading, has
pages etc.) information of the word, i.e. the lemma information.3 In response to
an action picture (e.g. ‘reading’), a verb lemma is activated, specifying lexical-­
semantic and syntactic information such as the verb’s argument structure, tense,
person, and number (Levelt 1989). For example, the verb read has two semantic
arguments, an agent and a theme, and, being a transitive verb, it takes one object,
e.g. ‘read a book’. With the retrieval of the lexeme or word form for the selected
lemma information about the phonology (number of syllables, prosody, segmen-
tation) and the word’s morphology (verbal and nominal inflections) becomes
available (Levelt 1989).
There is perpetuating contention in the literature (predominantly from the
perspective of aphasia) as to whether grammatical category deficits show a true
breakdown of a specific grammatical category (e.g. verbs vs. nouns or the reverse)
or whether such dissociations can be attributed to lexical, semantic, or syntactic,
differences between the two word classes (see Kambanaros 2009 for a review of
the literature on the differences). Difficulty with verb/noun retrieval may also arise
in the conceptual system prior to lexical access or during any further stage in the
process of lexical retrieval, that is, (i) within the lemma or (ii) at the lexeme level
where verbs are considered to be stored separately from nouns within the phono-
logical output lexicon (e.g. Rapp & Caramazza 2002).4

.  For Greek, noun gender information is also made available in the lemma. For the example
provided, ‘book’, this would be the additional feature of [+neuter].
.  Articulation of the selected lexeme (i.e. motoric information), is not pertinent to the
current study and therefore not explored in any detail.
 Lexical retrieval deficits in anomic aphasia and specific language impairment (SLI) 

5.  Retrieval context: Naming vs. connected speech

In the pursuit of disentangling the processes underlying verb–noun differences in

naming researchers have relied on words that can be pictured, that is, nouns rep-
resented by pictures of concrete objects (e.g. book) and verbs by concrete actions
(e.g. reading). Investigators have argued that picture-naming tasks favour the pro-
duction of nouns over verbs, since nouns represent concrete objects that are more
easily pictured. In fact, concrete verb pictures (e.g. reading) in either line draw-
ings (Sheng & McGregor 2010) or coloured photographs (Kambanaros et al. 2013)
are rated as more (picture) complex compared to object pictures (e.g. book); and
as being less imageable (see Kambanaros et al. 2013). It is possible that children
with SLI have trouble identifying the action component given the absence of verb
movement and temporal features when naming static pictures of verbs (Sheng &
McGregor 2010). Picture naming which relies on activating one “unique” con-
cept from the mental lexicon for the target (i.e. from many thousands of words
known) has also been criticized as not representing a true “communication act” or
an everyday life skill. Nevertheless, it remains the standard procedure for assessing
word retrieval ability in language impaired populations, including SLI and apha-
sia. As such an immediate objective of clinical significance is to determine if noun/
verb naming at the word level on a picture confrontation naming task can predict
noun/verb performance in connected speech.
Unlike picture naming, where verbs usually show an imageability disadvan-
tage compared to nouns, connected speech is hypothesised to peter out any dif-
ferences regarding concept imageability for both verbs and nouns (see Crepaldi
et al. 2006). In fact, reducing the confounding effects of lexical-semantic vari-
ables inherent in the picture naming process (e.g. imageability) by tapping into
connected speech will permit a “true” grammatical verb class deficit to surface.
According to the lemma-lexeme theory reported above, a severe verb breakdown
at either the lemma or the lexeme level will result in poor production of verbs also
in connected speech. On the other hand, a breakdown at the lemma–lexeme inter-
face is hypothesised to spare verb (or noun) retrieval in connected speech given the
beneficial nature of the syntactic-semantic interactions characterising spontane-
ous output,(i.e. boosting of intact lemma-level activation) but the verb (or noun)
impairment in confrontation naming will remain (see Crepaldi et al. 2011: 87–89,
for a detailed explanation). Finally, both (picture) naming and connected speech
tasks rely heavily on executive resources. Nevertheless, it is likely that picture
confrontation naming, has more pressing processing demands given the rapid
search for one “unique” concept from the lexicon (Brysbaert & ­Ghyselinck 2006).
However, the opposite view that connected speech has more of a processing load
and especially different demands for verbs within sentences as they need to agree,
inflect for tense and so on cannot be ignored.
 Maria Kambanaros & Willem van Steenbrugge

