Echolalia is a speech and language term that refers to when a child repeats what the speaker says. Echolalia is most often associated with children on the Autism Spectrum but is also how most children learn and develop language. All children go through a phase where they exhibit echolalia; However, when this phase persists passed 30-months of age it is considered atypical.
What might a child repeat?
– Favorite books
– Favorite television shows
This is only a few examples of potential scripts that a child with echolalia may repeat.
Types of Echolalia
- Immediate Echolalia refers to when a speaker says something to a child and the child immediately repeats what the speaker says.
- Delayed Echolalia refers to when a child repeats something they heard after an extended period of time has passed since they heard it. This time can range anywhere from minutes, hours, days, weeks, months or even years.
How can we teach children spontaneous language?
Therapy for correcting echolalia can vary based on how the child is using the echolalia
- Limited Vocabulary: When the child is using echolalia as a result of poor language skills or a limited vocabulary the therapist should target the language skills rather than the echolalia directly. This child is repeating the clinician because they do not know how to respond correctly.
- Requesting: Some children utilize echolalia when requesting desired objects and will phrase their request as a question because this is what they heard others say rather than as a statement. In this case you can respond to the child’s “question.” For example, if the child says “do you want a cookie?” You can respond, “No, I don’t want a cookie but do you?” You can then model the appropriate response for the child.
- Answering Questions: Many children may repeat questions rather than answering appropriately. In this case the clinician should chose one question type to begin with. The clinician should ask the question and immediately provide an appropriate answer in order to model an appropriate response for the child. Once the child is able to answer with the model the clinician should fade this cue and only provide the initial sound of the word. Once the child has met this step the clinician can then just mouth the word to the child and then eventually the child should learn to answer this question spontaneously. After the child has mastered a given question type, the clinician should begin another question type.
- Self-stimulatory: Some children utilize echolalia because it is comforting to them and as a result it is used a self-stimulatory behavior. In order to eliminate this use of echolalia the clinician must first determine what is causing the child to engage in self-stimulatory behaviors. The clinician can also utilize social stories to teach the child more appropriate ways to soothe as well as teach the child alternative calming strategies. This is often a result of stress, boredom or lack of attending to the task. In the case of stress, the clinician should find alternative ways to soothe the child that are more appropriate than echolalia. Sensory activities often work well in soothing children. If the child is bored or not attending to the task, the clinician could provide redirection to the task or choose another, more motivating task to elicit the same goal.
Source: Super Duper Publications, Speech and Language Kids
Jenna Oldfield, MA, CF-SLP TSSLD
At the start of speech and language services it may be overwhelming for parents. There are many terms that speech pathologists use that parents may not be familiar with. As SLPs it is important that we ensure our parents understand everything we are discussing when it comes to their child as this will optimize treatment and carryover at home. Since many of the words SLPs use are unique to our field and the field of special education it is important to educate parents on the meanings of these terms.
Here are a few of the common terms that parents may come across during the course of their child’s treatment.
- Speech/Language Difference vs. Speech/Language Disorder:
- Speech/language difference refers to a difference or variation in the child’s language background which may cause differences in their speech and language. For example, children who are bilingual may exhibit differences in their speech or language production of their second language due to the impact of their first language, dialect or accent.
- Speech/Language disorder refers to an actual impairment resulting in atypical development of the child’s speech/language development when compared to their age-matched peers. Children exhibiting a language impairment should seek a comprehensive speech/language evaluation to determine if speech therapy is necessary.
- Articulation vs. Phonology
- Articulation refers to the actual production of speech sounds. Articulation errors are different from phonological errors because these are errors occur due to difficulties executing the proper production of the speech sound. An example of an articulation error is a lisp.
- Phonology refers to how speech sounds go together and follow patterns to create words. Phonological disorders occur when a child’s speech does not follow the correct pattern for how to correctly produce specific sounds. An example of a phonological deficit is a child who produces the /t/ sound for the /k/ sound and the /d/ sound for the /g/ sound. This is known as velar fronting, which is a phonological process that results in a velar sound being replaced by a sound that is produced anteriorly in the mouth.
