Abstract
Empirical research studies have emphasized the importance of examining the strategic retrieval processes (i.e., clustering and switching) underlying verbal fluency (VF) performance. This systematic review aimed to summarize existing empirical studies on the development of clustering and switching strategies during VF in typically developing (TD) children and adolescents and further explore strategy use in children with atypical development (AD). A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Most studies used the scoring method developed by Troyer et al. (1997), and some used a combination of the other available approaches (e.g., Abwender et al.’s [2001] method considering the distinction between cluster switching [CS] and hard switching [HS]). The main results suggest that clustering and switching are components that follow distinct developmental trajectories. Indeed, most studies found that the number of clusters and switches, but not the mean cluster size, increases with age, with no differences based on sex. Both the number of clusters and the number of switches drive word productivity. Switches are highly related to VF phonological productivity, while clusters are most related to semantic productivity. Finally, different profiles are observed in AD, with patterns that distinguish between impairment in cognitive flexibility (less switching) and in the organization of semantic and phonological representations (smaller cluster size). This evidence highlights the importance of utilizing qualitative analysis of VF output for understanding strategic retrieval processes and lexico-semantic knowledge in children. Furthermore, it provides valuable data for informing the neuropsychological assessment of executive functions in children and adolescents with typical and atypical development.
Similar content being viewed by others
Data availability
Data sharing not applicable to this article as no datasets were analyzed during the current study.
References
Abwender, D. A., Swan, J. G., Bowerman, J. T., & Connolly, S. W. (2001). Qualitative analysis of verbal fluency output: Review and comparison of several scoring methods. Assessment, 8, 323–336. https://doi.org/10.1177/107319110100800308
Aksamovic, A., Djordjevic, M., Malec, D., & Memisevic, H. (2019). Relationship between the verbal fluency and academic achievement in second and third grade students: the effects of gender and parents’ educational level. Acta Neuropsychologica, 17(2), 139–150.
Arán Filippetti, V. A., & Allegri, R. F. (2011). Verbal fluency in Spanish-speaking children: Analysis model according to task type, clustering, and switching strategies and performance over time. The Clinical Neuropsychologist, 25(3), 413–436. https://doi.org/10.1080/13854046.2011.559481
Arán Filippetti, V., & Richaud, M. C. (2017). A structural equation modeling of executive functions, IQ and mathematical skills in primary students: Differential effects on number production, mental calculus and arithmetical problems. Child Neuropsychology, 23, 864–888. https://doi.org/10.1080/09297049.2016.1199665
Arán Filippetti, V., & Krumm, G. (2020). A hierarchical model of cognitive flexibility in children: Extending the relationship between flexibility, creativity and academic achievement. Child Neuropsychology, 26(6), 770–800. https://doi.org/10.1080/09297049.2019.1711034
Bahrami, H., Nejati, V., & Pooretemad, H. (2014). A comparative study of phonemic and semantic verbal fluency in children and adolescents with developmental stuttering. Zahedan Journal of Research in Medical Sciences, 16, 41–44.
Banerjee, P., Grange, D. K., Steiner, R. D., & White, D. A. (2011). Executive strategic processing during verbal fluency performance in children with phenylketonuria. Child Neuropsychology, 17(2), 105–117. https://doi.org/10.1080/09297049.2010.525502
Becker, N., Piccolo, L. R., & Salles, J. F. (2019). Verbal Fluency Development Across Childhood: Normative Data from Brazilian-Portuguese Speakers and Underlying Cognitive Processes. Archives of Clinical Neuropsychology, 7, 1217–1231. https://doi.org/10.1093/arclin/acz022
Begeer, S., Wierda, M., Scheeren, A. M., Teunisse, J. P., Koot, H. M., & Geurts, H. M. (2014). Verbal fluency in children with autism spectrum disorders: Clustering and switching strategies. Autism, 18(8), 1014–1018. https://doi.org/10.1177/1362361313500381
Borkowska, A. R. (2015). Language and communicative functions as well as verbal fluency in children with high-functioning autism. Journal of Intellectual Disability-Diagnosis and Treatment, 3(3), 147–153. https://doi.org/10.6000/2292-2598.2015.03.03.4
Bokat, C. E., & Goldberg, T. E. (2003). Letter and category fluency in schizophrenic patients: a meta-analysis. Schizophrenia research, 64(1), 73–78. https://doi.org/10.1016/S0920-9964(02)00282-7
Bousfield, W. A., & Sedgewick, C. H. W. (1944). An analysis of sequences of restricted associative responses. Journal of General Psychology, 30, 149–116. https://doi.org/10.1080/00221309.1944.10544467
Chami, S., Munro, N., Docking, K., McGregor, K., Arciuli, J., Baker, E., & Heard, R. (2017). Changes in semantic fluency across childhood: Normative data from Australian-English speakers. International Journal of Speech and Language Pathology, 20, 262–273. https://doi.org/10.1080/17549507.2016.1276214
Chertkow, H., & Bub, D. (1990). Semantic memory loss in dementia of the Alzheimer’s type. Brain, 113, 397–417.
