Transcript PBL case ON ECHOLALIA

BERNARDUS LARRYANT
SONJA RONDESTVEDT
VALERIE S. VARASTEH
OUTLINE

 MAMI & FAMILY
 BACKGROUND INFORMATION
 ASSESSMENT
 INTERVENTION
 CONCLUSION
MAMI & FAMILY

MAMI

 Mami Yamamoto
 6 years old
 Kindergarten
 Enjoys playing with light toys, soft music, and visual
movements
 Does not enjoy loud noises
 Limited play skills
 Repeating both English & Japanese phrases
Image taken from http://silveroses69.blogspot.com/2007_05_01_archive.html
FAMILY

 Lives with Mother (Reiko) and Grandmother (Akari)
Image taken from http://english.kimono-sakaeya.com/?eid=1440311 Image taken from http://flickrhivemind.net/Tags/obasan/Interesting
GOALS

 The family wants Mami to:
 Increase functional use of speech and other English
language skills
 Decrease her echolalia
BACKGROUND
INFORMATION

DEFINITION

 Echolalia is the repetition or echoing of verbal
utterances made by another person.
 Rydell & Prizant (1995) stated echolalia refers “to a
general class of speech repetition with few
distinctions made regarding the degree of repetition
or comprehension and intentionality underlying the
production of echolalic utterance” (p. 106).
 85% of verbal children with autism produce echolalic
language (Rydell & Prizant, 1995).
ECHOLALIA IN CHILDREN
WITH AUTISM

 There is a need to consider the acceptance of echoic behaviour.
That is, how comprehensive is the child with autism’s utterance
to the communicative partner? Rydell &Prizant (1995) suggest
observing the following points :
1. Do the words used in the echoic utterance have an equivalent meaning
to others?
2. Does it relates to the context in which it occurs?
3. Is intention created in the utterance?
4. Does the utterance assist in maintaining a social interaction by
providing novel or needed information?
5. Does the echoic utterance can evoke a response from another person?
6. Does the echolalia disrupt the child’s ability to partake appropriately
in a social interaction and/or an educational task?
7. Does the echolalic behaviour isolate the child with autism?
ECHOLALIA IN CHILDREN
WITH AUTISM

 Echoic behaviour is displayed in interactive and noninteractive forms (Prizant & Duchan, 1981):
 Interactive: degree of comprehension of the model
utterance by showing appropriate gaze; task attempt,
and the use indicating behaviours (point, gesture,
show, etc.).
 Non-interactive: little comprehension of model
utterance and lack the proper gaze, low in volume,
and there is no observable change in behaviour.
AUTISM AND
BILINGUALISM

 Bilingualism is not a hindrance for children with
developmental disabilities.
 Children who are growing up in a bilingual home
need to learn the spoken languages in order to
partake wholly within the family system. It is
important for their life context and for the children
with autism to communicate with those who are
important to them and play a large role in their life
(Kay-Raining Bird, Lamond, and Holden, 2012).
AUTISM AND
BILINGUALISM

 Kay-Raining Bird, Lamond, and Holden (2012) did a
survey to investigate a range of questions around
autism and bilingualism.
 Mode of Communication
 Language Exposure
 Professional Advice
 Family ratings display that bilingualism was of
importance and a majority felt they were successful
in raising their child in a bilingual home.
ECHOLALIA AND
BILINGUALISM

 Echolalia has also been used to teach receptive
naming of Chinese characters (Leung & Wu, 1997):
o When children with autism echo the response before
the matching task, the children display improved
receptive language skills. In addition, the difficulty
of the task affected the speed of acquisition.
o Echoic prompt may assist in reading the name of the
character and guided attention to the matching
symbol
ECHOLALIA IN LANGUAGE
DEVELOPMENT

 Two viewpoints in echolalia had been developed
around language acquisition:
a. Echolalia is a pathological behaviour that needs to be
extinguished due to interference with the development of
appropriate language skills; no functionality is observed in the
echoic utterances
b. Echolalia is used with a functional purpose; furthermore,
echolalia can be a tool to develop a more conventional
application of the child with autism’s language repertoire.
 Language development in children with autism is
linked to the Gestalt and Interactionist approaches.
GESTALT APPROACH

 Gestalt processor – develops language by using
memory and repeating multi-word utterances in
chunks. The process aids in the comprehension of
linguistic structures (albeit, in small amounts)
(Bebko, 1990; Rydell & Prizant, 1995; Prizant &
Rydell, 1993).
 Memorization and chunking of the conventional
linguistic structures also supports generalization and
applyinh the chunks in other proper and appropriate
ways (Prizant, 1983; Prizant& Rydell, 1993).
GESTALT APPROACH

