“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.
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:
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).
Model developmentally appropriate phrases that are specific to the individual’s interests and intentions and are immediately useful (Stiegler, 2015).
Give the child an opportunity to hear utterances similar to his/her scripts in different contexts (Blanc, 2013).
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).
Respond with comments or affirmations (Davis, 2017).
Give plenty of opportunities for the initiation of spontaneous communication by shaping therapy sessions around preferred and enjoyable tasks.
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.
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: http://www.communicationdevelopmentcenter.com/NLAScoringGuide.pdf
Blanc, M. (2013, March/April). Echolalia on the spectrum: The natural path to self-generated language. Autism/Asperger's Digest. Retrieved from http://www.communicationdevelopmentcenter.com/articles/echolaliaonthespectrum.pdf
Davis, K. (2017). Echoes of Language Development: 7 Facts about Echolalia for SLPs. The ASHA Leader Blog. Retrieved from https://blog.asha.org/2017/05/09/echoes-of-language-development-7-facts-about-echolalia-for-slps/
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