How to talk to someone with aphasia

Aphasia is a language disorder, most often caused by a stroke. It can affect speaking, understanding, reading and writing, in any combination and to any degree. It does not affect intelligence.

That last sentence is the one worth keeping hold of. The person in front of you has not become a different person, and they have not become a child. They have lost access to words, which is not the same as having lost thoughts. Almost everything useful in this page follows from that.

If you are reading this a few days or weeks after a stroke, you are probably exhausted and improvising. Nobody hands you a manual for this. What follows is what speech-language pathologists teach families, put plainly.

Start by assuming they understand

Keep your ordinary voice. Aphasia is not deafness and it is not confusion, so speaking loudly or slowly-and-brightly, as you might to a small child, lands as an insult even when it is meant kindly. People with aphasia notice this, and it is one of the most commonly reported frustrations.

Talk about real things. Their work, the news, the family argument, the football. An adult conversation held slowly is still an adult conversation. A stream of simplified small talk is not.

When a word will not come, it helps to say so out loud in a way that puts you both on the same side of the problem. Something like "I know you know this one" does more than it looks like it does.

And when other people are in the room, keep talking to them rather than about them. Being discussed in the third person while present is one of the fastest ways for someone to stop trying.

Helping them follow you

• One idea per sentence. Short sentences, and a pause between them. Not baby talk, just less at once.
• Slow down rather than speak up. Volume does not help. Pace does.
• Use your hands. Gesture while you speak, naturally. Most people do this anyway and then stop when they are concentrating, which is exactly when it helps most.
• Write down the key word. Large, clear, one or two words. Keep a pen and paper on the table where you usually talk.
• Show one thing at a time. One photo, one option, one piece of paper.
• Turn the television off. Background noise costs them far more effort than it costs you.
• Watch their face. You will usually see the moment something lands, and the moment it does not.

Helping them say what they mean

• Ask yes or no questions when it is hard. "Are you in pain?" is answerable on a bad day. "How are you feeling?" may not be.
• One question at a time. Two questions in one breath usually gets you an answer to neither.
• Offer a choice instead of an open question. "Tea or coffee?" is far easier than "What would you like to drink?" Naming the options gives them the words to reuse.
• Invite the other routes in. Pointing, gesture, drawing, writing the first letter, finding it on a phone. None of these are giving up. They are the message getting through.
• Give it time. Longer than feels comfortable. Count to ten before you step in. The silence is work, not failure.

Check that you actually got it

It is tempting, when someone has struggled to say something, to nod and move on. Do not. People with aphasia can nearly always tell when they have been humoured, and it teaches them that the effort was pointless.

Say back what you think you heard. "Let me make sure I have this. You want to ring your brother, not your son." Give them the chance to correct you. After a longer conversation, recap the whole thing briefly.

If you truly did not understand, say so honestly and try a different route. "I did not get that one. Can you show me?" is better than a false yes.

What to avoid

• Finishing their sentences, unless they have asked you to. This one genuinely divides people. Some find it a relief, others find it maddening. It is worth asking them directly which they prefer, on a good day, and then doing that.
• Correcting every word. If you understood the meaning, let the wrong word go. Conversation is not practice.
• Quizzing. "What's this called? Come on, you know this." Naming drills are something their speech-language pathologist may ask you to do in a specific way. Sprung on someone over dinner, it is a test they did not agree to sit.
• Speaking for them to a third person. Especially to doctors and receptionists. Give them the first go every time.
• Pretending to understand. Covered above, and worth repeating, because it is the easiest one to slip into when you are tired.

About the hard days

Frustration on both sides is normal and it is not a sign that you are doing this badly. Conversations that used to be free now cost effort, and effort runs out. It is allowed to stop, make a cup of tea, and come back to it.

It is also worth saying that this is heavy for the person doing the helping, and that the load is often invisible to everyone else. Aphasia support groups exist for families as well as for patients, and the National Aphasia Association keeps a directory of them.