Investigating grammatical category dissociations at the word level constitutes

an emerging area of more specific research in SLI with only four studies found in
the literature conducted in two languages, English and Greek (Kambanaros et al.
2010, 2013a, 2013b; Sheng & McGregor 2010). Across the studies, out of the three
datasets reviewed,5 91% of children with SLI performed significantly more poorly
on verbs than on nouns on picture confrontation naming tasks. This raises the
interesting possibility that when verbs and nouns do dissociate in children with
SLI, they do so in one direction (i.e. V<N), a finding first reported by Bastiaanse and
Jonkers (1998) with respect to individuals with aphasia. Similarly, a robust cross-
linguistic finding is that adults with anomic or fluent aphasia can also show a gram-
matical class dissociation with better naming performance for nouns over verbs
(Kambanaros & van Steenbrugge 2006; Kambanaros 2009 and references within).
With regards to grammatical class retrieval in spontaneous language, only one
study so far has investigated verb-noun retrieval in connected speech in children
with SLI (Kambanaros 2014). The findings from this study are summarised in the
results and discussion section of this paper.
Similarly, only a handful of group and single case studies have addressed the
relationship between confrontation naming for nouns and verbs and their cor-
responding use in connected speech by (the same) individuals with aphasia (see
Kambanaros 2010 for results and references). The findings from Kambanaros
(2010) for Greek are also reviewed here and compared with the results from the
study on children with SLI referred to above.

6.  Method

6.1  Participants
A total of 20 participants are included in this report divided into two groups:

i. 12 participants diagnosed with anomic aphasia6

ii. 8 children formally diagnosed with SLI

The aphasic individuals were diagnosed with anomic aphasia based on the Greek
version of the Boston Diagnostic Aphasia Examination (BDAE; Papathanasiou et

.  Note that 30 out of the 33 children with SLI reported in the published studies showed
a significant impairment for verbs. The remaining three showed equal difficulties retrieving
verbs and nouns. The study by Kambanaros et al. (2010) was not included in this analysis as
the children were significantly younger (preschoolers) and the verb-noun difference failed to
reach significance.
.  Spontaneous language samples were obtained from 10 participants.
 Lexical retrieval deficits in anomic aphasia and specific language impairment (SLI) 

al. 2008). No participant showed signs of agrammatism and/or difficulties in other

morphological domains. Likewise, no aphasic participant had moderate to severe
phonological problems. They all had aphasia due to a single stroke in the left hemi-
sphere, were right-handed, and the mean time post-onset was 42 months (range
12–84 months). No individual with aphasia had a history of neurological disease
and/or past mental illness including depression nor a history of alcohol/substance
abuse. All had adequate hearing for testing purposes and no visual impairments as
was reported in Kambanaros (2010).
For the SLI group, background language testing included measures of recep-
tive and expressive morphosyntax, receptive and expressive vocabulary, defini-
tions, and sentence recall.7 The SLI group scored significantly lower (1.25 SD)
below the mean on four out of six language tests meeting the criteria for SLI. The
reader is referred to Kambanaros (2014) for a detailed description of the assess-
ment procedure and results. All children with SLI presented with lexical (e.g. word
finding) and syntactic difficulties (e.g. production of morphosyntactic operations)
and were receiving language therapy at the time of study. Furthermore, no child
demonstrated a phonological deficit or had a background history of neurological,
emotional and/or behavioural problems. Children also showed adequate hearing
and vision for test purposes, normal articulation and no gross motor difficulties
(see Kambanaros 2014 for details).
The main characteristics of the two groups under investigation are presented
in Table 2.

Table 2.  Participants

Participants Age (range between brackets) Gender

Anomic aphasics 70.5 (60–84) 4 females; 8 males

Children with SLI 6.3 (5.3–9.2) 2 females; 6 males

.  The language assessment battery included measures of (a) receptive vocabulary (Greek
version of the Peabody Picture Vocabulary Test; Simos et al. 2011), (b) expressive vocabulary
(Diagnostic Language IQ Test/DVIQ; Stavrakaki & Tsimpli 2000), (c) comprehension and
production of morphosyntax (DVIQ), (d) metalinguistic concepts (DVIQ), (e) sentence repe-
tition (DVIQ), (f) articulation and phonological processing (Phonological and Phonetic Test;
Panhellenic Association of Logopedists 1995), (g) word definitions (subtest of the Athina Test;
Paraskevopoulos et al. 1999), (h) word finding (Greek version of the Renfrew Word Finding
Vocabulary Test; Vogindroukas et al. 2009), and (i) phoneme discrimination (subtest of the
Athina Test; Paraskevopoulos et al. 1999). All Greek tests were adapted into CG where possible
or relevant (lexical and/or phonological alternatives) which did not have any impact on the
single-word verb/noun picture naming tasks and narrative re-tell results.
 Maria Kambanaros & Willem van Steenbrugge

