A systematic review of interventions for echolalia in autistic children.

INTRODUCTION: Echolalia, the repetition of others' speech, is a common observation in autistic people. Research has established that echolalia is functional and meaningful for many; however, some clinicians and researchers continue to characterise it as pathological and in need of reduction. The aim of this systematic review was to understand the range and impact of interventions for echolalia in autistic children. METHOD: A systematic search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 15 studies met predetermined inclusion criteria. Screening, data extraction and quality rating using the Scientific Merit Rating Scale (SMRS) were performed in duplicate. RESULTS: Ten interventions across 15 papers were found. Results indicated that interventions generally decreased levels of echolalia. However, there were considerable inconsistencies in the definitions and conceptualisations of echolalia, administration, generalisation techniques and the measures used. The quality of the studies was very low. CONCLUSION: Interventions for echolalia vary widely in terms of administration and measurement. There is limited consensus on the definition of echolalia among the reviewed studies, and no evidence that echolalia is recognised as functional or meaningful to the autistic children. Further, the lack of methodological rigour makes it difficult to draw clinical conclusions about the interventions. WHAT THIS PAPER ADDS: What is already known Echolalia is the immediate or delayed repetition of others' speech and is a common observation in autistic children and in some older autistic people. While research and practice has established that echolalia is a functional and meaningful form of communication, particularly for those first developing spoken communication, some clinicians and researchers continue to characterise it as problematic and suggest that echolalia should be reduced or eliminated. What this study adds We systematically searched the literature about echolalia interventions to try to find out about the types of interventions that aim to reduce or eliminate echolalia. We found 15 studies on this topic. The way they defined echolalia was varied, and there was a range of interventions researched. None of the research papers recognised echolalia as functional or meaningful and the quality of the research was very low. What are the potential or actual clinical implications of this work? Clinicians, families and researchers should think carefully and critically about suggesting any programs or supports that aim to reduce echolalia as no recommendations can be drawn from the research we studied. Echolalia should be considered functional, and efforts made to understand the meaning and purpose of echolalic speech.

On the intersection of phonetic detail and the organization of interaction: clinical connections.

The analysis of language use in real-world contexts poses particular methodological challenges. We codify responses to these challenges as a series of methodological imperatives. To demonstrate the relevance of these imperatives to clinical investigation, we present analyses of single episodes of interaction where one participant has a speech and/or language impairment: atypical prosody, echolalia and dysarthria. We demonstrate there is considerable heuristic and analytic value in taking this approach to analysing the organization of interaction involving individuals with a speech and/or language impairment.

Subjective position sliding in utterances perceived as echolalic in a child with Language Disorder: a case study. / Deslizamentos de posição subjetiva em enunciados tidos como ecolálicos de uma criança com Distúrbio de Linguagem: um estudo de caso.

Within a linguistic-discursive framework, subject markers in a chain of utterances considered to be echolalia based on the recurring linguistic structure does X want Y? were investigated. This chain was produced during a speech therapy session by J., a female child, 10-years-old at the time of data collection, and with a speech-language pathology diagnosis of language disorder and a medical diagnosis of early psychosis. A set of linguistic fluctuations indicated a sliding of the subject position in the analyzed chain. Such fluctuations involved syntactic, lexical, semantic, morphological and prosodic elements. Discursively, the fluctuations left traces of a sliding of the subject position in the chain formed by these utterances, from a spoken subject (do you want Y?) to a speaking/desiring one (I want Y.). In this way, utterances considered echolalia can provide clues, via their linguistic fluctuations and discursive slippages, about the subject's desire in their relationship with the O/other. Given this, although they do not emerge in a conventional way, such utterances can demonstrate possibilities for changes in subject position. A contribution of the present research for clinical practice involving language in therapeutic settings therefore, was to highlight a listening to utterances, which could be seen as connected/grounded in the speech of the other. In clinical practice involving language, it is possible to create space for new/other senses for utterances, to allow the constitution of the subject of/in language, based on utterances often interpreted as being devoid of subjectivity.

