ABSTRACT Most adults use inner speech, the little voice in one's head, in daily life, but the experience of inner speech is not well understood for adults in middle and older age. Here, we used an adapted online version of the General Inner Speech Questionnaire to examine inner speech use in a group of 126 adults age 40 and above. Results confirm that middle‐ and older‐aged adults use inner speech regularly for a variety of expected topics/purposes, such as executive functioning, emotional processing, and self‐reflection. An exploratory factor analysis reveals nine dimensions in the questionnaire, with “emotions and the past” perhaps being the most salient factor. Finally, comparison to previous work in young adults reveals some meaningful differences, including that older adults report less frequent use of inner speech. Together, these findings provide preliminary insight into the experience of inner speech in adults across the lifespan.

PURPOSE:This single-subject design study examined whether self-reported inner speech (IS)-the subjective experience of retrieving a word internally-can predict item-level outcomes in a cueing-based naming treatment for individuals with poststroke aphasia. METHOD:Five adults with chronic, poststroke aphasia completed an IS self-report task and naming task to identify appropriate treatment stimuli in two categories: successful IS (sIS) and unsuccessful IS (uIS). Participants then completed 2 weeks of hierarchical, cueing-based naming treatment targeting both sIS and uIS items. Treatment effects were analyzed using Tau U and mixed-effects models, with additional insights from visual analysis of individual performance. RESULTS:In four of five participants, naming accuracy improved significantly for sIS items but not for uIS items. The participant who did not show treatment-based learning had the most severe aphasia and apraxia of speech among the group. Mixed-effects models confirmed that self-reported IS significantly predicted posttreatment naming accuracy, even when controlling for aphasia severity and baseline naming performance. The relationship between self-reported IS and naming accuracy also changed over time, as naming accuracy for sIS items increased to more closely align with participants' initial reports of sIS. CONCLUSIONS:Self-reported IS can serve as a clinically useful predictor of naming treatment outcomes in some individuals with aphasia. These findings support our hypotheses and suggest that IS can be a useful tool for guiding treatment stimulus selection and monitoring change during naming therapy. Future research should continue to explore individual variability in the relationship between IS and naming treatment response. SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.31865308.

Research over the past several decades has revealed that non-linguistic cognitive impairments can appear alongside language deficits in individuals with aphasia. One vulnerable cognitive domain is executive function, an umbrella term for the higher-level cognitive processes that allow us to direct our behavior towards a goal. Studies in healthy adults reveal that executive function abilities are supported by inner speech, the ability to use language silently in one’s head. Therefore, inner speech may mediate the connection between language and executive function deficits in individuals with aphasia.Here, we investigated whether inner speech ability may link language and cognitive impairments in 59 adults with chronic, post-stroke aphasia. We used two approaches to measure inner speech: one based on internal retrieval of words and one based on internal retrieval plus silent manipulation of the retrieved phonological forms. Then, we examined relationships between these two approaches to measuring inner speech and five aspects of executive function ability: response inhibition, conflict monitoring/resolution, general task-switching ability, phonological control, and semantic control. We also looked for dissociations between inner speech ability and executive function ability.Our results show tentative relationships between inner speech (across multiple measurement approaches) and all aspects of executive function except for response inhibition. We also found evidence for a double dissociation: many participants show intact executive function despite poor inner speech, and vice versa, so neither process is strictly reliant on the other. We suggest that this work provides preliminary evidence of a bidirectional relationship between inner speech and executive function: inner speech supports some aspects of executive function via internal self-cueing and certain aspects of executive function support performance on complex inner speech tasks.

Purpose: Picture stimuli are essential materials for language research and clinical practice. Here, we generated a modern, full-color set of 310 illustrations representing a carefully designed, culturally sensitive list of imageable nouns. We normed the images in a diverse sample of healthy adults, so the images can be used in various populations, including older adults. Method: We recruited a diverse online sample of 200 adults ages 19–76 years. Participants typed a name for each picture and reported how familiar they were with the item (familiarity) and how well the illustration matched their mental image of the item (image agreement). We assessed relationships among these three measures, between these measures and word features (e.g., frequency, length), and between these measures and demographic characteristics of our sample. Results: Two hundred ninety-seven of 310 items had 70% or higher name agreement among participants. Most items had good to excellent image agreement and familiarity. The image measures showed expected relationships with relevant word features (e.g., frequency, length). Older age was associated with higher image agreement and familiarity but not written naming accuracy. As a group, Black participants demonstrated lower written naming accuracy than White and mixed race participants. Education, sex, and self-reported multilingualism were not significantly related to image measures. Conclusions: We generated a novel set of illustrations with strong name agreement, familiarity, and image agreement, which are suitable for a variety of uses in research and clinical settings. Our normative data suggest a future need for item-level analysis to explore variability in performance across different racial groups. Supplemental Material: https://doi.org/10.23641/asha.26321926

