Echolalia……..What To Do About It

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.

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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!

Laura

Comments

  1. SLP says

    I have just spent hours trying to find out what I am supposed to do with the child I work with with echolalia. I will now have information to tell the parent. I feel like I have a much better understanding of echolalia and have something to work with.

    Thanks!

  2. mslp says

    Its great to have the information in a user friendly format. Just one suggestion…you didn’t mention the importance of visual strategies to help children (ASD) learn those appropriate phrases.(For example using a Boardmaker picture/word sentence strip in play routines to teach a scripted sentence.) Its much easier to fade that visual prompt than a verbal model!

  3. Laura says

    Dot – Glad to help! Echolalia is tough to treat, but I just keep reminding myself – at least this child can talk! Laura

  4. Aparna says

    I searched online, couldn’t find much info on how to help my echolalic son.Thanks for the examples.That would help us a lot.Please continue posting more info.You are doing wonderful job.

  5. Joy says

    Thanks Laura for your specific suggestions. How could I model a response when “can I play?” is asked by another child? The child with the echolalia (I’ll call him David) appears not to hear the question so I get his attention and have the child repeat his question. Of course I’m learning that David repeats the question and then I model “yes”. I’m stuck and would appreciate any suggestions to be effective.
    Thanks
    Joy

  6. Laura says

    Joy – I would model, “What?” or “What did you say?” when he appears not to understand/process/hear the original question so he learns this very functional sentence to help him learn to ask for clarification when he needs it. Also try the “Yes or no?” technique so that you’re still having him be a little more independent in answering since he chooses which answer to respond with. If he’s more confused by this, try just shaking your head “yes” to see if this will cue the word rather than direct imitation. Treating echolalia is hard!! I can still work myself into a tizzy doing this! Hang in there!! Laura

  7. Heather says

    Thanks so much for this article. My little one is probably on the spectrum though not officially diagnosed. He is 2 yrs 8 mos. he has come a long way. He is receiving services from school and clinic with therapy for improving language and apraxia and social/functional language. He has sensory issues and is getting help with that too. The problem is that four out of five days he will get stuck on routines where his mother needs to repeat what he has said before he goes on. This includes a whole conversation on a topic…albeit the same conversation always. For example. “The sun comes up. (Wait for rep.) The sun goes down. (Wait for rep) “Papa said that’s ok. Rep. It’s night. rep. It’s daytime.” His mom is adept at giving him greater amounts of knowledge about the topic, trying to shift him into saying other things about the topic, shifting the topic, but he keeps coming back over and over all day long. she is about going crazy as you can imagine. He also often seems anxious, wakes during the night and seems like he is a little sick during these days. On his good days he can use 5-8 word sentences and carry on other types of conversations for several turns. He has several routines that he gets stuck on. Have you ever heard of this? If his mother refuses, he doesn’t get upset, but he keeps coming back to it and trying to get her into the routine, by taking her hand and saying “come”. Any suggestions or thoughts?

  8. Laura says

    Heather – These kinds of behaviors are pretty typical in children with autism and are one of the diagnostic characteristics. It sounds like you guys are doing all of the right things and all of the strategies I usually suggest to moms to work to help him expand these exchanges. The encouraging part of this that he has “good days.” He can use longer novel sentences and carry on conversations about other things, so he IS making progress with language. I’ll continue to think about this and add more to this response if I come up with any new ideas.

    You said that he’s getting therapy thru school and a clinic. Is anyone on the team helping mom with the sleep issues and anxiety, perhaps a psychologist? His OT should also have some insights to share with her to address both of these issues as well.

    Thanks so much for your post, and I’ll let you know if I come up with some other ideas. Laura

  9. Laura says

    I have a 30 month girl who has hit all her verbal milestones late but following the “normal” path. She is repeating alot of words, but she is having a hard time with spontaneous lanuguage. She was mildly behind in receptive language as well (She had ear infections which lead to tubes and severe reflux as an infant.) For instance, if I ask her “Go get your backpack” She will go in another room to get it, then say “backpack” as she hands it to me. But, if I just take ehr backpack and ask “What is this?” she won’t or can’t tell me. She does this with many many words. I feel confident she knows what the words mean, but can’t produce them until she hears it from me. (She has been in speech therapy since 20 months of age).