Cermak, C. A., Scratch, S. E., Kakonge, L., & Beal, D. S. (2021). The effect of childhood traumatic brain injury on verbal fluency performance: a systematic review and meta-analysis. Neuropsychology Review, 31, 1–13. https://doi.org/10.1007/s11065-020-09475-z
Cohen, M. J., Morgan, A. M., Vaughn, M., Riccio, C. A., & Hall, J. (1999). Verbal fluency in children: Developmental issues and differential validity in distinguishing children with attention-deficit hyperactivity disorder and two subtypes of dyslexia. Archives of Clinical Neuropsychology, 14, 433–443. https://doi.org/10.1016/S0887-6177(98)00038-9
Esbensen, A., & Thomsen, P. (2021). Word Retrieval and Lexical Organization in Children With Hearing Loss and Developmental Language Disorder. Communication Disorders Quarterly, 42(4), 238–248. https://doi.org/10.1177/1525740120932531
Gonçalves, H. A., Cargnin, C., Jacobsen, G. M., Kochhann, R., Joanette, Y., & Fonseca, R. P. (2017). Clustering and switching in unconstrained, phonemic and semantic verbal fluency: the role of age and school type. Journal of Cognitive Psychology, 29(6), 670–690. https://doi.org/10.1080/20445911.2017.1313259
Gruenewald, P. J., & Lockhead, G. R. (1980). The free recall of category examples. Journal of Experimental Psychology: Human Learning and Memory, 6(3), 225. https://doi.org/10.1037/0278-7393.6.3.225
Hawks, Z. W., Strube, M. J., Johnson, N. X., Grange, D. K., & White, D. A. (2018). Developmental trajectories of executive and verbal processes in children with phenylketonuria. Developmental neuropsychology, 43(3), 207–218. https://doi.org/10.1080/87565641.2018.1438439
Henry, J. D., & Crawford, J. R. (2004a). A Meta-Analytic review of verbal fluency performance following focal cortical lesions. Neuropsychology, 18(2), 284–295. https://doi.org/10.1037/0894-4105.18.2.284
Henry, J. D., & Crawford, J. R. (2004b). Verbal fluency deficits in Parkinson’s disease: a meta-analysis. Journal of the International Neuropsychological Society, 10(4), 608–622. https://doi.org/10.1017/S1355617704104141
Henry, L., Messer, D. J., & Nash, G. (2015). Executive functioning and verbal fluency in children with language difficulties. Learning and Instruction, 39, 137–147. https://doi.org/10.1016/j.learninstruc.2015.06.001
Hurks, P. P. M., Hendriksen, J. G. M., Vles, J. S. H., Kalff, A. C., Feron, F. J. M., Kroes, M., et al. (2004). Verbal fluency over time as a measure of automatic and controlled processing in children with ADHD. Brain and Cognition, 55, 535–544. https://doi.org/10.1016/j.bandc.2004.03.003
Hurks, P. P., Schrans, D., Meijs, C., Wassenberg, R., Feron, F. J. M., & Jolles, J. (2010). Developmental changes in semantic verbal fluency: Analyses of word productivity as a function of time, clustering, and switching. Child Neuropsychology, 16(4), 366–387. https://doi.org/10.1016/j.bandc.2004.03.003
Hurks, P. P. (2012). Does instruction in semantic clustering and switching enhance verbal fluency in children? The Clinical Neuropsychologist, 26(6), 1019–1037. https://doi.org/10.1080/13854046.2012.708361
John, S., & Rajashekhar, S. (2014). Word retrieval ability on semantic fluency task in typically developing Malayalam-speaking children. Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence, 20, 182–195. https://doi.org/10.1080/09297049.2012.760538
John, S., Rajashekhar, B., & Guddattu, V. (2016). Word retrieval ability on phonemic fluency in typically developing children. Applied Neuropsychology: Child, 5(4), 252–263. https://doi.org/10.1080/21622965.2015.1050099
John, S., Rajashekhar, B., & Guddattu, V. (2018). Analysis of verbal fluency output on semantic Categories of ‘food’and ‘vehicle’in typically Developing malayalam speaking children. Psychology of Language and Communication, 22(1), 328–353.
