BERNARDUS LARRYANTBERNARDUS LARRYANT

SONJA RONDESTVEDT SONJA RONDESTVEDT

VALERIE S. VARASTEHVALERIE S. VARASTEH

MAMI & FAMILY

BACKGROUND INFORMATION

ASSESSMENT

INTERVENTION

CONCLUSION

OUTLINE

MAMI & FAMILY

Mami Yamamoto 6 years old Kindergarten Enjoys playing with light toys, soft music, and

visual movements Does not enjoy loud noises Limited play skills Repeating both English & Japanese phrases

MAMI

Image taken from http://silveroses69.blogspot.com/2007_05_01_archive.html

Lives with Mother (Reiko) and Grandmother

(Akari)

FAMILY

Image taken from http://english.kimono-sakaeya.com/?eid=1440311Image taken from http://flickrhivemind.net/Tags/obasan/Interesting

The family wants Mami to:

Increase functional use of speech and other English language skills

Decrease her echolalia

GOALS

BACKGROUND INFORMATION

Echolalia is the repetition or echoing of verbal

utterances made by another person. Rydell & Prizant (1995) stated echolalia refers

“to a general class of speech repetition with few distinctions made regarding the degree of repetition or comprehension and intentionality underlying the production of echolalic utterance” (p. 106).

85% of verbal children with autism produce echolalic language (Rydell & Prizant, 1995).

DEFINITION

There is a need to consider the acceptance of echoic

behaviour. That is, how comprehensive is the child with autism’s utterance to the communicative partner? Rydell &Prizant (1995) suggest observing the following points :

1. Do the words used in the echoic utterance have an equivalent meaning to others?

2. Does it relates to the context in which it occurs?3. Is intention created in the utterance? 4. Does the utterance assist in maintaining a social interaction by

providing novel or needed information?5. Does the echoic utterance can evoke a response from another

person?6. Does the echolalia disrupt the child’s ability to partake

appropriately in a social interaction and/or an educational task?7. Does the echolalic behaviour isolate the child with autism?

ECHOLALIA IN CHILDREN WITH AUTISM

Echoic behaviour is displayed in interactive and

non-interactive forms (Prizant & Duchan, 1981): Interactive: degree of comprehension of the

model utterance by showing appropriate gaze; task attempt, and the use indicating behaviours (point, gesture, show, etc.).

Non-interactive: little comprehension of model utterance and lack the proper gaze, low in volume, and there is no observable change in behaviour.

ECHOLALIA IN CHILDREN WITH AUTISM

Bilingualism is not a hindrance for children

with developmental disabilities.

Children who are growing up in a bilingual home need to learn the spoken languages in order to partake wholly within the family system. It is important for their life context and for the children with autism to communicate with those who are important to them and play a large role in their life (Kay-Raining Bird, Lamond, and Holden, 2012).

AUTISM AND BILINGUALISM

Kay-Raining Bird, Lamond, and Holden (2012)

did a survey to investigate a range of questions around autism and bilingualism.

Mode of Communication Language Exposure Professional Advice

Family ratings display that bilingualism was of importance and a majority felt they were successful in raising their child in a bilingual home.

AUTISM AND BILINGUALISM

Echolalia has also been used to teach receptive

naming of Chinese characters (Leung & Wu, 1997):

o When children with autism echo the response before the matching task, the children display improved receptive language skills. In addition, the difficulty of the task affected the speed of acquisition.

o Echoic prompt may assist in reading the name of the character and guided attention to the matching symbol

ECHOLALIA AND BILINGUALISM

Two viewpoints in echolalia had been developed

around language acquisition:a. Echolalia is a pathological behaviour that needs to be

extinguished due to interference with the development of appropriate language skills; no functionality is observed in the echoic utterances

b. Echolalia is used with a functional purpose; furthermore, echolalia can be a tool to develop a more conventional application of the child with autism’s language repertoire.

Language development in children with autism is linked to the Gestalt and Interactionist approaches.

ECHOLALIA IN LANGUAGE DEVELOPMENT

Gestalt processor – develops language by

using memory and repeating multi-word utterances in chunks. The process aids in the comprehension of linguistic structures (albeit, in small amounts) (Bebko, 1990; Rydell & Prizant, 1995; Prizant & Rydell, 1993).

Memorization and chunking of the conventional linguistic structures also supports generalization and applyinh the chunks in other proper and appropriate ways (Prizant, 1983; Prizant& Rydell, 1993).