  10. Laura says

    Laura – It sounds like she’s having some word retrieval issues, and this is very common for a new talker. On-demand naming is difficult for many late-talking children. Sometimes a simple cue such as you saying, “It’s a ______,” and then waiting for her to “fill-in” the word will cue her when, “What’s that?” is still too difficult.

    You can also work on naming common objects using game-like activities too. In play or in a daily routine gather up 3 or 4 objects, hold them in your arms, and then name them as you make a big deal about setting them down one-by-one. Or hide them under your shirt and make a big deal about naming them as you pull them out. Again, the cue, “What’s that?” can be worked in later as she improves, but you may just skip that for now and work on naming them without that added “pressure” of answering the question.

    By the way – the most important thing is that she UNDERSTANDS you when you say, “Go get your backback,” so good job there!!

    Also ask your SLP for ideas to use to target this. Some SLPs like pictures or flashcards for targeting this kind of thing, but I don’t like those as much for young children. I prefer REAL objects and situations. However, do ask your SLP since she may have a different take on this since she’s actually worked with her and I haven’t.

    Great question! Thanks so much! Laura

  11. says

    Hi,there. A big relief! I was so worried when I ask the speech therapist regarding the progress of my 4 year old daughter. She said that my daughter is keep on repeating all the question they are asking and that is their big problem after my daughter was talking. After I read your article I can say that I am not ALONE in this battle! Thanks a lot for this very helpful suggestion. Please keep on posting. Thanks. More power.

  12. says

    Laura,
    Thanks for the great ideas. Can you give me ideas to help a sudent understand they are using bad language. They do this usally when upset and transtion times.
    Thanks

  13. Laura says

    Pam – Fortunately I have very little personal experience with this (just one 2 year old several years ago who was not on the spectrum, but who lived in a chaotic home with older siblings where cursing seemed to be the 1st response to being upset!), but what I would do is try to give them a new script. Model what they should say using vocabulary that’s developmentally appropriate, a functioinal phrase that “fits” the situation, and something you can live with hearing them say!

    You do want to teach emotion words, “I’m upset,” or “I’m mad,” and that’s a “real” way to give these difficult-to-learn words meaning. Some parents don’t like that we’re teaching these kinds of words, but again, when you’re looking at the alternative, I’d rather than this kind of phrase than cursing or physical aggression.

    I did work with one little boy whose mom taught him to say, “One more minute” during transitions so that he could learn to negotiate for more time, but he still got upset when we’d counter with “No more minutes” after a few extra turns to reward his request. However, dealing with this is likely much better than what I suspect the kids you’re talking about are saying.

    Hope this helps! If anyone else has a better idea, please add it! Laura

  14. Mom of 3 says

    Hi there, This information is wonderful! I really look forward to trying to impliment this at home with my daughter. She is going to be 5 soon and has Optic Nerve Hypoplasia. I have just spoke to an O.T that told me echolalia is typically in children with a syndrom and that I should have her checked again….is this true? I provide my daughter with yes/no opportuities now. For example I will say “do you want a drink yes or no? and she will say no if she does not but if she does she repeats want a drink rather then saying yes? Any further suggestions of what I may be able to try with her? I am getting concerned because she is hitting now and I really believe its because she does not have the vocabulary to express what she really wants. Are there any books out there you would recommend Laura?
    Thanks for your time!
    A concerned Mom

  15. Laura says

    Dear Concerned Mom – I’d recommend a speech eval if you’re not seeing an SLP already. She should not be using echolalia at 5, so she is likely experiencing communication difficulty. Has someone previously told you she doesn’t need speech therapy or that she doesn’t have another diagnosis?

    If you are currently seeing an SLP, then ask for her advice. I love the OTs I work with, but this sounds like an area you should be addressing with an SLP.

    I think your interpretation of her recent increase in aggression is correct. Many children hit, bite, and throw tantrums because they can’t adequately communicate.

    Keep reading ideas here on the website for ways to work with her at home.

