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Echolalia...Friend or Foe? - November 2008

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Echolalia...Friend or Foe?

By: Kimberley Fox, MS, CCC-SLP

Mrs. Smith, "How are you Johnny?"
Johnny, "How are you Johnny?"

Who among us, having worked with a child with autism, has not experienced a situation such as this one? Although we are thrilled that Johnny is willing to reciprocate a communication attempt, we feel at a loss for what to do. This feature often serves as a point of frustration for anyone involved in teaching or providing intervention to children with autism. Echolalia is often considered a hindrance to communicative success and social appropriateness. Echolalia can also serve as a hindrance to the child being placed in an inclusive classroom setting, not because of a lack in the child's cognitive ability, but rather a lack in the classroom teacher's ability to get beyond the echolalic utterances to actually teach the child.

What exactly is echolalia? Echolalia is the act of repeating or echoing of verbal utterances made by another person. Lovaas (1981) reports that in typicallydeveloping children, echolalia peaks at approximately 30 months. An echolalic pattern in children's speech can be noted from 12 months to 30 months of age. For children with autism, however, the pattern persists beyond 30 months. Heffner (2000) states that echolalia occurs during the shift from gestalt language learning to analytical learning. A variety of studies report an echolalic prevalence of 75%-85% of verbal children with autism. Echolalia can be classified as either immediate or delayed. Immediate echolalia is the repetition of a word or phrase just after it has been spoken by another. Delayed echolalia is the repetition of a phrase or greater length utterance after some time lapse or delay. These echoes are typically commercials, movie/T.V. scripts or reprimands. It is evident, based on the prevalence of echolalia in children with autism, that echolalia serves a definite communicative purpose for the child with autism.

Prizant and Duchan (1981) identified seven (7) different functions of immediate echolalia divided into two (2) categories: Interactive and Non-interactive. The seven (7) functions of immediate echolalia according to Prizant and Duchan (1981) are as follows:

Interactive:
Turn-taking, Utterances used as turn fillers in an alternating verbal exchange
Declarative, Utterances labeling objects, actions, or location
Yes answer, Utterances used to indicate affirmation of a prior utterance
Request, Utterances used to request objects or others' actions; usually involves mitigated echolalia

Non-interactive:
Non-focused, Utterances produced with no apparent intent and often in states of high arousal
Rehearsal, Utterances used as a processing aid, followed by utterance or action indicating comprehension of echoed utterance
Self-regulatory, Utterances which serve to regulate one's own actions; produced in synchrony with motor activity
Prizant (1983) describes fourteen (14) functions of delayed echolalia. They can also be divided into Interactive and Non-interactive categories:

Interactive:
  1. Turn-taking, Utterances used as fillers in alternating verbal exchange
  2. Verbal completion, Utterances which complete familiar verbal routines initiated by others
  3. Providing information, Utterances offering new information not apparent from the situational context
  4. Labeling (interactive), Utterances labeling objects or actions in the environment
  5. Protest, Utterances protesting actions by others; may be used to prohibit others' actions
  6. Request, Utterances used to request objects
  7. Calling, Utterances used to call attention to one's self or to establish/maintain interaction
  8. Affirmation, Utterances used to indicate affirmation of previous utterance
  9. Directive, Utterances (often imperatives) used to direct others' actions


Non-interactive:
  1. Non-focused, Utterances with no apparent communicative intent or relevance to the situational context; may be self-stimulatory
  2. Situation association, Utterances with no apparent communicative intent that appear to be triggered by an object, person, situation, or activity
  3. Self-directive, Utterances which serve to regulate one's own actions


When the functions of echolalia are examined, it is evident that there is strong communicative intent on the part of the person with autism. It is, therefore, imperative that we shape these utterances to facilitate functional communication skills. Various studies show the benefit of shaping the echolalic utterances of children with autism. Charlop (1983) showed evidence of echolalia being used to teach receptive naming skills. Leung and Wu (1997) showed evidence of echolalia being used to teach Chinese characters. Shreibman and Carr (1978) noted that echolalia was most often used by people with autism in cases that they did not know the appropriate response to the question or command. Their intervention taught the children to say "I don't know" to questions they previously echoed.