 Children with autism take on a gestalt form of
language development. Most children with typical
development develop language through an
analytical process.
 Analytic processors - develop language skills with
acknowledgement of the basic structures in
language. The meaning behind words and phrases
are develops through linguistic stages toward more
complex utterances (Prizant & Rydell, 1993).
GESTALT APPROACH

 Children with autism are considered to develop
language through an extreme form of gestalt
processing and can be correlated to characteristics
linked to autism such as the degree of rigidity seen
in individuals with autism, coping with
unpredictability, lack flexibility, difficulty with
producing generative and flexible language, and
comprehending social-system rules (Prizant, 1983;
Prizant & Rydell, 1993).
INTERACTIONIST
APPROACH

 Examines “the relationship among the fundamental
variables in the social-communicative interaction
and the influence of these variables on an
individual’s communicative performance” (Prizant
and Rydell, 1993, p.275).
 Prizant and Rydell (1993) suggest two factors are
related to the interactionist approach:
 1. Cognitive, social, socio-emotional, linguistic strength or
weaknesses of the child may affect the nature of the interaction.
 2. The partner’s interactive style may influence the response.
COGNITIVE AND SOCIAL FACTORS
INFLUENCING ECHOLALIA

 Task Demand/ Unfamiliar Environment
o Echolalia may occur more frequently when the child is in a
challenging social scenario, and/or demanding and novel
setting (Prizant & Rydell, 1993).
 Comprehension
o Echolalia is employed when there is difficulty in
comprehension during verbal interaction with a communicative
partner (Bebko, 1990; Prizant & Rydell, 1993; Rydell & Prizant,
1995).
o Information-processing view: echolalia arises when the adult
uses abstract language and it does not match the semantics that
were previously used during the child’s turn in the
conversation (Prizant, 1983; Prizant, Rydell, 1993; Rydell & Prizant,
1995 Schuler, 1979).
COGNITIVE AND SOCIAL FACTORS
INFLUENCING ECHOLALIA

 Transitions (Prizant, 1983; Prizant & Rydell, 1993;
Schuler, 1979)
o Children with autism display an increase use of echolalia and
agitation due to confusion from a change in the usual routine.
In addition, fatigue and distraction linked to transitions also led
to higher incidences of echolalia.
 Adult influences (Rydell & Mirenda, 1994; Prizant &
Rydell, 1993)
o The style of communication affects the level of echolalia
produced in children with autism. The directive style increases
echolalia while the facilitative style consists of natural turntaking.
COGNITIVE AND SOCIAL FACTORS
INFLUENCING ECHOLALIA

 Adult influences (Rydell & Mirenda, 1994; Prizant &
Rydell, 1993)
 An association between the communicative style and linguistic
constraint.
 High constraint utterance: when the child is required to respond
to the adult’s utterance in a similar form of style in
communication which has “specific syntactic-semantic
structure or content” (Rydell & Mirenda, 1994, p.720).
 Low utterance constraint: not required to meet the adult directive
control, more natural conversational comments.
IMMEDIATE ECHOLALIA

 Is an utterance that is emitted immediately following
the original utterance, or a brief time following the
utterance from the communication partner (usually
within two comments) (Prizant & Duchan, 1981;
Prizant and Rydell, 1993; Rydell & Prizant, 1995)
 Retrieval of information from short term memory
(Prizant, 1983).
 The researchers determined that immediate echolalia
often was used with clear evidence of purposeful
communication (Prizant, 1983; Prizant & Duchan,
1981).
IMMEDIATE ECHOLALIA

 Immediate echolalia may support the development
of more elaborate language skills and the frequency
of echolalia depends on the level of language
development (McEvoy et al., 1988).
 Children with autism who display intermediate level
of language acquisition will emit more echolalic
utterances since it serves as a function to
communicate with others and a way to continue
acquisition (McEvoy et al., 1988).
DELAYED ECHOLALIA

 Delayed echolalia refers to utterances that are
repeated later on in time (Prizant & Rydell, 1984).
 Usually echoic utterances are derived from TV
commercials, movies, and repetition of parental
reprimands.
 Involves retrieval of information from the long term
memory storage (Prizant, 1983).
 It is easier for those familiar with the child with
autism to decipher the meaning behind the delayed
echolalia and how it may relate to the context in
which it occurs (Prizant & Rydell, 1984).
MITIGATED ECHOLALIA

