Anomia assessment is a fundamental component of clinical practice and research inquiries involving individuals with aphasia, and confrontation naming tasks are among the most commonly used tools for quantifying anomia severity. While currently available confrontation naming tests possess many ideal properties, they are ultimately limited by the overarching psychometric framework they were developed within. Here, we discuss the challenges inherent to confrontation naming tests and present a modern alternative to test development called item response theory (IRT). Key concepts of IRT approaches are reviewed in relation to their relevance to aphasiology, highlighting the ability of IRT to create flexible and efficient tests that yield precise measurements of anomia severity. Empirical evidence from our research group on the application of IRT methods to a commonly used confrontation naming test is discussed, along with future avenues for test development.