Kavé, G., Kigel, S., & Kochva, R. (2008). Switching and clustering in verbal fluency tasks throughout childhood. Journal of Clinical and Experimental Neuropsychology, 30, 349–359. https://doi.org/10.1080/13803390701416197
Khoddami, S., Mousavi, M., Jafari, S. Z., Dadgar, R., H., & Maroufizadeh, S. (2017). Comparison of Verbal Fluency between Children with Learning Disabilities and Typically Developed. Scientific Journal Rehabilitation Medicine, 6(1), 9–18. https://doi.org/10.22037/JRM.2017.1100423
Kodituwakku, P. W., Adnams, C. M., Hay, A., Kitching, A. E., Burger, E., Kalberg, W. O., & May, P. A. (2006). Letter and category fluency in children with fetal alcohol syndrome from a community in South Africa. Journal of studies on alcohol, 67(4), 502–509. https://doi.org/10.15288/jsa.2006.67.502
Koren, R., Kofman, O., & Berger, A. (2005). Analysis of word clustering in verbal fluency of school-aged children. Archives of Clinical Neuropsychology, 20, 1087–1104. https://doi.org/10.1016/j.acn.2005.06.012
Kosmidis, M. H., Vlahou, C. H., Panagiotaki, P., & Kiosseoglou, G. (2004). The verbal fluency task in the Greek population: normative data, and clustering and switching strategies. Journal of the International Neuropsychological Society, 10(2), 164–172. https://doi.org/10.1017/S1355617704102014
Landrø, N. I., & Ueland, T. (2008). Verbal memory and verbal fluency in adolescents with schizophrenia spectrum disorders. Psychiatry and Clinical Neurosciences, 62(6), 653–661. https://doi.org/10.1111/j.1440-1819.2008.01864.x
Levin, H. S., Song, J., Ewing-Cobbs, L., Chapman, S. B., & Mendelsohn, D. (2001). Word fluency in relation to severity of closed head injury, associated frontal brain lesions, and age at injury in children. Neuropsychologia, 39(2), 122–131. https://doi.org/10.1016/S0028-3932(00)00111-1
Lindgren, Å., Kihlgren, M., Melin, L., Croona, C., Lundberg, S., & Eeg-Olofsson, O. (2004). Development of cognitive functions in children with rolandic epilepsy. Epilepsy & Behavior, 5(6), 903–910. https://doi.org/10.1016/j.yebeh.2004.08.004
Löfkvist, U., Almkvist, O., Lyxell, B., & Tallberg, I. M. (2012). Word fluency performance and strategies in children with cochlear implants: age-dependent effects? Scandinavian Journal of Psychology, 53(6), 467–474. https://doi.org/10.1111/j.1467-9450.2012.00975.x
Marshall, C. R., Jones, A., Fastelli, A., Atkinson, J., Botting, N., & Morgan, G. (2018). Semantic fluency in deaf children who use spoken and signed language in comparison with hearing peers. International journal of language & communication disorders, 53(1), 157–170. https://doi.org/10.1111/1460-6984.12333
Mengisidou, M., & Marshall, C. R. (2019). Deficient explicit access to phonological representations explains phonological fluency difficulties in Greek children with dyslexia and/or developmental language disorder. Frontiers in psychology, 10, 638. https://doi.org/10.3389/fpsyg.2019.00638
Mengisidou, M. (2020). Verbal Fluency Difficulties in Dyslexia and Developmental Language Disorder (DLD). Poor Representations or Slower Retrieval Processes. International Journal of Education Advancement, IJEA-100007, 2652, 5232.
