Test for verbal fluency in children of preschool and primary school age

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This study implemented a verbal fluency test in a Bulgarian sample of children. The test consists of two parts – phonemic level and semantic level. In the study, the children were with typical development and those with language disorders. All children were from preschool and first grade. All examined children showed better results in the semantic part of the test than in the phonemic part. Therefore, the semantic level of the test was easier for all children compared to the phonemic level. Furthermore, generating forenames has proved a difficult task for children with language disorders. The improvement in fluency for words with the same initial sound reflected the development of a strategy of switching from one word to another. Semantic fluency was related to the enrichment of semantic knowledge and more efficient access to this knowledge. The verbal fluency tests could support the diagnosis of developmental disorders, which is important for examining children with learning disabilities in preschool and first grade.


Verbal Fluency, Typical Development Children, Children with Language Disorders


Verbal fluency tasks are widely used in cognitive psychology and neuropsychological assessment of search strategy and the process of retrieving information from the lexicon and semantic memory. The most commonly used tasks are for phonemic fluency, where subjects must generate as many words as possible starting with a specific letter within a limited time (Raskin et al., 1992; Troyer, 2000), as well as semantic fluency, where words must belong to a certain semantic category such as “fruits”, “supermarket”, etc. According to studies conducted during childhood, the number of words produced by children aged 5-11 years was greater on semantic fluency tasks than on word-first fluency tasks, suggesting that the semantic fluency task is easier (Riva et al., 2000).

In research, conducted in Sarajevo, Bosnia and Herzegovina, a test of verbal fluency with three different semantic categories (animals, food and musical instruments) was used for 133 children aged 3-6 years. The results confirm the effect of age on semantic fluency improvement. Given the rapid improvement of semantic fluency in preschool children, it is very important to actively promote its development in the early years (Memisevic et al., 2017). In fact, retrieving words beginning with the same letter requires studying more subsets of words than retrieving exemplars from a given semantic category (Monsch et al., 1992; Troyer et al., 1997). Regarding age differences in childhood, Riva et al. reported a clear age-related improvement in a semantic fluency test (Riva et al., 2000).

Verbal fluency tests are related to word knowledge, which depends on access to semantic memory and vocabulary capacity (Ruff et al., 1997; Sergeant et al., 2002). They are used to assess executive functions and related them abilities, such as working memory, attention, and inhibition (Baldo et al., 2001; Henry & Crawford, 2004; Van der Elst et al., 2006). Analysis of the strategic process of word retrieval emphasizes two types of processes—grouping (clustering) and switching (Beatty et al., 1989; Troyer, 2000). The switching process involves the search and retrieval of different semantic or phonemic subcategories, and the clustering process involves the search and retrieval of exemplars from the same subcategory. Therefore, regardless of the type of fluency (letter vs. semantics), a system was created to assess phonemic or semantic cluster and phonemic or semantic mastery of switching processes during word production with three main indicators: the number of switches, the number of clusters and average cluster size (Abwender et al., 2001). The number of switches and clusters is related to the capacity of frontal areas, reflecting the cognitive flexibility required to search for a new subcategory. The average cluster size associated with temporal lobe functions is thought to measure the extent of the knowledge network for a given subcategory (Robert et al., 1997; Troyer, 2000; Troyer et al., 1997). These assumptions are supported by several neuropsychological studies showing a reduction in the number of switches in patients with frontal lobe lesions (Randolph et al., 1993), and smaller cluster sizes in patients with temporal lobe lesions (N’Kaoua et al., 2001; Troyer et al., 1998). Thus, both the number of switches and the number of clusters can be indicators of the information retrieval process, while cluster size reflects the extent of lexico-semantic knowledge.

The purpose of the study is to standardize the verbal fluency test in a Bulgarian sample of preschool and first grade children and to compare the results with those of children of the same age with language deficits.

Material and Methods


Children from two age groups were studied. One group was children from the preschool group in the kindergarten (preschool group), with 18 being controls with a mean age of 6.2 years and 18 with language deficits (experimental group) with a mean age of 6.3 years. The other group were children from the first grade of the general education school (primary school group) – 33 controls with an average age of 7.6 years and 12 with language deficits (experimental group) with an average age of 7.5 years.


A verbal fluency test with phonemic and semantic levels was used.

Phonemic level instruction was:

  • I will tell you a sound. You will tell me as many words as possible that start with that sound. You will have one minute. You are not allowed to say proper names (names of people, cities or countries).
  • Now say as many words as possible that start with a sound: “K”.
  • Now say as many words as possible that start with a sound: “P”.
  • Now say as many words as possible that start with a sound: “Ж”.

All responses within 1 minute are recorded. The initial letters for the words that will be generated by the child are selected according to frequency.