6.2  Material and scoring

Both groups scored 90% or above correct on the comprehension subtest of the
verb and noun targets8 ruling out a conceptual and/or semantic deficit prior to
the naming study. For naming, noun and verb scores from subtests of the Greek
Object and Action Test were made available for both groups of participants: for
the aphasic group from the study by Kambanaros (2010) and for children with SLI
from Kambanaros (2014).
Nouns (42 items)9 were everyday words, i.e. non-living objects/things
from common semantic categories (e.g. household and garden items, fur-
niture, grooming implements) and included no body parts. Nouns were not
controlled for gender (i.e. masculine > feminine > neuter). The internal word
structure of verbs consisted of [root + affix] and [root + affix + affix] verbs.
Verbs (42 items)10 were mono-transitive and represented picturable actions.
Lemma frequencies for nouns and verbs were calculated based on the printed
word frequency count for Greek (Hatzigeorgiou et al. 2000). Both categories
had a mean lemma frequency of 0.01 each (0.02 SD). A Mann-Whitney test
revealed no significant difference between noun and verb frequency (z = −0.22,
p = .82). Nouns had a mean syllable length of 2.89 syllables (0.83 SD) and verbs
2.92 syllables (0.74 SD) with no significant difference in syllable length based
on the Mann-Whitney test between nouns and verbs (z = −0.61, p = .54). Fur-
thermore, nouns and verbs were measured using the Mann-Whitney test, for
other key psycholinguistic variables including age of acquisition (AoA)11 with
nouns (mean 2.77; 0.56 SD) and verbs (mean 2.73; 0.48 SD), showing no sig-
nificant difference (z = –0.40, p > .01). In contrast, when imageability ratings12

.  The comprehension subtest of the GOAT used the same photographs as in the naming test
and was given ten days before the naming study.
.  The adapted version of the GOAT used to test the children with SLI had 35 nouns
(instead of 42) as nouns with a mean age of acquisition greater than 6 years were removed
(see ­Kambanaros et al. 2013).
.  The adapted version of the GOAT used to test the children with SLI had 39 verbs
(instead of 42) as verbs with a mean age of acquisition greater than 6 years were removed (see
­Kambanaros et al. 2013).
.  Estimated age ratings were based on first contact with the given noun/verb in either
verbal or written form using a seven-point scale (with 1 representing 0–2 years of age, 2 being
3–4 years of age etc., up to 7 representing 13 years of age and older).
.  Ratings were performed on an eight-point scale (with 0 = impossible, 1 = least imageable,
up to 7 = most imageable).
 Lexical retrieval deficits in anomic aphasia and specific language impairment (SLI) 

were compared for nouns (mean 6.59; 0.33 SD) and verbs (mean 6.43; 0.17
SD) nouns were shown to be significantly more imageable compared to verbs
(z = −4.05, p = .01). Similarly, for picture complexity13 noun pictures (mean
6.57; 0.25 SD) compared to verb pictures (mean 6.19; 0.67 SD) were rated as
significantly less complex (z = −2.64, p = .01) based on the Mann-Whitney
test.14 All test items with number of syllables, frequency ratings, rated AoA,
rated imageability, and rated picture complexity values are reported in Kam-
banaros et al. (2013a).
From each participant with aphasia, a spontaneous speech sample of 300
words was obtained.15 For children with SLI, a re-tell narrative sample based on
the (Cypriot) Greek adaptation of the Bus Story Test (Theodorou & Grohmann
2010) was available and used for the connected speech analyses. The number of
words produced by children with SLI on the narrative re-tell task was on average
82.6 (ranging between 53–127).
The following lexical information was coded from all the language samples:
numbers of types and tokens of verbs, and number of types and tokens of nouns.
All tokens were counted irrespective of any morphologically related form (e.g.
‘drive’, ‘driving’, and ‘drives’ include three verb tokens). The number of types was
computed by counting only the first occurrence of each token (e.g. ‘drive’, ‘driving’,
and ‘drives’ include two verb types). Also, verb and noun diversity was calculated
by dividing the total number of verbs and nouns produced in connected speech
with the total number of verb and noun types, respectively, to express a type-token
ratio (TTR) for each word class.