- Augmentative Communication vs. Alternative Communication
- Augmentative Communication is a device that helps a child who is limited in their verbal expressive language communicate by adding to their communication. These devices or tools can be utilized in conjunction with the child’s verbal language to help them better communicate their wants/needs. An example is using picture cards in conjunction with verbal words to better communicate their wants/needs.
- Alternative communication is a new/different type of communication that replaces another form of communication such as speaking. These devices can be utilized for children who are nonverbal and need an alternative form of communication to express themselves.
- MLU: Mean Length Utterance
- MLU is another term which is often utilized by speech language pathologists and may be unfamiliar to parents as it is specialized to this field. MLU refers to the mean or average length of a child’s utterance. Many children with language delay have deficits in MLU as they have often exhibit shorter utterance length. MLU corresponds to a child’s age and increases as a child grows older. A child of 1 year of age should be speaking in single word utterances which correlates to an MLU of 1. This MLU increases as the child gets older with an MLU of 2 or more at 2-years of age, 3 or more at 3-years of age and 4 or more at 4-years of age.
- Syntax vs. Semantics
- Syntax refers to the structure of language and how sentences should be constructed. Syntax encompasses the grammatical rules of a given language. A child with a poor understanding of grammar such as verb tenses or plurals will have deficits in the area of syntax.
- Semantics refers to the meaning of words and correlates to the child’s vocabulary development. Children who have a limited understanding of age appropriate vocabulary and concepts will have deficits in the area of semantics.
- Prosody is another common speech and language term which refers to the melody of speech including suprasegmental features such as rate, rhythm, intonation, volume, stress and pitch. Prosody helps individuals convey emotions, sarcasm a question verse a statement and energy.
- Pragmatic language refers to the social use of language, including tone of voice, turn taking, topic maintenance, providing context to a story, and appropriate usage of words given a specific audience or situation. Pragmatic deficits are often associated with specific disorders such as those included under the realm of Autism Spectrum Disorders.
- Resonance refers to the flow of air through the nose or mouth during speech. The velum is an essential structure within the vocal tract as it helps control resonance. The velum closes off airflow to the nose for all English phonemes except nasal sounds /m/, /n/ and /ng/. Resonance disorders are often associated with cleft palate or velopharyngeal incompetence.
SOURCE: Super Duper Publications, ASHA
-Jenna Oldfield MA, CF-SLP, TSSLD
According to the American Speech-Language and Hearing Association (ASHA), Central Auditory Processing includes the auditory mechanisms that underlie the following abilities or skills:
- sound localization and lateralization
- auditory discrimination
- auditory pattern recognition
- temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking
- auditory performance in competing acoustic signals (including dichotic listening)
- auditory performance with degraded acoustic signals.
Central Auditory Processing Disorder refers to difficulties in the perceptual processing of auditory information in the Central Nervous System as demonstrated by poor performance in one or more of the above skills.
What can we do to help individuals with deficits in auditory processing?
Strategies for Central Auditory Processing Disorder:
- Identify the KEY Information: Individuals with auditory processing deficits often struggle identifying the key information from ideas, instructions or other types of information presented to them. Teaching individuals to gather the key or most important information out of longer materials such as stories or directions can help the individual better understand and process that information.
- Chunking: When using this strategy individuals learn how to break down information into smaller parts or chunks. This strategy is great for remembering telephone numbers or locker combinations and allows the individual to better process and remember this information.
- Linking: When using this strategy individuals learn how to form connections between ideas presented to them. The ability to categorize their thoughts is very helpful when processing information and can allow individuals with auditory processing deficits to better retain and understand information.
- Make a list: Making lists is an external memory strategy that can help individuals with auditory processing deficits better remember information. Lists also provide additional modalities to process information. The individual will hear the information verbally, write the information down which allows for a tactile and kinesthetic modality for processing and then refer back to this information which adds a visual modality for processing.
- Rehearsal: Repeating information over and over again can help the individual retain this information. This is very helpful when given complex or multi-step directions and can help the individual remember these instructions.
- Paraphrase: When using this strategy individuals learn to better understand information by putting the information into their own words. This can allow for the information to be simplified and allows the individual to better understand the information.
- Visualize: During this strategy individuals with auditory processing deficits can close their eyes and picture the information in their mind. This adds an additional modality for processing the information as the individual can now interpret the information both visually as well as the auditory modality.
