Communicative echolalia in autism

Though echolalia can be non-communicative, in many cases it is used for communication.

Parents of autistic children (with echolalia) can decode their child’s utterances. For example, for many years (up until he was in his late teens), Alyosha was echolalic and used set phrases to talk to us. Most of the time it worked because I knew his particular ways to let me know that he was hungry or wanted to watch TV, or to go for a walk.

The problem is, however, that for others (neighbours, teachers, doctors, etc.) it is hard to guess what the child is trying to communicate – Does he/she ask for help? Is he/she in pain? Does he/she want something? The misinterpretation may bring frustration for both communicative partners.

It is important to remember that in many cases, echolalia is communicative and can serve several functions, the most common ones are:

- Echolalia can mean ‘I don’t understand’. It increases when children are confused and cannot work out what is going on around them.

When the child doesn’t understand the use of words (which are just sound patterns for him), isn’t it clever of him to repeat the same sound patterns (‘a phrase/sentence’) back, just to show that he/she can understand that some sort of response is required in the situation).

- Echolalia can be a means to ‘buy time’ (in the case of delayed processing) or to ‘get the meaning’ from what has been said as some individuals understand speech better if they repeat the message.

Repeating things other people say helps to clarify the meaning in an autistic person’s mind as it aids the cognitive process: an autistic child will repeat a question someone asks her to be able to hear the words in her own voice – to take an external stimulus inward, accept it and prepare a reply. Immediate echolalia in this case is a strategy to ‘translate’ verbal words into meaningful inner language (whether visual, olfactory or kinaesthetic, etc.). Thus, while repeating the sentence, either loudly or silently (silent echolalia), they elicit pictures, tactile, olfactory images (whatever their inner language is) in their mind. Using this strategy, they gradually develop skills to speak meaningfully without any noticeable delay. (However, acquiring these ‘immediate translation’ skills sometimes takes years and a lot of practice.)

- Echolalia can be means to express emotions: a child echoes phrases (often from commercials, cartoons, conversations) he has heard when he was happy/ excited/ angry/ sad.

These phrases do not mean what the words mean but rather they are ‘exclamations’ for the feelings (surprise, delight, anger, etc.) the child experience. These phrases can be strings from TV advertisements, songs, TV shows, films, cartoons, etc. that emotionally associated with a variety of situations, moods and emotional experiences. For example, When Alyosha is excited, he giggles and repeat the phrases from the cartoon Carlson is back that he watched when he was a young (non-verbal) child: “They told me not to watch TV from morning till night. Here you are!” Whenever he sees a dog (he is scared of dogs), he starts shouting, ‘I’m a coward!’ When Alyosha is anxious, he repeats ‘Enough dueling for today – this is from The Three Musketeers!’

- Echolalia can be used as a request.

Isn’t it brilliant that while unable to formulate the request for something the child wants, he uses the same phrase/sentence his mother had said before giving him, for example, a biscuit, some time ago? So, to ask for a biscuit he approaches his parent and says: ‘Do you want a biscuit?’ – meaning ‘give me a biscuit (please).

- Echolalia as affirmation by repetition: ‘Yes’ is often a difficult word for autistic children to use and understand. (You cannot sensorily define ‘yes’.) Instead, the child who wants to respond in the affirmative will repeat the question he was just asked.

Until Alyosha was nine, he didn’t use ‘yes’ and ‘no’ but repeated the question he had been asked for ‘yes’ or ignoring the question altogether for ‘no’. If he wanted something, he’d use the same sentence one would use offering it to him, or, just take my hand and throw it in the direction of the desired object.

- Echolalia can be used to connect/ to start or join a conversation/ to establish relationships: It shows that the child wants to socialise, even without understanding what the conversation is about. He adds whatever word that (he thinks) fit. For example, Alyosha likes to ‘comment’ on everything and happily joins in (from his point of view but, in fact, interrupts) a conversation:

The family are discussing the shopping trip:

Mother: The prices are up again. I can’t believe it – a small loaf of bread costs nearly three pounds!

Alyosha: It’s a bargain!

Mother: No, it’s too expensive.

They also use set-phrases that they heard people use in similar situations, for example:

- Alyosha, how are you today?

- Fine, thank you (even if he is unwell. The response is automatic.)

When working with echolalic children, consider the communicative functions of echolalia:

If echolalia is the only means the child uses to interact, introduce other means of communication. For example, if the child does not understand what was asked/ said, translate it into the child’s language (visual, tactile, etc.). Give them more time to process the question/ request/ instruction.

If it is used to ‘buy time’ (in the case of delay processing) and/or to clarify the meaning to be able to hear the message in her own voice, give the child more time to process and respond.

One of the strategies to support the child’s attempt to communicate and to help ‘shape’ echolalia into meaningful speech is to back it with a substitute close to the child’s inner language – pictures, tactile images, movements, etc. – emphasizing the key words. It will allow the child to break the gestalt-word down into meaningful ‘syllables’ that eventually will be learned as words. To model the correct usage of the sentence, repeat the child’s (corrected) utterance and add some additional information, e.g., "You want a glass of juice? Here you are. This is a glass of apple juice. You like apple juice."

If it is used to express emotions, give the ‘name’ for the emotion and ‘join in’, if it’s appropriate. (Remember, however, the child can be easily ‘emotionally overloaded’, so don’t exaggerate emotional expressions, but use this opportunity to teach the child to recognise the conventional ways to express the emotions (body language, facial expressions, etc.).

If it is used as a request, teach the person to make changes in sentence structure.

If it is the child’s attempt to initiate the interaction, respond and model ways to start, maintain, etc. communicative exchanges.

References

Bogdashina O. (2024) Autism: Becoming a Professional Parent (2) Learning to Speak Autistic. Life & Learn.