GESTALT APPROACH

Children with autism take on a gestalt form of

language development. Most children with typical development develop language through an analytical process.

Analytic processors - develop language skills with acknowledgement of the basic structures in language. The meaning behind words and phrases are develops through linguistic stages toward more complex utterances (Prizant & Rydell, 1993).

GESTALT APPROACH

Children with autism are considered to

develop language through an extreme form of gestalt processing and can be correlated to characteristics linked to autism such as the degree of rigidity seen in individuals with autism, coping with unpredictability, lack flexibility, difficulty with producing generative and flexible language, and comprehending social-system rules (Prizant, 1983; Prizant & Rydell, 1993).

GESTALT APPROACH

Examines “the relationship among the fundamental

variables in the social-communicative interaction and the influence of these variables on an individual’s communicative performance” (Prizant and Rydell, 1993, p.275).

Prizant and Rydell (1993) suggest two factors are related to the interactionist approach:

1. Cognitive, social, socio-emotional, linguistic strength or weaknesses of the child may affect the nature of the interaction.

2. The partner’s interactive style may influence the response.

INTERACTIONIST APPROACH

Task Demand/ Unfamiliar Environmento Echolalia may occur more frequently when the child is

in a challenging social scenario, and/or demanding and novel setting (Prizant & Rydell, 1993).

Comprehensiono Echolalia is employed when there is difficulty in

comprehension during verbal interaction with a communicative partner (Bebko, 1990; Prizant & Rydell, 1993; Rydell & Prizant, 1995).

o Information-processing view: echolalia arises when the adult uses abstract language and it does not match the semantics that were previously used during the child’s turn in the conversation (Prizant, 1983; Prizant, Rydell, 1993; Rydell & Prizant, 1995 Schuler, 1979).

COGNITIVE AND SOCIAL FACTORS INFLUENCING ECHOLALIA

Transitions (Prizant, 1983; Prizant & Rydell,

1993; Schuler, 1979)o Children with autism display an increase use of

echolalia and agitation due to confusion from a change in the usual routine. In addition, fatigue and distraction linked to transitions also led to higher incidences of echolalia.

Adult influences (Rydell & Mirenda, 1994; Prizant & Rydell, 1993)

o The style of communication affects the level of echolalia produced in children with autism. The directive style increases echolalia while the facilitative style consists of natural turn-taking.

COGNITIVE AND SOCIAL FACTORS INFLUENCING ECHOLALIA

Adult influences (Rydell & Mirenda, 1994;

Prizant & Rydell, 1993) An association between the communicative style and

linguistic constraint. High constraint utterance: when the child is required to

respond to the adult’s utterance in a similar form of style in communication which has “specific syntactic-semantic structure or content” (Rydell & Mirenda, 1994, p.720).

Low utterance constraint: not required to meet the adult directive control, more natural conversational comments.

COGNITIVE AND SOCIAL FACTORS INFLUENCING ECHOLALIA

Is an utterance that is emitted immediately

following the original utterance, or a brief time following the utterance from the communication partner (usually within two comments) (Prizant & Duchan, 1981; Prizant and Rydell, 1993; Rydell & Prizant, 1995)

Retrieval of information from short term memory (Prizant, 1983).

The researchers determined that immediate echolalia often was used with clear evidence of purposeful communication (Prizant, 1983; Prizant & Duchan, 1981).

IMMEDIATE ECHOLALIA

Immediate echolalia may support the

development of more elaborate language skills and the frequency of echolalia depends on the level of language development (McEvoy et al., 1988).

Children with autism who display intermediate level of language acquisition will emit more echolalic utterances since it serves as a function to communicate with others and a way to continue acquisition (McEvoy et al., 1988).

IMMEDIATE ECHOLALIA

Delayed echolalia refers to utterances that are

repeated later on in time (Prizant & Rydell, 1984). Usually echoic utterances are derived from TV

commercials, movies, and repetition of parental reprimands.

Involves retrieval of information from the long term memory storage (Prizant, 1983).

It is easier for those familiar with the child with autism to decipher the meaning behind the delayed echolalia and how it may relate to the context in which it occurs (Prizant & Rydell, 1984).

DELAYED ECHOLALIA

Mitigated echolalia- when the child changes a word,

phrase, intonation, or feature of the utterance that is repeated (Bebko, 1990).

Mitigation is used in both types of echolalia. Rydell and Mirenda (1994) suggest mitigated echolalia is

not derived from rote repetition. Mitigation demonstrates a control over the echolalic

utterances and utilization of rule-governed grammatical competence (Bebko, 1990; Prizant & Rydell, 1993; Roberts, 1989).

