How To Help a Child with Sensory Processing Disorder Succeed in Speech Therapy

As SLPs, comprehending the sensory needs of children with sensory processing disorder allows us to better understand, help, and have more effective speech therapy sessions.

It is not uncommon for a child with sensory processing disorder (SPD) to also receive speech services. SPD is especially common in those diagnosed with autism – research shows 78% of autistic children present with sensory difficulties! [1] Often times children with SPD are viewed as lazy or as having behavioral issues, when in reality the sensory problems are the cause. This is why it is crucial that, as SLPs, we gain an understanding of SPD and how to help a child with their sensory needs. In doing so, we can understand the root of the behavior, avoid meltdowns, and make progress in intervention.


Children with SPD do not have adequate sensory processing skills to receive, organize, interpret and respond to sensory information efficiently. This negatively affects their attention, behavior, and development.


sensory processing disorder

Indicators that a child may have sensory processing disorder:

  • Unusually high activity level
  • Unusually low activity level
  • Displays poor body awareness – clumsy, difficulty with balance and motor skills
  • Unpredictable and/or unsafe behaviors
  • Behavior issues – short attention span, impulsivity, excessive tantrums
  • Takes a long time to learn a new skill
  • Display low muscle tone – floppy, leans on others for support
  • Difficulty with academic areas despite normal intelligence
  • Difficulty with gross and fine motor skills – handwriting, using scissors, tying shoes, buttoning, etc.
  • Avoids certain textures while eating or playing

You may know that a child on your caseload has SPD because they have a diagnosis and are seeing an occupational therapist (OT). If you suspect a child has SPD, recommend them for an OT evaluation.
*Speech-language pathologists do not diagnose or treat SPD.


Little stimulation overloads the sensory system. High-alert.

  • Hyper-Responsive Type: high level of arousal, distracted (eye darting and fidgety), irritable, impulsive
  • Avoidant Type: high level of arousal, fearful, anxious, avoids engagement and stimulation

Requires a lot of stimulation to register sensory information. Lethargic.

  • Hypo-Responsive Type: low level of arousal, lack of interest, passive engagement
  • Sensory-Seeking Type: low level of arousal, seeks excessive movements, takes risks


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Overall, try to decrease sensory experiences. A quiet, dim, enclosed space is ideal. If the child starts to get over-stimulated, use calming sensory strategies such as firm squeezes, rocking, or white noise. Avoid any toys or games with unexpected movements, loud sounds, or that are scented (markers, play dough). Using a visual schedule can help them anticipate future sensory experiences.

Overall, try to increase sensory experiences. Create a sensory-rich environment for the child to explore and engage with. Use alerting sensory strategies to help the child engage. For example, jumping, swinging, tickling, loud noises, crashing on a pad, and using sensory bins can help with the child’s attention. Try using novel and motivating toys and activities to increase engagement and sensory reactivity. The use of a visual schedule is also helpful.

If the child is older and aware of their sensory difficulties, encourage them to communicate when they are feeling overwhelmed or underwhelmed. Discuss their sensory strategies with them and help him or her with them. If the student is seeing an OT, talk with them to get their suggestions of how to help that particular student with their sensory needs.

Websites for more information regarding SPD:

[1] Miller, L.J., S. Schoen, J.Coll, B. Brett-Green, and M. Reale. Final report: Quantitative psychophysiologic evaluation of Sensory Processing in children with autistic spectrum disorders. Los Angeles, CA: Cure Autism Now, February 2005.

[2] Miller, L.J., Nielsen, D.M., Schoen, S.A. (2012). Attention deficit hyperactivity disorder and sensory modulation disorder: A comparison of behavior and physiology. Research in Developmental Disabilities, 33(3), 804-818. 

Allison Fors has primarily worked with diagnoses of autism, Down syndrome, and developmental delays. My journey began when I realized most materials I was using weren’t engaging enough and weren’t targeted to effectively teach these populations. I realized I need to adjust my teaching to each child’s learning style and that the best learning happened when it didn’t feel like work!
That’s when I began making my own resources  –  especially for my non-verbal, low attention kids. I found that interactive and engaging resources were an effective way to make progress with my students. You can find her resources and tip art on TPT   You can read more on her blog here.

