Expert: Valerie Herskowitz - 12/16/2009

Question
Dear Ms. Herskowitz,

My daughter is 31 months old and is quite the chatterbox.  After getting a bit of a late start with her language development(didn't put 2 words together until about 25 months), she now regularly putting 3-5 word sentences together and using nouns, verbs and adjectives.  Overall, I felt that she was age-appropriate with her language skills.

However, last night I happened upon a website about echolalia, and it does have me slightly concerned.  

My concerns as it relates to delayed echolalia:
•         My daughter, Brooklyn, has an amazing memory.  Truly, everyone is astounded by it.  She has always enjoyed reading books, and has memorized most of them.  In fact, once I’ve read a book to her 4-5 times, she knows most of the words.  If you turn to any given page in the book, she will recite the words, nearly word for word.  But she will also spout out with memorized phrases from her favorite stories multiple times throughout the day, even when it’s not related at all to what we are doing.  Example – Nearly every morning, once she wakes up and we go in the living room she’ll say, “With a stomp, stomp, stomp.  And a trot, trot, trot.  And a skippity, skip, skip.”  This is one of her favorite lines from The Three Bears.  Now that I think about it, she has done this for quite some time, even in front of her pediatrician once, who didn’t mention any concerns about it.  I didn’t realize this was a problem; I just thought it was one of her little quirks that I adore.  From what I read last night though, this can be an issue.
•         She still does not use pronouns correctly.  She still refers to herself as Brooklyn (which I realize is still fairly common at 31 months).  She will often say, “Mommy, hold you,” when she wants me to pick her up.  
•         She frequently repeats phrases she hears me say, though they are usually within the correct context.  Example – Many mornings when she wakes up, I’ll ask her, “Did you have a good night’s sleep?”  Lately, when she wakes up from nap and is in a pleasant mood, she’ll greet me with, “Good night’s sleep.”  I believe she’s trying to tell me that she napped well, but repeats a phrase I’ve used.

I’m not thinking ASD, because other than this possible delayed echolalia, she does not have any other typical autism characteristics.  I completed an M-CHAT checklist, and there are no areas of concern.  Her eye contact and interaction is age-appropriate.  She asks questions frequently.  (Ex – “What’s Daddy doing?”  She loves to ask this question…multiple times…..even when she knows what he’s doing.  I think she’s trying to be funny.  She will also ask me, “What’s Brooklyn doing?” when she is doing something silly.)  She points to objects and responds to her name.  She will also answer questions appropriately most of the time.  (Ex – One day, I thought she had put something in her mouth.  I asked her what was in her mouth.  She said, “Just a tongue.”)  She also does initiate conversation and wants/needs appropriately.

However, I would like your professional opinion about this.  Again, this behavior is nothing new; she’s been memorizing her books for quite some time (even when she was only using single words….she would finish every sentence in every book).  I also distinctly remember her saying at Sesame Place during a visit there this past summer summer, “Bye animals.  Squirrels.  Lizards.”  Our neighbors has figurines of squirrels and lizards on their front steps, and for a few weeks, whenever we left our house, she would say this.

Do you feel that this is just developmental in nature and there is no need for concern?  Or is there possibly a bit more to this?

Thank you in advance,
Jenn


Answer
Hi Jenn

Thanks for writing.

The delayed echolalia does concern me as it is not a typical part of language development. She also has some other little quirky language things that I see with ASD kids like saying "you" instead of "me."Also the repetition of her saying goodbye to your neighbors figurines. All of these things are characteristics of ASD.

I have worked with lots of kids through the years who have displayed quirky behaviors that are characteristics of autism, but are not severe enough to be considered autistic. Sometimes they just outgrow the behaviors, though sometimes, other issues surface later on. Because these behaviors are not typical they mean something. The repetitious behaviors that she displays including the delayed echolalia have something to do with anxiety-a need to comfort herself using control (the repetition of the behavior that is constant.) Something about repeating the words from the stories or saying the same goodbye over and over again makes her feel she has some control over the universe. Even if the behavior goes away (and it probably will), she may exhibit some anxiety later in her life. It may come in several forms, so you have to keep a watchful eye out even through her adolescence and adulthood. It may be very mild and not debilitating at all, so it's nothing to be worried about, but you have to learn all about anxiety and the manifestations. (There are some things that you may not immediately recognize as a sign of anxiety.)

The echolalia is also telling you that she is having some problems with language usage. For instance, you has generalized that she is to say, "goodnight's sleep " when she takes a nap. But she should be able to say,"I had a good nap." So I am wondering if she is having some language usage issues. To really know if she has appropriate language skills, I would have her tested by a speech and language pathologist. But not just any speech and language pathologist. Someone who is very skilled in spotting language development issues in echolalic children. The reason that I say this is that sometimes a child can be tested and their language age score is fine, but that is because they may have some splinter skills that are above the age level and other things that are not showing yet and the average skews the score. A really well-skilled speech pathologist will also know to look for the "swiss cheese" effect that is often prevalent in these kids meaning that they may be missing some lower level language skills while still demonstrating higher level skills.  

The "me-you" thing often shows up with ASD kids because these pronouns are abstract in nature. It's really hard for them to understand why you say something like, "What are YOU doing?" when the answer to the question doesn't use the word, "you." But again, I am certainly not saying she is ASD, just that this is a characteristic of ASD because of the abstract quality of the language structure.

The truth be told: so many kids these days are not developing totally in the normal way. Something has happened in the universe to create some sort of developmental issue for many many children.I certainly don't know why, but having been in this field for over 32 years, it's quite apparent to me. Some are truly involved and will need years of intervention services while others remain quite mild and have just a bit of something that doesn't debilitate them in the least but does require either some treatment or just the understanding of themselves. Thank goodness your daughter does appear to be in the latter group, but since these behaviors are there, you are going to have to follow up with them.

If you have any other questions, you can write me back, or simply just email me at info@valerieherskowitz.com.