Many children on the autism spectrum use echolalia (repeating other people’s words and sentences) as a way of responding to direction, as well as expressing their wants and needs. Echolalia may be confusing for parents and neurotypical people but it need not be distressing.
To explore the subject of echolalia and look at solutions for learning more acceptable verbal communication, this article will use “Caleb”, a fictional boy with autism, as an example of how echolalia might present itself.
Examples of echolalia in children with autism
Caleb fell down the steps into his backyard and cried out in a startled voice, “Are you okay? Are you okay?” Then, as his alarm abated, he shifted to “You’re okay, Honey. You’re okay!” and pushed away his mother as she ran to dust him off.
Like most children with autism who echo language, four-year-old Caleb uses whole chunks of other people’s conversations to express himself. He remembers their words easily and often associates them with similar situations. In the example above, he recycled the words and tone his mother had used the last time he fell.
Similarly, he might make a request by asking: “Do you want some ice cream?” or “Do you want ketchup with that?” When Caleb asks for help, it might sound like: “Let me help you,” or “Can you do it all by yourself?” Or he might say: “Do you need help?” to no one in particular, as he struggles to open a container.
As an ASD child who is an extremely fussy eater, Caleb is often encouraged to try new foods. He finds this very stressful, but while he is pushing away the offered food, he may squeal: “Try it! It’s delicious!”
While he plays with his toy trains, Caleb often recites lines from his favorite train videos, but does not usually match his actions to the words. He might say: “And the little train raced through the tunnel!” while he is spinning the wheels on an upended caboose.
If someone greets him, he responds with an echoed: “Hi Caleb”, or does not respond at all. Young children might use early words and phrases, and gestures, to communicate their requests, protests, directives, greetings, and comments. Caleb’s echoes often serve these same communicative functions, but his listeners have to interpret the meaning behind his actions.
Why do children with autism echo?
A child with autism such as Caleb may have a very strong memory and good ability to imitate speech and sounds, but poor understanding of language. He does not recognize that I/you pronouns shift with the speaker, nor does he separate individual words from the whole phrase or sentence he is echoing. He cannot use the words he echoes to create new sentences. Many of his echoes are questions because adults ask children a lot of questions. Like many young children with autism, Caleb does not yet answer or ask typical questions.
Caleb is both physically and verbally active, but some children who echo language speak only occasionally and not as clearly. Often the play skills of echolalic children are limited and repetitive, as are those of children with autism who do not echo language.
The most effective way I have found to assist children using echolalia begin to communicate in more conventional ways is through modeling language and play. Modeling means demonstrating a behavior that a child with autism imitates. Children who echo readily imitate language but initially need to copy it from their point of view.
Here are some general suggestions about modeling and then some examples for modeling early functional communication during play and daily routines with children on the autism spectrum.
Modeling language for echolalic children
- Model language that will still be true and appropriate if echoed. “Time for the bathroom” works to direct him and works if he says it to you, but “Do you need to use the bathroom?” is confusing when Caleb later echoes it as an answer to express his need
- Model short phrases at first, even if your child can echo long sentences, and match the words to what he/she is experiencing. He/She needs the simplicity to connect the meaning with the words even though his/her memory allows him/her to say longer phrases and sentences
- Avoid questions if your child doesn’t answer questions yet. Children who echo often sound like everything they say is a question
- Use names instead of pronouns for a while as a way of minimizing the “I-you” confusion
- Expect comprehension difficulties even though he/she can follow some directions. Children who understand language well do not routinely echo whole sentences to communicate
- Expect he/she will need direct instruction on using pronouns and answering or asking questions, but for now, avoid them to minimize his/her confusion while he/she masters early speech and communication skills
Ideas for teaching early functional communication to children with ASD
When Caleb says: “Do you want some ice cream?” you reply: “Want some ice cream”, being careful not to let it sound like a question. Repeat “Want some ice cream” a few times while you get it for him. As you start to give it to him, say: “Want some…” and he will probably add: “ice cream”. If not, you say the whole phrase again and give it to him. If he correctly repeats: “want some ice cream”, you just say: “Ice cream!” and give it to him.
If he is jumping and reaching for a toy airplane on a shelf, help him point to it as you model: “Airplane! Want the airplane!” a couple times and then give it to him. If you include “please”, just tack it on the end, as in: “Want the airplane please.”
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You can support Caleb to give you the toy he can’t wind up or the box he can’t open, by saying, “Please help!” or “Please open it” as if telling yourself what to do.
When he’s playing with his train, put your hand on the track to block his progress. When he pauses or fusses, you direct yourself to “Please move!” and move your hand out of his way. After a few times, he will probably start telling you, “Please move!”
If Caleb is pushing away an avocado and crying: “Try it! It’s delicious!”, you say: “Don’t want avocado!” and help him push it away. But sometimes you will have to overrule him. If he’s resisting an antibiotic, you can acknowledge his protest with: “Don’t want medicine!”, pause, and add: “Sorry, Caleb needs the medicine,” and proceed with the struggle.
If saying “Bye Caleb” gets no response or he repeats “Bye Caleb” to you, just say “Caleb!” and when he looks up or pauses, you say “Bye!” and he may say “Bye” back to you. If not, you repeat the “bye” once or twice. Often you will get an answer and eye contact. Instead of coaching him to “Say ‘Bye/Hi’” to…” friends and family, ask them to prompt him this way too.
If he is obviously enjoying a food, acknowledge it with a comment instead of asking if he likes it, which he may echo instead of answering. For example, say: “Ranch dressing is yummy,” or: “Mmmm, it’s a good cookie,” either of which is true from his point of view if he repeats it.
Join his play and demonstrate things he can do and say to develop both his use of toys and his language.
Some examples include: Caleb is flipping a piece of a farm puzzle. You gently guide his hand to the puzzle board saying: “It’s a cow…it goes here…the cow is in!” or “Here’s a chicken…uh-oh, won’t go in…it fits!” as you assist him in finding the right holes for the puzzle pieces.
Riding in the car, you might say: “The light is red. We have to stop…The light turned green…We can go now.” Or you might say: “Here comes a school bus,” or “It’s starting to rain.”
Or at bath time, if he’s watching, comment on what’s happening: “The water is on…filling up the tub…that’s enough water…time to turn off the water.”
You and Caleb are sharing a book, but he won’t stay to hear a story. You just comment on the pictures, pointing with his finger if he will let you, and say: “Here’s a train with three cars; one, two, three,” or “The dogs are running,” or “This girl looks sad. She is crying.” Don’t be afraid to model the same things repeatedly in books. He is more likely to learn sounds and imitate language he has heard a few times.
Therapies and treatment for echolalia
If you feel you need to look beyond the home to reduce your child’s echolalia, there are some treatments available. A popular choice is speech therapy where you can work with a therapist to encourage your child to say what he/she is thinking. Play therapy is also an option, where the child is encouraged to communicate while taking part in enjoyable activities.
It is best to speak with a professional therapist about the needs of your individual child. And remember, your child is using echolalia as a way of communicating with you. Attempting to eliminate echolalia completely might not be the best option.
Many children with autism who echo speech are ideally suited for language modeling because they usually are actively trying to communicate, have strong memories, and imitate readily. They are already showing they have some ability to learn language. Match the words with the meanings from the point of view of the child with autism. Model now, conversation later.
Delayed language development is common in children with autism and, although echolalia may feel unsettling, parents need not worry prematurely: there are plenty of communicative tools and teaching options you can use at home or with speech language pathologists to support your child and help them with language acquisition.