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.

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.

Control of echolalic speech in psychotic children.

Immediate echolalia, a common language disorder in psychotic children, was studied in a series of replicated single-subject designs across six schizophrenic and five normal children. In Experiment 1, each child was presented with several questions and commands, some of which set the occasion for specific, appropriate responses and some of which did not. The former were referred to as discriminative stimuli and the latter, as neutral stimuli. The psychotic children tended to echo the neutral stimuli while responding appropriately to the discriminative stimuli; the normal children, in contrast, typically echoed neither type of stimulus. In Experiment 2, three psychotic children were taught appropriate responses to each of several neutral stimuli. Following this training, the children generally responded appropriately to these stimuli without echoing. A plausible interpretation of these results is that the neutral stimuli were initially incomprehensible or meaningless to the children (whereas the discriminative stimuli were comprehensible or meaningful) and that verbal incomprehensibility may be one important determinant of immediate echolalia. Finally, the results are noteworthy in that they isolate a sufficient treatment variable (i.e., the reinforcement of alternative, nonecholalic responses) for eliminating instances of this language anomaly.

Long-term follow-up of echolalia and question answering.

A long-term follow-up of echolalia and correct question answering was conducted for 6 subjects from three previously published studies. The follow-up periods ranged from 26 to 57 months. In a training site follow-up, subjects were exposed to baseline/posttraining conditions in which the original trainer and/or a novel person(s) presented trained and untrained questions. Four subjects displayed echolalia below baseline levels, and another did so in some assessments. Overall, echolalia was lower than in baseline in 80.6% of the follow-ups. Five subjects displayed correct responding above baseline levels. No clear differences were noted in correct responding or echolalia between the trainer and novel-person presentations or between trained and untrained questions. In a follow-up in a natural environment conducted by a novel person, lower than baseline levels of echolalia were displayed by 3 subjects; 2 subjects displayed lower than baseline levels in some assessments. Two subjects consistently displayed correct responding above baseline, and 3 did so occasionally. Issues related to the study of maintenance are discussed.

Increasing spontaneous language in three autistic children.

A time delay procedure was used to increase spontaneous verbalizations of 3 autistic children. Multiple baseline across behaviors designs were used with target responses, selected via a social validation procedure, of two spontaneous responses ("please" and "thank you") and one verbally prompted response ("you're welcome"). The results indicate gains across target behaviors for all children, with occurrence across other stimuli and settings. These gains were validated socially with 10 adults. Furthermore, increases in appropriate language had no effect on levels of inappropriate speech.

Some direct and generalized effects of replacing an autistic man's echolalia with correct responses to questions.

We extended the use of operant procedures to decrease immediate echolalia and increase the appropriate responding to questions of a 21-year-old autistic man. Three experiments were conducted in which the overall plan was to encourage the subject to remain quiet before, during, and after the presentation of questions and teach him to use environmental cues (i.e., word cards or a model's responses) to increase the likelihood of responding correctly. Multiple baseline designs demonstrated that echolalia was rapidly replaced with correct stimulus-specific responses. In addition, there were a variety of generalized improvements in the subject's verbal responses to questions. The procedures and results are contrasted to previous research in an attempt to explain the encouraging findings.

The effects of echolalia on acquisition and generalization of receptive labeling in autistic children.

This investigation, consisting of two experiments, was designed to assess the effects of autistic immediate echolalia on acquisition and generalization of receptive labeling tasks. Experiment 1 addressed whether autistic children could use their echolalia to facilitate acquisition. The results indicated that incorporating echolalia (echo of the requested object's label) into the task before manual response (handing the requested object to the experimenter) facilitated receptive labeling. Experiment 2 was designed to determine the effects of incorporating echolalia into task response on acquisition and subsequent generalization. These results indicated that echolalia facilitated generalization for echolalic autistic children but not for functionally mute autistic children. The results of the experiments are discussed in terms of stimulus control. Additionally, it is proposed that perhaps in certain cases, echolalia should not be eliminated, but used to advantage in receptive responding.

Elimination of echolalic responding to questions through the training of a generalized verbal response.

Echolalia, the parroting of the speech of others, is a severe communication disorder frequently associated with childhood schizophrenia and mental retardation. Two echolalic children, one schizophrenic and one retarded, were treated in a multiple-baseline design across subjects. Each child was taught to make an appropriate, non-echolalic verbal response (i.e., "I don't know") to a small set of previously echoed questions. After such training, this response generalized across a broad set of untrained questions that had formerly been echoed. The results obtained were the same irrespective of the specific experimenter who presented the questions. Further, each child discriminated appropriately between those questions that had previously been echoed and those that had not. Followup probes showed that treatment gains were maintained one month later. The procedure is economical, in that it produces a rapid and widespread cessation of echolalic responding.

Replacing maladaptive speech with verbal labeling responses: an analysis of generalized responding.

We taught three mentally handicapped students to answer questions with verbal labels and evaluated the generalized effects of this training on their maladaptive speech (e.g., echolalia) and correct responding to untrained questions. The students received cues-pause-point training on an initial question set followed by generalization assessments on a different set in another setting. Probes were conducted on novel questions in three other settings to determine the strength and spread of the generalization effect. A multiple baseline across subjects design revealed that maladaptive speech was replaced with correct labels (answers) to questions in the training and all generalization settings. These results replicate and extend previous research that suggested that cues-pause-point procedures may be useful in replacing maladaptive speech patterns by teaching students to use their verbal labeling repertoires.

An alternating treatment comparison of oral and total communications training programs with echolalic autistic children.

An alternating treatment comparison was conducted of the relative effectiveness of oral and total communication training models for teaching expressive labeling skills to three echolalic autistic children. The results of this comparison demonstrated that total communication proved to be the most successful approach with each of the subjects. In addition, the replication of these findings both within and across subjects suggest that total communication may be, in general, the most effective of these two training models for teaching basic vocal language skills to echolalic children. A number of hypotheses are presented that may provide a basis for the demonstrated effect.

An evaluation of two methods for increasing self-initiated verbalizations in autistic children.

Three children with autism and mental retardation were treated for deficits in self-initiated speech. A novel treatment package employing visual cue fading was compared with a graduated time-delay procedure previously shown to be effective for increasing self-initiated language. Both treatments included training multiple self-initiated verbalizations using multiple therapists and settings. Both treatments were effective, with no differences in measures of acquisition of target phrases, maintenance of behavioral gains, acquisition with additional therapists and settings, and social validity.