Sob ótica linguístico-discursiva de orientação francesa, foram investigadas marcas de subjetividade numa cadeia de enunciados tidos como ecolálicos, ancorados na estrutura linguística recorrente X quer Y?. No interior de uma sessão de fonoterapia, essa cadeia foi produzida por J., uma criança do sexo feminino, com 10 anos de idade à época da coleta dos dados, com diagnóstico fonoaudiológico de distúrbio de linguagem e diagnóstico médico de psicose precoce. Um conjunto de flutuações linguísticas indiciaram um deslizamento de posição subjetiva na cadeia analisada. Tais flutuações envolveram elementos sintáticos, lexicais, semânticos, morfológicos e prosódicos. Discursivamente, as flutuações deixaram rastros de um deslizamento de posição subjetiva, ou seja, de sujeito falado (cê quer Y?) para falante/desejante (eu quero Y.) na cadeia formada por esses enunciados. Desse modo, enunciados tidos como ecolálicos podem dar pistas do desejo do sujeito em sua relação com o O/outro, por meio de suas flutuações linguísticas e de seus deslizamentos discursivos. Portanto, embora não irrompam de forma convencional, tais enunciados podem mostrar possibilidades de mudanças de posição subjetiva. Por conseguinte, uma contribuição da investigação relatada à clínica de linguagem é a de que, no setting terapêutico, pode haver escuta para enunciados que, em primeira instância, poderiam ser tidos como colados/enraizados no dizer do outro. Na clínica de linguagem é possível, então, dar lugar a novos/outros sentidos a tais enunciados, de maneira a favorecer a constituição do sujeito da/na linguagem a partir de enunciados frequentemente interpretados como esvaziados de subjetividade.

Repeat After Me? Both Children With and Without Autism Commonly Align Their Language With That of Their Caregivers.

Linguistic repetitions in children are conceptualized as negative in children with autism - echolalia, without communicative purpose - and positive in typically developing (TD) children - linguistic alignment involved in shared engagement, common ground and language acquisition. To investigate this apparent contradiction we analyzed spontaneous speech in 67 parent-child dyads from a longitudinal corpus (30 minutes of play activities at 6 visits over 2 years). We included 32 children with autism and 35 linguistically matched TD children (mean age at recruitment 32.76 and 20.27 months). We found a small number of exact repetitions in both groups (roughly 1% of utterances across visits), which increased over time in children with autism and decreased in the TD group. Partial repetitions were much more frequent: children reused caregivers' words at high rates regardless of diagnostic group (24% of utterances at first visit), and this increased in frequency (but not level) over time, faster for TD children (at final visit: 33% for autism, 40% for TD). The same happened for partial repetition of syntax and semantic alignment. However, chance alignment (as measured by surrogate pairs) also increased and findings for developmental changes were reliable only for syntactic and semantic alignment. Children with richer linguistic abilities also displayed a higher tendency to partially re-use their caregivers' language (alignment rates and semantic alignment). This highlights that all children commonly re-used the words, syntax, and topics of their caregivers, albeit with some quantitative differences, and that most repetition was at least potentially productive, with repeated language being re-contextualized and integrated with non-repeated language. The salience of echolalia in ASD might be partially explained by slight differences in frequency, amplified by lower semantic alignment, persistence over time, and expectations of echolalia. More in-depth qualitative and quantitative analyses of how repetitions are used and received in context are needed.

The pathophysiology of echopraxia/echolalia: relevance to Gilles de la Tourette syndrome.

Echopraxia and echolalia are subsets of imitative behavior. They are essential developmental elements in social learning. Their persistence or reemergence after a certain age, though, can be a sign of underlying brain dysfunction. Although echophenomena have been acknowledged as a typical sign in Gilles de la Tourette syndrome (GTS) since its first description, their clinical significance and neural correlates are largely unknown. Here, we review the course of their scientific historical development and focus on their clinical phenomenology and differential diagnosis with a particular view to GTS. The neural basis of echophenomena will also be addressed. © 2012 Movement Disorder Society.

Engagement with electronic screen media among students with autism spectrum disorders.

This study investigated the relative engagement potential of four types of electronic screen media (ESM): animated video, video of self, video of a familiar person engaged with an immersive virtual reality (VR) game, and immersion of self in the VR game. Forty-two students with autism, varying in age and expressive communication ability, were randomly assigned to the experimental conditions. Gaze duration and vocalization served as dependent measures of engagement. The results reveal differential responding across ESM, with some variation related to the engagement metric employed. Preferences for seeing themselves on the screen, as well as for viewing the VR scenarios, emerged from the data. While the study did not yield definitive data about the relative engagement potential of ESM alternatives, it does provide a foundation for future research, including guidance related to participant profiles, stimulus characteristics, and data coding challenges.