    You can also write back in and tell me where she’s functioning communicatively and then maybe I can recommend some additional reading for you. Laura

  16. Jennifer says

    Laura,

    Your information has been very helpful to me in understanding my son’s echolalia. It seems like his speech is becoming more echolalic recently(I’m not sure why)so I was glad to finally find some useful tools.
    Blake is 9 years old and has Down Syndrome. He is an excellent reader and speller. He also seems to have good receptive language but his expressive language is very delayed.
    When doing cognitive work such as catagorizing animals, adding, telling time,etc. he does well but we use a lot of visual aids.
    I’m starting to wonder if I should start using sign language with him along with the suggestions you have mentioned to see if he starts having more spontaneous speech. We stopped using the sign language after he started to talk.
    Any suggestions would be greatly appreciated.
    Thanks again!

  17. Laura says

    Jennifer – You could certainly try it, and if it’s not successful, at least you’ll know you gave it your best shot. What does his SLP think? Children with Down Syndrome have low muscle tone which makes it more difficult to talk, but many children with Down Syndrome also have apraxia, or verbal motor planning problems. Using signs for children with apraxia also helps them verbally motor plan since you’re giving them an additional way to access the word. Targeting easier verbal things like animal sounds and other play sounds may also be more fun for him too to do spontaneously, and then work your way toward spontaneous words, phrases, and sentences. You’ll have to goofy and playful while you’re doing this, even with a 9 year old, so he drops any inhibitions he’s acquired and “goes for it” with his speech. I hope these ideas are helpful. Let me know how he does with them! Thanks for your questions! Laura

  18. Dan's Mom says

    My 11 year old son has echolalia issues that are different than what you mentioned in the article and I need some help. He will repeat lines from movies/TV shows/video games VERY dramatically (loudly, pointing, etc). I’m not worried about this when we are at home because it’s just what he does but I have concerns when we are out in public. He usually does this when he is looking directly at someone (although, I’m not really sure he is seeing the person) and I’m afraid people will think he’s yelling at them, acting aggressive, etc. I know this is a self calming thing for him so I’m not sure how I should handle it. Should I ask him not to do it (because, technically, he really can’t help it) or is there some other thing I can have him do that will help with the self stimming? Any help you can give me will be appreciated. Thank you

  19. Laura says

    Dan’s Mom – What does his SLP recommend he do? I specialize in treating infants and toddlers, so a child who is 11 is like geriatrics to me!! But I’ll tell you what my instinct would be.

    Is he able to respond to behavioral redirection such as, “You can do this at home, but not when we are away from home.” If he can understand and follow through with these kinds of redirections or “rules,” I’d go ahead and implement those so that he doesn’t isolate himself socially. Can you find another less dramatic way to help him self-calm? His OT and/or SLP should be able to help you find other things that work for him. Does he calm to deep pressure or any kind of tactile stimulation, or does it always seem to be loud talking that calms him? You may have to help him find another substitute for the loud quoting first such as squeezing his hands or handling a fidget toy, but if doesn’t respond to the tactile feedback like he does his loud talking, you may have to teach him to excuse himself to a restroom or outside to do the yelling and pointing. This is a tough issue which may need lots of trial and error for you to find a solution that works. Good luck and let me know how he does! Laura

  20. Worried Mom says

    Hi Laura,

    I have a 34 month old son who repeats 85% of the time. He can answer questions like “What color is this” or answer “What is this” and he can communicate what he wants with 2-3 word sentences. He is very smart but he seems to echo too much. He has a large vocabulary but seems to just not be able to put it together. I did have him evaluated for early intervention services (in NYC) but they said that he is where he should be and to just monitor him. I am hoping that your advice on this website will help me as I plan to implement the advice you give and I also bought your DVDs. I am just very worried. Any advice you can give would be greatly appreciated.

  21. Laura says

    Worried Mom – As you know, just because he can say it, doesn’t mean it understands it! Echolalia occurs when there’s also an underlying auditory processing/receptive language problem. Work on helping him learn to understand more and his spontaneous language should increase. The DVDs will help you learn what kinds of things you can work on during play.

    Use the ideas here in this article on the website to help him learn to understand questions.

    Since you’re still worried about him, I’d recommend that pursue a private speech-language evaluation, even if you have to pay out-of-pocket for these servicves. Many times children don’t qualify for services from early intervention programs because they don’t meet eligibility requirements which are very, very low. Children usually have to be functioning in the bottom 1-5% when compared to other children their same age, so even children who are only in the 10th percentile won’t qualify for services, and many times therapists don’t explain that clearly enough to parents. There’s a big difference between typically developing and “eligibile for services.” Typically developing 34 month olds certainly don’t echo 85% of the time and are talking in longer sentences.

