Expert: Sharon Rosen Lopez - 4/8/2009

Question
Hi,
I hope you can help me. My 3 year old child has been diagnosed with Autism by a psychologist. Some other experts, specfically two pediatricians, question the validity of the moderate to severe ASD based on speech and language development as well as behaviour of my child. I specifically want to focus on speech/language with you.   About 26% of my child's speech is contextually relevant and original thought, although most pertaining to his point of view or needs. The other 74% is echolalia or contextually inappropriate speech/ language. I want to maximize relevant language and minimize the other. What do you recommend, either from the point of view of language exercises or what I should ask an SLP that specializes in autism. I have a appt. soon.

Thanks for your support.

Answer
Hi C,

It sounds like your daughter's diagnosis is as of yet uncertain, and as I'm sure you know, echolalia is a behavior that is not specific to any one disorder, such as autism. In fact, echolalia is noted in many young children as they grapple with learning to understand and produce language.  In 'typical' language development, echolalic behavior reduces in children as their vocabulary and language processing skills increase.  In children who have difficulty  participating in the speaker-listener communicative dyad, however, echolalia can remain fairly pervasive, interfering with the spontaneity and give-and-take of communicative interactions long beyond those earliest language learning stages of the toddler years.

Generally speaking, a child's echolalia reveals his/her difficulty with language understanding and/or language production, and it can significantly impact  communicative interactions.  It's a complex behavior, and it's causes and manifestations vary.  Echolalia can be nothing more than an immediate and automatic parroting response to an auditory stimulus -- a child hears something and automatically repeats it without any apparent awareness of meaning or intent  --  or it can be the path of least resistance -- used intentionally because it's easier to respond by mimicking than to have to really attend and think up an answer on the spot.  Echolalia can 'buy time'  -- a child with a processing lag responds immediately by imitating a question -- such as, "What did you eat?" -- and delays an extra minute before being able to provide an appropriate response -- 'I had a sandwich and juice.'

Echolalia has been differentiated into two main types --  'immediate echolalia,' -- repetition that happens immediately after a verbal stimulus -- is differentiated from 'delayed echolalia,' -- when automatic repetitions happen subsequent to (that is, minutes, hours or years after) the original stimulus.  Both typically developing children and children with language disorders sometimes use delayed echolalia to help them regulate their own behavior.  When my son was 5 years old and we went to the supermarket one October day,  as we walked past the candy aisle he said aloud, 'The candy is for Halloween!"  That was something I had said to him afew days prior, when he had asked for candy while we were in that same market.  Similarly, one of the 12 - year old children with autism with whom I work cues himself  "No noise! Hurts my ears!" when he hears himself being too loud.  Delayed echolalia can also be a learned response that is topically related though lacks intent:  a child sees a loud, barking dog and says,  "Can I pet the dog?," but ignores the dog as he walks by it.   A child can respond echolalically when they have word-finding problems, and make an associative label -- Happy Birthday! -- when they see a cake.

All this is to say that echolalia is not a 'one size fits all' behavior and as such, there is no single key to eradicating it.   There are, however, certainly ways to help reduce echolalia by improving the odds in favor of communicative engagement, vocabulary development, and processing flexibility.

Auditory attention is an important factor in verbal engagement, and one way to work towards reducing echolalia is by assuring that you have a child's attention before speaking to him/her.  When a parent is aware that a child has difficulty attending in conversation,  eliciting a child's attention before speaking to them is the best way of enabling their ability to participate in the interaction.  We are all our habits -- good and bad --- and that habit of being attentive can reallly help a child learn the turntaking dynamic that characterizes  communicative interactions.  This is not to say that diminishing echolalia is easy, even when you've done all you can to elicit attention prior to speaking.  But it's definitely an important strategy to use.

Repetition is important to helping children with language processing deficits learn, and I use repetition as I work towards improving turntaking skills  -- both during play and verbal interactions. I also try to facilitate 'mental flexibility' as much as possible, so that there is differentiation between what I do and what the child does.  If I put a block on, the child needs to take the block off; if I put the car in the garage, he takes the car out, etc.  I'll use and remove props to help with this -- for example,  I'll  feed the dog as I comment about the ongoing action, and then I'll remove the dog's  bowl and tell the the child, "Dog's tired. Dog wants to sleep! Put dog to sleep!" as I provide the child with the dog's bed. If the child doesn't follow along, I'll use hand over hand to help the child lay down the dog on it's bed, as I repeat what I had just said.  Ideally the child will become independent in that activity --  following the embedded directive -- and then we'll  reverse roles and replay the scene again -- this time, I'll put the dog to sleep and the child will feed the dog.   

In that echolalic responses can replace word-specific vocabulary, vocabulary development can also help to reduce echolalia. Capitalizing on a child's interest and focus will make it easier for a child to learn new words and use those words spontaneously.

Improved language processing and listening skills will really reduce a child's echolalia, and some audiologists and occupational therapists offer auditory processing/'therapeutic listening protocols to stimulate listening capabilities. Sheila Frick, a well-known occupational therapist in Wisconsin, describes some of the well known listening programs available at her site: http://www.vitallinks.net/auditory.shtml and there are more programs besides these.  FastForward is a software program that can help improve processing speech in children abit older than your daughter.

I hope that some of the strategies in this note are relevant to you, C, and wish you all the best going forward. Please do feel free to write again if you have further questions!

Sharon Rosen Lopez, MA, CCC-SLP
Speech/Language Pathologist
http://www.SpeechSkillsForKids.com
http://www.SpeechArts.com