Criminal and legal responsibilities in Tourette's syndrome.

Tourette's Syndrome (TS) is a neuropsychological disorder characterized by the presence of multiple involuntary motor tics accompanied by one or more vocal tics. Articles about TS and criminal responsibility and the restriction of civil rights are limited. A person with TS was evaluated to consider his criminal responsibility after swearing at a referee during a football game. He was also evaluated as to whether or not he was capable of professionally driving a service bus. Additionally, medico-legal situations regarding military service, obtaining a shotgun license and marriages of patients with TS were considered.

Using time-delay to improve social play skills with peers for children with autism.

Interventions that teach social communication and play skills are crucial for the development of children with autism. The time delay procedure is effective in teaching language acquisition, social use of language, discrete behaviors, and chained activities to individuals with autism and developmental delays. In this study, three boys with autism, attending a non-public school, were taught play activities that combined a play sequence with requesting peer assistance, using a graduated time delay procedure. A multiple-baseline across subjects design demonstrated the success of this procedure to teach multiple-step social play sequences. Results indicated an additional gain of an increase in pretend play by one of the participants. Two also demonstrated a generalization of the skills learned through the time delay procedure.

Discovering communicative competencies in a nonspeaking child with autism.

PURPOSE: This article is intended to demonstrate that adapted conversation analysis (CA) and speech act analysis (SAA) may be applied by speech-language pathologists (SLPs) to (a) identify communicative competencies in nonspeaking children with autism spectrum disorder (ASD), especially during particularly successful interactions, and (b) identify communicative patterns that are exhibited by interventionists and communication partners that may positively or negatively impact interactions with such children. METHOD: A case example involving an 8-year-old boy with autism and the author, an SLP, is explicated. A videotaped segment from an intervention session was transcribed and subjected to adapted forms of CA and SAA. RESULTS: CA and SAA helped reveal several underlying competencies in the boy's communicative output, including an awareness of conversational structure and sequence, diversity of communicative acts, functional use of gaze and smile behavior, and the ability to spontaneously initiate interactions. Observations regarding the SLP's interactive style included the use of multiple instances of "asking" as well as multiple "derailments" of the boy's obvious communicative bids. CONCLUSION: CA and SAA may be adapted to gain a clearer picture of what takes place during especially positive communicative interactions with nonspeaking children with ASD.

Examining the Echolalia Literature: Where Do Speech-Language Pathologists Stand?

PURPOSE: Echolalia is a common element in the communication of individuals with autism spectrum disorders. Recent contributions to the literature reflect significant disagreement regarding how echolalia should be defined, understood, and managed. The purpose of this review article is to give speech-language pathologists and others a comprehensive view of the available perspectives on echolalia. METHOD: Published literature from the disciplines of behavioral intervention, linguistics, and speech-language intervention is discussed. Special areas of focus include operational definitions, rationales associated with various approaches, specific procedures used to treat or study echolalic behavior, and reported conclusions. CONCLUSIONS: Dissimilarities in the definition and understanding of echolalia have led to vastly different approaches to management. Evidence-based practice protocols are available to guide speech-language interventionists in their work with individuals with autism spectrum disorders.

Effects of high and low constraint utterances on the production of immediate and delayed echolalia in young children with autism.

This study examined the effects of adult antecedent utterances on the occurrence and use of echolalia in children with autism during a free play setting. Adult antecedent utterances were differentiated into two types, high and low constraint, based on the degree of linguistic constraint inherent in the adult utterance and social-communicative control exerted on the child's social and verbal interaction. Results of this study identified a variety of patterns of echolalia usage following adult high and low constraint utterances. Overall results found that a majority of immediate echoes followed high constraint utterances and were primarily used as responsives, organizational devices, and cognitives. The majority of delayed echoes followed low constraint utterances and were primarily used as requestives, assertives, and cognitives. Delayed echoes were more likely than immediate echoes to be produced with evidence of comprehension, but there were no differences in comprehension within the two categories of echolalia following high and low constraint utterances. Educational implications are discussed.

The effects of two levels of linguistic constraint on echolalia and generative language production in children with autism.