 Mitigated echolalia- when the child changes a word, phrase,
intonation, or feature of the utterance that is repeated (Bebko,
1990).
 Mitigation is used in both types of echolalia.
 Rydell and Mirenda (1994) suggest mitigated echolalia is not
derived from rote repetition.
 Mitigation demonstrates a control over the echolalic utterances
and utilization of rule-governed grammatical competence
(Bebko, 1990; Prizant & Rydell, 1993; Roberts, 1989).
 Bebko (1990) describes two basic capabilities of language are
intact for children with autism who use mitigated echolalia:
labeling and symbolic function. A third component in language
that is seen with mitigated echolalia shows inference to one’s
self (Bebko, 1990).
ASSESSMENT

Data Collection

Language Samples & Ecological Assessments
 Preferably videotaped samples in multiple
environments.
 If videotaping is not an option, audio taping or
written observations from an observer is advised.
 In Chapter 5 of Teaching Children with Autism:
Strategies to Enhance Communication and
Socialization, Rydell and Prizant offer 18 different
suggested activities for collecting language samples
in different environments.
Some Suggested Activities
for Language Sample

 Eat a desired food item in front of the child without
offering any to him or her.
 Activate a wind-up toy, let it deactivate, and hand it
to the child.
 Give the child four blocks to drop in a box, one at a
time, then immediately give the child a small animal
figure to drop in the box.
 Look through a few books or magazines with the
child.
 Open a jar of bubbles, blow bubbles, and then close
the jar tightly and give the closed jar to the child.
Suggested Activities for
Language Sample

 Initiate a familiar social game with the child until the
child expresses pleasure, then stop the game and
wait.
 Blow up a balloon and slowly deflate it; then hand
the deflated balloon to the child or hold the deflated
balloon up to your mouth and wait.
 Offer the child a food item or toy that he or she
dislikes.
 Place the child’s hands in a cold, wet, or sticky
substance, such as Jell-O, pudding, or goo.
Step 1

After you have the language sample, you can now
categorize the unconventional verbal behaviour.
 Immediate echolalia
-immediate repetition of words or phrases
 Delayed echolalia
-significantly delayed repetition of words or phrases
(hours, days, or weeks later)
Step 2
Determine the function of the echolalia

From Prizant and Rydell (1984)
If it’s immediate echolalia there are two categories:
1.Interactive functions
 Turn-taking
 Declarative
 Request
2. Noninteractive functions
 Nonfocused
 Rehearsal
 Self-regulatory
Step 2
Determine the function of the echolalia

If it’s delayed echolalia there are also two categories:
1. Interactive functions
 Turn-taking
 Verbal completion
 Providing Information
 Labeling (interactive)
 Request
 Calling
 Affirmation
 Directive
Step 2
Determine the function of the echolalia

2. Noninteractive function
 Nonfocused
 Situation association
 Self-directive
 Rehearsal
 Labeling (noninteractive)
Step 3
When does it occur?

Possible Antecedents
Echolalia is more likely to occur in these conditions:
1. Specific situations
2. Specific interactions
3. Person-specific situations
Step 4
Communicative Intent

What is the communicative intent?
From Wetherby and Prizant (1989)
 Is there no awareness of the goal?
 Is there awareness of the goal?
 Is there a plan to achieve the goal?
 Is there a coordinated plan to achieve the goal?
 Is there an alternative plan to achieve the goal?
 Is there metapragmatic awareness to achieve the
goal?
Step 4.5
Communicative Function

Determining the communicative function of the echoic
utterances are done by examining the
communication partner’s interpretation of and
reaction to the behavioural act.
Interviewing the home and school team members to
gain greater information about their interpretation of
and reaction to the unconventional verbal behaviour
is suggested. A functional assessment interview
could be used to gather this information.
Step 5
Challenging behaviours

Another factor to consider for echolalia is the whether
the unconventional verbal behaviour is challenging
and who is it challenging for.
 Does it add new or relevant information?
 Does it interfere with the person’s ability to have
conversations or be apart of conversations?
 Does it have stigmatizing effects on the person in
certain contexts?
A functional behaviour assessment could be done to
assist with determining those factors.
Step 6
Intervention?

