Future Reflections         Winter 2011

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You Can Say that Again!
Or, Echolalia, Echolalia, Echolalia

by Mary McDonach

Reprinted with permission from <www.wonderbaby.org>

L’Écho by Georges SeuratFrom the Editor: To the parents and teachers of blind children, persistent echolalia can be a maddening problem. In this article Mary McDonach of Paisley, Scotland, looks at echolalia from the child's perspective and discovers reasons for this perplexing behavior.

The word echolalia is derived from an ancient Greek myth about a nymph named Echo who could only repeat the last words stated by other people. Unrequited love left her heartbroken, and she pined away until only her voice remained. It's a cautionary tale about love and loss. You may think it's an old story with little relevance today, unless your blind child constantly repeats everything you say or seems to get stuck repeating one word or phrase over and over. In that case, you may have your own little Echo on your hands.

Does this conversation ring a few bells? It's a real-life example from my own real life!

Parent: Which story would you like tonight?

Child: What story am I wanting?

Parent: That's right. Which story are you wanting?

Child: What story am I wanting?

Parent: Yes, what story are you wanting?

Child: What story am I wanting?

Parent (now exasperated): What story am you wanting. I mean ...  never mind. No stories tonight!

That really is a cautionary tale!

It is thought that as many as 80 percent of young blind and visually impaired children exhibit echolalia in their speech patterns. Echoing is an excellent way to learn and practice language skills, and it is part of language development in most children, blind or sighted. However, in sighted children the period of echolalic speech tends to be relatively short. Blind and visually impaired children, on the other hand, seem to find this behavior more useful, so for them it has a more extended life.

How Can Echolalia Be Useful?

The uses of echolalia are many and varied. For blind and visually impaired children it can function in some ways that sight does for other children. Here are some examples.

Who's There? A sighted child simply looks around to see who is in a room. Your blind child does not have this option, but he/she has the same interest in finding out. A young child lacks the verbal skills to get this information in an unobtrusive way. Repeatedly asking questions that may have no bearing on what your child is trying to find out can seem odd to older children and adults. However, when we consider that your child's question will elicit some form of response from the others within a room, it is more readily understandable as adaptive behavior. Frequent repetition of the behavior can be seen as the child's way of staying informed about who is there and who has left.

Who's Where? Getting people to respond will also help your child know where others are in relation to himself/herself. Notice how in the following example everyone at the table engages with Tommy in some way in response to his echolalia:

Mum says, "Dinner time, Tommy. Yum, yum."

Tommy says, "Dinner time, Tommy. Yum, yum."

Mum interprets correctly that this is Tommy's way of saying that he heard her.

Tommy, now sitting at the dinner table with his siblings, says, "Dinner time, Tommy. Yum, yum."

His older brother says, "That's right, Tommy."

Tommy says, "Dinner time, Tommy. Yum, yum."

Older Sister says, "You've already said that. Stop saying that."

Tommy says, "Dinner time Tommy. Yum, yum."

Baby sister says, "Yum, yum."

Tommy says, "Yum, yum."

Older Sister says, "Mum, make him stop doing that."

Baby says, "Yum, yum."

Mum pulls her hair out, strand by strand.

Basic Connections: A sighted child will make a primary connection with others by using eye contact. Although eye contact is not possible for the blind child, he/she has the same need as the sighted child for that initial connection with other people. Echolalia gives him or her the semblance of this contact. It is not necessary for the speech to do anything other than provide connection. The child may not understand a need for speech to be relevant, as echolalia does the job of mimicking frequent casual glances.

Conversations and Social Connections: At this stage the blind child's understanding of language (called receptive language) is greater than his or her ability to express things verbally (called expressive language). Your child may want to get involved in the conversation of others, but may not have the ability to initiate or continue discussion of appropriate subjects. Echolalia can give the blind child the opportunity to seem to be involved in the conversation before his/her verbal abilities allow it. This behavior provides the child with a feeling of inclusion in the social aspects of conversation that would otherwise be fulfilled through eye contact and body language. Ironically, though the blind child seeks social inclusion through the use of echolalia, he/she is increasingly seen by others as different.

In addition to echolalia, pronoun confusion is apparent in the speech of many blind children. This confusion serves to multiply the child's apparent detachment from the group. Breaking away from these speech patterns can be very difficult, and what started as a transient developmental stage can become a rigidly performed habit.

What Can You Do to Minimize Echolalia?

It is crucial to your sanity as a parent that you remember that this too will pass. Every child at some point exhibits idiosyncratic quirks of behavior. Showing your child that there are easier, more practical ways to use language is the most effective way for you to spend your time. Gentle, persistent guidance may be difficult when your child is repeating for the thirtieth time something that was inane the first time around, but it will pay off in the end. Your effort is not about preventing him or her from speaking, and neither is it about exerting your dominance or control. On the contrary, this is about providing a path for your child to explore language and expand his/her abilities. You are guiding your child to behave as an ordinary, social person and eventually a well-rounded, socially aware, and happy adult.

