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Word-finding difficulties (WFDs) in children have been hypothesized to be caused at least partly by poor semantic knowledge. Therefore, improving semantic knowledge should decrease word-finding errors. Previous studies of semantic therapy for WFDs are inconclusive. To investigate the effectiveness of semantic therapy for secondary school-aged pupils with WFDs using a randomized control trial with blind assessment. Fifteen participants with language impairments and WFDs (aged 9;11-15;11) were randomly assigned to a therapy versus waiting control group. In Phase 1 the therapy group received two 15-min semantic therapy sessions per week for 8 weeks with their usual speech and language therapist. Therapy for each participant targeted words from one of three semantic categories (animals, food, clothes). All participants were tested pre- and post-phase 1 therapy on the brief version of the Test of Adolescent Word Finding (TAWF), semantic fluency and the Test of Word Finding in Discourse (TWFD). In Phase 2 the waiting control group received the same therapy as the original therapy group, which received therapy targeted at other language areas. Testing after Phase 2 aimed to establish whether the waiting control group made similar progress to the original therapy group and whether the original therapy group maintained any gains. The original therapy group made significant progress in standard scores on the TAWF (d= 0.94), which was maintained 5 months later. However, they made no progress on the semantic fluency or discourse tests. Participants in the waiting control group did not make significant progress on the TAWF in Phase 1 when they received no word-finding therapy. However, after Phase 2, when they received the therapy, they also made significant progress (d= 0.81). The combined effect of therapy over the two groups was d= 1.2. The mean standard scores on the TAWF were 67 pre-therapy and 77 post-therapy. Four hours of semantic therapy on discrete semantic categories led to significant gains on a general standardized test of word finding, enabling the participants to begin to close the gap between their performance and that of their typically developing peers. These gains were maintained after 5 months. A small amount of therapy can lead to significant gains even with secondary aged pupils with severe language difficulties. However, further studies are needed to find ways of improving word-finding abilities in discourse.