Echolalia and what can I do about it?
Recently, I had a few parents enquired about their children repeating words or sentences. I decided to write up this article to help my parents understand echolalia more, and hopefully benefit the other parents as well.
Here are some questions that concerned my parents:
1. What is echolalia?
2. My child echos, does he/she have autism?
3. Why does my child echo?
4. Types of echolalia
5. What do we do about it?
What is echolalia?
Echolalia happens when a child repeats messages or words that he/she hears other people say. It is part of normal language development and is actually how most children learn language (what we call, imitation). However, most children “outgrow” echolalia by about 30 months of age.
My child echos, does he/she have autism?
Firstly, we are aware that echolalia is part of typical language development. It generally starts at about 18 months when the children learn to speak in phrases, and peaks at about 3 years old when they learn to be involved in conversations.
Echolalia is also commonly linked to autism as it is one of the characteristics sometimes noted in these children. 75% of persons with autism who are verbal exhibit echolalia in some form. In children with autism, echolalia occurs with greater frequency and lasts for a longer period of time than typically developing children. Note that there are other characteristics common in children with autism that are shared with children with other issues, such as sensory differences. Thus, echolalia is not an indicator of autism.
It appeared that children with motor planning issues, or apraxia, can also stay in the "echolalia phase" for a considerable length of time. This is attributed to their poor imitation skills, and thus take a longer time to acquire the language.
Being an interventionist, I believe it is more important to understand why the child exhibits echolalia and help him/her work through it (if necessary), than to work towards labelling the child.
Why does my child echo?
As with everything, there is no single reason for it. Sometimes, echolalia may be an indication of how your child process information and their style of learning. He/she learns in "chunks" without processing meanings of individual words. Thus your child is a "gestalt learner", which will give you some ideas about how to help her reduce the echolalia.
In other cases, children may be using language more sophisticated than what they understand. Thus, this child may "talk" a lot of words but does not seem to understand completely what he/she is saying and thus not really able to "use" them. Thus, to help them understand will be a goal for us.
There are also times when echolalia could just be a way to cope with stress or anxiety.
Types of echolalia
There are 2 basic types of echolalia: Immediate and Delayed. Understanding the types of echolalia also helps us understand why it happens and how we can help.
Immediate echolalia is when a child repeats something he/she just heard. For example, an adult says, “What do you want, apple or orange?” and the child repeats, “Apple or orange?,” instead of answering the question.
Delayed echolalia is when a child repeats something after some delay or lapse of time. For example, repeating "We did it!" from a TV character or a jingle from an advertisement.
In both cases, the echolalia serves 2 functions: Interactive or non-interactive (Prizant & Duchan, 1981; Prizant,1983). When the child echos with a communicative intent, it can be for purposes such as turn-taking, to provide information, answer questions, or make a request. When it is not intended to be used as an interaction, children use echolalia when they are not focused, to label something, direct oneself, or as a rehearsal. It could also be a means of regulation (to calm themselves).
What do we do about it?
The key to help our children, is to observe them when it happens, and determine if the echoing serves a purpose? And for what purpose? In this way, we can find ways to help our children and maybe teach them to communicate appropriately for that purpose.
View it as an opportunity to know what he or she has difficulty learning. As I will say to my parents, believe in your child and trust that he/she is trying to tell you something. What is he/she trying to communicate? Can I help him/her say it in a more appropriate way? For example, if a child is repeating after me, "Good job!", I will say "I did it!" because this is actually what he/she wants to exclaim. Or if a stressed and anxious child repeats, "mummy is coming", I may help him/her say, "I don't like this, I want my mommy".
Other useful tips
- Use visuals (pictures or words) to prompt the child. For example, if the child repeats, "What is this?", prompt them with gestures (by pointing), pictures or words for the answer (adapted from the Cues-Pause-Point method, McMorrow & Foxx, 1986). We always remember that visual cues are easier to fade off than verbal cues.
- Limit your talking, bring child's attention to the context. This is if the child's difficulty is in understanding the situation/question. It is important not to add too much talking to overwhelm them more. Keep to simple language, facial and body expressions to communicate. Remember, actions speak louder than words - literally!
- Teach meanings of different questions to help with comprehension. Improve receptive language on the whole.
- Teach ways to express different communicative intent. For example, how to make a rejection. Then carry these learnt phrases into context to help with generalization.
- Say the phrases in the way your child would express it. For example, when he/she repeats, "..you climb the stairs..". Help them say, "I want to climb stairs".
- Respond to the child literally (adapted from the Judevine(R) Center for Autism Method). For example, if the child repeats after you, "Do you want juice?", you will say, "No thank you. I think you want to tell me something though." Then use prompt to help the child say, "I want juice". I personally find this useful for children who are verbal and can engage well.
The take home message is that echolalia is not something devastating. It is actually a positive indication that your child has the verbal skills and wants to communicate. Take some time to figure what your child is trying to communicate. If the echolalia continues to worry you, stick to your instincts and consult a speech and language therapist who can help you work through it.
Useful articles on the topic
Meng Yi Yui, January 2013