Reframing Echolalia In Autism: It’s Not a Bad Thing!

Echolalia in autism can be confusing for educators and parents who are trying to teach their child or student to talk. They are happy the child is verbal, but aren’t sure how to guide the child from echolalia to spontaneous, flexible speech.

WHAT IS ECHOLALIA IN AUTISM?

Echolalia is simply the repeating or echoing of what someone else has said. This can be repeating sounds, words, phrases, or sentences. Repeating words is actually a normal part of language development in young children! It is a phase that they pass through when learning how to speak from those around them. After learning these single words, young children will start to string them together to speak in phrases and eventually sentences. The difference with some autistic children is that they seem to get “stuck” in this phase. They also may echo more than just single words. Many times, children with autism will repeat long sentences without understanding what each word means. These sentences are often more complicated in a grammatical sense than what they could come up with spontaneously. An example of this might be a child with autism who says “It’s time for you to go to bed” when his parents bring him into his bedroom at night. He has linked that phrase with that routine, but really doesn’t know what each of those words mean (e.g. “it’s”, “time”, “go”, “bed”), but knows that the chunk of words together goes with the activity he is doing. He doesn’t use these words spontaneously in other sentences and if his parents pointed to his bed and said “what is it?”, he may not be able to say “bed” on his own. Speech/language pathologists and other professionals usually consider language to be “echolalic” when most of the words or phrases used by the child seem to be repetitions that they have heard vs. new utterances that they come up with on their own.

AUTISM AND ECHOLALIA: WHAT ARE THE DIFFERENT TYPES?

There are different “types” of echolalia in autism. One is “immediate echolalia”, and just like it implies, it is when someone immediately imitates something they have heard. For example, you might say “what is it?”, and the child repeats “what is it?”. Sometimes, in echolalia, the child echos the entire sentence, and other times, they repeat the last couple of words in a sentence. An example of this would be “what do you want for lunch. Pizza or hot dog?” and the child says “hot dog”. If you switch up the choices and say “hot dog or pizza” they will say “pizza”. When the words are repeated at a later time, it is called “delayed echolalia”. An example of delayed echolalia would be a child who says, “do you want to go outside?” when they are getting their shoes on. This is likely a phrase they have heard many times, that is linked with that routine. Delayed echolalia might also consist of lyrics to a song, line from a favorite book or movie. That brings us to “scripting”. Scripting is when children can recite long lines or scenes from shows, cartoons or movies.

WAYS AUTISM IN ECHOLALIA CAN BE HELPFUL

Echolalia is often looked at in a negative light. However, I like to look at it like this. The child is demonstrating the ability to speak verbally. This is awesome! Since they are talking in some way, echolalia can be looked at as a bridge to more flexible language. We just need to focus on directly teaching receptive language skills to increase understanding. In the meantime, let’s look at the function of the echolalia and the communicative intent of echolalia. Barry Prizant has been one of the leading researchers when looking at this. He found that while some echolalia was non-focused, much of the echolalia in autism had a function. One of the functions he discovered is “self-regulatory” and is much like “self-talk” in young children. An example of this is when a child with autism is upset and says “it’s okay baby” over and over to herself. She is repeating exactly what her mom says to her when she is helping her calm down. The function of the child saying it to herself is to help with self-regulation. Another function of echolalia in autism is “yes/no answer”. This is when the function of the echolalia is to affirm something said by the adult. If the adult says “do you want juice?” and the child says “do you want juice?”. The only way to know if the function is an affirmation vs. non-focused is by knowing the child well and being able to interpret that. The last function is a “request”. An example of a request might be a child using delayed echolalia and saying “do you want to go outside?”. That is their request to go outside, but with the grammar and sentence structure, you can see it is a repetition of what is said TO them. All of these functions look at that communicative intent. Echolalia is not ALL random and meaningless. If you know the child well, you can tease out these functions and determine communicative intent. The child’s parents are often the key to determining the intent and function of echolalia in autism since they know their child so well.

