One of the key features that we often come across in verbal children under the spectrum of Autism is the use of scripted language and echolalia, which is repetition of others’ words and utterances without necessarily understanding meaning behind it. Children often repeat words immediately after hearing them (immediate echolalia) which appears like parroting what is being said. This typically appears as repetition of questions or comments one makes. Few kids have a tendency of repeating utterances a while later (delayed echolalia) which often makes them appear as irrelevant and out of context. When kids use echolalia it becomes difficult for parents and caregivers to figure out what they actually intend to communicate. But, there’s a lot that these little kiddos are trying to tell us.
With easily available access to screen time given to kids these days, one of the most common hallmarks that we come across in children with autism and social communication difficulties, is the use of scripted language where they memorize stories, rhymes, songs, monologues, advertisements. Often parents want their therapist to address this problem as it tends to hinder their peer play and interaction with others. Parents are many times in a dilemma about whether to be happy about the child’s verbal skills and memorization abilities or to be concerned about the fact that whatever they’ve self-learned is not used meaningfully for social interaction which is the essence of an individual’s development where higher cognitive aspects like verbal reasoning, logical, relative, abstract thinking, etc., emerge.
In my experience of using Child and Family – centred approach like the DIRFloortime model, addressing the underlying foundations of functional emotional developmental levels become more important and are extremely effective as compared to superficially tapping the problematic symptom or behaviour. From the perspective of language, Lauren Lowry, a Hanen certified SLP, in one of her articles, talks about reasons children might use echolalia for a communicative purpose. It is difficult to figure out what a child is trying to convey while using echolalia in a given moment. Learning a bit about this pattern of speech can help parents and caregivers figure out the meaning behind the child’s message.
Dr. Stanley Greenspan, the founder of DIRFloortime model emphasises tremendously on thinking about possible triggering factors that cause echolalia. This gives information about the child’s functional emotional developmental levels. For instance, there are kids with ASD who tend to use echolalia not with a purpose of communication, but in a self-stimulatory way, to pull and organize themselves. This is especially seen when there is a change in the child’s pattern (out of his or her comfort zone) that causes stress and anxiety. As a superficial behaviour, many people generally call this ‘self-talk’ and thus pose demands by intending to stop it, making the child’s anxiety even stronger. This is why it becomes crucial to focus on the basics like strengthening calm regulation, getting the child re-engaged, back into interactive communication and shared problem-solving, and then back to using language interactively. We would also want to think of factors that are possibly overloading and stressing the child (sensory profile).
Now, I would like you to take a while and think of two situations while addressing echolalia. One, where you are traditionally teaching the child, the ‘right’ way of using language to communicate by correcting utterances and getting the child to repeat, and the other where you’re establishing pleasurable intimacy with the child and he develops the desire to communicate meaningfully (using activities that your child enjoys with you the most). In the former scenario, it can be often noted that the child repeats the grammatically correct utterances as a response but rarely does he understand the meaning behind what has been said. In the latter case, you may notice that the child is better connected, engaged in emotional back-and-forth continuous interaction. When you playfully try to obstruct and engage the child, you have better opportunities to turn the constant parroting into short meaningful conversations. You can do this by,
(1) physically demonstrating the meaning behind what you are conveying, by breaking down the utterance into simple chunks along with acting it out.
(2) use of high emotional content, affect, intonation and stress.
By doing this, you ensure that the child is sharing the moment with you and the intent to communicate meaningfully is driven by desire and not with the use of tokens or reinforcements. After repeated attempts of similar situation in your play, the child will eventually take the bait and just say the part of the phrase that reflects his desire.
When children tend to use echolalia to soothe themselves as a self-stimulatory pattern, one has to understand that the utterances may not be attempted to convey a message. However, echolalia is also used for many purposes to communicate. It could be used to request for something, to start an interaction or keep it going, to draw someone’s attention, to protest or to answer ‘yes’. Being mindful in understanding the context and staying tuned-in is crucial and takes a bit of conscious practice!
Echolalia can be tricky to address. As therapists, we need to understand when and why children use echolalia, how it can serve as a bridge to more flexible language by means of more naturalistic opportunities for interaction and also more importantly, when to step down to focus on fundamental developmental levels if there are any constrictions noted.
-Aakanksha Chitnis – Gupte
Hanen certified Speech Language Pathologist, DIRFloortime Practitioner
Director, Co-Founder, FutuReady Pediatric Intervention Services, Bangalore