Is Your Child Repeating Words or Phrases? Understanding Echolalia in Children with Autism
Echolalia is defined as repeated words, phrases, or sentences. Many children diagnosed with autism spectrum disorder (ASD) may repeat what they hear familiar people say or repeat lines from their favorite shows.
Due to the time difference between when a child hears the words and when they repeat them, the delayed echolalia is typically out of context. Children may repeat a song, something a teacher said at school, or repeat lines from a show during a time where it is not appropriate.
Children with echolalia often use it for a purpose, such as to request something, to interact with someone, to get someone’s attention, to protest, or to answer a question. Many times, echolalia serves a function of automatic or sensory reinforcement, which can be one of the hardest functions to treat. Echolalia can be very reinforcing to the child and thus hard to compete with to teach other communication methods. It is important to look at the context when echolalia is happening and then help the child communicate more effectively in that context.
Prizant (1983) found that children will echo “chunks” of language without knowing what the language they are echoing means. The child will then modify these language chunks and sometimes mix the words and phrases they say.
As children learn to use and understand language, children may begin to use short sentences and eventually longer, more complex sentences. A child’s language takes time to become more spontaneous and flexible which often reduces the occurrence of echolalia. However, even if echolalia fades as a child develops language skills, it can re-emerge when a child is upset or tired.
For parents, one of the first things you can do is to figure out why your child’s echolalia is occurring. In behavior analysis, we talk about determining the function of the behavior. There are four functions of behavior – sensory, escape, attention, and tangible.
It is important to figure out when and why your child is using echolalia in order to give them more appropriate means to communicate that can be understood by anyone around them. Determining the function will take some detective work – listen carefully to your child, watch them closely, and wait to see what they do. Follow your child’s lead.
Helping a child appropriately communicate without echolalia involves giving them the words they need to use from their perspective to get their needs met. For example, if you ask your child “do you want a snack” and they respond with “do you want a snack,” you as the parent should model an appropriate answer for them, such as “I want chips” or “yes.” It is important to use the correct pronouns (me, my, I, etc.) as if you are speaking for the child so that they learn the correct pronouns and grammar for non-echolalic responses. The goal is for the child to repeat your response as their own and hopefully learn to use this type of responding in the future when they are asked a question.
Many intervention strategies have been researched and used to redirect echolalia and in turn, increase verbal responses in children and adults with autism. McMorrow and Foxx (1986) used environmental cues such as word cards and a model to increase correct responses to questions. They found that echolalia reduced, and correct responses increased. The research subject also showed generalized improvements, as well.
McMorrow and Fox (1986) used two methods to reduce echolalia. The first is called the cues-pause-point method. The first step is to select a total of thirty questions: ten identification questions, ten interaction questions, and ten factual questions.
Once you have all thirty questions, ask the child all the questions and record how many they get right and wrong. You would then make word or picture cards for each of the question answers. Then teach the child to tell you what is on each card. Once they can do this consistently, these cards can be used as cue cards for answering questions. Now, you will ask the question, hold up your finger in front of your mouth in a “quiet” motion, then point to the cue card with the correct question answer. Prompt the child as necessary to respond correctly.
Once the child can answer the questions with the cue cards, it is time to fade out the cue cards. Ask ten questions and continue to use the “pause” prompt while the question is being asked. If the child answers the question correctly, make sure to provide reinforcement. If the child does not answer correctly, make sure to provide feedback so they can learn to respond independently. As the child becomes more and more successful, slowly fade out reinforcement.
To generalize this skill, have another person ask the questions in a random order. To take this skill to the next level, use “pause” prompts as needed when asking the child untrained questions. Ignore echoed responses, prompt the correct answer, and have them try again if they make a mistake.
McMorrow and Fox found that echolalic responses were reduced from using their training program. Children should also be taught to use “I don’t know” as an acceptable response. A wrong response or an “I don’t know” response should get more results and reinforcement than an echoed response.
The second method McMorrow and Fox used was the alternated modeling method. As in the first procedure, the thirty questions should still be selected. Now, a model person should be selected who can answer the thirty questions correctly. Ask the model the first question, then provide feedback and reinforcement for the correct answer. Next, ask the child the same question then provide feedback and reinforcement for the correct answer. Once the child can answer all the questions with 100% accuracy, remove the model from the training sessions. Fade reinforcers as the child is successful, and have another person ask the questions in a random order to encourage generalization.
