Echolalia

Adapted from: Echolalia: Modeling Functional Communication, by Elizabeth Ives Field, M.Ed., CCC-SP and Increasing Expressive Skills for Verbal Children with Autism by Susan Stokes, Autism Consultant

Echolalia is the repetition of previously heard words or phrases. There are two basic types of echolalia: immediate and delayed. Immediate echolalia is the repetition of words and phrases that occurs immediately or very soon after the original words. Delayed echolalia is the repetition of words or phrases that are echoed hours, days, or weeks after they were originally heard. Both may serve a variety of functions for communication for the individual.

Echolalia occurs in approximately 85% of children with Autistic Spectrum Disorders who eventually develop speech. In many cases, the individual may learn to use echolalia in a functional way.

Characteristics:

Echolalia is when the child repeats verbal information stated by others (e.g., people's conversational exchanges, videos, books read aloud, songs, etc.).

Echolalia can include repetition of part of the utterance as well as an identical repetition of the entire spoken utterance, sometimes including an exact replication of the inflectional pattern used by the speaker.

Echolalia can be both immediate (a repetition of something they have just heard) or delayed (a repetition of information heard previously - minutes, hours, days, weeks, months, years!).

Echolalia occurs in normal language development yet decreases as the typically developing child gains more spontaneous generative language. In children with autism, echolalia occurs with greater frequency and lasts for a longer period of time as the child with autism typically experiences significant difficulty developing spontaneous, generative language skills

Echolalia is reflective of how the child processes information. The child with autism processes information as a whole "chunk" without processing the individual words that comprise the utterance. In processing these unanalyzed "chunks" of verbal information, many children with autism also process part of the context in which these words were stated, including sensory and emotional details. Some common element from this original situation is then triggered in the current situation which elicits the child's echolalic utterance.

Example: A student with autism became upset with his teacher over completing a task. He then verbalized loudly, "Go to hell lieutenant!" His parents reported that he had been watching the movie "A Few Good Men" quite frequently. This movie contains this exact same utterance in the emotional context of anger. This child with autism was unable to spontaneously generate language to communicate "I'm upset and I don't want to complete this assignment", but could pull forth an echolalic utterance which he had processed in the context of the emotional state of anger.

The presence of echolalia in children with autism can be a positive indicator for future meaningful language development. It indicates that the child is at least processing language, although at a "surface" level.

Use of echolalia for Non-Communicative and Communicative Purposes:

It is important to consider how the child is using echolalic utterances, for non-communicative and/or communicative purposes. In either case, it is important to note that, although he may be using sophisticated utterances (e.g., lengthy sentences, advanced vocabulary and grammatical forms), these echolalic utterances are generally being repeated without a clear or complete understanding of the meaning of the utterance

Non-Communicative Purposes:

Echolalia used without communicative intent occurs when the child does not anticipate a response to his verbalization.

Some examples include: Echolalic utterances which do not appear relevant to the situation or context (e.g., a child repeats utterances from a Disney video during a group calendar activity);

Utterances that may be triggered by something in the situation or context (e.g., a child walks into the lunchroom and begins to engage in echolalic utterances which have been heard in this context: "Everyone find a seat and start eating.")

Utterances that may be used as self-direction for his own actions (e.g., a child produces echolalic utterances to engage in a previously taught verbal routine to wash his hands: "Turn on the water. Get some soap. Rinse hands. Turn the water off. Get a towel and dry hands.").

Sometimes, children with autism engage in echolalia when they are feeling stressed or anxious. It is important to determine whether the child's arousal level could be a precipitating factor for the presence of his echolalia.

Example: A child walks into a classroom that he attended the previous school year. He begins to engage in a variety of delayed echolalic utterances spoken by the teacher from the previous school year. This child may be exhibiting an increase in stress and anxiety because he does not understand why he is in this environment again.

Communicative Purposes:

As the child's cognitive and language skills develop, his use of echolalia may become more functional and communicative.

When echolalia is used more communicatively, the child will generally exhibit an increase in spontaneous, appropriate eye gaze and/or body orientation.

Echolalia can be used communicatively for the following functions:

Conversational turn taking:

The child recognizes when he is to take a conversational turn and that some sort of response is required. However, the child lacks the spontaneous generative language to engage in the conversation, so he relies upon an echolalic utterance to take his "turn" in the conversation.

Example: A person says, "What did you do in gym?" The child with autism responds with "Everyone line up in your gym spots." The child takes his conversational turn by using an echolalic utterance from the gym teacher.

Initiation of communicative interactions:

The child is beginning to recognize and notice others. Because he lacks the spontaneous generative language skills to initiate a communicative interaction with someone, he uses an echolalic utterance.

Example: A child with autism approaches an adult, spontaneously engages in direct eye contact and says, "Susan, I think I'm going to die tonight". Upon further investigation, it is discovered that the child has been watching the movie "Charlotte's Web". In order to initiate a communicative interaction, he uses an echolalic utterance obtained from the movie.

Requesting :

The child uses echolalia to request a desired object, action or event.

