Echolalia…What To Do About It
This is a follow-up article to my recent post “Echolalia…What It Is and What It Means.”
I am always so frustrated when I go to a continuing education conference or read an article by an expert when the bulk of the time is spent addressing the identification/assessment aspects of an issue, and then five minutes or two lines are spent offering recommendations for intervention. In an effort to overcome this irritating trend, I constantly remind myself to spend most of my time on this site writing about the part that most of us seek – the “What To Do About It” part!
I hope that you’ll find these strategies helpful for your child at home, or for the children on your caseload. This list has been compiled from my personal knowledge, from the tried and true recommendations I use with my own clients. I even found a few BETTER strategies as I researched this article that I will share with you.
Let me also add that treating echolalia can be very frustrating, not only for a parent, but for a professional. With a child who is echolalic, your teaching mistakes are often amplified because he is repeating EXACTLY WHAT and HOW you taught him. I have one darling little boy on my caseload right now who is making me rethink every word that comes out of my mouth during his sessions, and I do this language thing all day, every day! I understand your frustration if you, too, are searching for a better way to teach language to a child who learns in this way.
However, I hope you’ll find solace in the same way that I have for my particular little friend… at least he’s talking!!! He may be mixing up pronouns, re-asking my poorly-worded questions, and imitating things I didn’t fully intend for him to repeat, BUT HE’S TALKING! Compared to nonverbal children whose parents are eagerly anticipating their first little peeps, this is a huge, dramatic, BIG DEAL! It should not be viewed as something we need to eliminate.
On the other hand…it is NOT normal for a child to repeat so many of the phrases and sentences he hears while displaying an obvious difference in how he understands and processes language. It is heartbreaking for me when I evaluate a child and hear from a grandparent, a teacher, or even a parent who is oblivious to the fact that their child’s language is not “advanced,” even though they are able to quote large chunks of a Disney movie or know the words to every commercial they hear on TV. Even when parents have initiated the evaluation on their own, I think sometimes they still wish I’d come in and say that everything really is fine, even when they know in their heart of hearts that it’s not. So with that in mind, let’s get on with learning what to do about echolalia.
The KEY to treating echolalia is to model every word, phrase, or sentence in just the way your echolalic little friend should say it. Easier said than done, right? This can be hard! Even when I am teaching a parent how to do this and modeling it for them, I can still screw it up. (As the mother of the little boy I mentioned can attest!)
Initially, this means that you need to stop asking this child so many questions and giving so many directions and start modeling more requests, labels, and comments. You need to say things EXACTLY the way you want your child to say it since he learns by repeating EXACTLY what you’ve said.
Some parents and professionals balk at this advice saying, “He’s got to learn it the right way.” Well that is wrong, at least for now. One thing I try to tell parents is not to look at echolalia as right or wrong; it just is. This is how he learns. This is what we’ve got to work with. Learn to use this heightened skill of imitation to your advantage.
MORE SPECIFIC EXAMPLES
1. Model language from your child’s point of view. Model the kinds of words and phrases he can actually imitate AND understand.
Narrating play with a child who is echolalic is EXCELLENT because he will likely rehearse this even when he plays independently.
Be sure to provide words (even ones you’d prefer he not say) for activities rather than what you’d probably normally say. For example, if he’s trying to refuse an activity, model, “No” or “Don’t like it.” If a sibling or peer is taking a toy, help your child learn to say, “Stop,” or “Mine.” Many parents don’t like the idea of “teaching” their children these unpleasant, impolite words, but then again, I’d rather hear a word rather than a scream, or deal with a child who’s been bitten or hit (or is the biter or hitter), all because we failed to teach an appropriate response.