PURPOSE:Adults with acquired communication disorders are particularly vulnerable to potential negative effects from the changes that arose during the COVID-19 pandemic. In this longitudinal study, we asked: How did the self-perceived impacts of the pandemic on adults with acquired communication disorders change over time? METHOD:We developed an online survey to investigate changes in day-to-day behaviours, psychosocial elements, and communication abilities among members of a community-based stroke recovery centre in the USA. Participants included adults with aphasia or other cognitive-communication disorder from stroke or brain injury. We compared survey responses from summer 2020 (n = 50) and summer 2021 (n = 24) using a concurrent mixed methods design. RESULT:The impacts of the pandemic changed over time. By 2021, participants reported a more "normal" amount of time spent on in-person socialising and healthcare, improved quality of life and connectedness to others, and an improvement in overall communication ability. Across both years, participants shared comments regarding changes in routine, increased use of technology, and the positive benefit of therapy groups. CONCLUSION:Self-perceived psychosocial elements and communication abilities among stroke and other brain injury survivors changed over the course of the pandemic. Clinicians and researchers should continue providing this population with support and opportunities for engagement.

Despite the many mistakes we make while speaking, people can effectively communicate because we monitor our speech errors. However, the cognitive abilities and brain structures that support speech error monitoring are unclear. There may be different abilities and brain regions that support monitoring phonological speech errors versus monitoring semantic speech errors. We investigated speech, language, and cognitive control abilities that relate to detecting phonological and semantic speech errors in 41 individuals with aphasia who underwent detailed cognitive testing. Then, we used support vector regression lesion symptom mapping to identify brain regions supporting detection of phonological versus semantic errors in a group of 76 individuals with aphasia. The results revealed that motor speech deficits as well as lesions to the ventral motor cortex were related to reduced detection of phonological errors relative to semantic errors. Detection of semantic errors selectively related to auditory word comprehension deficits. Across all error types, poor cognitive control related to reduced detection. We conclude that monitoring of phonological and semantic errors relies on distinct cognitive abilities and brain regions. Furthermore, we identified cognitive control as a shared cognitive basis for monitoring all types of speech errors. These findings refine and expand our understanding of the neurocognitive basis of speech error monitoring.

Optimal performance in any task relies on the ability to detect and correct errors. The anterior cingulate cortex and the broader posterior medial frontal cortex (pMFC) are active during error processing. However, it is unclear whether damage to the pMFC impairs error monitoring. We hypothesized that successful error monitoring critically relies on connections between the pMFC and broader cortical networks involved in executive functions and the task being monitored. We tested this hypothesis in the context of speech error monitoring in people with post-stroke aphasia. Diffusion weighted images were collected in 51 adults with chronic left-hemisphere stroke and 37 age-matched control participants. Whole-brain connectomes were derived using constrained spherical deconvolution and anatomically-constrained probabilistic tractography. Support vector regressions identified white matter connections in which lost integrity in stroke survivors related to reduced error detection during confrontation naming. Lesioned connections to the bilateral pMFC were related to reduce error monitoring, including many connections to regions associated with speech production and executive function. We conclude that connections to the pMFC support error monitoring. Error monitoring in speech production is supported by the structural connectivity between the pMFC and regions involved in speech production, comprehension, and executive function. Interactions between pMFC and other task-relevant processors may similarly be critical for error monitoring in other task contexts.

Spoken sentences are continuous streams of sound, without reliable acoustic cues to word boundaries. We have previously proposed that language learners identify words via an implicit statistical learning mechanism that computes transitional probabilities between syllables. Neuroimaging studies in healthy young adults associate this learning with left inferior frontal gyrus, left arcuate fasciculus, and bilateral striatum. Here, we test the effects of healthy aging and left hemisphere (LH) injury on statistical learning. Following 10-minute exposure to an artificial language, participants rated familiarity of Words, Part-words (sequences spanning word boundaries), and Non-words (unfamiliar sequences). Young controls (N = 14) showed robust learning, rating Words > Part-words > Non-words. Older controls (N = 28) showed this pattern to a weaker degree. Stroke survivors (N = 24) as a group showed no learning. A lesion comparison examining individual differences revealed that "non-learners" are more likely to have anterior lesions. Together, these findings demonstrate that word segmentation is sensitive to healthy aging and LH injury.