- Drawing: During this strategy individuals can trace, write or draw in order to connect information. The individual is then able to process the information through multiple modalities: visual, auditory and tactile-kinesthetic modalities.
Sources: ASHA, TheSpeechPathforKids.com
-Jenna Oldfield, MA, CF-SLP, TSSLD
At first glance, little things like transitioning from one activity to the next may seem like an easy task. We do it everyday… when we go to school, to go grocery shopping, when it’s time for bed. However, many children struggle with this task due to their difficulty with accepting change within their environment. This is especially difficult for children who are on the Autism Spectrum as these children have a hard time with change and benefit from a repetitive and routine schedule. Deviating from routine can result in changes in moods, behaviors and could impact their performance on certain academic tasks. So what can parents or teachers do to help these children?
PREPARING FOR THE DAY:
- Visual Schedules:
- Visuals are key for children with Autism Spectrum Disorder as it adds an additional modality for processing new information. Parents can create visual schedules for daily routines at home such as morning routine, bedtime routine or weekend routines. Parents should go over these routines with their children to ensure the child understands what is going to happen for that day. It is especially important for parents to inform their children if changes to the routine are expected for that day such as additional events (e.g. birthday parties, trips etc.) as this will help the child expect and prepare for these changes to their daily routine. If last minute changes are to be made and there is no time to tell the child beforehand, parents should inform the child verbally but still change the picture on the visual schedule when they get home. When the parents change the picture, they should educate the child on what this event may have replaced on the schedule so the child isn’t expecting an event that is no longer happening.
- Benefits for teachers: Many changes and transitions happen during a typical school day. Teachers can create each students schedule before the children arrive for the day. These visual schedules should include all events that are to take place for the day such as related services, morning circle, lunch, recess, extracurricular activities, and bus pick up. This allows the students to prepare for their day and expect changes that will occur during their day. Each student’s schedule should be individualized to them and should be created in the order that the events will take place. Student’s can take off pictures for completed tasks which adds an additional visual of what is to come and what has already happened.
- Sequencing Schedules for Activities of Daily Living:
- Facilitating independence is an essential part of helping and teaching children with Autism Spectrum Disorder. Parents and teachers should always presume competence. Sequencing schedules are beneficial for teaching daily routines. These can be created for any routine such as brushing your teeth, washing your hands, folding laundry etc. These visuals help children understand the order and steps that are included in a task and allows them to perform tasks independently.
SHORT TERM TECHNIQUES:
Okay, the child has their visual schedule for the day and it is time to transition from one activity to the next. You show them their visual schedule… but wait…. the visual schedule is not working and the child is still demonstrating difficulty transitioning…. what else can you do?
- Visual timers
- Visual timers are a great tool for helping children better understand when a task will be completed and how much time is left on a specific task. This helps with transitioning from preferred activities but also helps motivate children during non-preferred activities.
- Preferred Activities: It’s play time during school or at home and you want to prepare the child for the end of this activity. This may require a little more help than the visual schedule alone. Visual timers are great for transitioning from preferred activities. The timer can be set to the allotted amount of time and as the timer ticks down it creates a visual for the child. There are many visual timer apps available for children. I prefer using the app “Timer for Kids” by Idea4e. This app allows the child to pick an animal and as the timer ticks down the animal begins to appear until the time is up and the full picture of the animal is shown. This app also has background music which is comforting for the child. The child should be informed of the amount of time the timer will be set to and verbal reminders can be given throughout the activity. Visual timers help the child understand when their preferred activity will be over and helps them prepare for that transition.
- Non-preferred Activities: Visual timers are also very helpful for motivating children for non-preferred activities such as classroom work or daily routines such as brushing their teeth. Visual timers can be set and the child can be informed that the task will only last for the amount of time decided upon by the teacher. This is also a great way to help children work up to longer tasks. For example, the first week during classroom work the child may only sit for 5 minutes at the table. The teacher can set the timer for 5 minute increments and allow breaks in between. The next week the teacher may choose to increase the time on the timer and have the child sit at the table for longer. The teacher can continue increasing this time for each week until the child sits at the table for the entire time during classroom work.
Source: Super Duper Handout #134
-Jenna Oldfield MA, CF-SLP, TSSLD