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