Bebko (1990) describes two basic capabilities of language are intact for children with autism who use mitigated echolalia: labeling and symbolic function. A third component in language that is seen with mitigated echolalia shows inference to one’s self (Bebko, 1990).

MITIGATED ECHOLALIA

ASSESSMENT

Language Samples & Ecological Assessments Preferably videotaped samples in multiple

environments. If videotaping is not an option, audio taping or

written observations from an observer is advised. In Chapter 5 of Teaching Children with Autism:

Strategies to Enhance Communication and Socialization, Rydell and Prizant offer 18 different suggested activities for collecting language samples in different environments.

Data Collection

Eat a desired food item in front of the child without

offering any to him or her. Activate a wind-up toy, let it deactivate, and hand it

to the child. Give the child four blocks to drop in a box, one at a

time, then immediately give the child a small animal figure to drop in the box.

Look through a few books or magazines with the child.

Open a jar of bubbles, blow bubbles, and then close the jar tightly and give the closed jar to the child.

Some Suggested Activities for Language

Sample

Initiate a familiar social game with the child

until the child expresses pleasure, then stop the game and wait.

Blow up a balloon and slowly deflate it; then hand the deflated balloon to the child or hold the deflated balloon up to your mouth and wait.

Offer the child a food item or toy that he or she dislikes.

Place the child’s hands in a cold, wet, or sticky substance, such as Jell-O, pudding, or goo.

Suggested Activities for Language Sample

After you have the language sample, you can now

categorize the unconventional verbal behaviour.

Immediate echolalia-immediate repetition of words or phrases

Delayed echolalia-significantly delayed repetition of words or

phrases (hours, days, or weeks later)

Step 1

From Prizant and Rydell (1984)If it’s immediate echolalia there are two categories:1.Interactive functions Turn-taking Declarative Request

2. Noninteractive functions Nonfocused Rehearsal Self-regulatory

Step 2Determine the function of the echolalia

If it’s delayed echolalia there are also two categories:1. Interactive functions Turn-taking Verbal completion Providing Information Labeling (interactive) Request Calling Affirmation Directive

Step 2Determine the function of the echolalia

2. Noninteractive function Nonfocused Situation association Self-directive Rehearsal Labeling (noninteractive)

Step 2Determine the function of the echolalia

Possible AntecedentsEcholalia is more likely to occur in these

conditions:1. Specific situations2. Specific interactions3. Person-specific situations

Step 3When does it occur?

What is the communicative intent?From Wetherby and Prizant (1989) Is there no awareness of the goal? Is there awareness of the goal? Is there a plan to achieve the goal? Is there a coordinated plan to achieve the goal? Is there an alternative plan to achieve the goal? Is there metapragmatic awareness to achieve

the goal?

Step 4Communicative Intent

Determining the communicative function of the

echoic utterances are done by examining the communication partner’s interpretation of and reaction to the behavioural act.

Interviewing the home and school team members to gain greater information about their interpretation of and reaction to the unconventional verbal behaviour is suggested. A functional assessment interview could be used to gather this information.

Step 4.5 Communicative Function

Another factor to consider for echolalia is the

whether the unconventional verbal behaviour is challenging and who is it challenging for.

Does it add new or relevant information? Does it interfere with the person’s ability to have

conversations or be apart of conversations? Does it have stigmatizing effects on the person

in certain contexts?A functional behaviour assessment could be done

to assist with determining those factors.

Step 5Challenging behaviours

The last stage of assessment is looking at

whether direct intervention is needed and/or wanted.

Once the language samples have been analyzed and coded, suggestions for either direct or indirect intervention can be made if the family or school feel it is beneficial.

Step 6Intervention?

The Inventory of Potential Communicative Acts

(IPCA) by Jeff Sigafoos et al.

Social Networks: A Communication Inventory for Individuals with Complex Communication Needs and their Communication Partners by Sarah Blackstone and Mary Hunt Berg, Published in 2003.

Other Assessments continued

INTERVENTION

Focus on modifying the environment Based on information gathered from

Functional Assessment

INDIRECT INTERVENTIONS

Lack of appropriate play skills

Introduce different activities and toys in order to expand her repertoire of preferred activities and toys – increase choices for her reinforcer menu

SETTING EVENT INTERVENTIONS

Environment is too loud/noisy

Gradual exposure to loud and noisy environment Short period of exposures (5 minutes) Removal upon request using AAC or speech Gradually increase the amount of exposure in small

increments Provide safety signal for Mami to make it through the session Use a timer to provide a visual support for Mami

Pre-correct Mami to use her AAC or speech to ask for break “Remember, if you want to leave, you can ask for a break.”

