Thank you Joy for your suggestion. Every now and then I DO "get it" and we do get a little excited. But even then, he sometimes loses track of what we're talking about and then I just have to look at him like a deer in the headlights (just not too extreme) and strain to figure it out. When choices are appropriate I give him choices when he can't find the word and show him the choices. Like... orange juice or chocolate milk. or.... the black shirt or blue shirt. From what i understand from his sister is that Tom dealt with dyslexia when he was younger and at times he displays some of that again. But that's an easier hurdle to manage. He's also losing his ability to write.
Thanks for your warm words of kindness.