ECHOLALIA’S EFFECTS ON PRONOUN DEVELOPMENT

Besides wanting their children to be able to talk, one of the biggest frustrations I hear from parents is regarding the pronoun reversal in autism. Now that we’ve talked about echolalia and autism, you can probably see how this impacts pronoun development. If a child is learning pronouns by repeating others, their pronouns are going to be reversed! A parent might say “do you want juice?” and that is the way the child learns that “chunk” of words. They start requesting juice by saying “do you want juice” instead of “I want juice”. Then, the more the adult tries to prompt them by saying, “say I want juice” (child repeats “say I want juice”), the more confusing the pronouns become. The best way to start to address this is to be really mindful about the words you are using. You will need to switch up what you are saying to reflect what you want your child or student to say. Instead of asking them “do you want juice” when you know they are thirsty, you may need to switch it up and say “I want juice” instead. This seems counterintuitive and unnatural, but will help the child with autism start to use the correct pronouns more often. It should be noted, that by doing this you are not “teaching” correct use of pronouns, you are simply changing up your model for them to echo. You can begin to directly teach understanding of pronouns later on down the line. First, you need to make sure they are understanding how to follow directions, as well as demonstrating understanding of nouns, verbs and even some prepositions.

HOW YOU CAN HELP SHIFT ECHOLALIA IN AUTISM

You’ve learned about what echolalia in autism is, the different types of echolalia, and some of the functions of it. Now, the focus should not be on stopping the echolalia, but on expanding language so you can build a bridge to spontaneous language. I would definitely start by doing a language sample and tracking the number of echoed words and phrases. I’ve done this with students and was able to come up with a percentage, such as “48% of utterances were immediately echoed”. This way, you can track this over time to see if your intervention is reducing the amount of echolalia and increasing the spontaneous flexible production of utterances. We can help children who use echolalia by directly teaching them identify and label vocabulary and verbs in pictures and then moving on to combining them into short phrases. It is also important to teach them to imitate motor actions and to follow one-step directions, so you are targeting comprehension vs. just imitating what you say. For information on how to do this, you will find a list of my past blog posts and FB Lives on these topics. As these communication skills develop, often with visual supports to add structure, the echolalia will start to diminish. Another important piece of this is to implement an effective communication system to help the child learn to INITIATE communication. With young children with autism, I often start with a communication book, like PECS (the Picture Exchange Communication System). The great thing about PECS is that it teaches children to initiate communication rather than only respond to what other people say. This is HUGE for teaching children to spontaneously communicate. I will be addressing how to make a low tech communication book in a blog later this month. As the child learns to initiate communication using a book with visual choices, at the same time that they are working directly on their receptive language skills, you should slowly see a reduction in echolalia. Let’s go back to that lunch example. If you are spinning your wheels when you give your child or student “choices”, think to yourself, “how can I make this visual for now so I can ensure understanding?”. So, if you say “do you want a hot dog or pizza” and the child just repeats whatever the last word or couple of words in your sentence are, try offering a choice board with the two options. Say “what do you want” and put your hand out. See if they will give you the picture. For me, this has helped a lot and has also prevented meltdowns in the lunchroom. I’ve had students who are echolalic simply repeat the last thing I say (hot dog), so that is what was sent to the lunch room as their choice. Then, we get to the lunchroom and the hot dog is placed on the tray and the student has a huge meltdown because they actually wanted pizza. THIS can be the problem with echolalia and why a “backup system” for communication can be so helpful. One last helpful tip is to use visual sentence strips around the house and classroom to practice structured labeling. For example “I see ….” or “It’s a ….”. Click here for your free set. The pictures are a bridge to help with communication and understanding.

Additional Resources & Trainings:

Click here to watch the Facebook Live Mini-Training titled “WH Questions For Speech Therapy – 3 Tips To Help”. The blog post and recommended resources can be found here.

Click here to watch the Facebook Live Mini-Training titled “How To Target Vocabulary Goals For Speech Therapy”. The blog post and recommended resources can be found here.

Click here to watch the Facebook Live Mini-Training titled “7 Steps To Teaching One Step Directions”. The blog post and recommended resources can be found here.

Click here to watch the Facebook Live Mini-Training titled ‘How To Use One Of The Best Hacks To Teacher Prepositions In Speech Therapy”. The blog post and recommended resources can be found here.

Click here for free sentence starter strips.

Click here for your free echolalia language sample form.

Also available for FREE: “The Ultimate Guide for Targeting Language Skills in Young Children with Autism”. Sign up HERE to receive your guide!