Here are some tips to help you cope with your child's echolalia and encourage him/her to move on to more expressive forms of communication. Read through these suggestions and try the ones that seem the best suited to your situation. Remember that all kids learn at their own pace and react in their own ways, so be patient and don't give up! There is no quick fix. It is important for you to know and accept at the outset that giving your child an alternative to what currently works for him or her will take patience, commitment, and time.

Build a Language Bridge.  Language is your child's bridge to the world. His abilities with language will come directly from those around him. Make language work for both of you by providing him with a commentary on his world that grows with his understanding and abilities. The more expressive the language he is exposed to, the greater will be his ability with words--perhaps the most useful tool to give any child.

Be sure to explain to your child in very descriptive language what is going on around him. Who is in the room and what are they doing? What are the sounds he is hearing? A nice game to play is "I hear a ..." This game builds on the child's desire to repeat a single phrase, but it also requires her to think and fill in the blank. Sit outside and listen. Have your child tell you what she hears. Help her out by saying, "I hear a motorcycle ... I hear an airplane ... I hear the leaves rustling in the breeze." Encourage her to listen and label sounds herself.

Explain the unspoken language of sighted people. Your blind child needs an understanding of what people do and why they do it. Describe the nonverbal language of others, giving detail about the smiles, nods, and gestures that complement other people's speech. Help your child emulate this nonverbal communication where appropriate. It will bridge what might otherwise be perceived as a gap in his or her social behavior.

Model the correct response to a question or situation. Sometimes a gentle nudge in the direction of appropriate responses is all your child needs to act correctly. Positive feedback will help him remember what he did right, so he can use a variation of the behavior the next time. Success breeds success. Here's an example:

The kindergarten teacher says every morning: "How are you today, Tommy?"

Every morning Tommy replies: "How are you today, Tommy?"

Standing behind Tommy, his mum whispers in his ear: "Tommy's fine and he had a big bowl of cereal for breakfast." This is the correct response if Mum were answering the teacher, but she's offering it to Tommy. Now he has a choice. He may still say what he usually says, but one morning soon he may give the correct response.

In another example, the teacher says, "How are you today, Tommy?" Then she says, "That's a question, Tommy. I'd love to know if you are feeling well or grumpy or sad or happy."

Tommy now has the answers to her question and a better idea of the parameters to follow. In addition, even if he is echolalic, he is more likely to repeat her last word, "happy." "Happy" can be interpreted as a positive and appropriate response to her question, so he's winning already!

Simplify your speech. When your child is very young and just beginning to speak, it's a good idea to keep things simple. That way, when he does repeat what you've said, he's actually correct. For example, you may say, "Bye bye, sweetheart," instead of, "Bye bye, Tommy." When he repeats, "Bye bye, sweetheart," his language will actually sound correct. Also, since blind children tend to have a hard time with pronouns, it's a good idea to drop them, at least until your child has mastered other language skills and is ready to move on to pronouns. You may feel a little silly saying things like, "Mummy is going to pick you up now," or, "Tommy sounds tired," but it will help him know who you are talking about without having to decipher all those difficult words like you and me.

Don't ask unnecessary questions. When you ask a question that you don't really expect to be answered, you're placing needless pressure on your child. Instead of saying, "Are you ready for a bath?" you could say, "The bath is ready!" or, "Tommy's bath is ready." Either way, you're giving your child a phrase that he can repeat and learn as the signal that he's about to take a bath. Besides, what if he did answer your question and said no? You'd give him a bath anyway, so don't leave yourself open to debate!

Play up your child's strengths. If your child is good at repeating words and phrases, harness that power to teach him to talk on his own! Let him copy your phrases while you slowly phase out your words and encourage him to fill in the blanks. This is a great way to help your child to gain control and take ownership of his language. Here's an example:

Mum rolls a ball to Tommy and says, "Tommy has the ball!"

Tommy, holding the ball, says, "Tommy has the ball!"

The next day, Mum rolls the ball to Tommy and says, "Tommy has the b--"

Tommy, holding the ball, says, "Ball. Tommy has the ball!"

The next day, Mum rolls the ball to Tommy and says, "Tommy has the --"

Tommy, holding the ball, says, "Ball. Tommy has the ball!"

The next day, Mum rolls the ball to Tommy but doesn't say anything. Tommy, holding the ball, says, "Tommy has the ball!" At this point Tommy gets lots of hugs and kisses for saying something on his own!

Don't be tempted to ignore your child's echolalic speech. Any speech is an attempt to communicate and deserves a response from you. Whatever the quality of the content, your child needs to know that his efforts are valued.

Find a speech and language therapist who motivates and inspires you and your child. Advice from a trusted professional will be an invaluable asset. This is a long-term issue and there are no magic wands. It's a bit like guerrilla warfare; you'll have to be ever vigilant, ever ready with the correct word or phrase (or sometimes just an understanding cuddle) to save the day. Remember, it's no fun for your child either. Start today and help your child move toward freedom of expression. (And just think of all the great arguments you're going to have when he's older!!!)

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