June 24th, 2010
11:03 AM ET

Why am I mixing up my words? Is this a learning disability?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Matthew, Mount Laurel, New Jersey

"I'm 45. Don't smoke, drink. Married since '93. Have 11-year-old sons, both diagnosed with Asperger's but mainstream and doing fine. Over the past year or so, I've caught myself saying a similar word to the one I'm thinking. Talking about pouring a "box" instead of bowl of cereal. Calling the boys down for "breakfast" instead of dinner. Reminding them to eat their "hot dog'"when they're clearly holding a hamburger. My family notes when this happens and it's worrying me. My wife (a special ed teacher) believes it's a learning disability and it's just becoming more pronounced as I age. I did go to speech lessons in elementary school. Does this sound like anything to look into?"


Language issues like the ones you describe, Matthew, can be relatively innocuous or they may be subtle, early clues about more serious problems occurring in the brain, such as a tumor or infection. You cannot be sure until you are checked out by a doctor, but what you are describing can occur in a brain disorder called aphasia or dysphasia.

It occurs when there is damage to regions of the brain that control language. According to the National Aphasia Association, about 1 million people in the U.S. deal with some form of aphasia. More specifically, your symptoms sound like something neurologists call semantic paraphasia. That is, substituting the word you intend for one that has a similar meaning.

"The word you're substituting is still within the context of the word you mean to say," said Dr. Olajide Williams, a neurologist at Columbia University Medical Center. "Instead of saying 'clock' you say 'watch' or instead of saying 'dinner' you say 'lunch.' Instead of saying 'spoon' you say 'fork,' and on down the line."

Semantic paraphasia is usually due to sudden brain trauma, such as a stroke or a blow to the head. Your symptoms sound different - like they have developed gradually. According to Williams, that would rule out a stroke, which typically occurs suddenly.  And he says that speech problems related to semantic paraphasia usually happen alongside other communication problems involving writing, reading, repetition and comprehension.

In your case, that may or may not rule out semantic paraphasia. What is left are a host of other possibilities. Neurodegenerative disorders, brain tumors, and brain infections affecting language areas of the brain could also be to blame.

Now before you become too concerned, you should follow your instinct and look into this further. Seek the advice of a neurologist, who will most likely give you a comprehensive language exam. The exam involves an evaluation of your speech - from basics to more complex tasks. You may also be tested for reading, writing and grammar to try to pick up brain abnormalities.

An important part of this complex equation is that you have had your symptoms for a relatively short period of time, so if there is a problem, you have a better chance of addressing it.

Good luck Matthew.

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