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.

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.

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.

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.

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.

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.

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.

Neumomediastino espontáneo tras accidente de motocicleta. Caso clínico y revisión de la literatura / Spontaneous pneumomediastinum following a motorcycle accident. Report on a case and review of the literature

Introducción: el neumomediastino espontáneo es una entidad muy rara. Presentamos un caso de esta enfermedad. Caso clínico: varón de 17 años de edad que, tras sufrir un accidente de motocicleta de baja energía, acudió a urgencias por cefalea relacionada con dolor en el cuello. En la exploración física se apreciaba ecolalia, así como amnesia retrógrada del episodio. Destacaba una crepitación a la palpación en la región anterior y lateral derecha del cuello. El resto de la exploración física por aparatos fue normal. Las pruebas de imagen realizadas mostraron aire en el trayecto de la vena yugular derecha. Con el diagnóstico de neumomediastino espontáneo, el paciente quedó ingresado en observación. Con el reposo y la medicación analgésica mejoró en las horas siguientes y se pudo darle el alta sin incidencias. Se presenta el caso y se hace una revisión de la literatura. Conclusiones: el neumomediastino espontáneo normalmente es una enfermedad benigna que suele resolverse favorablemente sin tratamiento(AU)

Introduction: The spontaneous pneumomediastinum is an extremely rare condition. We hereby present a case of this pathology.Clinical case17 year-old man who suffered a low-energy motorcycle accident and came into the emergency department complaining of headache and neck pain. Physical examination showed echolalia and retrograde amnesia and crepitation on the anterior and right lateral part of the neck. No other physical signs were found. Plain radiographs and a CT-scan showed air in the right jugular vein. With the diagnosis of spontaneous pneumomediastinum, the patient remained under observation. With rest and analgesia the patient improved within the next hours and was discharged without any complication. The case is presented and the literature is reviewed.ConclusionsSpontaneous pneumomediastinum is a normally benign pathology that tends to resolve favourably without any treatment (AU)

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.

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.

Breve revisión histórica del autismo / Brief historical review of autism

Reflexión acerca del desarrollo histórico y estado actual en la investigación del autismo (AU)

Reflection on the historical development and present state of research into autism (AU)

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.

Psychopathology of catatonic speech disorders and the dilemma of catatonia: a selective review.

OBJECTIVE: Over the past decade there has been an upsurge of interest in the prevalence, nosological position, treatment response and pathophysiology of catatonia. However, the psychopathology of catatonia has received only scant attention. Once the hallmark of catatonia, speech disorders--particularly logorrhoea, verbigeration and echolalia--seem to have been neglected in modern literature. The aims of the present paper are to outline the conceptual history of catatonic speech disorders and to follow their development in contemporary clinical research. METHOD: The English-language psychiatric literature for the last 60 years on logorrhoea, verbigeration and echolalia was searched through Medline and cross-referencing. Kahlbaum, Wernicke, Jaspers, Kraepelin, Bleuler, Kleist and Leonhard's oft cited classical texts supplemented the search. RESULTS: In contrast to classical psychopathological sources, very few recent papers were found on catatonic speech disorders. Current clinical research failed to incorporate the observations of traditional descriptive psychopathology. CONCLUSIONS: Modern catatonia research operates with simplified versions of psychopathological terms devised and refined by generations of classical writers.

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.

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.