Playing With Purpose: Articulation Therapy

Children learn to say sounds correctly by listening to and hearing the people around them speak. Sounds, sometimes called phonemes, are acquired and mastered at all different ages. For instance, the /p/ phoneme develops early for children, and we often hear it as they babble; whereas, the /s/ phoneme develops much later. For example, it's perfectly normal at the age of 3 for a child to say "tat" instead of "sat." As a child grows, they should learn to say and use their sounds correctly. For some children, learning to articulate their speech sounds correctly isn't that easy. A child may have difficulty producing a few sounds, or they may have trouble producing many. These children are considered to have a speech sound or articulation disorder. ASHA defines an articulation disorder as "the atypical production of speech sounds characterized by substitutions, omissions, additions or distortions that may interfere with intelligibility." (ASHA, 1993)

When a child presents with an articulation disorder or deficits with speech sound production, articulation skills, and phonology, we conduct articulation therapy. I am going to come out and say it. Articulation therapy is repetitive and redundant (and sometimes a bit boring). I know I am not the only speech-language pathologist who has had a child say something like, "Are we done yet?" or "How many more words do I have to say?" However, as an SLP, we know that those repetitions of correction sound/phoneme productions are crucial to our client or student's success.

My goal during articulation therapy sessions is a minimum of 100 trials. Trying to achieve the 100+ trials during a session can be challenging. We have to contend with a child's motivation, attention, and willingness to participate in our repetitive tasks. I keep myself engaged and therefore the child I am working with engaged, by Playing With Purpose. In this context, PWP refers to the fun games or activities I use in my articulation therapy sessions to stay productive and achieve my goal of 100+ trials.

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Here are my favorite Playing With Purpose activities for articulation therapy:

(contains Amazon affiliate links)

I got this first idea from a teacher friend who used Jenga as a tool for her students practicing their spelling words. Take your classic plain, wooden Jenga game and write numbers on each of the blocks in permanent marker. The lowest number I have written on mine is 5, and I go up to 12, leaving some blocks blank for a free turn. Then you play the game as you typically would. I get out my word lists for the target phoneme, and each time it’s the child’s turn, they say as many words as the number on their block indicates. You can do this with a phoneme in isolation, in words, phrases, or even formulated sentences.

The Uno card game is a favorite of the children I work with. Play the game as the rules intended, but whatever card the child lays down, that is how many times they have to practice their speech sound. Get creative with the rules you have for the special cards like the Draw 4. I like to have kids practice 20 words with this card, particularly if they have had a series of lower numbered cards. This tip holds up with most other board games where a child has to move a specified number of spaces per turn. Chutes and Ladders is a good one for the younger children. In addition to articulation therapy, you can also address turn taking or other pragmatic language elements.

If you are not familiar with a toy called a ball popper, then this one is going to be a treat for you and your kids. Ball poppers come in a plethora of characters/animals to suit the child’s interests but note this toy has small parts, so it’s for children over the age of 3. “Target practice” is a fun ball popper game I play in articulation therapy. Draw a target on a piece of paper and stick it up on any door. I use 2 points in the center, 5 for the middle, and 10 in the outside ring. Then hand over the ball popper to the child to shoot the soft, foam balls at the target. Again, whatever number the ball hits closest to dictates how many times your child practices their target sound. I shared more PWP tips specifically for the ball popper toy on my blog back in September if you’d like to use the toy to address other skills.

  1. The ‘Race to 100 Game’ comes to us from fellow school SLP blogger Felice of The Dabbling Speechie. She created a quick game board with 100 squares and used a die to get her students engaged and practicing their target sounds. The child rolls the die, and then they get to color or check off that number of spaces as they practice their speech sound. School SLPs are often doing group therapy, so it can become a competition; whoever gets to 100 first is the winner. In my individual therapy, I have children work for a small prize. Along a similar line are these “Roll, Say, Color” activities from SLP blogger Hallie of Speech Time Fun.

  2. I use technology in therapy when it’s appropriate and, I am always careful to follow the same lesson I teach to parents about technology for speech therapy. The technology is meant to be used together with the child so that I can add language to their experience. During articulation therapy, my role is to help monitor and correct productions of the target sound. My clients and I love the game Artic Scenes by Smarty Ears Apps. It includes all the consonant sounds of English in the initial, medial, and final word positions. This game has 4 different levels which makes it usable for kids at many different ages and levels. I use level 1 with my younger kids working at word level practice and use level 4 with my older kids or when addressing carryover of speech sounds. Additionally, the app includes data tracking and homework sheets you can email to parents.