Metternich, B., Buschmann, F., Wagner, K., Schulze-Bonhage, A., & Kriston, L. (2014). Verbal fluency in focal epilepsy: a systematic review and meta-analysis. Neuropsychology review, 24(2), 200–218. https://doi.org/10.1007/s11065-014-9255-8
Mielnik, A., Łockiewicz, M., & Bogdanowicz, M. (2015). Semantic and phonological verbal fluency in students with dyslexia. Acta Neuropsychologica, 13(3), 253–266.
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., Stewart, L., & PRISMA-P Group. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4(1), 1. https://doi.org/10.1186/2046-4053-4-1
Nash, H. M., & Snowling, M. J. (2008). Semantic and phonological fluency in children with Down syndrome: Atypical organization of language or less efficient retrieval strategies? Cognitive Neuropsychology, 25, 690–703. https://doi.org/10.1080/02643290802274064
Nieto, A., Galtier, I., Barroso, J., & Espinosa, G. (2008). Fluencia verbal en niños españoles en edad escolar: estudio normativo piloto y análisis de las estrategias organizativas. Revista de neurología, 46, 2–6.
Oberg, G., & Ramírez, M. (2006). Cross-linguistic meta‐analysis of phonological fluency: Normal performance across cultures. International Journal of Psychology, 41(5), 342–347. https://doi.org/10.1080/00207590500345872
Pastor-Cerezuela, G., Fernández-Andrés, M. I., Feo-Álvarez, M., & González-Sala, F. (2016). Semantic verbal fluency in children with and without autism spectrum disorder: Relationship with chronological age and IQ. Frontiers in psychology, 7, 921. https://doi.org/10.3389/fpsyg.2016.00921
Paz, E. V., Puga, C., Ekonen, C., Pintos, P., Trossero, I., Richards, A., & Basalo, M. J. G. (2021). Letter and category Fluency Test in Spanish-Speaking Children with Neurodevelopmental Disorders. Neurology India, 69(1), 102. doi: https://doi.org/10.4103/0028-3886.310066
Pineda, D., Ardila, A., Rosselli, M. N., Cadavid, C., Mancheno, S., & Mejia, S. (1998). Executive dysfunctions in children with attention deficit hyperactivity disorder. International Journal of Neuroscience, 96(3–4), 177–196. https://doi.org/10.3109/00207459808986466
Raskin, S. A., Sliwinski, M., & Borod, J. C. (1992). Clustering strategies on tasks of verbal fluency in Parkinson’s disease. Neuropsychologia, 30(1), 95–99. https://doi.org/10.1016/0028-3932(92)90018-H
Raskin, S. A., & Rearick, E. (1996). Verbal fluency in individuals with mild traumatic brain injury. Neuropsychology, 10(3), 416. https://doi.org/10.1037/0894-4105.10.3.416
Reiter, A., Tucha, O., & Lange, K. W. (2005). Executive functions in children with dyslexia. Dyslexia, 11(2), 116–131. https://doi.org/10.1002/dys.289
Resch, C., Martens, R., & Hurks, P. (2014). Analysis of young children’s abilities to cluster and switch during a verbal fluency task. The Clinical Neuropsychologist, 28(8), 1295–1310. https://doi.org/10.1080/13854046.2014.978382
Robert, P. H., Lafont, V., Medecin, I., Berthet, L., Thauby, S., Baudu, C., & Darcout, G. (1998). Clustering and switching strategies in verbal fluency tasks: comparison between schizophrenics and healthy adults. Journal of the International Neuropsychological Society, 4, 539–546. https://doi.org/10.1017/S1355617798466025
Sánchez-López, M. P., Román-Lapuente, F., & García-Rubio, M. J. (2021). Verbal fluency in school-aged Spanish children: analysis of clustering and switching organizational strategies, employing different semantic categories and letters. Anales de Psicología/Annals of Psychology, 37(3), 449–458.