Purpose The COVID-19 pandemic has led to stay-at-home orders and social distancing guidelines that have the potential to greatly impact individuals' behavior and social engagement. Adults recovering from stroke or other brain trauma, who often have communication difficulties and other long-term challenges, are a population already at risk of isolation and lower quality of life. We investigated the impact of public health guidelines and related behavioral changes on self-perceptions of communication abilities and psychosocial factors in this population. Method The Stroke Comeback Center, a community-based center for stroke and other brain trauma survivors with communication impairments, disseminated an online survey to current members to investigate changes in communication, social engagement, and quality of life. Results Participants ( N = 50) reported a number of changes in their day-to-day activities that reflect the current social distancing guidelines, such as reduced outings into the community and fewer in-person conversations with those living outside one's home. Overall, feelings of connectedness to others and overall quality of life were reported to be decreased when compared to before the COVID-19 pandemic, whereas receptive language abilities and technology skills were reported to have improved. Perhaps most interestingly, certain behavioral changes (including healthy movement activities and participation in virtual programs) had specific relationships with perceived communication abilities and social engagement. Conclusions Changes in daily life resulting from the COVID-19 pandemic have had a tangible impact on self-perceived psychosocial elements (e.g., quality of life) and communication abilities among stroke and other brain trauma survivors. Clinicians and researchers may consider these perceived changes when engaging with this population as the effects of the pandemic continue and in the period of community re-entry that may follow. Supplemental Material https://doi.org/10.23641/asha.14830881

Anosognosia, or lack of self-awareness, is often present following neurological injury and can result in poor functional outcomes. The specific phenomenon of intellectual awareness, the knowledge that a function is impaired in oneself, has not been widely studied in post-stroke aphasia. We aim to identify behavioral and neural correlates of intellectual awareness by comparing stroke survivors' self-reports of anomia to objective naming performance and examining lesion sites. Fifty-three participants with chronic aphasia without severe comprehension deficits rated their naming ability and completed a battery of behavioral tests. We calculated the reliability and accuracy of participant self-ratings, then examined the relationship of poor intellectual awareness to speech, language, and cognitive measures. We used support vector regression lesion-symptom mapping (SVR-LSM) to determine lesion locations associated with impaired and preserved intellectual awareness. Reliability and accuracy of self-ratings varied across the participants. Poor intellectual awareness was associated with reduced performance on tasks that rely on semantics. Our SVR-LSM results demonstrated that anterior inferior frontal lesions were associated with poor awareness, while mid-superior temporal lesions were associated with preserved awareness. An anterior-posterior gradient was evident in the unthresholded lesion-symptom maps. While many people with chronic aphasia and relatively intact comprehension can accurately and reliably report the severity of their anomia, others overestimate, underestimate, or inconsistently estimate their naming abilities. Clinicians should consider this when administering self-rating scales, particularly when semantic deficits or anterior inferior frontal lesions are present. Administering self-ratings on multiple days may be useful to check the reliability of patient perceptions.

Purpose: Anomia, or difficulty with naming and word finding, is a pervasive deficit among individuals with aphasia. There is an extensive literature on the mechanisms underlying anomia and on approaches to treatment, but very little is known about the subjective experience of anomia during day-to-day life.Method: As part of a larger testing battery, 53 adults with poststroke aphasia took part in a novel, structured interview that included an open-ended question about the general experience of anomia: “Do you ever know what you want to say, but you can’t say it out loud? Please describe that feeling.” Video-recorded interview responses were transcribed and analyzed using thematic analysis, an iterative, data-driven process that categorizes interview data into common themes.Results: Five main themes emerged among the data from 37 participants who produced adequate responses for use in thematic analysis: strategies to cope with or compensate for anomia, comments on awareness of the level of breakdown (e.g., I have an idea, but can’t get the right words), negative emotions, impact on relationships, and changes in frequency over time.Conclusions: Participants showed strong awareness of anomia and its implications, demonstrating an ability to describe their language breakdown, identify relevant strategies to compensate and/or cope, and acknowledge the impact of anomia on their emotions and social interactions. This patient perspective may serve as a valuable supplement to information typically gained via objective language assessments. Clinicians and researchers may wish to consider incorporating similar subjective measures during assessment and treatment planning.Supplemental Material S1. Complete list of participant responses. Responses are shown in full, separated into those that were included in the analysis (n = 37) and those that were excluded due to limited content (n = 16). Comments by the interviewer are included in brackets and begin with “MEF.” Any names used have been replaced with a single initial in brackets for anonymity, e.g., [D].Fama, M. E., Lemonds, E., & Levinson, G. (2021). The subjective experience of word-finding difficulties in people with aphasia: A thematic analysis of interview data. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2021_AJSLP-20-00265Publisher Note: This article is part of the Special Issue: Select Papers From the 50th Clinical Aphasiology Conference.