  3. For the crafty children on my caseload, I like to use Dab and Dot Markers in a variety of paper-based activities. I own the workbook Dot Articulation by Say it Right which has premade worksheet for 19 commonly misarticulated sounds. I always sneak in extra words with these sheet by having children produce 2-5 words per dot instead of just one before making a dot. When working on a phoneme in isolation, I will draw or print out a large, block letter outline. Then the child has to work on coloring in the letter with the dot marker by correctly producing their new sound. Lastly, you can find many printable coloring sheets online and in books for dot markers. Again, as the child produces their target sound or words, they get to dot and color in the photo.

Remember, articulation therapy does not have to be mundane for you or your students and clients. No matter what repetitious activity you choose for sound production work, be sure you are Playing With Purpose!



American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations [Relevant Paper]. Available from


Tell Me a Story: Narrative Language Skills

by Susan Berkowitz, SLP

A recent discussion among some SLPs sent me looking to the research.  In a  2008 edition of Topics in Language Disorders (vol.28:2. Apr-June 2008) editors Nickola Wolf Nelson, Katherine Butler, and Donna Boudreau quoted Jerome Bruner:

    “One of the most ubiquitous and powerful discourse forms in human communication is narrative.”  (Bruner 1990).  Narrative is crucial in human interactions, yet often receives the least attention.  Bruner went on to name the 4 areas of grammar critical to narrative production:

  1. A means for emphasizing actions towards obtaining a goal,
  2. A sequential order should be established and maintained; so that events are stated in a linear way
  3. Sensitivity to what forms and patterns of language are acceptable
  4. Containing a narrator’s perspective or ‘voice.’

Narrative has been found (Nelson et al 1989) to capture not only the events of daily interactions, but to encourage interpretation, imagination, and use of self-talk to solve problems.  This particular issue of TLD includes an update from J. Johnston on her seminal work (1982), which signaled a wake-up call to clinicians to consider examining narratives in clinical practice.

Johnston was the first to call attention to the importance of narratives in clinical practice.  She argues for distinct areas of knowledge in order to support narrative skills:

  •     knowledge of the content  of narrative
  •     knowledge of an appropriate framework in which to build narratives
  •     linguistic abilities to form a cohesive text
  •     the ability to consider the adequacy of the listener’s comprehension.

This last point is particularly discussed in her update, considering the processing competence of the listener;  how well can he comprehend at the narrative level.


Narrative skills begin to develop in young children and are mediated by parental support.  These early interactions build the foundation upon which children build their narrative and academic skills (Boudreau 2008).  The narrative skills of preschoolers are predictive of academic success in school, as well as social success.  As students with narrative language deficits continue having difficulties in academic and social success, we are reminded of the importance of intervention at the narrative levels.


Johnston’s (2008) update to her original article discusses the value of narrative intervention in school aged children.  While this study is now 10 years behind in current research into narrative development in students, the continuum of crucial skills for SLPs to consider continues along the same path that Johnston took.


Johnston (1982) listed on the 4 areas crucial in narrative development, and reviews and elaborates on it in the 2008 update.

  1.     The speaker must know the content of the narrative; both general qualities and specific details
  2.     The speaker must have understanding of a narrative framework, in order to turn the facts of the event into a story that includes context and emotion.
  3.     The speaker must have understanding of the forms of language, in order to create a cohesive story whose sentences blend together well with appropriate parts of speech.
  4.     The speaker must be able to shape the narrative to meet the linguistic needs of the listener; must be able to tailor the content of his narrative to the processing and knowledge levels of his audience.


Johnston goes on to discuss the cognitive difficulties of narrative creation.  Narratives require planning ahead for content and structure, for cohesion, and for adjusting to the partner’s abilities.  This is a huge cognitive load.  In addition, Johnson points our that the listener’s needs may change over time during this narrative, and the speaker must be able to process this information, change his narrative to meet it, and continue with the narrative.


