Expert: James Michael Roan - 9/22/2008

Question
hi -
I've battled with this for a few months... My son Matt is attending a Montessori preschool.  Today, I asked the teacher how his language was.  She said that he basically repeats what she says.  He does a lot of that at home too.  He has no hand-flapping or other repetitive behaviours.  But if I ask him "where are your shoes?", he'll repeat the question.  Then, he'll go get his shoes.  But I've spent the last few months really wondering about this echolalia.  We went to his pediatrician in June '08, who said that she could understand what he was saying, and I shouldn't worry and we should bring him back in 6 months.  He has no problem requesting what he wants, though he does it in as few words as possible, eg. "water, please."  or "pancakes?"  But he just doesn't respond to questions.  It shocks me everytime I hear another 2 yr old explain that he drew on the wall because X didn't give him any paper.  I think to myself:"Matt can't express himself like that at all!"  He just does NOT do 'why' questions. period. the closest he's ever come is when we announce it's time to brush teeeth, ask: "why not brush your teeth?"
I blame myself and wonder if we don't talk enough to him at home..he used to LOVE VH1 music videos...never took to cartoons.  but now, he doesn't care for tv much at all.  He's to and fro, finding things to keep himself busy.  He feeds himself well (spoon and fork), loves puzzles and does very well at them and has (to my surprise!!) learned to click and drag, using the mouse.  He can answer the questions: "how old are you?, what's your name?, what's the name of your school?, what's mommy's name?", but we taught him the answers for these questions and now I am wondering if it's all just part of the echolalia that we enabled.  I know this is a lot to sift through, but I just wanted to help you get as true a picture of my son as possible.  This is tearing me apart and I really would like to know your take on it.  Thanks for reading and for your help.

tessa.

Answer
Hi Tessa;

I'm purely speculating here and NOT diagnosing. Usually, echolalia occurs as both a natural aspect of speech acquisition or stands out as a condition of very low receptive language, yet he seems to understand simple commands and literal questions. He may have some mild executive function delays, meaning he has difficulty organizing his thoughts, sequencing them, and then responding to your question in a coherent and relevant way. You see a lot of echolalia in autism because these folks almost always have impaired receptive language and significantly impaired executive functions.

Let's take the prudent course of action. Download the M-CHAT and scoring instructions. The M-CHAT is only a screening tool for an autism spectrum disorder and NOT a test. Let me know what the specific items that were failed, if any, and add your detailed comments from there.

M-CHAT: http://www.utmem.edu/pediatrics/general/clinical/m-chat.pdf

Scoring: http://psychlops.psy.uconn.edu/ED/downloads/M-CHATscoring.pd

Also, do you live in the U.S.? If so, I can provide you with more guidance.

Kind regards,
James