Example: The child says: "Do you want a snack?" to indicate that he wants a snack.

Protesting:

The child uses echolalia to protest the actions of others.

Example: A child who does not want to watch the current T.V. program uses the utterance he has learned from T.V., "Stay tuned for back-to-back episodes of the Simpsons", to communicate his dislike of the current program.

Indicating affirmation in response to a previous utterance:

The child uses echolalia to respond affirmatively to the previous utterance.

Example: Another person says, "Want to go swing?" The child responds with the echolalic response, "Want to swing?"

Supporting Communication

Requesting

If the child reaches for, points to or moves your hand toward a ball, model “ball” or “want the ball” or “Sarah wants the ball” as you give it to her. If he says, “You want a cookie?” you say “David wants a cookie” as you give it to him. He may later spontaneously say, “David wants a cookie,” which is still a delayed echo but provides a more appropriate intermediate step between the echoed question as request and the more natural form, “I want a cookie.” Avoid direct praise such as “good talk ing,” which is likely to be echoed without comprehension.

Choosing

For the child who cannot respond to a verbal choice such as “Do you want crackers or an apple?” omit the question for a while. Show the two items and say, “Crackers…apple…Matthew wants….” If he names one and reaches for it, confirm his choice and give it to him, saying something like “Matthew wants an apple.” Avoid saying “You want an apple” or “Okay, here’s your apple,” as he may use your statement as a spontaneous request next time he wants an apple. If he says nothing and just grabs one, name it for him as you give it to him, saying “apple,” and pausing to see if he echoes before you release the apple. If he doesn’t, just say it again and give it to him. When he’s reliably choosing with a fill-in-the-blank format, you can gradually build back up to the natural question form.

Greeting

Avoid saying “Hi, Andrew,” to a child who repeats back “Hi, Andrew.” Just say “Hi” or “Bye” without adding his name. If you need to get his attention first, say “Andrew!” and then “Bye.” He may be more likely to respond if you bridge the gap between you and him by bending down and putting his hand on your shoulder to direct his attention. Encourage others to use words and phrases that will be acceptable if echoed, such as “See you later” rather than farewells like “Come again soon, Honey,” that are inappropriate if echoed by the person who is leaving.

Rejecting/Prohibiting

If the child pushes away food or screams at having her face washed, help her push the food away, or back off and say, “No cake! Don’t want cake!” or “Stop!” or “No washing face!” Sometimes you can accept the refusal, but in other cases, you will have to overrule the child. If so, pause, say something empathetic like “Don’t like face washing,” and then go on, “Becca’s face is dirty. Mommy has to wash it.” If someone takes her toy, help her pull it back and model “Stop!” or “No!” or “Don’t take it!”

Directing

If your child hands you objects to fix or open, puts your hand on an object, or just screams in frustration, you can say “Please help” or “Need help” or “Open it,” as if directing yourself. Don’t say it with a questioning intonation like “Need help?” or else the child will probably say it that way. Depending on the child’s readiness and state of attention at the moment, you can wait for him to echo or just proceed to the needed action. Be careful how you respond when the child does repeat your model. If you say “OK” several different times, he may begin to say “Please help OK.” To avoid creating an inappropriate pattern, either do the requested action without comment or vary your verbal response.

Commenting

Modeling comments is useful not only for building vocabulary and concepts, but also as an early social and pre-conversational activity. It provides many opportunities to use echoing as a teaching tool and supplies the child with appropriate language to practice as he does the same actions during solitary play.

When doing a puzzle, you could say, “Here’s the horse…going to put it in…uh-oh, doesn’t fit…there, it’s in!” Time your words to match the child’s independent or assisted action.

If you’re looking at a book together, start with wordbooks because noun vocabulary is often a strength and understanding of stories is apt to be weak.

To encourage visual focusing, use the child’s finger to point to pictures as you model comments depending on the child’s level of comprehension, like “Shoes…hat,” “Here’s the brown puppy,” “The girl is painting a picture,” “ Flowers on the table,” “The baby is crying, he’s sad.” If he does not spontaneously name some, put his finger on a picture so he knows—and pause. The established pattern of point and name, and your silence, will often elicit a spontaneous label from the child.

SOME IMPORTANT POINTS TO REMEMBER

• Model language structures that are only slightly longer and more complex than those you’ve heard the child use meaningfully.
• Say things that match what’s happening from the child’s point of view.
• Avoid questions and verbal instructions.
• Use people’s names if pronouns are confusing.
• Use words and intonation that will be appropriate and accurate if echoed.
• Respond to the child’s speech with words and actions that confirm your understanding of the message, not with praise, which may be echoed.
• Relax, enjoy yourself, join the child’s activity and follow his lead in play while gradually encouraging more varied and appropriate use of toys.
• Remember that most children who echo are actively trying to communicate despite their confusion about communicative functions, conversational roles and the meanings of concepts that vary as speakers and situations change. The procedures suggested here tap their strong memories, need for predictable patterns and echoic tendencies to begin to establish a basis of meaningful, functional communication.