Sauzéon, H., Lestage, P., Raboutet, C., N’Kaoua, B., & Claverie, B. (2004). Verbal fluency output in children aged 7–16 as a function of the production criterion: Qualitative analysis of clustering, switching processes, and semantic network exploitation. Brain and Language, 89, 192–202. https://doi.org/10.1016/S0093-934X(03)00367-5
Schonfeld, A. M., Mattson, S. N., Lang, A. R., Delis, D. C., & Riley, E. P. (2001). Verbal and nonverbal fluency in children with heavy prenatal alcohol exposure. Journal of studies on alcohol, 62(2), 239–246. https://doi.org/10.15288/jsa.2001.62.239
Slomine, B. S., Gerring, J. P., Grados, M. A., Vasa, R., Brady, K. D., Christensen, J. R., & Denckla, M. B. (2002). Performance on measures of ‘executive function ‘following pediatric traumatic brain injury. Brain Injury, 16(9), 759–772. https://doi.org/10.1080/02699050210127286
Tallberg, I. M., Carlsson, S., & Lieberman, M. (2011). Children’s word fluency strategies. Scandinavian Journal of Psychology, 52(1), 35–42. https://doi.org/10.1111/j.1467-9450.2010.00842.x
Takács, Á., Kóbor, A., Tárnok, Z., & Csépe, V. (2014). Verbal fluency in children with ADHD: strategy using and temporal properties. Child Neuropsychology, 20(4), 415–429. https://doi.org/10.1080/09297049.2013.799645
Temple, C. M. (2002). Oral fluency and narrative production in children with Turner’s syndrome. Neuropsychologia, 40(8), 1419–1427. https://doi.org/10.1016/S0028-3932(01)00201-9
Toazza, R., Salum, G. A., Jarros, R. B., DeSousa, D., Salles, J. F. D., & Manfro, G. G. (2016). Phonemic verbal fluency and severity of anxiety disorders in young children. Trends in psychiatry and psychotherapy, 38, 100–104. https://doi.org/10.1590/2237-6089-2016-0018
Troyer, A. K. (2000). Normative data for clustering and switching on verbal fluency tasks. Journal of Clinical and Experimental Neuropsychology, 22, 370–378. https://doi.org/10.1076/1380-3395(200006)22:3;1-V;FT370
Troyer, A. K., Moscovitch, M., & Winocur, G. (1997). Clustering and switching as two components of verbal fluency: evidence from younger and older healthy adults. Neuropsychology, 11, 138–146. https://doi.org/10.1037/0894-4105.11.1.138
Troyer, A. K., Moscovitch, M., Winocur, G., Alexander, M. P., & Stuss, D. O. N. (1998). Clustering and switching on verbal fluency: The effects of focal frontal-and temporal-lobe lesions. Neuropsychologia, 36(6), 499–504. https://doi.org/10.1016/S0028-3932(97)00152-8
Troyer, A. K., & Moscovitch, M. (2006). Cognitive processes of verbal fluency tasks. The quantified process approach to neuropsychological assessment, 143–160. In A. M. Poreh (Ed.), The quantified process approach to neuropsychological assessment (pp. 143–160). Psychology Press. https://doi.org/10.4324/9780203720899
Viapiana, V. F., Rodrigues, A. C. R. D. B. G., Peters, R., Tramontina, S., Passos, I. C., & Fonseca, R. P. (2021). Pediatric bipolar disorder: Executive, linguistic, mnemonic, and cognitive efficiency mapping. Applied Neuropsychology: Child, 1–14. https://doi.org/10.1080/21622965.2020.1848568
Wakefield, C. E., Homewood, J., & Taylor, A. J. (2006). Early blindness may be associated with changes in performance on verbal fluency tasks. Journal of Visual Impairment & Blindness, 100(5), 306–310. https://doi.org/10.1177/0145482X0610000508
Weckerly, J., Wulfeck, B., & Reilly, J. (2001). Verbal fluency deficits in children with specific language impairment: Slow rapid naming or slow to name? Child Neuropsychology, 7(3), 142–152. https://doi.org/10.1076/chin.7.3.142.8741
Wechsler-Kashi, D., Schwartz, R. G., & Cleary, M. (2014). Picture naming and verbal fluency in children with cochlear implants. Journal of Speech Language and Hearing Research, 57(5), 1870–1882. https://doi.org/10.1044/2014_JSLHR-L-13-0321
Funding
This work was financed by the Argentinean National Scientific and Technical Research Council (CONICET) and the Adventista del Plata University.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical Statement
We did not interact with live subjects for the purposes of data collection. To the best of our knowledge, the studies we reviewed here have complied with the 1964 Declaration of Helsinki and its later addenda.
Informed consent
Not applicable.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Arán Filippetti, V., Krumm, G. & López, M.B. Clustering and Switching During Verbal Fluency in Typical and Atypical Development: A Systematic Review in Children and Adolescents. Curr Psychol 42, 27516–27533 (2023). https://doi.org/10.1007/s12144-022-03787-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12144-022-03787-4