The last stage of assessment is looking at whether direct
intervention is needed and/or wanted.
Once the language samples have been analyzed and
coded, suggestions for either direct or indirect
intervention can be made if the family or school feel
it is beneficial.
Other Assessments
continued

 The Inventory of Potential Communicative Acts
(IPCA) by Jeff Sigafoos et al.
 Social Networks: A Communication Inventory for
Individuals with Complex Communication Needs
and their Communication Partners by Sarah
Blackstone and Mary Hunt Berg, Published in 2003.
INTERVENTION

INDIRECT INTERVENTIONS

 Focus on modifying the environment
 Based on information gathered from Functional
Assessment
SETTING EVENT INTERVENTIONS

 Lack of appropriate play skills
 Introduce different activities and toys in order to
expand her repertoire of preferred activities and
toys – increase choices for her reinforcer menu
ANTECEDENT INTERVENTIONS

 Environment is too loud/noisy
 Gradual exposure to loud and noisy environment
 Short period of exposures (5 minutes)
 Removal upon request using AAC or speech
 Gradually increase the amount of exposure in small
increments
 Provide safety signal for Mami to make it through the
session
 Use a timer to provide a visual support for Mami
 Pre-correct Mami to use her AAC or speech to ask for break
 “Remember, if you want to leave, you can ask for a break.”
TEACHING INTERVENTIONS

 Echolalic speech – minimal functional speech
 Teach Mami to use her AAC to request for a break
from the loud and noisy environment
 Every request made using AAC should be followed
by vocal approximation in order to encourage speech
 Echolalia replacement strategy
FOXX (2004)

 Response training - getting the subject to correctly label picture
symbols that will be used
 Cue-pause-point procedure
 Deliver the instruction (CUE)
 Holding up a finger to signal silence and say “shh” or “no”
whenever silence is desired (i.e. during instruction).
(PAUSE)
 Move your finger so that it touch the picture card about 2
seconds after the instruction was delivered. (POINT)
 Prompt to ensure the correct labelling occurs
 Intermittently reinforce correct responding
FOXX (2004)

 To fade the prompts, cover the picture card with a
folder and touch the folder during the POINT phase
 Eventually, fade the prompts all the way to simply
PAUSE after delivering the instruction
MAMI’S CASE

 Practice with Mami so she can correctly label the
“break” card- “I want a break”
 In a loud and noisy environment:
 Ask her, “What do you want?”
 Holding up a finger and saying “shh” whenever her
echolalia starts
 Touch the “break” card approximately 2 seconds after
 If no response, prompt her to say “I want a break”
 Immediately, let Mami leave the noisy environment
upon asking
MAMI’S CASE

 Eventually, cover the “break” card with your hand
and simply point to the hand
 Finally, simply pause 2 seconds after delivering the
question for Mami to respond correctly
GENERALIZATION
The same procedure can be used in other situations
as well, such as requesting for items, asking for
attention, and others.
AUGMENTATIVE AND ALTERNATIVE
COMMUNICATION (AAC) DEVICES

 Has been shown to help children with autism make
gains in speech production (Schlosser & Wendt,
2008; Millar, Light, & Schlosser, 2006)
 Comes in a number of different modes: manual
signs, picture symbols, or voice output devices
(Mirenda, 2003)
 Use it in the early part of Mami’s intervention in
order to give Mami an appropriate mean of
communication
 Gradually fade it out as her functional speech
increases
PROLOQUO2GO

 Augmentative and Alternative Communication application for iPad,
iPhone/iPod Touch
 Consists of picture symbols as well as voice output capabilities
 Chosen because of its functionality & cost
 Costs:
 App: $189.99
Total Cost
 iPad 2: $419.00
$400.00 – $650.00
 iPhone: $375.00
 iPod Touch: $199.00
http://www.youtube.com/watch?v=vomkNSluWW4
Images are taken from http://www.proloquo2go.com/About/
CONSEQUENCE INTERVENTIONS

 Main function is ESCAPE
 Let Mami have a break when she uses her AAC to
ask for one
 Reinforce Mami with a preferred activity or toy
when she uses appropriate and functional speech
 Create a reinforcer menu for Mami to choose from
 Prompt Mami to use appropriate speech
REPLACING ECHOLALIA

 Risley and Wolf (1967) – replace echolalia with
stimulus specific responses
 Schreibman and Carr (1978) – replace echolalia with
a generalized verbal response
 Foxx (2004) – replace echolalia with functional use of
verbal labelling
CONCLUSION

CONCLUSION

 Believe that the function of her echolalia is, for the
most part, escape
 Functional communication training
 Cue-pause-point method to teach her appropriate
speech
 AAC to help Mami use appropriate language at the
beginning of the intervention
 Proloquo2Go is the choice due to its functionality and
cost
Questions?

Image is taken from http://therealkenjones.wordpress.com/2012/02/08/capitalism-and-socialism-making-sweet-love-for-over-200-st-valentines-days/
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
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
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