When you’re reading books (often a favorite activity for this kind of kid because they like visual, repetitive, and predictable information), point to and label the pictures using single words at first, and then short descriptive comments as his comprehension skills improve. If he doesn’t name the pictures as you’re naming them, take his finger and pause to give him a chance to “echo” what you’ve taught him previously. While many experts recommend this is a great way to increase vocabulary initially, don’t over-use books and pictures. Be sure to play with toys MOST OF THE TIME since children like this generally need more help learning to use language during everyday activities. Reading books, looking at flashcards, and naming pictures from videos are NOT functional or useful skills when your toddler is in the kitchen and can’t figure out how to tell you he’s thirsty and wants milk!
2. Don’t ask your child “Do you want…?” questions since he will initiate his requests by saying, “Do you want …?” In this kind of situation, model what he should say if you know what he wants. For example, if he’s reaching for an object, say the item’s name or model, “I want the ________.” If you’ve already messed this up and your child is doing this, model his name as you give it to him and say, “_____ wants the _________.”
One thing I do is to respond to a question like this literally by saying, “No, Laura doesn’t want the _________, but _ (child’s name) does.” Then model, “I want ________.” Wait until she repeats this phrase as the request before giving her the item.
Once a child’s language has become more advanced, ask the question, but offer responses at the end. “Do you want ice cream, yes or no?” Again watch your tone so that you’re not modeling the question inflection for the yes/no response part of the question.
3. When offering choices, also drop the “Do you want _____ or _______?” Model the names without the question tone at the end and holding each one forward when offering the choices. If your child is reaching for one, again model the objects’ name and withhold until he repeats you.
One expert suggested using a fill-in-the-blank format. Offer the choices by modeling the words in a statement tone of voice (not a questioning intonation) and then adding, “(Child’s name) wants…” Wait for him to complete the phrase, and then give the object.
4. Stop asking other questions like, “Do you need some help?” or “Should I hold you?” Model what your child should say before and while you’re doing what he needs. Try, “Help,” or “Hold me.” Also drop the question tone since your child may also imitate this voice pattern. Later, you can start to wait a while and expectantly look at him for his “echoed” request.
5. Be careful how you respond to requests. If you’re saying, “Okay” habitually after a request, your child may also incorporate this into his script saying something like, “Help you? Okay.” To avoid this, either perform the request without a verbal response, or vary what you say so that he’s not “locked in” to a particular pattern.
6. Avoid using praise such as, “Good job ______” or “Good talking __________” with the child’s name since she will often imitate this. If you can’t stop yourself, at least don’t use her name. I try to use lots of hugs, smiles, and cheer, “Yay” to replace this habit. It sounds less abnormal when a child cheers to congratulate herself when she’s not using her own name.
7. Avoid greeting or closing using the child’s name since he will always repeat it the way you’ve said it instead of using your name. (By the way, I screw this up regularly!) Use just, “Hi” and “Bye.” Hard to remember! You may also try other good-byes such as, “See you later!” or “Be right back,” since it’s okay if a child echoes these.
Several sources recommended using a verbal cue, such as calling the child’s name first or touching him, and then using your greeting or closing.
8. When you notice your child echoing, look at this as an opportunity to teach him what he needs to know. Model the way he should say something and wait.
9. Sometimes echolalia is a child’s response when his system is overstimulated. Children who are tired, hungry, scared, sick, extremely bored, or overwhelmed often lapse into echolalia as a way to self-calm. Analyze the situation and see what kind of support you can provide to them environmentally before you begin to look for ways to eliminate the echolalia.
In closing, let me remind you again of the bright side of echolalia. He’s talking! He’s trying! He is working on learning to communicate. You can see it right before your very eyes! It may be frustrating for you, even for a looooooooooong time, but remember that it’s better than the alternative of being silent and not showing any evidence of learning language. The positive qualities of echolalia, having strong memory skills and learning from predictable patterns, CAN and SHOULD be used to help your child learn to communicate. Use these suggestions and ask your SLP to help you figure out how to do this for your child.
I welcome your comments to this and all articles on my site!
Remember, you can teach words anywhere, anytime!