The effects of specific types of adult antecedent utterances (high vs. low constraint) on the verbal behaviors produced by three subjects with autism were examined. Adult utterance types were differentiated in terms of the amount of control the adults exhibited in their verbal interactions with the subjects during a free play setting. Videotaped interactions were analyzed and coded according to a predetermined categorical system. The results of this investigation suggest that the level of linguistic constraint exerted on the child interactants during naturalistic play sessions affected their communicative output. The overall findings suggest that (a) adult high constraint utterances elicited more verbal utterances in general, as well as a majority of the subjects' echolalia; (b) adult low constraint utterances elicited more subject high constraint utterances; and (c) the degree of constraint of adult utterances did not appear to influence the mean lengths of subjects' utterances. The results are discussed in terms of their implications for educational interventions, and suggestions are made for future research concerning the dynamics of echolalia in interactive contexts.

I, you, me, and autism: an experimental study.

The nature of autistic individuals' abnormalities in the use of personal pronouns has been a topic of considerable speculation but little systematic investigation. We tested groups of CA- and verbal MA-matched autistic and nonautistic mentally retarded children and young adults on a series of tasks that involved the comprehension and use of the personal pronouns "I," "you," and "me." All subjects were able to comprehend these pronouns within the test situations, and there were few instances of pronoun reversal. However, autistic subjects were significantly less likely to employ the pronoun "me" in a visual perspective-taking task (when instead they tended to say: 'I can see the . . .'), and lower ability subjects were more likely to use their own proper names rather than personal pronouns in certain photograph-naming tasks. There were also circumstances in which autistic subjects were less likely than controls to employ the pronoun "you" to refer to the experimenter. A high proportion of these autistic subjects were reported to have current difficulties with personal pronouns in their everyday life, and we discuss some alternative interpretations of the results.

Transcortical motor aphasia: one or two aphasias?

The name "transcortical motor aphasia" has been used to refer to two different types of language alterations: damage in the left supplementary motor area and Luria's dynamic aphasia. It is proposed that they represent two types of language disturbances different enough to be considered two different forms of aphasia.

Children with inadequate language development: management guidelines for otolaryngologists.

Otolaryngologists are in the front line of physicians asked to evaluate children whose language development is lagging. The 4 most prevalent conditions to consider in the differential diagnosis are impaired hearing, mental deficiency, developmental language disorder or dysphasia, and one of the disorders on the autistic spectrum. Guidelines on when to become concerned and what to do about such children are provided. Early diagnosis is essential in order to provide remedial education at the language learning age when intervention is likely to be most efficacious.

Quantifying repetitive speech in autism spectrum disorders and language impairment.

We report on an automatic technique for quantifying two types of repetitive speech: repetitions of what the child says him/herself (self-repeats) and of what is uttered by an interlocutor (echolalia). We apply this technique to a sample of 111 children between the ages of four and eight: 42 typically developing children (TD), 19 children with specific language impairment (SLI), 25 children with autism spectrum disorders (ASD) plus language impairment (ALI), and 25 children with ASD with normal, non-impaired language (ALN). The results indicate robust differences in echolalia between the TD and ASD groups as a whole (ALN + ALI), and between TD and ALN children. There were no significant differences between ALI and SLI children for echolalia or self-repetitions. The results confirm previous findings that children with ASD repeat the language of others more than other populations of children. On the other hand, self-repetition does not appear to be significantly more frequent in ASD, nor does it matter whether the child's echolalia occurred within one (immediate) or two turns (near-immediate) of the adult's original utterance. Furthermore, non-significant differences between ALN and SLI, between TD and SLI, and between ALI and TD are suggestive that echolalia may not be specific to ALN or to ASD in general. One important innovation of this work is an objective fully automatic technique for assessing the amount of repetition in a transcript of a child's utterances.

Analysis of functions of delayed echolalia in autistic children.

This study was a preliminary attempt to determine how autistic children used delayed echolalia in naturalistic interactions with familiar people. Fourteen functional categories of delayed echolalia were derived based on videotape analyses of linguistic, extralinguistic, and paralinguistic features. Individual differences in functional usage were apparent across the three subjects. Delayed echolalia was found to vary along the dimensions of interactiveness, comprehension of the utterance produced, and relevance to linguistic or situational context. The diversity of delayed echolalic behavior is discussed in reference to its conventionality, the presence or absence of communicative intent, and its status as symbolic communicative activity.