Echolalia, What is it? What can you do?

Echolalia, What is it? What can you do?

Echolalia is where in a child repeats or imitates what he/she hears. It is a form of verbal imitation. For example, when asked, “do you want water?”, the child says “want water” instead of “yes/no”. Sometimes children may immediately repeat what they hear, but in some instances they can repeat hours or days later. This is termed as ‘delayed echolalia’. For example, quoting movies or ads or words spoken by people around. This is also known as ‘scripting’. Another form of echolalia, called the ‘mitigated echolalia’, is produced with a change in wordings or intonation. Research suggests that, mitigation is an important developmental stage in children, especially in children with Autism.

IS ECHOLALIA NORMAL?

Echolalia is a normal part of language development in children. As they grow, they add their own words to these ‘echoed’ words. As their language surges, they use more of their individual utterances, and this ‘echoing’ or ‘repeating’ declines. Typically, echoing should stop between the age of 2-3 years when they start using more and more of their own utterances.

However, in some children, this ‘echoing’ is persistent. This is widely recognized as a feature of children with Autism Spectrum Disorder. Echolalia makes up a larger percentage of utterance in children with Autism than in typically developing children.

WHAT CAN BE DONE?

Look at echolalia as a window of opportunity!

Firstly, the reason for Echolalia’s occurrence must be determined. Echolalia maybe present for different reasons- it could be the lack of ability to understand questions, lack of understanding that an answer is expected or an inability to formulate an answer among a few reasons. A Speech-language Pathologist can help you determine the reason for Echolalia. Once the reason is ascertained, you can begin to tackle it accordingly. Some of the methods are mentioned here.

1. Poor language skills.
   If the child has echolalia due to poor language skills, do not treat ‘echolalia’, instead treat the language delay that is causing echolalia. Look at which language skill the child is missing and work on that. For instance, if the child lacks the concept of pronouns, this is how he would respond –
   Mother: “who wants milk?”
   Child: “who wants milk”.
   In this situation you would work on introducing the pronoun “I”. Model the sentence to the child “I want milk”. Similarly, other missing concepts can be worked on, to help the child to spontaneously request, answer etc.

 

2. Build the child’s vocabulary. 

This builds on to the previous point. When a child lacks words to express himself, he/she will resort to repetitions or imitations. Therefore, it is important to build up on vocabulary.

3. Model age-appropriate phrases. 

When a particular answer/phrase/sentence is expected off the child, model the phrase for him/her. Modeling is to provide the appropriate phrase to the child instead of waiting for his/her response. Eventually, this ‘model’ helps the child to understand the expected response. The model needs to be the EXACT way you want the child to say it. This includes the words and the intonation as well.

 

4. Offering choices.

When offering choices, use just the words without the questioning tones. Just hold the two choices forward when named. When the child is reaching out for the object, model the word to the child, and withhold it till the child repeats the word.

5. Don’t ask too many questions.
This would just lead to the child repeating the questions over and over. Instead, use the sentence “Tina wants ____” minus the questioning tone. The key is to model more of requests, labels and comments rather than questioning.

6. Respond with comments or affirmations. 

If the child has good understanding skills, comment on what ‘words’ he missed out while producing the sentence. Highlight the omitted words or concepts during other contexts.

7. Avoid phrases like “good work” or “good job ___” using the child’s name. The child may tend to imitate that and use after every activity is accomplished. Instead use claps, cheers or use words “yippie” or “yay”. A child saying “yippie” or “yay” sounds much more appropriate than praising himself.

8. There are times when a child may say “do you want juice?”, when in reality he is actually requesting for juice. But instead they are just repeating what they heard you say, “do you want juice?”. In this instance you could say “No, I don’t want juice, but you do”. This would slowly bring about awareness in the child that he is making an incorrect statement.

9. Be cautious of the way a response is given to a child’s request. For instance, a child may say want jam? You respond saying “Okay”. Before you realize the child has begun to echo the word “okay”. To prevent this, just carry out the request without a verbal response or use another appropriate phrase.

10. Provide planned language experiences for the child.
Example, put up a play activity where all the sentences and words used are pre-planned. This would work well for children who have “scripts”. The scripts can be matched to the activity.

Example:
You: Good morning Tina!
Child: Good morning (name).
You: How are you?
Child: I’m fine. Thank you.
Similarly, the child’s interest can be incorporated in the scripts. It is important that you include sentences which the child can IMITATE and UNDERSTAND.

11. Create opportunities for the child to initiate conversation. This can be done by focusing on activities of the child’s interests. This will provide an opportunity to the child to use more of his own words.

12. Echolalia is also used by the child to comfort himself. This could be self-stimulatory, as constant echolalia makes them feel good and satisfied. This behavior could also increase when a child is overwhelmed with emotions due to stress, anxiousness or boredom. When a child is bored, he may find it easy to recite the movie dialogues or ads as this is running in their head and it gives them pleasure. When it is a form of pleasure activity, do not stop your child from doing it, as he/she requires some amount of downtime. Just like a child would enjoy playing with his car in some time during the day, a child with echolalia needs his/her time.

However, a child may start echoing in inappropriate places or situations. Say in a library or in a classroom. In such situations try to find out the reason for this self-stimulatory behavior. If the child is stressed give him a break and provide him an activity which he enjoys doing. This acts as a diversion or distraction from something stressful.
If you feel a child is simply echoing due to distraction or loss of attention, bringing his focus back would help.

ALWAYS REMEMBER ECHOLALIA IS BETTER THAN SILENCE.
IT IS A SIGN OF LEARNING!!