7.  Results

In Table 3 the group mean results are presented for verb-noun naming accura-
cies (% correct), verb-noun tokens produced in connected speech and verb/noun
type-token ratios.

.  Ratings were performed on a seven-point scale related to the ease with which the noun/
verb picture was recognized (with 1 = least ease, up to 7 = most ease).
.  This finding is typical in the literature investigating verb-noun dissociations using pic-
tures (see Crepaldi et al. 2006 for more evidence).
.  See Kambanaros (2010) for details on the method employed.
 Maria Kambanaros & Willem van Steenbrugge

Table 3.  Naming accuracies (% correct) for verbs and nouns; number of verbs and nouns
produced (tokens) in connected speech and verb/noun type-token ratios (TTRs)
Verb naming Noun naming Verb tokens TTR Noun tokens TTR
Verbs Nouns

Aphasic 62.7% 67.3% 58 0.59 41 0.63

SLI 62.1% 74.9% 21 0.78 14 0.70

7.1  Naming accuracy

A two-way ANOVA with repeated measures (Verbs vs. nouns x Group) revealed
a significant overall difference between verb and noun naming (F(1,18) = 27.90,
p = 0.001). There was no overall Group difference (F(1,18) = 0.16, p = 0.69).
Two dependent (paired) t-tests revealed that both groups showed a signifi-
cantly lower performance for action (verb) naming compared to object (noun)
naming: the SLI group t(7) = 3.84, p = 0.006 ; and the individuals with aphasia
t(11) = 2.99, p = 0.012. Combined with the significant interaction effect between
Verbs vs nouns and Group (F(1,18) = 6.19, p = 0.023), these findings show a larger
mean difference between verb and noun naming in the SLI children than in the
adults with anomia.

7.2  Naming error analysis

A total of 1,600 naming responses were analysed across the two groups. Spoken
errors on the naming subtests were classified into semantic errors, phonologi-
cal errors, grammatical word class substitutions, and word form errors; semantic
errors were divided into semantic types and semantic circumlocutions.
Semantic type errors included all semantically related single lexical labels
for the target word (e.g. the output “broom” for the entry ‘mop’, “threading”
for ‘sewing’). The latter type involved describing the target verb/noun concept
using more than one word (e.g. “use with pencils” for ‘sharpener’, “making a
house” for ‘building’). Phonological errors (evident only in the aphasic group)
included words that shared the same onset and number of syllables with the tar-
get word (e.g. the output “grader” for the entry ‘grater’). Grammatical word class
or V–to–N substitutions (or vice-versa) were those where the noun was pro-
vided instead of the verb (e.g. instead of the verb ‘sweeping’, the noun “broom”
was produced). Word form errors included “Don’t know” responses. Only the
significant error types and patterns will be discussed. Group error means are
presented in Table 4.
 Lexical retrieval deficits in anomic aphasia and specific language impairment (SLI) 

Table 4.  Error types committed by language-impaired groups

Group Aphasic SLI

Error types
Verbs
Semantic circumlocutions 15.6 19.6
Semantic 7.8 11.9
Phonological 5.5 0
Word form (i.e. no response or “don’t know” 1.9 7.1
response)
Grammatical class 0.5 0.6

Nouns
Semantic circumlocutions 3.8 3.2
Semantic 7.4 6.8
Phonological 9.5 0
Word form (i.e. no response or “don’t know” 2.4 10.4
response)
Grammatical class 0.5 0.7

7.3  Connected speech

A two-way ANOVA with repeated measures (verb TTR vs. noun TTR x Group)
revealed no significant overall differences for the TTRs (F(1,18) = 0.34, p = 0.571)
across the two groups. There was a significant Group difference showing that the
overall TTR across verbs and nouns was slightly lower in the adults with anomia
than in the SLI group (F(1,18) = 4.78, p = 0.044). The interaction between verb
TTR vs. noun TTR and Group was not significant (F(1,18) = 3.59, p = 0.076).
Two dependent (paired) t-tests revealed that, although the mean verb TTR
was lower than noun TTR in the adults with anomia and in the SLI group, these
differences were not significant in either group: respectively, t(7) = 1.747, p = 0.124
in the SLI group and t(9) = 0.951, p = 0.366 in the individuals with aphasia. Thus
both language-impaired groups did not show a difference between nouns and verb
TTRs, i.e. in verb-noun diversity in connected speech.
The data were also subjected to partial correlations to explore the relation-
ship between verb and noun diversity in connected speech and verb/noun nam-
ing while controlling for group membership. As expected, a significant, positive
relationship was found between Action (Verb) naming and Object (Noun) naming
(rho = 0.94, p = 0.001), and between the TTRs for verbs and nouns (rho = 0.53,
 Maria Kambanaros & Willem van Steenbrugge

