In the article Has Your Therapist Told You Everything About Echolalia? we discussed the meaning of Echolalia and its functions. Now that we are armed with the ‘whats’ and ‘whys’, let’s look into the ‘hows’. Here are a few strategies to improve your child’s communication skills and reduce Echolalia.
An Echoic can act as a medium or cue which you can use to help your child vocalise in a particular situation. For instance, when you ask your child, ‘What do you want?’, the response you may get is the question ‘what do you want?’ repeated to back to you. When this happens try to get your child’s attention and give out the correct answer (I want the puzzle).
Once you give the answer, wait for your child to echo your words. If not, repeat the statement again while showing the object (here, a puzzle). The moment your child repeats, ‘I want the puzzle’, give the puzzle to him. This acts as a reinforcement for your child to repeat this sentence every time he or she wants the puzzle, in turn leading to an increase in his communication and understanding.
● Reinforcement and Punishment:
Any object, action or intervention that you can use to increase the frequency of a behaviour can be termed as a reinforcement. It strengthens a particular behaviour by pairing a pleasurable consequence with an action (Positive reinforcement). Another way to encourage communication, when the child does Echolalia is by attaching rewards to a correct response (uses echolalia in appropriate places) and prevent errors by giving feedback to incorrect responses. With the use of reinforcement the child will try to use the correct responses more often. For instance, if when asked ‘Do you want to eat an apple?’ and your child repeats “eat apple”, you should immediately give your child an apple, as it acts as motivator for similar responses in future. There would also be instances wherein, on asking the same question your child may say an incorrect phrase, “eat red” (as he has been taught red apple in the past), you should then correct him, instead if giving him the apple first. Correction can be done through verbal imitation, prompts, showing a visual cue or non verbally by pointing at the apple.
While Positive Reinforcement can increase the frequency of certain behaviours to improve communication, Negative Punishment can be used to decrease the frequency of irrelevant speech and Echolalia. If used sparingly with kids with certain level of insight, negative punishment is effective for delayed and non interactive echolalia. For example, if your child repeats a conversation or phrase he has heard from his favourite cartoon, you may bar him from watching that cartoon for a whole day.
Another way to get responses from your child who indulges in Echolalia is by using the three step, Cue-Pause-Point method. The first step involves using a visual or other ‘cues’ and verbal imitation to train your child to give a particular response. For instance, while teaching your child to say ‘This is a dog’, the word dog and picture of dog should be paired. The pairing should be practiced until your child gives the response spontaneously looking at the cue card. When your child gives the correct response, it should be reinforced.
After the repetitive pairing, the second step is to try and keep as minimal distractions in the environment as possible and to let your child know that certain questions are going to be asked to him, which he has to answer as correctly as possible (pause). The third step involves the cue with the correct answer to be held onto. While the question ‘What is this?’ is asked to the child, the picture of dog should be ‘pointed’ to, so that the child is able to give the correct response, by saying dog. Every correct response that your child then gives should be reinforced, so that in future he or she is more likely to vocalise this answer.
● Mand training:
Children on the spectrum show limited interests in their environment or in stimuli that it consists. Hence, encouraging communication for things they prefer, initially opens a channel for communication. Mand is understood as a verbal response which has positive or reinforcing consequences attached to it. The consequences attached to a Mand done by the child, are environmentally controlled. For instance, after completing the task in therapy the child mands by saying ‘I want the blue car’ (car being reinforcement). As soon as the child mands the blue car is rewarded by the therapist. If the child fails to mand, he can be prompted to do so using Echoic.
● Response distraction and redirection:
Quite often, your child would engage in echolalia as a sensory outlet. You may mainly notice this when a child is bored, hungry, tired or anxious. This is your child’s way to calm himself/herself. Assessing and addressing the situation can help reduce echolalia in such a situation. As per the situation, engage your child in other activity while distracting him from Echolalia. For instance, if the child seems hungry, say to the child, ‘Do you want some biscuits?’ (A short pause). I want biscuits’. Wait for the child to repeat the phrase I want biscuits. Once the child does so, help him to get himself some snacks. Sometimes a simple verbal que like ‘quiet mouth’ can be effective if the echolalia is a means of self stimulation. Once the child has followed through the verbal command he can be engaged in other productive activities.
● Developing communication skills:
Prompting, imitation, video and role modelling are other means of developing communication skills. In most cases, a child echos the words of another speaker as an attempt to communicate in more sophisticated ways, while lacking the skills to do so. Teaching him better skills by asking the child to complete a sentence is less demanding for the child than constructing a sentence. Simultaneously, by doing so, the child is also learning in small measures, how to construct a sentence. An example of prompting is saying ‘I want _____’ while showing the object a child desires. Wait for the child to complete the sentence Sometimes, the child doesn’t know how to respond in a given situation. To teach that, create the simulation of everyday situations. Enact the part while prompting the child to do the same.
● Use simple words and phrases:
A child is more likely to respond with repetition of what he has heard from the speaker when he fails to comprehend the meaning of what is spoken to him. In order to avoid confusion try using simple words/sentences while communicating with the child. Avoid repeating the sentence over and over, instead allow the child to process the information to respond.
These are some methods to manage and reduce Echolalia. Understanding and utilizing Echolalia as a means of communication can help parents to de-stress and children to gain new skills. As the proverbial saying goes, ‘every cloud has a silver lining!’
– Miss Sukaina Lokhandwala & Miss Urvi Mange
Clinical Psychologists at NeuroGen Brain & Spine Institute
Masters in Applied Clinical Psychology