Echolalia and Speech Therapy

I had this "aha" moment the other day when I was reading more about echolalia. Echolalia is when a person echoes a word or sentence that someone (or even something like a TV) speaks. For a really good paper on it, go here.

Many high-functioning autistic adults say that nouns and verbs make sense to them because they can picture what that is. Literally they see a picture of "jumping" and know what someone is talking about. But filler words have no meaning. Words and concepts like "Will, faith, To Be, etc" have no concrete visuals to assign to it and therefore are much more difficult to process.

After reading that if FINALLY made sense why H. can't say YES! The word yes has absolutely no meaning for him. He doesn't say it because it has not value to him. When I ask him "Do you want carrots?" he looks at me and says "carrots." No matter how hard we work on having him answer yes, it is the noun or the verb that describes what he wants that he answers with. When he was little(er) he would come bring his toys to us and say their name, like "Woody!" We would answer "yea" or nod our heads. And it was like this response wasn't good enough - he would just stand there and say "Woody! Woody. Woody" until we responded with "Woody." He was looking for confirmation that he was naming something correctly and that he got it right and us nodding or saying "yea" had absolutely no weight because it doesn't mean anything to him. He wanted us to say the name of what it is.

Now that I grasp this, it makes it much easier to see if from his perspective. It would be like going up to someone in a foreign land saying "Is this a bathroom?" and having them respond "QPDRUVG." We would just sit there and say, "so is that a yes or a no - is this a bathroom? Bathroom?" Until they responded in a way we could understand, hopefully with an affirmative "bathroom."

Getting H. to assign a value to the word Yes is one of the things we are working with a Speech Pathologist on. It is super unnatural for him so we're working hard on it. He's actually pretty good at "no" for the most part so it's just transitioning him away from repeating the noun or verb that he is favoring and does want for the word yes.

Most people who see H. in public don't know he's autistic. He's high-functioning, imitates other kids, plays with other kids (for the most part), and is super friendly. He's a happy kid and other kids seem to like him (thankfully). It is when you try to have a conversation with him that something clicks and you're like "ok there's something different here."

Here's are some definitions of echolalia and examples from our home:

DEFINITION
Echolalia is reflective of how the child processes information. The child with autism processes information as a whole "chunk" without processing the individual words that comprise the utterance. In processing these unanalyzed "chunks" of verbal information, many children with autism also process part of the context in which these words were stated, including sensory and emotional details. Some common element from this original situation is then triggered in the current situation which elicits the child's echolalic utterance.

EXAMPLE
Me: "Do you like Buzz Lightyear?"
H: "Buzz Lightyear, the coolest toy ever! He shoots lasers..." etc (I don't remember the whole line, but it's from Toy Story 3)

DEFINITION
Conversational turn taking: The child recognizes when he is to take a conversational turn and that some sort of response is required. However, the child lacks the spontaneous generative language to engage in the conversation, so he relies upon an echolalic utterance to take his "turn" in the conversation.

EXAMPLE:
Me: "H. how was school today?"
H: "Learn 'bout numbers and letters."

DEFINITION
Initiation of communicative interactions: The child is beginning to recognize and notice others. Because he lacks the spontaneous generative language skills to initiate a communicative interaction with someone, he uses an echolalic utterance.

EXAMPLE
Friend: I'm xxxx, and I'm 3
H.: "Hi, my name is H. about spring is flowers" (in school he memorized a line to say when they held up his name. Now we can't get him to stop repeating the entire line - which is missing "my favorite thing"...before the spring part.

DEFINITION
Utterances that may be used as self-direction for his own actions.

EXAMPLE
He self-talks all the time to help get through tough situations.
Me: "It's time for bed"
H: "Park! Park! Park!"
Me: "No right now it's time for bed."

Later.....
H: "It's time to jump in bed." or "You can go to the park after you take a nap"

DEFINITION
Indicating affirmation in response to a previous utterance

EXAMPLE
Me: "Did you have a nice nap?"
H: "Did you have a nice nap?"

DEFINITION
Requesting: The child uses echolalia to request a desired object, action or event.

EXAMPLE
Teacher: "Do you want ranch with your broccoli?"
H: "Do you want ranch with your broccoli?"

The great thing about echolalia is that is can be a really positive sign because if he can echo he can talk. And at least he has language. The key is turning that language into conversations that make sense to both the utterer and the receiver. H. loves his SLP and is so good about going, playing, talking, and cleaning up at the end. He's really getting the hang of it! And we learn how to help him better. It's been really good.

Sensory Integration Dysfunction and Heavy Lifting

I took Holds to get evaluated by an Occupational Therapist this week. My fabulous friend Stacey recommended I take him to an OT to get a "sensory diet" for him. Holden has always been sensitive to sound. He covers his ears and gets really anxious around loud noises or anything he thinks is scary. And he gets easily over-stimulated around a lot of people. He does a good job of dealing with that, though - in my opinion. Instead of throwing a huge tantrum like a lot of autistic children, he just goes off in a corner or away from the crowd to give himself a time-out.