p = 0.03). However, no relationship was found between verb naming and the TTR
for verbs (rho = –0.26, p = 0.243). Moreover, a moderate negative relationship was
found between noun naming and the TTR for nouns (rho = –0.46, p = 0.063).
Overall, the lack of (positive) relationships demonstrates the absence of a
strong association between the retrieval of verbs and nouns in naming and in con-
nected speech.

8.  Discussion

The question of grammatical class dissociations in SLI and anomic aphasia was
addressed in this paper by bringing together results of verb/noun retrieval on a
picture confrontation naming task and verb/noun use in connected speech from
two previous separate investigations. The first aim was to compare the perfor-
mance of both language impaired groups in terms of the pattern of the verb–noun
dissociation in naming and in connected speech. The second aim was to deter-
mine whether the observed lexical impairment pattern for verbs/nouns was simi-
lar or not between the two groups.
These two aims are discussed in relation to the findings in first instance. This is
then followed by a discussion of the potential underlying locus of the verb impair-
ment in SLI and anomic aphasia with reference to models of lexical retrieval (e.g.
lemma-lexeme levels).
All language impaired participants in both groups showed significant diffi-
culty retrieving verbs compared to nouns on the picture confrontation naming
tasks. By and large, children with SLI showed more severe word finding difficulties
or anomia for both word classes compared to adults with anomic aphasia. On the
other hand, both impaired groups demonstrated a similar pattern in connected
speech, namely no grammatical class differences as measured by the type-token
ratio of verbs compared to the type token ratios of nouns. Collectively, the results
illustrate that the verb naming deficit does not surface in connected speech but is
limited to the confrontation picture naming paradigm. The analogous finding in
the two impaired groups first supports recent propositions that anomia can mani-
fest itself in comparable ways in developmental and acquired language disorders
(see introduction) and secondly, adds to the growing evidence that verb-noun dif-
ferences may be task-dependent (Arevalo et al. 2011) and are not necessarily the
result of an overall grammatical class category deficit per se.
Of theoretical and clinical significance is that both impaired groups dem-
onstrated a low association between verb naming and verb use in connected
speech which indicates that the ability to predict lexical retrieval ability for
verbs during spontaneous or connected speech from the performance on a
 Lexical retrieval deficits in anomic aphasia and specific language impairment (SLI) 

picture naming task may be ineffective in children with SLI and adults with
anomic aphasia.
Relating the findings to the lemma-lexeme distinction presented in the intro-
duction section, we suggest that the common naming deficit overall characterizing
both impaired groups16 originated at post-semantic levels (i.e. at the connective
links between the lemma-lexeme levels affecting phonological/word retrieval).
This suggestion is further supported by a number of shared characteristics of
the two impaired groups: intact comprehension of target verbs/nouns, preserved
lemma information (e.g. the lack of grammatical word class substitutions in nam-
ing, see Table 4) and no verb-noun dissociation in connected speech.
In fact, we propose for both impaired groups that the greater difficulty with
verb naming compared to noun naming at the word-level was not linked to the
grammatical information contained in the lemma (verbs were simple with a one-
argument structure), but to the non-grammatical or lexical-semantic information
contained in the verb instead. This is further supported by the larger number of
circumlocution errors for verbs compared to nouns seen in both impaired groups.
As the predominant naming error type for verbs, these circumlocutions revealed
that children with SLI and adults with anomic aphasia were able to describe one
or more components of the action involved (e.g. “sweeping the garden” for rak-
ing, “hitting the nail with a hammer” for hammering, or “mixing the food with
a spoon” for stirring), revealing incomplete specific information of the target
meaning. Moreover, these responses suggest that semantic representations were
not strong enough to achieve threshold or activation levels via the activation of
additional associations (e.g. the instrument, manner, or core meaning) for suc-
cessful selection of the “single” target verb and later compromising retrieval of (the
phonological form of) the target word.
Following on from the semantic complexity hypothesis (Breedin et al. 1998),
children with SLI, typically developing peers and adults with anomic aphasia dem-
onstrated a hierarchical top-down approach to semantic verb usage, that is, general
verbs were available (e.g. make, do, put), moderately specific verbs were retrieved
(e.g. clean, hit, fix) most of the time, but the verbs with the greatest specificity (e.g.
mop, hammer, build), i.e. those considered to have a greater number of (specific)
semantic features (i.e. [+instrument]) were the most difficult to retrieve.17