Johnston continues with an interesting notion based on the research results of Gillam and Pearson, (2003).  While language-competent students were equal in both form and content in their narratives, students with language disorders tended to be stronger in one area than another.  This was seen to indicate that focusing cognitive energy in one area left the other area weak. 


Narratives are important because they allow us to move away from the “here and now,” and to focus less on our immediate personal experiences, while allowing students to talk about what is not immediate, but rather the decontextualized language of the classroom.


There are 3 basic types of narrative scripts: personal experiences, scripts, and fictional stories (Hudson & Shapiro, 1991). Personal narratives are the easiest place to begin in intervention with children.  And they are the most often used types of narrative.


Narrative interventions have been used to improve listening skills; by providing a supportive framework of story elements  for listening.

They have been used to improve reading comprehension. The link between oral language skills and reading success has been verified (Catts, et al, 1999); making it appear that oral language facilitates literacy.  Students who understand and use the general narrative schemes use this knowledge to help the understand and grab meaning from texts.


    “By focusing on narratives in our language intervention, we can explore processing limitations, create opportunities for using decontextualized language, facilitate social relationships, provide practice in constructive listening, improve reading comprehension, and identify language learning strengths and weaknesses.” (Johnston 2008)

The editors of Topics in Language Disorders have graciously provided us with a discount coupon for 35% off the cost of a subscription for our readers.  That’s about a $45. savings. Each issue of this journal covers a central topic and includes a variety of related research.

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Susan Berkowitz, M.S.,C.C.C., M.Ed. has been a speech-language pathologist for 40 years. She has worked in a variety of settings, both as a SP and as an administrator. She speaks at local, national, and international conferences, and has published research in peer-reviews professional journals. She is currently the Director of Print Content for Speech Science.

Boudreau, D. (2008) Forword. Topics in Language Disorders, 28 (2), 91-92

Catts,H et al (1999). Language basis of reading and reading disabilities: Evidence from a longitudinal investigation. Scientific Studies of Reading, 3(4), 331-361.

Gillam, R, & Pearson, N. (2003)The Test of Narrative Language. Austin, Tx: Pro-Ed.

Johnston, J. (1982). Narratives: A new look at communication problems in older language-disordered children. Language, Speech, and Hearing Services in the Schools, 13, 144-155.

Johnston, J. (2008). Narratives: Twenty-five years later. Topics in Language Disorders, 28 (2), 93-98

The Arts and Speech/Language Development: Music

By Peter Kao, M.S., CCC-SLP

This is part 1 of a three-part series discussing speech and language development and the arts.

“Music is the universal language of mankind.”

― Henry Wadsworth Longfellow

When I was a youngster, my parents told me, “Playing piano makes you smarter”. At the time, I thought it was a just ploy to get me to practice more. Yet for decades, researchers have studied links between literacy and music. More recently, research has linked training in music to speech and language development. While not necessarily “smarter”, the research shows that students with music training perform better on speech and language tasks than non-musicians.

The Research

Training in music has been shown to correlate with reading scores on standardized tests in school-age children (Strait, Hornickel, & Krauss, 2011). Students from low socio-economic backgrounds with music training retained reading skills over the course of a year better than those without (Slater et al., 2014).

Music training has also been shown to affect encoding speech sounds, auditory working memory, and attention. In fact, children with music training showed neurological differences in automatic brainstem responses to speech sounds and auditory working memory tasks than other children  (Strait, Hornickel, & Krauss, 2011).  A systematic review of research correlating phonological skills in children with music training showed that students who received 40 hours of music training performed better on rhyming tasks than those who had no music training (Gordon, Fehd, & McCandliss, 2015). Current research suggests that a student’s ability to process and produce rhythms has a strong connection to literacy (Harrison, Wood, Holliman, & Vousden, 2017) and syntax (Gordon, et al., 2015).

The Reality

According to the U.S. Department of Education, National Center for Education Statistics (NCES), in 2011-2012, there were approximately 82,000 music educations in elementary schools across the nation. This was a drop from 103,000 music educators in 2007-08. While 93% of elementary schools offered music education, 78% of the schools offered music class only once or twice per week (U.S. Department of Education, National Center for Education Statistics, 2013). The other 23% offered classes three or more times per week.