Purpose: Anomia, or difficulty with naming and word finding, is a pervasive deficit among individuals with aphasia. There is an extensive literature on the mechanisms underlying anomia and on approaches to treatment, but very little is known about the subjective experience of anomia during day-to-day life. Method: As part of a larger testing battery, 53 adults with poststroke aphasia took part in a novel, structured interview that included an open-ended question about the general experience of anomia: “Do you ever know what you want to say, but you can't say it out loud? Please describe that feeling.” Video-recorded interview responses were transcribed and analyzed using thematic analysis, an iterative, data-driven process that categorizes interview data into common themes. Results: Five main themes emerged among the data from 37 participants who produced adequate responses for use in thematic analysis: strategies to cope with or compensate for anomia, comments on awareness of the level of breakdown (e.g., “I have an idea, but can't get the right words”), negative emotions, impact on relationships, and changes in frequency over time. Conclusions: Participants showed strong awareness of anomia and its implications, demonstrating an ability to describe their language breakdown, identify relevant strategies to compensate and/or cope, and acknowledge the impact of anomia on their emotions and social interactions. This patient perspective may serve as a valuable supplement to information typically gained via objective language assessments. Clinicians and researchers may wish to consider incorporating similar subjective measures during assessment and treatment planning. Supplemental Material https://doi.org/10.23641/asha.15032643

Neuroimaging studies have implicated left temporal lobe regions in audiovisual integration of speech and inferior parietal regions in temporal binding of incoming signals. However, it remains unclear which regions are necessary for audiovisual integration, especially when the auditory and visual signals are offset in time. Aging also influences integration, but the nature of this influence is unresolved. We used a McGurk task to test audiovisual integration and sensitivity to the timing of audiovisual signals in two older adult groups: left hemisphere stroke survivors and controls. We observed a positive relationship between age and audiovisual speech integration in both groups, and an interaction indicating that lesions reduce sensitivity to timing offsets between signals. Lesion-symptom mapping demonstrated that damage to the left supramarginal gyrus and planum temporale reduces temporal acuity in audiovisual speech perception. This suggests that a process mediated by these structures identifies asynchronous audiovisual signals that should not be integrated.

Purpose Typical language users can engage in a lively internal monologue for introspection and task performance, but what is the nature of inner speech among individuals with aphasia? Studying the phenomenon of inner speech in this population has the potential to further our understanding of inner speech more generally, help clarify the subjective experience of those with aphasia, and inform clinical practice. In this scoping review, we describe and synthesize the existing literature on inner speech in aphasia. Method Studies examining inner speech in aphasia were located through electronic databases and citation searches. Across the various studies, methods include both subjective approaches (i.e., asking individuals with aphasia about the integrity of their inner speech) and objective approaches (i.e., administering objective language tests as proxy measures for inner speech ability). The findings of relevant studies are summarized. Results Although definitions of inner speech vary across research groups, studies using both subjective and objective methods have established findings showing that inner speech can be preserved relative to spoken language in individuals with aphasia, particularly among those with relatively intact word retrieval and difficulty primarily at the level of speech output processing. Approaches that combine self-report with objective measures have demonstrated that individuals with aphasia are, on the whole, reliably able to report the integrity of their inner speech. Conclusions The examination of inner speech in individuals with aphasia has potential implications for clinical practice, in that differences in the preservation of inner speech across individuals may help guide clinical decision making around aphasia treatment. Although there are many questions that remain open to further investigation, studying inner speech in this specific population has also contributed to a broader understanding of the mechanisms of inner speech more generally.

The brain structures and cognitive abilities necessary for successful monitoring of one's own speech errors remain unknown. We aimed to inform self-monitoring models by examining the neural and behavioral correlates of phonological and semantic error detection in individuals with post-stroke aphasia. First, we determined whether detection related to other abilities proposed to contribute to monitoring according to various theories, including naming ability, fluency, word-level auditory comprehension, sentence-level auditory comprehension, and executive function. Regression analyses revealed that fluency and executive scores were independent predictors of phonological error detection, while a measure of word-level comprehension related to semantic error detection. Next, we used multivariate lesion-symptom mapping to determine lesion locations associated with reduced error detection. Reduced overall error detection related to damage to a region of frontal white matter extending into dorsolateral prefrontal cortex. Detection of phonological errors related to damage to the same areas, but the lesion-behavior association was stronger, suggesting that the localization for overall error detection was driven primarily by phonological error detection. These findings demonstrate that monitoring of different error types relies on distinct cognitive functions, and provide causal evidence for the importance of frontal white matter tracts and the dorsolateral prefrontal cortex for self-monitoring of speech.