ANTECEDENT INTERVENTIONS

Echolalic speech – minimal functional speech

Teach Mami to use her AAC to request for a break from the loud and noisy environment Every request made using AAC should be

followed by vocal approximation in order to encourage speech

Echolalia replacement strategy

TEACHING INTERVENTIONS

Response training - getting the subject to correctly label

picture symbols that will be used Cue-pause-point procedure

Deliver the instruction (CUE) Holding up a finger to signal silence and say “shh” or

“no” whenever silence is desired (i.e. during instruction). (PAUSE)

Move your finger so that it touch the picture card about 2 seconds after the instruction was delivered. (POINT)

Prompt to ensure the correct labelling occurs Intermittently reinforce correct responding

FOXX (2004)

To fade the prompts, cover the picture card

with a folder and touch the folder during the POINT phase

Eventually, fade the prompts all the way to simply PAUSE after delivering the instruction

FOXX (2004)

Practice with Mami so she can correctly label the

“break” card- “I want a break” In a loud and noisy environment:

Ask her, “What do you want?” Holding up a finger and saying “shh” whenever her

echolalia starts Touch the “break” card approximately 2 seconds

after If no response, prompt her to say “I want a break” Immediately, let Mami leave the noisy environment

upon asking

MAMI’S CASE

Eventually, cover the “break” card with your

hand and simply point to the hand Finally, simply pause 2 seconds after delivering

the question for Mami to respond correctly

GENERALIZATIONThe same procedure can be used in other situations as well, such as requesting for items, asking for attention, and others.

MAMI’S CASE

Has been shown to help children with autism make

gains in speech production (Schlosser & Wendt, 2008; Millar, Light, & Schlosser, 2006)

Comes in a number of different modes: manual signs, picture symbols, or voice output devices (Mirenda, 2003)

Use it in the early part of Mami’s intervention in order to give Mami an appropriate mean of communication

Gradually fade it out as her functional speech increases

AUGMENTATIVE AND ALTERNATIVE COMMUNICATION (AAC) DEVICES

Augmentative and Alternative Communication application for

iPad, iPhone/iPod Touch Consists of picture symbols as well as voice output

capabilities Chosen because of its functionality & cost Costs:

App: $189.99 iPad 2: $419.00 iPhone: $375.00 iPod Touch: $199.00

http://www.youtube.com/watch?v=vomkNSluWW4

PROLOQUO2GO

Total Cost $400.00 – $650.00

Images are taken from http://www.proloquo2go.com/About/

Main function is ESCAPE

Let Mami have a break when she uses her AAC to ask for one

Reinforce Mami with a preferred activity or toy when she uses appropriate and functional speech Create a reinforcer menu for Mami to choose

from Prompt Mami to use appropriate speech

CONSEQUENCE INTERVENTIONS

Risley and Wolf (1967) – replace echolalia with

stimulus specific responses

Schreibman and Carr (1978) – replace echolalia with a generalized verbal response

Foxx (2004) – replace echolalia with functional use of verbal labelling

REPLACING ECHOLALIA

CONCLUSION

Believe that the function of her echolalia is, for

the most part, escape Functional communication training

Cue-pause-point method to teach her appropriate speech

AAC to help Mami use appropriate language at the beginning of the intervention Proloquo2Go is the choice due to its

functionality and cost

CONCLUSION

Questions?

Image is taken from http://therealkenjones.wordpress.com/2012/02/08/capitalism-and-socialism-making-sweet-love-for-over-200-st-valentines-days/

ABCNews. (2010). The Conversation: iPad Gives Voice to the Autistic. Retrieved from http://www.youtube.com/watch?v=vomkNSluWW4

AssistiveWare. (2012). What is Proloquo2Go? Retrieved from http://www.proloquo2go.com/About/article/what-is-proloquo2go

Augmentative Communication Inc. (2012). Social Networks. Retrieved from http://www.augcominc.com/index.cfm/social_networks.htm

Bebko, J.M. (1990). Echolalia, mitigation and autism: Indicators from child characteristics for the use of sign language and other augmentative language systems. Sign Language Studies, 66, 61-78.

Design to Learn at Oregon Health & Science University. (2012). The Communication Matrix. Retrieved from http://www.communicationmatrix.org/

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