Now that you are aware of the merits of the functions of echolalia, how do we shape it into functional communication?

In a preschool or early intervention setting, circle time provides a great opportunity to address echolalia. If there is a child available to serve as a peer model, then utilize that child. The child with echolalia is paired with the peer model and is always positioned to respond after the peer model responds. You can ask simple concept questions related to shape, color or alphabet.

Example: Ask the peer, "What color is this?" Have the peer grab the echolalic child's hand and gently tap the peer's chest while the peer responds to the question.

Immediately after the peer responds, ask the same question with the same probe of the echolalic child and have the peer get the echolalic child's hand and gently tap the echolalic child's chest while the peer models the correct response.

If you do not have an appropriate or willing peer then have "flash cards" with the responses to all the questions you ask during circle time printed on individual cards. Ask the simple concept question and then you immediately show the response card. For a while you will have to ask all the children, or at least all the children who respond before the child with echolalia the same probe question with the same response. This will help ensure that the child echoes the correct response to the question. Do not be concerned about mundane repetition. Remember that this repetition is what helps children, at this level, master basic concepts.

This next technique can be utilized for school-aged children or older, or in a clinic setting where utilizing a peer is not an option. It works for children who are able to read whether they are hyperlexic or not. It utilizes a discrete trial type methodology. As Speech-Language Pathologists it is typically not our preference to utilize a discrete trial type technique. However, this methodology provides the structure that children with autism respond to.
  • Determine some basic concepts that the child already knows: name, colors, letters, numbers.
  • Choose 10 items from the child's repertoire.
  • Print these responses onto individual flash cards
  • Sit within arm's length reach of the child.
  • Ask the questions to prompt the responses printed on the cards.
  • As soon as the question is asked, immediately present the card with the correct response in the child's line of sight while gently tapping the child on the chest as the prompt for the child to say what is written on the card. If and when the child starts to echo what you have said instead of what is printed on the card, use a hand gesture to indicate to the child that his echo of your voice is not desirable and quickly point to the words on the card and then gently tap the child on the chest again. It is important to refrain from any extraneous verbalizations as much as possible. Minimize or eliminate the verbal prompts that are given as much as possible. These extra verbalizations are confusing for the child; remember they tend to echo the words they hear. If a magnetic card reader is available, this would be ideal. Record onto the magnetic card reader cards the same information that you have printed onto the flash cards. Use the same techniques as with the flash cards, except immediately after asking the question, run the magnetic cards through the reader while using the gentle hand tap on the child's chest.
    This card reader technique may also be used in the circle time setting.

The ideal intervention for echolalia would combine the best features of the available research: teaching the child to provide a different response to a question when asked, teaching the child to respond in a variety of scenarios, teaching the child to say "I don't know", providing opportunities for generalization of skills learned, and teaching the child to develop generative speech.

References available upon request.

This Month's Featured Vendor: No Echo Echolalia Intervention

Special Thanks to Kimberley Fox, MS CCC-SLP for contributing this month's Therapy Corner article.

Kimberley is a Speech-Language Pathologist with over 10 years experience working with children with severe cases of autism and working with medically involved children in an early intervention setting. In addition, she is the founder and developer of the No Echo Echolalia Intervention system the only systematic intervention program to remediate echolalia in children with autism.

Please support our contributing authors and visit No Echo Echolalia.com. Kimberley can be contacted at [email protected]; 1-866-935-ECHO (3246), or at Echolalia Intervention

Visit Kimberly Powell's blog HERE


Tags: November 2008 Newsletter SLP OT Autism Echolalia Semantic Pragmatic Language Disorder Article