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Despite the evidence showing a correlation between language, literacy, and music; music education tends to end up first on the chopping block in schools across the country due to budget cuts.  If our students are no longer attending music classes, how can we give them some of the music exposure in our therapy sessions to compensate?

The Therapy

Here are just a few ideas on how to increase the use of rhythms and music in therapy:

  • Children’s nursery songs: They are full of rhyming patterns, rhythms, and words with complex phonemic patterns.

  • Rhythm-based cues: Clap out syllables with kids working on weak syllable reduction or have difficulty pronouncing longer words.  For the preschoolers, play hand clapping, rhythm games (as a bonus, you indirectly work on gross and fine motor movements, making your OT and PT happy).

  • Theme songs: For my upper elementary and middle school students working on storytelling, sometimes I use sound effects or music clips to give each character or event a “theme song”.  Those same sound effects and music clips can then serve as auditory cues during the retell.

As speech-language pathologists in the schools, we are often presented with challenging cases and asked to to unlock a child’s ability to communicate. Perhaps music could be one of those keys.

Peter Kao, MS, CCC-SLP is a speech-language pathologist working in Milwaukee, Wisconsin. His interests include early childhood language, fluency, and voice disorders. You may contact Peter on LinkedIn.


Gordon, Reyna L., Hilda M. Fehd, and Bruce D. McCandliss. (2015) "Does music training enhance literacy skills? A meta-analysis." Frontiers in psychology 6.

Gordon, R. L., Shivers, C. M., Wieland, E. A., Kotz, S. A., Yoder, P. J., & Devin McAuley, J. (2015). Musical rhythm discrimination explains individual differences in grammar skills in children. Developmental Science, 18(4), 635-644.

Harrison, E., Wood, C., Holliman, A. J., & Vousden, J. I. (2017). The immediate and longer‐term effectiveness of a speech‐rhythm‐based reading intervention for beginning readers. Journal of Research in Reading.

Slater, J., Strait, D. L., Skoe, E., O'Connell, S., Thompson, E., & Kraus, N. (2014). Longitudinal effects of group music instruction on literacy skills in low-income children. PLoS One, 9(11), e113383.

Strait, D. L., Hornickel, J., & Kraus, N. (2011). Subcortical processing of speech regularities underlies reading and music aptitude in children. Behavioral and Brain Functions, 7(1), 44.

U.S. Department of Education, National Center for Education Statistics (2013).Number and percentage distribution of teachers in public and private elementary and secondary schools, by selected teacher characteristics: Selected years, 1987-88 through 2011-12. [Table] National Center for Education Statistics.  Retrieved from

The Arts and Speech/Language Development: Visual Art

By Peter Kao, M.S., CCC-SLP

This is part 2 of a three-part series discussing speech and language development and the arts.
Part 1 was about Music.

"All art is communication of the artists' ideas, sounds, thoughts; without that no one will support the artist."
- Lionel Hampton

The creation of visual art has been shown to be an effective tool in the emotional development of children, especially in how they handle negative emotions (Brown & Sax, 2013; Dalebroux, Goldstein, & Winner, 2011).  But what about language development?  While there is not a large body of  research linking visual art to language development, there is some research available..  This post covers some of this  research and discusses how visual art can be used to enhance speech/language therapy sessions.

The Research

Research on visual art and its effect on language development is limited.  For children with Autism Spectrum Disorders (ASD), current research suggests that interventions using drawing as a medium can increase expressive language output, especially if descriptive language is incorporated to describe the  art and emotions depicted in the art (Round, Baker, & Raynor, 2017).  Group art therapy intervention has also been shown to increase social skills, such as assertion, in children with ASD.  Negative social behaviors, such as internalization and hyperactive behaviors, decreased in children with ASD as a result of being able to draw to express their emotions (Epp, 2008).


visual arts in language development

Coates and Coates (2006) found that in typical preschool programs in the UK preschool children’s art showcased a wide variety of interests and continued scenarios from previous imaginative play.  When children were given the opportunity to draw  in pairs or groups rather than with an adult, language focused on the content of the art.  Children shared ideas, asked each other questions, discussed the content of their pieces, and used descriptive language to share their art with others (Coates & Coates, 2006).