Anyway, so I really liked the OT. She was good at earning his trust and teaching me what she was doing at the same time. She uses the Jean Ayres method from what I understand, which is to incorporate deep pressure and slow vestibular stimulation done on a swing - while encouraging speech and social interaction (but making it fun). The theory here is that autistic kids (and other kids with sensory integration problems) have nervous systems that don't give them correct information. So they're in a state of fight or fright over any little thing because they're nervous system isn't telling them "hey, this isn't that big of a deal - this is not a threat."

In "Thinking in Pictures," Temple Grandin talks about sensory processing for herself and many autistic people she's interviewed. It's fascinating. So many people thing autism is merely a psychological disorder, but there are usually biological reasons for why they do what they do. For example, she says "When two people are talking at once, it is difficult for me to screen out one voice and listen to the other. My ears are like microphones picking up all sounds with equal intensity. In a noisy place I can't understand speech, because I cannot screen out the background noise. When I was a child, large noisy gatherings of relatives were overwhelming, and I would just lose control and throw temper tantrums."

And then she says "Overly sensitive skin can also be a big problem. Shampooing actually hurt my scalp. It was as if the fingers rubbing my head had sewing thimbles on them. Scratchy petticoats were like sandpaper scraping away at raw nerve endings. In fact I couldn't tolerate changes in clothing altogether. When I got accustomed to pants, I could not bear the feeling of bare legs when I wore a skirt...Most people adapt in several minutes, but it still takes me at least two weeks to adapt."

Holden doesn't have (from what I can tell) visual problems and he looks people in the eyes when he really wants something, but this is also really interesting: "Fluorescent lighting causes severe problems for many autistic people, because they can see a sixty-cycle flicker. For Donna Williams reflections bounced off everything, and the room looked like an animated cartoon. . . . Distorted visual images may possibly explain why some children with autism favor peripheral vision. They may receive more reliable information when they look out of the corners of their eyes."

It is SO interesting how many kids (not with autism) have sensory issues. It's great that Occupational Therapy and sensory diets can help sensory mixing and calm down heightened senses.

Our OT recommended we do deep pressure hug therapy with Holds throughout the day. Some autistic kids HATE being touched, but we're lucky with Holden. He'll let us touch him and loves hugging baby Fitz. But with others it's usually a no-go. In fact, he said "ouch that hurts me!" when this one therapist at the school district touched his arm.

She also instructed us to encourage him to do Heavy Lifting every hour. She explained that it's just like how I feel after a good workout where I've really used my muscles. Heavy Lifting sends a wave of calm to the nervous system and over time it should even Holden out so he feels more relaxed and less anxious and scared.

We got right to it! He's been carrying groceries, lifting up his toys to put them away, climbing, playing at the playgrounds, running, lifting actual weights, and anything else we can come up with.

The Stuff I'm Figuring Out

I wish I had known about Holden's autism earlier. Not so much for early intervention, but just so I could have been a more understanding parent. I'm sure most parents feel like they don't know what's going on with their kid, but for me it was one of the most pervasive feelings. It explains a lot of things:

It explains why he didn't like to be held as a baby and would cry when I tried to hold him in my sling or stiffen up when I tried to put lotion on him. He was his most content happy self when he was sitting alone in his chair.

It explains why me taking him to San Antonio when he was 18 months old was such a torturous trip (for us both). I just couldn't understand why he didn't connect with my family at all. Or why he was so frazzled the whole time. It makes sense now. Change is just excruciatingly hard for him.

It explains the hour-long scream fests in the middle of the night when he was utterly inconsolable. And why his frustration levels go from 0-60 in a 1/2 second.

It explains why he was the only kid at play-dates that would come unglued at the end of them. I seriously just stopped going to them because Holden couldn't leave without an enormous tantrum. At least one of us left in tears every time we went anywhere. I just seriously stopped taking him places by myself. I was afraid to. Transitions were just impossible.

And it makes it totally understandable why he HATES the Lehi Legacy center pool when the big bucket and bell goes off every 10 minutes and splashes water. The noise and the commotion are complete agony to his hyper-sensitive senses.

I speak in past-tense because now that I know more about ASD I am becoming a much better parent. Understanding Holden has brought so much clarity into our lives. I used to be so embarrassed when Holden would tell someone who just came to our house to leave. Actually, he didn't understand leave so he would say "STAY HERE! STAY HERE!" meaning "go away" and people probably thought he was so rude and we were rude for having a rude boy. But now we just try to prepare him for when people (we know of) come to the house and he handles it fine (usually). I'm reading Thinking In Pictures
right now and am learning so much. Temple Grandin is amazing.

Holden is such a bright, beautiful boy. I love him so much and am thankful to be ever-learning more about him and how to be a better mom to him. It has taken me a while to get here, but I'm ok with him being autistic. At first I was shocked, then angry, then really sad. But I am ok with now. I don't want to train the autism out of him. I absolutely adore that boy and I believe he - like me and everyone else - has a purpose here and it's my job to help him fulfill his mission. It's just my job to see that he gets all the resources and help he needs to be as healthy, happy and high-functioning in this crazy world as possible. And I'm learning a lot on the way.