Many individuals with aphasia report the ability to say words in their heads despite spoken naming difficulty. Here, we examined individual differences in the experience of inner speech (IS) in participants with aphasia to test the hypotheses that self-reported IS reflects intact phonological retrieval and that articulatory output processing is not essential to IS. Participants (N = 53) reported their ability to name items correctly internally during a silent picture-naming task. We compared this measure of self-reported IS to spoken picture naming and a battery of tasks measuring the underlying processes required for naming (i.e., phonological retrieval and output processing). Results from three separate analyses of these measures indicate that self reported IS relates to phonological retrieval and that speech output processes are not a necessary component of IS. We suggest that self-reported IS may be a clinically valuable measure that could assist in clinical decision-making regarding anomia diagnosis and treatment.

Two maintenance mechanisms with separate neural systems have been suggested for verbal working memory: articulatory-rehearsal and non-articulatory maintenance. Although lesion data would be key to understanding the essential neural substrates of these systems, there is little evidence from lesion studies that the two proposed mechanisms crucially rely on different neuroanatomical substrates. We examined 39 healthy adults and 71 individuals with chronic left-hemisphere stroke to determine if verbal working memory tasks with varying demands would rely on dissociable brain structures. Multivariate lesion-symptom mapping was used to identify the brain regions involved in each task, controlling for spatial working memory scores. Maintenance of verbal information relied on distinct brain regions depending on task demands: sensorimotor cortex under higher demands and superior temporal gyrus (STG) under lower demands. Inferior parietal cortex and posterior STG were involved under both low and high demands. These results suggest that maintenance of auditory information preferentially relies on auditory-phonological storage in the STG via a nonarticulatory maintenance when demands are low. Under higher demands, sensorimotor regions are crucial for the articulatory rehearsal process, which reduces the reliance on STG for maintenance. Lesions to either of these regions impair maintenance of verbal information preferentially under the appropriate task conditions.

Purpose Individuals with aphasia often report that they feel able to say words in their heads, regardless of speech output ability. Here, we examine whether these subjective reports of successful "inner speech" (IS) are meaningful and test the hypothesis that they reflect lexical retrieval. Method Participants were 53 individuals with chronic aphasia. During silent picture naming, participants reported whether or not they could say the name of each item inside their heads. Using the same items, they also completed 3 picture-based tasks that required phonological retrieval and 3 matched auditory tasks that did not. We compared participants' performance on these tasks for items they reported being able to say internally versus those they reported being unable to say internally. Then, we examined the relationship of psycholinguistic word features to self-reported IS and spoken naming accuracy. Results Twenty-six participants reported successful IS on nearly all items, so they could not be included in the item-level analyses. These individuals performed correspondingly better than the remaining participants on tasks requiring phonological retrieval, but not on most other language measures. In the remaining group ( n = 27), IS reports related item-wise to performance on tasks requiring phonological retrieval, but not to matched control tasks. Additionally, IS reports were related to 3 word characteristics associated with lexical retrieval, but not to articulatory complexity; spoken naming accuracy related to all 4 word characteristics. Six participants demonstrated evidence of unreliable IS reporting; compared with the group, they also detected fewer errors in their spoken responses and showed more severe language impairments overall. Conclusions Self-reported IS is meaningful in many individuals with aphasia and reflects lexical phonological retrieval. These findings have potential implications for treatment planning in aphasia and for our understanding of IS in the general population.

Purpose This article furthers the conversation about how speech-language pathologists (SLPs) can incorporate an understanding of language variation as they provide services to multicultural populations—particularly African Americans, a population that disproportionately receives speech-language pathology services yet is underrepresented within the speech-language pathology community. We call for moving beyond discussions of linguistic difference versus deficit that tend to largely focus on strategies to avoid penalizing dialect speakers and moving toward investigations of other cultural, social, and linguistic considerations that hold immediate and practical importance. In addition, we share insights and recommendations from 2 SLPs with training in sociolinguistics who draw upon an understanding of language variation, particularly African American English (AAE), in their work. Conclusion There are a number of methods that SLPs can use in their practices that incorporate knowledge about AAE to empower African American clientele. To further benefit this population, there must be an increase in the percentage of SLPs who speak and use AAE and the percentage who apply sociolinguistic understandings of language variation to assessment and intervention. More research is needed that explores SLPs' experiences working with clientele who speak AAE and other varieties—notably, how they perceive and understand AAE and how this impacts their practice.