    Hope this info helps.

    Laura

  22. says

    Worried Mom – Your 34 month old sounds very similar to mine!

    Laura, would you say I’m wasting my time by pursuing only the EI evaluation at this point? I feel like this whole process is going to take forever and we are losing precious time where he could be getting help.

  23. Laura says

    Krista – Get the EI eval for the primary purpose of someone helping you through the transition process and to get recommendations for what services would be helpful for him, even if he doesn’t qualify for therapy or there’s little time to get started. You’ll still know more about him than you would have without the information. Laura

  24. Shannon says

    Hi Laura.
    I’m starting to suspect that my son (21 mo.) might be echolalic. He began talking kind of late? (15 1/2 months) and now has a broad vocabulary. He began by repeating EVERYTHING, which to us, was fantastic considering we’d been waiting for him to speak at all. Now he is starting (trying) to put two words together. He has absolutely no concept of pronouns yet and will often say things like “Help you” or “good job,____”, etc – phrases that obviously I say BUT they do seem to fit the situation at the moment. There is a definite routine going on as well. For example everytime we get into an elevator he will say “door shut” and “door open” because I pointed it out to him before- but now he says it EVERY TIME with little/no variance. I guess my main question is at what age would you expect a child who is definitely self aware to use/understand using pronouns?

  25. Laura says

    Shannon – The milestone for children with typically developing language is mastering early pronouns me, my, mine, I and you by 30 months, so he’s still a little young to have fully gotten the hang of those by now.

    Since you know this pattern is his learning profile, follow the recommendations listed in the above article to avoid problems. Model phrases exactly as he should say it. Point to who you’re talking about as you say the correct pronoun to help him understand. Avoid names if he tends to repeat those. Those are all recommendations that are easy to say (or type), but much harder to actually carry out!

    I’m glad he’s now talking all the time, but redirect your focus on language comprehension with him to be sure he understands what he’s repeating. Following directions is CRITICAL. Give him oppportunities to demonstrate that he comprehends language all day long. If you need some more specific ideas, take a look at my DVD Teach Me to Listen and Obey 2.

    Thanks for your question! Laura

  26. Concerned Mom says

    I spent the last hour and a half reading the material on this website. I was searching for information on Autism but more specifically Echolalia. This site is so informative. My son who is 35 months was recently diagnosed with an ASD. He memorizes everything and repeats it back. He can quote DVDs from beginning to end. Each question I ask him, he repeats it back to me. I desperately want to give him all the help that I possibly can. I was told to get him speech therapy. Can you please provide me with a guide as to what I can do? I am so scared right now. This is all new for me and I have read so much in the past few days since his diagnosis but I am still so confused.

  27. Rose says

    Hi Laura. My son is 38 months and I am very worried that he could be autistic on some level. He displays some of the symptoms like memorizing books, singing complete songs and he LOVES puzzles. He can complete puzzles designed for 4 year olds. He started preschool in March and is currently attending summer camp at the same school. While he likes to play with his cousins, he tends to be a loner at school. He loves music and was receiving services form our states early childhood until the age of three. At tthat time, they told me that they didn’t feel he needed any more services from the school’s child find program.

    He repeats alot of what I say, including voice inflection. He is learning to answer his name when asked and knows that he is “3 years old”. When he wants something, he pulls me by the hand and says “come with me” or “help” and then he points at what he wants.He knows the alphabet song and can recognize all individual letters when asked. He can also recognize and count numbers up to twenty. Please advise.

  28. Marina says

    Thank you, Laura, for such a great article. My son is 26 months old. After reading your article I realized that he is learning lsnguage through some form of eholalia. For instance, he learned to say lots of phrases from his favorite TV shows. He will point at something interesting to him and say:”Look at that!” Even though he is repeating, he is using it appropriately. One time, he said: “Look at the mommy!” when he saw me. It doesn’t count as a sentence though since he didn’t form it completely on his own. Am I right? He says: “Here you go” when he hands me something and “I got it” or “You did it” when he grabs something. I have noticed that when I say “Hi, Mitchell”, he repeats the phrase. He doesn’t understand the concept of “I and me” yet and I am having a hard time teaching it to him.

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