The Therapy

One common pitfall that many therapists (myself included) fall into when discussing children’s art is asking the question, “What did you draw?” leading to short, concrete responses instead of allowing the children to freely express themselves.  As therapists, I believe we should use the same procedures eliciting language samples through art as we do with interactive play by following the child’s lead and allowing him/her to discuss the drawing while the therapist comments and responds.

While more research needs to be done in the area of visual art and children’s language development, using and creating art allows children to express their interests and emotions, and use personal narratives to describe what they are seeing, feeling, and experiencing.

Peter Kao, MS, CCC-SLP is a speech-language pathologist working in Milwaukee, Wisconsin. His interests include early childhood language, fluency, and voice disorders. You may contact Peter on LinkedIn.

Brown, E. D., & Sax, K. L. (2013). Arts enrichment and preschool emotions for low-income children at risk. Early Childhood Research Quarterly, 28(2), 337-346.

Coates, E., & Coates, A. (2006). Young children talking and drawing. International Journal of Early Years Education, 14(3), 221-241.

Dalebroux, A., Goldstein, T. R., & Winner, E. (2008). Short-term mood repair through art-making: Positive emotion is more effective than venting. Motivation and Emotion, 32(4), 288-295.

Epp, K. M. (2008). Outcome-based evaluation of a social skills program using art therapy and group therapy for children on the autism spectrum. Children & Schools, 30(1), 27-36.

Round, A., Baker, W. J., & Rayner, C. (2017). Using Visual Arts to Encourage Children with Autism Spectrum Disorder to Communicate Their Feelings and Emotions. Open Journal of Social Sciences, 5(10), 90.


"Stop Copying Me!" Echolalia and Autism

“Stop copying me!”  The 4-year-old snaps at her 2-year-old brother.  

“Copy me,” he exclaims in glee, echoing her last few words.  This scenario may seem familiar to you if you have interacted with very young children.  This pattern of imitating the speech of others is called echolalia.  Echolalia, or repeated speech, is a natural part of language acquisition and usually decreases as a child begins to generate his/her own utterances spontaneously.  


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Echolalia in individuals with autism, however, often persists for much longer periods of time.  In children with autism echolalia has been described as a persistent phenomenon and is often described as one of the most common language symptoms in autism (Saad & Goldfeld, 2009; Sterpni & Shankey, 2014). Even deaf children with autism have been found to demonstrate echolalia in their use of echoed signs (Shield et al., 2017).

Echolalia:  Delay or Disorder?

While many disciplines have believed in the past that echolalia has no communicative function and as such should be discouraged, speech-language pathologists have long held that echolalia has important communicative and cognitive functions (Prizant & Duchan, 1981).  In her book, Natural Language Acquisition on the Autism Spectrum: The Journey from Echolalia to Self-Generated Language, Marge Blanc further specifies that echolalia should be considered a delay, not a disorder (Blanc, 2012).  Dr. Barry Prizant, author of Uniquely Human: A Different Way of Seeing Autism, recently shared the following thoughts on echolalia:

Research has found that some forms of delayed echoic utterances are produced with intent; that is, the utterances are produced as a means to an end or for the purpose of accomplishing some goal (e.g., requesting objects, directing others' behavior, labeling, etc.). It is possible that, due to specific linguistic formulation difficulties, autistic persons must often rely on utterances "borrowed" from others in order to express their needs and intentions . . . even though the internal structure (i.e., semantic-syntactic relationships) of such utterances may not be analyzed or fully comprehended (Prizant, B., Email Communication, October 30, 2017).

Types of Verbal Echolalia

Echolalia can be divided into two types, immediate and delayed.  Immediate echolalia, as suggested by its title, is echolalia that occurs very close to the modeled stimulus.  For example, “This is fun!” imitated as “fun!” by a child with autism after the clinician says it.  This type of echolalia typically occurs within two conversational turns (Prizant & Duchan, 1981; Stiegler 2015).  

Delayed echolalia, on the other hand, is echolalia that occurs some time after the modeled stimulus has occurred.  This is often informally called “scripting.”  For example, a child who repeats an entire episode of his favorite TV show viewed the evening before may be said to be “scripting.”  Another example of delayed echolalia or “scripting” is a child who repeats, “Johnny, no,” on his morning bus ride even though the words were said by his mother much earlier.  Delayed echolalia is echolalia that occurs after two or more conversational turns (Prizant & Rydell, 1984; Stiegler 2015).  

