Echolalia
high constraint vs low constraint utterances
*high constraint: direct questions and commands. these are the most frequent utterances that are echoed *low constraint are comments / open ended questions
facilitate low-constraint interaction styles among all communication partners
- this means partners should avoid too many direct questions and commands because they are most likely to result in echolalia. try to use comments more often than questions
Cognitive functions of echolalia
-Rehearsal of things they have heard -To assist with memory -Self-Direction to help them through a task
as SLPs, we may have a bias that _____ processing is typical, and ____ processing only occurs in children with delays/disorders. This is not necessarily true.
-analytic -gestalt
carefully observe to assess comprehension, discern underlying functions, and watch for mitigations. -look for... -try to...
-look for gaze, gesture, body orientation, etc. as markers of comprehension -try to discover the functions of utterances by context, consistency of us -mitigations are clear indicators of progress and should be tracked
researchers have described many communicative functions of echolalia -
-requests -yes answer -directive/commands -calling -affirming -protesting -labeling -providing information -verbal completion -turn taking
to obtain language samples, you can: -have parents or teachers record samples -"describe" what the child says -look at the utterances and think about language components like vocabulary, syntax, and pragmatic functions -think about your next steps in treatment
...
Language Intervention PRINCIPLES derived from research evidence
1. Carefully observe to assess comprehension, discern underlying functions, and watch for mitigations 2. Write down what your client says. 3. facilitate verbal initiations - structure intervention so that the individual initiates as often as possible 4. facilitate low-constraint interaction styles among all communication partners 5. model useful gestalts 6. avoid teaching a rote set of functional/survival utterances that may result in gestalts 7. lead the communicative team 8. find treatment activities that have a chance of competing with animated media
once you determine that the client is using stage 2 gestalts, you can..(2)
1. continue to model stage 2 utterances 2. redundantly and meaningfully model stage 3... this means breaking out individual words. (if your client is clearly using stage 3 utterances at least 50 percent of the time, you can model stage 4 - very simple, useful, meaningful, and age-appropriate sentences that contain familiar words)
in ASD, echolalia has been qualitatively described as (7)
1. immediate 2. delayed 3. pure 4. mitigated 5. functional for communication 6. functional for cognition 7. functional for self-regulation
if you determine that the child is functioning primarily at Stage 1 gestalts, you can.. (2)
1. model more useful stage 1 Gestalts and 2. some stage 2 utterances that break down current gestalts
Stage 2 Gestalts A. B.
A. when they can breakdown the gestalts and mitigate them into chunks. "lets get" and "out of here" broken up. B. recombining the chunks: "lets get" and adding it with "some more". they can learn to recombine these original chunks into new chunks. it is NOT the same as making up your own phrase. *this is a mix and match stage *this is a natural process, it just needs to be supported *a bit less rigid and more original, but still not grammar.
everyone _____ sometimes... that is, everyone repeats utterances that were originally produced by others. -pretend play -quotes -sayings -lines in plays -backchanneling -therapies
Echoes
Stage 3 Gestalts
Further mitigation into single words - isolation of single words, recombination of words, and generation of their own (original) two word phrases -although this seems much less sophisticated than utterances in stage 1 and stage 2, it represents an enormous leap forward.
Stage 4 Gestalts
Generation of first sentences - they are making a lot of syntax errors. you can tell they did not echo it from somewhere else *allows flexible self expression *actual simple sentences *we can help by surrounding child with sentences that are his own developmental level *this can help us as SLPs because when they produce a sentence where syntax is very off, then we can tell they are generating it themselves. *we should avoid question forms for now - they can use questions to control conversation.
Stage 5 Gestalts
Generation of more complex sentences
Stage 6 Gestalts
Generation of most complex sentences
however, some children are ____ processors. their units are large, intentionally defined strings known as ____
Gestalt Processors -gestalts
after completion of the task, clinician confirms that the motor task is correct and successfully implemented
Memory Assist strategy
clinician confirms that the child's participation is successful; a time delay is inserted to allow information processing
Rehearsal strategy
some people with ASD still use _________ gestalts in adulthood. this often allows them to participate more fully in social interactions.
Stage 1 Gestalts
facilitating verbal initiations...
Structural intervention so that the individual initiates as often as possible, rather than respond to questions and/or commands -we want to ensure the conversation is 50/50 so they are able to initiate conversations with us
normal language acquisition begins with _____ of language captured from the ongoing speech stream
UNITS.
Stage 1 Gestalts
Use of gestalt language wholes -at first, their entire repertoire of gestalts will be what they heard from other places -should never be taken literally -can be meaningful and functional, but they are rarely an exact fit for what the person wants to say -we can help by offering gestalts that are easy to mitigate
some children are ____ processors, and their units are small : words.
analytic processors
why does echolalia develop so often in ASD?
because many children with ASD are Gestalt Language Processors
what is delayed echolalia
can be repeated any time after one or two conversational turns
what is immediate echolalia
considered when someone repeats something within one or two conversational turns
clinician models an appropriate linguistic form to match the child's expressed intent
declarative strategy
can be repeated any time after one or two conversational turns
delayed echolalia
we know that echolalia is simply a reflection of ...
gestalt processing. Taking away echolalia could severely impede a child's potential for language acquisiton
echolalia may serve a self-regulatory function at times.. self regulatory means that they are
helping themselves to not become dysregulated
considered when someone repeats something within one or two conversational turns
immediate echolalia
children who are analytic processors may be more ____ and thus seem to speak earlier
intelligible
writing down what your client says is critical...
language sample data are the physical evidence of our field
need to lead the communicative teams and provide..
many opportunities for practice. variety of partners, peers, topics, and settings.
when it is changed in some way from original. words can be changed, sometimes the tense is changed, maybe extra words added
mitigated echolalia
when you see this type of echolalia, this is when you know progress is occurring.
mitigated echolalia
clinician redirects attention by providing additional instruction about the activity
non-focused strategy
How can SLPs help children move through the gestalt stages?
our role is to listen, write what they say, figure out their zone of proximal development, and systematically plan our support
what is the zone of proximal development
place in learning where the individual needs assistance but with assistance, they can achieve what they are trying to do. We keep pushing that zone up higher and higher so that there is more and more things that they can do without anybody's help.
if your client uses immediate echolalia (stage 1 gestalts) during his/her conversational turn, try to use your turn to..
provide information that will build comprehension and honor the client's communicative intent
whether immediate or delayed - it is uttered without changing any of the linguistic elements. the same words, prosody, and sometimes even the same gestures
pure echolalia
our therapy is always guided by ...
really basic principles
children who are gestalt processors may be less intelligible for an extended period. This is because...
their longer units are much harder to articulate
principles are ... that are derived from research evidence
truisms
clinician provides a physical demonstration that helps the child comprehend critical vocabulary
turn-taking strategy
what are gestalts
units that are large, intentionally defined strings. ex: time to go to bed or lets get in the tub
what is mitigated echolalia
when it is changed in some way from original. words can be changed, sometimes the tense is changed, maybe extra words added
what is pure echolalia
whether immediate or delayed - it is uttered without changing any of the linguistic elements. the same words, prosody, and sometimes even the same gestures
clinician provides additional information relative to the conversational topic
yes-answer strategy