Practical Tips for Treating Echolalia

Echolalia in autism is a unique disorder to treat. One of my readers expressed  frustration with this earlier in the year, and I promised to write a post about it. Here we are!

The basic descriptions of types of echolalia are immediate and delayed echolalia. Immediate echolalia is when a child with autism answers your question by repeating the question or echoes whatever you just said. Delayed echolalia happens when a child with autism repeats something that was said earlier in time, often a statement that has been heard frequently or even sections of a favorite TV show or movie. Echolalic statements may or may not have communicative functions.

It is no wonder that echolalia can be confusing to the treating SLP!  I found it helpful to read the research by Dr. Barry Prizant, which indicates that echolalia can occur for a variety of communicative, interactive and non-communicative functions. If you prefer to read his original research, click here for a free download.

If you’d like a more reader friendly version, there’s a great condensed version at Indiana University Bloomington.

If you are looking for a parent friendly version of echolalia and what can be done, this WikiHow article is excellent.

Read these practical tips for treating echolalia by Looks-Like-Language!
Using visuals is the best strategy I have found in working with students on the autism spectrum. Did you figure out the statement in my picture, courtesy of Smarty Symbols? A picture is worth a 1,000 words!

I have had success personally  in treating young children who demonstrated immediate, communicative echolalia. Instead of answering questions, the only strategy these children had was to echo the question. I felt that this was a positive event that indicated that the children actually understood that they were being asked a question, since the echolalia did not occur when they were given a simple direction that was understood or were asked a question that they knew the answer to.

Because of this, I thought that the echolalia meant that they couldn’t process the question they were being asked and formulate a response, but they understood that a response was required.

Visual supports were an important part of the strategies that worked for me. I made sure that the language I was using either spoke directly about an ongoing activity where the child was demonstrating joint attention skills for what I was talking about, or was in a literacy activity where the pictures showed exactly what the words being used meant.

On-going Activity Tips
*Make sure the child is looking a directly at what is happening (joint attention) and then use simple language that tells about what is being done.

*Model the language multiple times before ever asking for a verbal response.

*Repeat one action, providing a model yet again, and then ask a question to elicit the  response, immediately modeling the response.

*If the child still echoes the question, model the language with a little more emphasis and stop the action.

*Don’t start the action again until the child gives the desired response. Use the visual to help the child point at the pictured words in the response if you don't get a verbal non-echolalic answer.

*Repeat the question and the response as the action begins again, with more emphasis on the answer than on the response.

*Repeat as needed! Practice, practice, practice!

Read these practical tips for treating echolalia by Looks-Like-Language!
Literacy Activity Tips
*Find a book with repetitive text that models the same language you are using in your activity.

*Make your own, if needed, using a set of pictures that show variations of the activity while the language remains the same. It is great to include photos of the child doing that activity!

*Don’t downplay the importance of written text and/or visual symbols even for young non-verbal students. Children with autism who are nonverbal can be hyperlexic and may make sense of the written words first, using that as their cue to understanding the oral language.

*Bring the parents in on what you are doing! I made a personal book for a student I had who could answer “What is it?” by labeling nouns, but had no other functional language and immediate echolalia.  Every day, therapy culminated in gluing a picture related to the day’s activity in his book.  It’s easy now, thanks to Google, but I spent hours with magazines and coloring book pages back then!

*The related question was on the left hand side of the page, with the pictured activity and a phrase or sentence written under it on the right side of the page. This book became his bedtime story every night. The parents used my modeling technique at first, but by the end of the year, my hyperlexic  two year old read the entire book himself and used that language functionally.

Use Visuals and Scripts
*Use the list of possible functions for echolalia from Dr. Prizant to make a hypothesis about what the child is using the echolalia for. This will help you determine an a more appropriate way of communication to model.

*Make your modeling visual as well as verbal! Use pictures that SHOW the language.

*Use scripted words, phrases or sentences with symbols and/or written words.  Scripted basically means a functional, communicative phrase or sentence that is visual and modeled/practiced in a communicative context until the child can use it to communicate independently.

*If the words are being used for non-interactive and non-communicative functions, using procedures to extinguish this behavior during interactions and activities may be the way to go, while also working on expanding communicative and interactive skills.

*If there is a communicative function in the way the child is using the echolalic utterances, do the same thing we do for all of our students with language needs!
Set up the situation, model the desired response, pause, model again and wait for a response. Just be sure to provide a visual way to respond using pictures, symbols and written words to match the verbal words you are modeling. Pointing to the visual while modeling the auditory often helps students with autism make sense of the words. It also gives you a way to physically prompt the modeled response, with assisted pointing, before the student becomes too frustrated.

What have you found helpful for reducing echolalia?
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