Meaning in Echolalia/Another Way of Acquiring Language

Some researchers have suggested that delayed echoes are more likely than immediate echoes to be produced with evidence of comprehension (Rydell & Mirenda, 1994).  Through observation and study of the child’s language, clinicians can often determine whether an echoed utterance has meaning in that particular context (Stiegler, 2015).

An example from my own clinical practice comes to mind.  I had a student who “scripted” regularly.   On this particular day, I was taking a little longer than usual to get his favorite activity together.  His scripts kept employing the phrase, "You're wasting my time. You're wasting my time," in a string of other longer, and seemingly meaningless, comments.  Eventually I began to observe the repeated phrase and realized he was trying to tell me "you're wasting my time" even though he was actually repeating the phrase, “Something's wrong with you, really. You're wasting my time. I have to find my son.”  Blanc describes this phenomenon as a “language soup” of sorts.  She explains that meaningful and useful phrases can be extracted from this “language soup” and mixed and matched to form new meaningful and useful phrases (Blanc, 2012).

 While many typically developing children begin learning language by first using single word utterances and then combining those words into longer and longer utterances, children with autism may acquire language differently by first capturing “sentence-length strings” and then pulling out individual words and phrases.  Both methods of learning language are said to be valid (Blanc, 2012; Stiegler, 2015).  In the example from my own clinical practice, my student used a “sentence-length string” to convey his impatience rather than a single word “hurry.”

One of our goals as clinicians working with children who demonstrate echolalia is to help the child begin to recognize and use functional words and phrases repeated in their echoed utterances and to use those words and phrases to begin to generate their own utterances for the purpose of commenting, requesting, refusing, etc.  In response to my student’s use of delayed echolalia to communicate, I responded by agreeing and apologizing.  “We’re wasting time.  Sorry.  Almost done."  He stopped scripting that line immediately after.  

How Can Clinicians Help?

So, how can clinicians effectively help children who frequently produce echoed utterances to use them in a clear and meaningful manner?  The following are a few suggestions from the literature and clinical experience:

  1. Complete comprehensive language sampling and analysis in order to determine what utterances are frequently echoed and the context in which they are being used across settings (Blanc, 2013; Stiegler, 2015).  

  2. Model developmentally appropriate phrases that are specific to the individual’s interests and intentions and are immediately useful (Stiegler, 2015).  

  3. Give the child an opportunity to hear utterances similar to his/her scripts in different contexts (Blanc, 2013).

  4. Provide planned language experiences for the child. This works best if you understand the child’s loves and interests and are familiar with his/her frequently used “scripts” (Blanc, 2013).

  5. Respond with comments or affirmations (Davis, 2017).

  6. Give plenty of opportunities for the initiation of spontaneous communication by shaping therapy sessions around preferred and enjoyable tasks.

  7. Create opportunities where the child must initiate communication to achieve a goal (e.g., favorite activities visible, but just out of reach). This is also known as creating ‘temptations,’ or using sabotage.

  8. Ensure teachers and parents are following a similar plan to help with generalization of skills to other communicative settings.

Echolalia should not be automatically viewed as mindless repetition of words and something that should be discouraged at all costs.  Echolalia is more than just a part of the many symptoms of autism spectrum disorder.  Echolalia is a part of society as a whole. It is a natural part of language acquisition and often leads to self-generated utterances.  Perhaps the next time you catch yourself using a funny phrase from a movie in conversation with a peer, or observe a small child imitating an older sibling, you will reflect further on echolalia and the role it plays in the development of language.


Givona A. Sandiford, Ph.D., CCC/SLP, is a licensed speech–language pathologist with over ten years of experience working with individuals with autism and other speech/language disorders. Dr. Sandiford has served as a speech–language pathologist in public schools, alternative schools, outpatient clinics, home health, private practice, and various other settings. She has also served as a peer reviewer for the Journal of Autism and Developmental Disorders. She is the owner of MeloComm Speech and Language Therapy and the developer of Melodic Based Communication Therapy (M.B.C.T.) for nonverbal autism, which was the subject of her dissertation research. Her research on Melodic Based Communication Therapy was the recipient of the LLU School of Allied Health Professions 2013 Outstanding Doctoral Research Award and has been published in and cited by multiple publications in peer–reviewed journals.  Dr. Sandiford enjoys research, reading, writing, painting, creating apps to help treat speech and language impairments, and working closely with students with disabilities.




