Tuesday, June 16, 2009

Can a Child Overcome Echolalia?

I was asked this by a parent recently. Worded this way, the question is a little hard to answer. The answer is mostly yes. Yes, many children with autism go through a period of echolalia and use less and less echolalia as they learn more language skills. Many children continue to use rote, memorized language even after the immediate echolalia is gone. It is a long haul for children with autism to learn how to use original, self-generated language to convey original self-generated ideas. Every step of the way is a cause for celebration.

It is not so much that the child overcomes echolalia; it is like if there were 1000 skills that a child would need to talk in complete self-generated, original sentences, a child with echolalia has learned 287 of those skills. I am entirely making up those numbers but my point is, if a child is echolalic, that child knows some important things about communicating--but still needs to acquire many more communication skills. We can systematically teach the child the skills he is missing but meanwhile, echolalia is wonderful because it indicates that the child wants to communicate, is learning to communicate and is trying to communicate with what he knows so far.

The very first thing that I ever read about language development in children with autism was an article by Dr. Barry Prizant on echolalia. I am not even sure if he was a Doctor when he wrote it, it was so long ago. Like many aspects of language development, typical or atypical, it turns out that echolalia is a lot more complicated than one would imagine. I remember the article because it was so unexpectedly complicated that I kept thinking about it even though I had never met a child with autism in my life.

Some reasons why children use echolalia and what to do to help:
  1. The child hears people talking as though listening to a song in a foreign language. The child may not have any idea that there are individual words in the long streams of sound that he hears. I hear French this way--like it is a song with a melody that I can imitate even though I don't know what the words mean. I can sound kind of French but not know what I am saying as I imitate someone speaking French. The thing is, I want to imitate that interesting French sound that I hear just like I want to hum a catchy tune. I don't even try to figure out what the speaker is saying. Trying to decode the French is too hard for me but I really like how French sounds so I imitate it. If a child is doing this empty imitation, you needs to help the child understand the meaning of words and phrases. Shorten your sentences. Use less language. Use visuals. Demonstrate meaning. Echolalia is an important sign that you need to do more to help your child with language comprehension.
  2. The child repeats what you say because the child wants to take a conversational turn but does not yet have the necessary expressive language skills. The good news is that a child using echolalia for this reason understands that conversation goes back and forth between two people. This back and forth can be hard to teach so it is cool if a child understand this aspect of conversation. A chatty child with autism is much easier to teach than a silent child. But this child still needs to learn how to put his or her ideas into words. You can help a child who uses echolalia in this way by watching for clues as to what the child would say, if he could express ideas, feelings, and intentions in words. Try to read any and all of this child's behavior and translate his behavior it into words. If the child pushes, you say Move, Mommy and the child may then repeat Move, Mommy particularly if you guessed correctly about why you were being pushed. In this case, you use echolalia to help a child learn expressive language skills. It is good that the child repeats because repeating your words will help your child develop expressive language skills.
  3. The child does not entirely understand what he hears and repeats it so as to give himself a second go at hearing and understanding. Sometimes the child repeats what he hears under his breath even. Use plenty of wait time after you say things to give this child time to process the meaning of what you say. Add visual supports and demonstrations (as in the previous situations) to increase the child's comprehension of language. It is good that your child repeats language to help himself comprehend better because without doing this, your child would understand less of what you say.
  4. Some children are able to use self-generated original language but it still requires more mental effort than repeating what others have said. Echolalia is habitual and easier. For this child, you may need to help the child focus by getting down at the child's level, saying things that alert the child to your genuine interest in his or her thoughts, and in a variety of ways support the child's hard mental work of composing original language. Today, for example, I put a child in a swing, pushed him several times, then stopped the swing and asked him to compose an original sentence, Tell mom what we saw on our field trip. He repeated some of what I said, what we saw.. I gave him a couple more swings and stopped him and said Mom, we saw____ . He said a balcony. I gave him two more swings, stopped the swing and held up one finger and said, Mom, we saw a cool balcony. I held up another finger and and looked at Jacob. He said And there was no one in the audience. I nodded and said, We were the only people in the theater, no one was in the audience. Jacob was on to my topic now and mom, of course, responded with interest to everything he said. Jacob's sentences became increasingly complete and interesting. However, he went back to using more rote, memorized language as soon as we stopped providing that level of support. In this case, it is good that your child uses echolalia because it alerts you to the fact that you need to provide more language support in order for your child to successfully generate original thoughts and express these thoughts in words and sentences.

The main point that I remember from that long ago article by Barry Prizant is that echolalia is a good thing, not a bad thing. Kids with autism learn language differently than other children and echolalia is a tool of that learning process. There are many reasons why a child might use echolalia and if you can figure out the reason, you are better able to teach the child the next important language skill.


Paulene Angela said...

Echolalia at times can drive you mad and finding yourself counting to ten, however when you have a child with very little speech, it can sound almost magical.

As you rightly say "teach the child the next important language skill".

Thank you for sharing your knowledge.

Michelle (lynnsdecor on twitter) said...

THANK YOU so much for answering this! We can't afford speech therapy yet and my daughter did not qualify for free services because she is not officially diagnosed with anything. But as of last Dec she was only speaking about 75 words (she had just turned two yrs) and with what I have been learning to do with her, her speech (and echolalia) has increased dramatically. So I am happy she is learning to talk finally and thank you for helping me learn how to help her.

Tahirih said...

Michelle, I was happy to have an excuse to write a post about echolalia and you are welcome.

Building Block Resolutions, Inc said...

Great Article! Very nicely written! Parents can become alarmed with the sometimes sudden "non-functional" language that their child emits. Your suggestions were great for parents to follow. Since no two cases are alike at Building Blocks we try to let them know it's all part of the process.

Anonymous said...

Is this also called scripting or is it different?

Tahirih said...

I have heard the term "scripted language" used to describe the language of children with autism whenever the child uses memorized phrases, sentences, or whole books. This is a kind of echolalia if the child is using language that he or she heard another person say (or write). Some children and adults use scripted language well and it serves to accomplish many of the functions that original, self-generated language might serve. There are limitations, though as you might imagine.

AllChildrenRInnocent said...

I really need help with my 3 yr old son. he shows a lot of signs indicating he has immediate echolalia, though not all the time. He can ask me questions, he can say about 15 to 20 phrases to me but he can not answer any questions you ask him.. the only responses that you will receive is the question repeated back to you. At first I thought he just was being stubborn but now I can see the frustration and defeat when he doesn't understand why his response was wrong. Its holding him back from learning his basic needs to transfer into kinder garden and I don't want him to be behind.. how can I help him understand a question?