Instruction for the semantic level was:

  • Now forget all the rules I told you in the previous task. I would like you to say as many names as possible that can start with different sounds. You have 1 minute again.
  • Now tell me as many personal names as possible.
  • Now tell me as many names of fruits and vegetables as possible.
  • Now tell me as many animal names as you can.

To make sure that the child knows what a noun is, we give him an example close to himself. All responses within 1 minute are recorded.

Results and Discussion

Multivariate MANOVA analyses of variance were conducted with the data from all groups of examined children. Results were compared between the preschool and first-grade groups for both the controls and the experimental group. An analysis was made of the achievements between the two groups for each age separately. When conducting the test, certain difficulties were observed in switching from the first (phonemic) to the second (semantic, categorical) task, which reflects the executive control performed by the children.

Regarding the phonemic level, there were no significant differences in the controls according to age, but only according to the initial letter of the words generated by the child. There were significant differences between the initial letters in the words: between “К” and “П” (F= 4.5, p<0.05), between “П” and “Ж” (F=17.5, p<0.001) and between “К” and “Ж” (F=37.8, p<0.001; Figure 4.1).

Figure 4.1. Phonemic level for the control group

The most words were generated with the initial letter with the highest frequency of use – “K”, and the least with this letter, which is used least often – “Ж”. The semantic level of the verbal fluency test in the controls was without statistical significance both for the age factor and between semantic clusters.

In the experimental group, there was a significant age difference in the phonemic level due to a lower number of words generated by the children in the preschool group compared to those in the first grade (F=21.3, p<0.001; Figure 4.2).

Figure 4.2. Phonemic level for the experimental group

Regarding words starting with a certain letter, there was a weak statistical significance between the initial letters “П” and “Ж” (F=5.4, p<0.05), and a strong significance between “К” and “Ж” (F=15.5, p<0.001; Figure 4.2).

In the experimental group for the semantic level, there was no statistical significance according to age (p>0.05; Figure 4.3). There was no statistical significance between the studied semantic categories, except for a slight significance difference between the categories of names and animals (F=6.3, p<0.05), where there are more words for animals than for names (Figure 4.3).

Figure 4.3. Semantic level for the experimental group

From the comparisons of control and experimental groups, it was found that there were significant differences only in terms of the phonemic level of the verbal fluency test (F=13.3, p<0.001). Children in the control group said many more words, regardless of what the initial letter was. For this level there was a strong statistical significance also according to age (F=9.7, p<0.001). Older children in both controls and those with language deficits produced more words per minute (Figure 4.4, A and B).

Figure 4.4. Comparisons of control and experimental groups (A: preschool groups; B: elementary school groups)


The phonemic level of verbal fluency in the Bulgarian sample is more difficult than the semantic level, which is also confirmed by the research of other authors in other languages (Riva et al., 2000). This trend was maintained for both the control group of children and the group of children with language deficits. In both groups of children (control and experimental), the number of words generated per minute was closely related to the frequency of use of the initial sound in the word. Words starting with the sound “K”, which is high-frequency in the Bulgarian language, are significantly more than those starting with the sound “Ж”, which is low-frequency. On the other hand, significantly more words were generated by the preschool and first-grade children from the control group compared to the experimental group.

The semantic categorization task gives us information on general cognitive functioning. For poorer results in the semantic domain, therapy will be directed to the semantic fields and networks. The lack of semantic networks leads to difficulties in comprehension. In the case of poor results in the phonemic area, the therapy is aimed at developing phonological abilities and syntax.

When conducting the test for verbal fluency, in addition to showing the children’s verbal abilities, it also gives us information about the executive control they perform when switching from the first to the second task as well as the ability to free themselves from the influence of the first (phonemic) task and begin the second (categorical, semantic) task. Difficulties of this nature when switching from one task to another were observed in both groups of participants, and in the experimental group, they were more, which indicates a lack of flexibility in the implementation of executive control. Also, verbal fluency tests are widely used to assess cognitive functions such as semantic memory, suppression of irrelevant stimuli and attention in short-term executive tests, supporting the diagnosis of developmental disorders, attention deficit and hyperactivity disorders, which is important for research of a normative group in preschool and first grade.

Improvement in fluency for words with the same initial sound reflects the development of a strategic switching component, whereas semantic fluency is related to the enrichment of semantic knowledge and more efficient access to that knowledge. According to this view, poor performance on fluency tests may be an early sign of difficulties in both gist retrieval (and, more generally, executive functions) and the acquisition of semantic network skills (Sauzeon et al. al., 2004).


This research was funded by the Scientific Research Institute of the Ministry of Education and Science, project DN05/14 from 2016.


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