Blanc, Marge (2012). Natural Language Acquisition on the Autism Spectrum: The Journey from Echolalia to Self-Generated Language.  Madison, WI. Communication Development Center Inc.

Blanc, M., Prizant, B., Snow, M., & Lee, K. (2013). Natural Language Development in Autism: Echolalia to Self-Generated Language. American Speech-Language-Hearing Association Convention. (Natural Language Acquisition Summary Handout (Blanc, 2012)). Retrieved from:

Blanc, M. (2013, March/April). Echolalia on the spectrum: The natural path to self-generated language. Autism/Asperger's Digest. Retrieved from

Davis, K. (2017). Echoes of Language Development:  7 Facts about Echolalia for SLPs. The ASHA Leader Blog. Retrieved from

Prizant, B., & Duchan, J. (1981). The function of immediate echolalia in autistic children. Journal of Speech and Hearing Disorders, 46(3), 241-249.

Prizant, B., & Rydell, P. (1984). Analysis of functions of delayed echolalia in autistic children. Journal of Speech and Hearing Research, 27, 183–192.

Rydell, P., & Mirenda, P. (1994). Effects of high and low constraint utterances on the production of immediate and delayed echolalia in young children with autism. Journal of Autism and Developmental Disorders, 24, 719–735

Saad, A., & Goldfeld, M. (2009). Echolalia in the language development of autistic individuals: a bibliographical review. Pro-Fono, 21(3), 255-260.

Shield, A., Cooley, F., & Meier, R. (2017). Sign Language Echolalia in Deaf Children With Autism Spectrum Disorder. Journal of Speech, Language, and Hearing Research, 60(6), 1622-1634

Sterponi, L., & Shankey, J. (2014). Rethinking echolalia: Repetition as interactional resource in the communication of a child with autism. Journal of Child Language, 41(2), 275-304. doi:10.1017/S0305000912000682

Stiegler, L. (2015). Examining the Echolalia Literature: Where Do Speech-Language Pathologists Stand? American Journal of Speech-Language Pathology, 24, 750-762. doi:10.1044/2015_AJSLP-14-0166




Crafty Creations: Gingerbread People

By Peter Kao

Using art and craft projects in your therapy is a great way to keep kids engaged while they practice their speech and language skills. Creating visual art has been shown to increase verbal output and nonverbal communication, specifically in children with autism spectrum disorders (Round, Baker, & Raynor, 2017).

Recommended age: 6 years and up

Bring Crafty Creations _FB.pnggingerbread man craftivity


To create this Crafty Creation, you will need the following materials (most of which should be available at your local craft store):


  • Prefabricated craft foam gingerbread figure cutouts

  • Assorted 3-D rhinestone stickers

  • Assorted colors of decorative tape*

  • Googly eyes (optional)

    * Certain kinds of tape don’t have enough adhesive to stick to the craft foam.  Colored electrical tape, decorative duct tape, or drawing with markers can be good alternatives.


Below is a list of how speech and language skills that can be targeted using this craft.



  • Articulation / Phonology:  Every 5-10 productions adds a decorative item to the gingerbread man.

  • Expressive Language:  Labeling body parts, requesting, using descriptive language (describing where items are placed, what the gingerbread figure looks like).
    Upper elementary, middle, and high school students may create a story about their gingerbread characters.

  • Receptive Language:  Following multiple step directions.



Literary tie-in: Read or watch a telling of the classic folktale, The Gingerbread Man.  
This would be a great extension for students working on retelling stories , answering wh-questions, identifying main idea, and inferencing/predicting.


Round, A., Baker, W. J., & Rayner, C. (2017). Using Visual Arts to Encourage Children with Autism Spectrum Disorder to Communicate Their Feelings and Emotions. Open Journal of Social Sciences, 5(10), 90

Peter Kao, MS, CCC-SLP is a speech-language pathologist working in Milwaukee, Wisconsin. His interests include early childhood language, fluency, and voice disorders. You may contact Peter on LinkedIn.


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