Another strategy that has been used on vocal stereotypy and echolalia is response interruption and redirection (RIRD). This is an evidence-based intervention that involves presenting demands or other distractors in order to interrupt echolalia or stereotypy and then redirect it to a more appropriate response. Response interruption and redirection has been used with learners in preschool, elementary, middle, and high school to address a variety of behaviors and skills in social, communication, school readiness, play, and adaptive domains.
Some vocal stereotypy and echolalia are maintained by automatic or sensory reinforcement. Response intervention and redirection has been found to decrease the stereotypy and can increase appropriate vocalizations, as well. Automatically maintained and sensory maintained behaviors are typically resistant to many types of intervention because these behaviors are so reinforcing to the individual. For example, a child is much more interested in their own thoughts about their favorite TV show than answering questions about math. RIRD can be especially helpful in behaviors that are sensory maintained because the adult interrupts the interfering behavior (echolalia) and then redirects them to alternative behaviors (communicating through spontaneous language) instead.
As the name implies, there are two stages to RIRD starting with response interruption and then redirection. To use response interruption and redirection with echolalia or vocal stereotypy:
There are many different strategies that can be used alone or in combination to address echolalia in children with autism.
To further dive into appropriate intervention use, especially response interruption and redirection, the first thing to do is to figure out why the behavior is occurring. Taking behavior data can tell us when and why echolalia is happening. Antecedent-behavior-consequence (ABC) data can help parents determine what is happening right before the behavior (the antecedent), the behavior that happens, and what happens right after the behavior (the consequence).
In addition to ABC data, scatterplots can be used to determine when the behavior is occurring and what times of day intervention strategies should be used. There are many things that can contribute to the occurrence of echolalia, including what activities are happening, who is present, the noise level in the area, and the function of the behavior.
Now that data has been taken, it is important to learn how to properly implement the response interruption and redirection. For echolalia and vocal stereotypy, using verbal blocking (issuing a verbal direction to prevent the learner from engaging in echolalia or stereotypy) is recommended. You could do this by first saying the child’s name in a neutral tone of voice, establishing eye contact, and finally asking a social question so the child uses an alternative vocalization. These social questions should be ones that are already in the child’s repertoire, so we know that the child knows the answer to the question.
Differential reinforcement of alternative behaviors (DRA), differential reinforcement of other behavior (DRO), and differential reinforcement of incompatible behaviors (DRI) have been shown to reduce stereotypic behaviors in research. Vollmer (1994) stated that the efficacy of the differential reinforcement technique depends on if the alternative reinforcer can compete with the sensory reinforcement the stereotypy provides.
Echolalia, defined as repeated words, phrases, or vocalizations, and vocal stereotypy, defined as vocalizations that have no apparent function and are not directed toward another (non-contextual laughing/giggling, non-contextual words/phrases, unrecognizable words) can be redirected by teaching the child to say “I don’t know” in response to a question and/or teaching them to use more appropriate language when they engage in these verbal stereotypies.
Outside of these structured interventions, there are some general ideas that can help encourage a child to communicate effectively and decrease their echolalia. First, make sure to respond to echolalia literally when it makes sense to do so. For example, if a child says, “Do you want milk?” after you ask them the same question, respond to them with “No, thanks.” Then you can say, something like “Do you want to ask me something?” and prompt the child to ask for milk using their communication method.
Next, starter sentences like “I want ____” can be used for the child to fill in the blank. Using a visual or the item can help the child label the item they want.
Asking yes and no questions can help a child choose between responses as well. If the child answers no by echoing your last word, accept that response. It is important for children to know that their words have meaning. If the child is unhappy when they echo no to a question, you can guide them to the correct response by prompting yes after re-asking them the yes or no question.
Another idea to encourage communication is to use a carrier phrase while modeling language. For example, you can say “say” in a whisper tone then say “want milk” in a normal tone of voice. With this strategy, the hope is that the child will be less likely to echo what you whispered and instead only echo the appropriate communication of “want milk.”
Overall, there are many ways to address echolalia and vocal stereotypy that are evidence-based. There are some strategies like response interruption and redirection, differential reinforcement, and the cue-pause-point method.
Consultation with a behavior analyst can help a parent implement these strategies effectively. If you suspect your child may be exhibiting signs of echolalia, it could be a sign of autism. Contact Behavioral Innovations to see if ABA therapy for your child can help.
Content Credits: Lisa Freed, Heather Gilmore