Expressive Language Assessment and Intervention for Children with Echolalia

Lisa R. Audet, Ph.D., CCC-SLP

Kent State University

laudet@kent.edu

Language Defined

• A generative, shared, rule governed symbol system.– Generative: novel utterances can always be

produced– Shared: A culture or community agrees to the

system– Rule Governed: sentence structure and

pragmatic rules are intrinsic to all languages– Symbol: words are arbitrarily assigned to

represent ideas/concepts

Echolalia Defined

• Immediate or deferred expressive production of what has been said before where both the linguistic and non-linguistic features are repeated

• May reflect lack of comprehension skills

• May serve a pragmatic function

• May serve as a practice or self-calming tool

Research Design

• Purpose: To compare the spontaneous language to echolalic language in children with autism

• Assessment: CARS (Schopler); REEL (Bzoche-League); CSBS Parent Interview; MacAuthor Scale.

• Method: language samples were collected on 6 children dx with autism ages 5-9 who demonstrated echolalia in a variety of contexts:– 10 minutes sensory motor play– 10 minutes cause effect play– 10 minutes pretend play– 10 minutes shared book reading– 10 minutes child choice

Language Sample Analysis

• Samples were transcribed and analyzed using SALT (Miller)

• Spontaneous utterances were separated from echolalia utterances

• Average Sentence Length (MLU) was calculated for spontaneous

• MLU was calculated for echolalic utterances

Findings

• All children had higher echolalic MLUs than spontaneous MLUs

• Echolalic Mean=3.412; ELA=37.9m

• Spontaneous Mean= 2.343; ELA= 29.3m

• 5 out of 6 children produced the most spontaneous utterances during pretend play

Questions

• Can Spontaneous MLU be compared to scores on assessment given?

• What type of assessment would be appropriate to use to compare receptive and expressive language age with MLU? How would spontaneous and echolalic MLUs compare with receptive and expressive language functioning?

• How does MLU compare with performance on the CARS? How would it compare to performance on ADOS, ADI?

• Why did so many children produce more language during pretend play?

• What type of context would elicit the most reliable language samples from children with autism?

Additional Questions

• If language sampling proves to be a viable assessment instrument for children with autism who have echolalia…– What type of intervention would increase

spontaneous language?– When would the focus of intervention be to

increase frequency of spontaneous without regard to length or grammar?

– When would the focus of intervention be to increase spontaneous MLU?

A Case for Language Sampling

• Evidenced Based Practice principles encourages continuous evaluation of intervention.

• In absence of a full body of research data collection becomes the Evidence

• NRC evaluation of the literature indicates limited assessment of treatment and targeted skills in naturalistic/generalized context

• Individuals with ASD are known to have difficulties with generalization

A Case for Language Sampling Cont.

• Language Sampling is Data

• Language Sampling when done at regular intervals is representative

• Language Sampling allows for assessment of skills in a generalized context

Principles of Language Sampling

• Use time or number of utterances for the sample and keep this consistent

• Calculate MLU and do other analyses when at least 50% of spontaneous utterances are single words

• Use Rescorlia Vocabulary Checklist when child has fewer than 50 spontaneous single words

• Child must have at least 75 words on the Rescorlia to begin to combine words spontaneously

• Use the Rescorlia as the data collection system at regular intervals

Using Assigned Structural Stages

• Developed by Jon Miller (based on N=123)

• Based on Brown’s Stages

• Once MLU is identified using A.S.S. correlate other goals with morphological and syntactic expectations

Application

• Use language sample to evaluate expressive language of children with autism

• Analyze sample for:– % spontaneous v. % echolalic– MLU spontaneous v. MLU echolalic

• Use language sample as a pre-post assessment instrument

• Focus on increasing frequency v. increasing length for children who have more echolalic v. spontaneous productions

• Keep data on how MLUs change as frequencies change

Sample

• Randy produces 5 utterances in a 20 minute interval during a supervised peer play activity.

• 4 of the utterances are echolalic; 1 is spontaneous.

• The echolalic utterances are 5 words in length. The spontaneous utterance is a single word

• All utterances serve the pragmatic function of requesting

Sample

• Objectives:• Randy will use verbal means to protest,

request, greet, and comment 7 times in a 20 minute period.

• Randy will respond to other’s verbal initiated acts with a single word on 7/10 occasions during a 20 minute interval

Focus: Increasing pragmatic functionsIncreasing frequency of productions

Sample 2

• Jacob produces 30 utterances in a 20 minute

• MLU for spontaneous is 1.5

• MLU for echolalic is 2.7

• Frequency of spontaneous is 18

• Frequency of echolalic is 12

• Functions of productions is to request, protest

Sample 2

• Objectives:• Jacob will increase spontaneous MLU to 2.0• Jacob will use spontaneous language to

provide information answering “What doing” questions

• Jacob will increase frequency of spontaneous utterances to 75% of a sample collected during a 20 minutes supervised peer play session

Considerations

• Continue to use echolalic productions to increase readability of communicative act

• However, use caution in teaching and reinforcing rote utterances as sole intervention (Avoid the “I want more X please” Syndrome)

• Reinforce spontaneous utterances using responsive elaboration and expansion techniques

Linguistic Mapping

• Method to increase receptive language

• Method to code communicative intent

• Method to increase spontaneous language

• Grounded in information processing, semantic-cognitive, and social pragmatic theory

• Developed by Lisa Audet

Linguistic Mapping Sequence

• Initial Phase

• Child communicates via echolalia or non-verbal means; adult codes the intent with carrier phrase: “(child’s name) says” 1-3 words to express the intent (e.g. get top) and meets the child’s needs.

Second Phase

• Child communicates via echolalia or non-verbal means;

• Adult responds with carrier phrase: “(child’s name) says”

• Adult uses expectant wait.

• Meets the child’s needs after the child produces an utterance.

• Accepts and shapes all productions.

Final Phase

• Child signals intent,

• Adult uses expectant wait and meets the child’s need following production.

• Adult uses elaboration and expansion to shape productions.

Final Phase

• Child signals intent,

• Adult uses expectant wait and meets the child’s need following production.

• Adult uses elaboration and expansion to shape productions.