On the last track we discussed Compensating for the Autistic Child’s Lack of Language. Compensating for Lack of Language included finding something worth trying for, modeling the words, getting them to talk on their own, keeping things social and interactive, turning requests into conversation and encouraging initiations.
One common obstacle...to teaching autistic children communication skills is Echolalia or echolalic speech. This track will include why autistic children echo, teaching "I don’t understand," rewording the question, adding questions, giving choices and repetition for its own sake.
Josephine, age 54, had an autistic granddaughter who echoed everything she said. Josephine asked, "Why would she do that? I say to her, ‘Hi Bethany!’ and she’ll repeat right back to me, ‘Hi Bethany!’ in the same tone of voice and everything."
Josephine stated, "I’ve heard the word echolalia mentioned, but I have no idea what it is." I stated to Josephine, "Echolalia or echolalic speech occurs when a child repeats part or all of the previous sentence spoken by another person, usually without understanding. Sometimes they do this immediately after hearing it, and other times it is a while later. When it is later, such as the next day, week, or month, it’s called delayed echolalia. This can often be misinterpreted as appropriate communication. Many children with echolalia repeat the word or phrase back with exact intonation patterns they have heard."
5 Areas Regarding Echolalia
#1 - Why Autistic Children Echo
Josephine then asked, "What causes echolalia?" I stated to Josephine, "Oftentimes children echo when they don’t understand what has just been said, and other times they do understand but just can’t use the grammar correctly. Other children will simply echo when they don’t want to make the effort to really listen to what the adult is saying, process it, and prepare an answer—all very time-consuming and difficult. It’s much easier just to repeat how well this usually works." Do you have a Josephine who would benefit from listening to this track during your next session?
#2 - Teaching "I Don’t Understand"
I felt it would be helpful to further state to Josephine, "Many children with autism aren’t able to let you know that they don’t understand what you’ve just asked them, so they echo the question back to you. It may be helpful to prompt Bethany to say, "I don’t understand,’ at these times. You can practice this by picking specific questions that you know that Bethany can’t answer and prompting her to respond with, "I don’t know what you mean" or "I don’t understand."
Once she’s done it with your help, remind her to do it whenever she can’t process a question. People will then rephrase questions in a way she’s more likely to understand, leading to a genuine exchange."
#3 - Rewording the Questions
Tristan, age 13, was an autistic boy whose parents came to see me because he did not understand the word where. Every time they asked him where he was going, he echoed the complete phrase. I suggested that they try asking "What place?" instead of "Where?" His parents started pairing the two. They would say, "Tristan, where, what place did we go today?" After a while, they were able to drop the "What place"—he now understood what "where" meant. By rewording the question and pairing it with a phrase he knew, Tristan’s parents were able to cut down on his echolalia and increase his vocabulary.
#4 - Adding Questions
For children who echo just about everything, or who are just beginning to learn words, rewording or teaching ‘I don’t understand’ is not a viable solution. In these cases, it may be helpful to intersperse another question. Melinda, age 9, was an echolalic, autistic child just learning to speak. Her dad, Rodney, age 40, stated, "I ask Melinda if she wants juice, and she’ll respond, ‘Juice.’ However, if I give her cup of juice, she’ll throw the cup and go into a tantrum! How do I know if she’s echoing or really saying what she wants?"
I stated, "It might be helpful to add another question. For example, if you’ve chosen a highly desired item, such as candy, and you ask Melinda, ‘Do you want candy?’ and she says, ‘Candy,’ you can then ask, ‘What do you want?’ If Melinda responds with ‘Want,’ you’ll know it’s echoed. However, if Melinda responds with ‘Candy,’ you’ll know it’s understood." Do you have a client who needs to have the "adding a question" technique reviewed with him or her?
#5 - Giving Choices
Jerricho, age 3, repeated everything his parents said to him. I stated to his parents, "Most of the time, echolalic children echo the last thing you said, so when you give Jerricho a choice of items like, ‘Do you want an apple or an orange?’ he is likely to say ‘Orange,’ because it was the last thing he heard.’" Jerricho loved chips, but hated lettuce. Jerricho knew the word "chip," so I asked him, "Do you want chips or lettuce?"
At first, being echolalic, he always said, "Lettuce," so I handed him the lettuce. After a while, he started self-correcting, saying, "Lettuce, chip." After a while, he started saying "lettuce-chip" as though it were one word. I backed up and asked the question again using two choices, "Do you want chip or lettuce? Chip?"
For a while he only said "chip" on occasion, and those were the only times he got a chip. Gradually, he started saying "chip" more frequently, and eventually he stopped adding the lettuce. When he started just saying, "chip," I faded the model. The great thing was that once it sank in on him that he was genuinely making a choice, he could choose one thing over the other. Have you found, as I have, that it is effective to pair desirable and undesirable items in particular to help an autistic child make a decision?
#6 - Repetition for its Own Sake
Sometimes, echolalia isn’t in response to questions, but appears to be the child’s desire to repeat whole phrases and sentences for the sheer pleasure of hearing them. Sophie, age 32, and Quinn, age 33, related a story to me regarding their autistic daughter, Jada, age 8. The family was flying across the country just after the September 11th Twin Towers attacks. Jada got on the plane, buckled up, and then, in a loud voice, Jada proceeded to announce what she had heard on the news, "Sky marshals will be placed on planes in the near future to decrease the likelihood of terrorist activity on airplanes."
Of course, the mere mention of terrorists caused the plane to be greatly delayed while the flight crew investigated—and were ultimately given a crash course in autism by the frantic parents. I stated to Sophie and Quinn, "What’s good about this story is that Jada related what she heard on the news in the right context. What Jada’s still learning, of course, is that talking about terrorists in an airplane is not a good idea. In situations like this, it is possible to teach Jada to reference another source.
For example, she can learn to say, ‘On the news, they said that sky marshals will be placed on planes.’" Do you have a client whose child repeats for repetition’s sake? Would playing this track be beneficial for him or her?
On this track, we discussed Echolalia. This included why autistic children echo, teaching "I don’t understand," rewording the question, adding questions, giving choices and repetition for its own sake.
On the next track, we will discuss the difficulties surrounding inclusion of autistic children in a typical school setting.
Peer-Reviewed Journal Article References:
Field, T. (2017). Imitation enhances social behavior of children with autism spectrum disorder: A review. Behavioral Development Bulletin, 22(1), 86–93.
Speckman, J., Longano, J. M., & Syed, N. (2017). The effects of conditioning three-dimensional stimuli on identity matching and imitative responses in young children with autism spectrum disorder. Behavioral Development Bulletin, 22(1), 111–128.
Wang, Q., Hoi, S. P., Wang, Y., Lam, C. M., Fang, F., & Yi, L. (2020). Gaze response to others’ gaze following in children with and without autism. Journal of Abnormal Psychology, 129(3), 320–329.
What are five parts to echolalia?
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