.  Individual patterns of deficit in relation to noun-verb retrieval and context-effects are
currently under investigation in a larger follow-up study.
.  The effect of semantic complexity in regards to verb type and frequency is statistically
factored out in Kambanaros (2013: 165–166).
 Maria Kambanaros & Willem van Steenbrugge

The results of the present study reveal that performance on single-word naming
tasks is not automatically predictive of word finding abilities regarding verbs or nouns
in connected speech of children with SLI and adults with anomic aphasia. In fact,
single-word assessment measures may over-estimate the lexical retrieval difficulties
observed in connected speech. This was certainly the case for verbs in the present
study, given that the grammatical class effect favouring nouns over verbs in a naming
task was no longer apparent in the connected speech of either impaired group.
The clinical utility or feasibility of applying discourse-level word retrieval mea-
sures for studying grammatical word class differences in children with SLI and adults
with aphasia across different languages remains open to investigation. The cur-
rent findings highlight the need for speech–language therapists to elicit connected
speech samples as part of their assessment in addition to assessing naming abil-
ity. Also, applying psycholinguistic models (such as, lemma-lexeme distinction) to
determine the level of breakdown is instrumental to therapy planning. Intervention
offered to remediate lexical retrieval deficits in individuals with language impair-
ments should be aimed and evaluated relative to the level of breakdown (e.g. lemma
vs. lexeme vs. interfaces) as well as to the elicitation context, that is, single word level
(see Bragard et al. 2012 for SLI; Raymer & Kohen 2006 for aphasia ) or connected
speech (see Marks & Stokes 2010 for SLI; Lee & Cherney 2008 for aphasia).
The bigger picture painted in this paper concerns the classic competence–­
performance distinction. We suggest to use insights from work on the lexical–
syntactic interface and transform competence-based research into a performance-
sensitive model: It is not an issue of being able to name a particular action with
a single verb which is well known – it is a matter of activating and retrieving the
concept speedily and successfully within the human language faculty and its inter-
face with the performance systems for which there is a model. Put simply, in the
current minimalist framework (Chomsky 2000 et seq.), there is a well-defined
pathway from the lexicon to the conceptual-intentional interface (vocabulary,
syntax, semantics) with the add-on component of sound (phonological structure,
instructions to the articulatory-perceptual/sensorimotor system).

9.  Conclusion

Children with SLI and adults with anomic aphasia showed a similar pattern of
verb-noun performance in relation to context-effects (picture naming vs. con-
nected speech) on lexical retrieval. The findings reveal that the verb specific nam-
ing impairment observed reported in both language impaired groups during a
picture confrontation task involving concrete verbs (and nouns) does not resur-
face in connected speech.
 Lexical retrieval deficits in anomic aphasia and specific language impairment (SLI) 

Overall, there seems to be no direct, one-to-one relationship between the

production of verbs/nouns in connected speech, and the retrieval and naming of
these word types in isolation. Children with SLI and adults with anomic aphasia
showed a differential retrieval performance according to context, with poorer
naming than word retrieval in connected speech. It is conceivable, that mul-
tiple factors influenced greater retrieval success for verbs in connected speech.
These include the lexical characteristics of the target words (e.g. lexical-semantic
heaviness or specificity), the interactions among activations at different linguis-
tic levels (i.e. semantic, phonological) and the cognitive demands of the experi-
mental tasks on verb use (e.g. contextual influences on lexical retrieval).
To conclude, children with SLI and adults with anomic aphasia showed sig-
nificant difficulty naming verbs compared to nouns on picture confrontation
naming tasks but the verb deficit did not surface in connected speech. As such,
verb deficits cannot serve as an overall, distinctive clinical characteristic for either
­language-impaired group but only as a clinical characteristic in the context of
naming in light of preserved verb entries.

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Authors’ addresses
Maria Kambanaros Willem van Steenbrugge
Department of Rehabilitation Sciences Flinders University of South Australia
Cyprus University of Technology Department of Speech Pathology
Vragadinou 15 and Audiology
3041 Limassol G.P.O. Box 2100
Cyprus 5001 Adelaide
South Australia
maria.kambanaros@cut.ac.cy
willem.vansteenbrugge@flinders.edu.au